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1 운동을통한내몸의변화 : 살을빼는것만이운동의목적인가? 서울대학교 건강운동과학연구실 송욱

3 대사증후군 혈당 인슐린 저항성 복부비만 대사증후군 고중성지방 제2형당뇨병심혈관 질환 고혈압 저 HDL-C (Trevisan et al., 1998; Lopez, 2001; Meigs, 2002)

4 대사증후군의판정 고혈당 : 100 mg/dl 최근합의한진단기준 고 TG 혈증 : 150 mg/dl 저 HDL-C 혈증 : 남자 < 40 mg/dl, 여자 < 50 mg/dl 고혈압 : 130 (SBP) / 85 (DBP) mmhg 복부비만 ( 허리둘레 ) : 남자 > 90 cm, 여자 > 85 cm WHO (2000) 아시아 - 태평양기준

5 대사증후군에대한 운동의효과

6 운동과고혈압 활동적인유산소성운동은고혈압환자의수축기혈압을 6.9% 낮추는효과가있다. 약 3 명중 1 명꼴로발생 (Veronique et al., Hypertension. 2005;46: ) 국민건강영양조사

7 운동과중성지방 16 간의유산소운동으로간내의중성지방수치가약 10.3% 감소시킨다. Shelby et al., 2012, 55(6), Hepatology

8 운동과 HDL-cholesterol 꾸준한운동은좋은콜레스테롤의양을증가시킬뿐만아니라크기또한증가시킴으로써좋은콜레스테롤의기능까지향상시킨다. Varady et al. Lipids in Health and Disease 2011, 10:119

9 운동과체중감소 ( 허리둘레 ) T. Church, Cardiovascular Diseases 53 (2011)

10 운동과공복혈당 Dorth et al., 2010, J appl Physiol, 108:

11 How Is Metabolic syndrome Treated? 심장질환과당뇨병의위험을낮추기위한치료의목적 체중감량 걷기와같은중강도의운동을주당 5-7 회 30 분씩 체중감량을위한운동과콜레스테롤을낮출수있는약물을사용하여콜레스테롤을낮출것. 운동과체중감량그리고약물등으로혈압을낮게조절할것. -NIH recommendations-

13 [Fitness-Mortality Curve, 심폐지구력 - 사망률곡선 ] 13,344 명의성인에서심폐지구력과사망률과의관계 Role of Low energy expenditure and sitting in obesity metabolic syndrome, type 2 diabetes, and cardiovascular dieases, Diabetes, Marc T. Hamilton et al.,, 2007, 56

14 최대산소섭취량 (maximal oxygen consumption) = VO2max = 최대심박수 X 1 회심박출량 X 동정맥산소차 (ml/kg/min) 황영조 ( 마라토너 )? 박지성 ( 축구선수 )? 대좌업생활자? 제일낮은사람 ( 환자 )?

15 노화로인한최대산소섭취량의개인차이

16 유산소운동으로인한적응 Endurance Training Effect

17 1. 심장에서혈액을통해각조직에필요한산소를운반하는능력을향상시키는것 2. 근육에서산소를이용하여에너지를활용하는능력을향상시키는것 Exercise Physiology 5 th edition, McArdle et al., 2001

18 Exercise Physiology McArdle et al., 5 th edition, 2001

19 Exercise Physiology 5 th edition, McArdle et al., 2001

20 HDL 증가 LDL감소 혈압감소 인슐린반응개선 당화혈색소 (HbAIc) 감소 혈관신생성 (angiogenesis) 혈전형성경향감소 피브리노겐 (fibrinogen: 혈액응고관련 ) 수치감소 Fibrin deposit 감소

Skeletal muscle mass and distribution in 468 men and women

relationship between whole body SM mass and age in men and

B: relationship between relative SM mass and age in men and

22 Skeletal muscle mass and distribution in 468 men and women aged yr 나이에따른골격근양의변화와분포 (18 세 ~88 세남녀 468 명 ) A: relationship between whole body SM mass and age in men and women. B: relationship between relative SM mass and age in men and women. Solid lines, regression lines. Note that slope of regression line is greater (P, 0.01) in men than in women.

Skeletal muscle mass and distribution in 468 men and women aged 18 88 yr A: relationship between upper body

23 Skeletal muscle mass and distribution in 468 men and women aged yr A: relationship between upper body and lower body SM mass in men ( 남성 ) B: relationship between upper body and lower body SM mass in women ( 여성 )

Muscle loss increases to 5% to 10% each decade after age 50, averaging approximately 0.4kg per year after the fifth decade of life 50 세이후 10 년마다 5~10% 근감소가증가, 평균적으로약 0.4kg/ 년감소 Walter R.

24 Muscle loss increases to 5% to 10% each decade after age 50, averaging approximately 0.4kg per year after the fifth decade of life 50 세이후 10 년마다 5~10% 근감소가증가, 평균적으로약 0.4kg/ 년감소 Walter R. Frontera et al., 2000 Loss of Skeletal muscle over 3 years in older adults The loss of skeletal muscle strength, mass, and quality in older adults, Journal of Gerontology, Goodpaster et al., 2006, 61A

25 MRI of the cross-section of the mid-thigh ( 대퇴근육의횡단면 MRI 사진 ) 70 year-old 48 year-old *magnified 15% relative to the right image Conley et al., J. Gerontol. 50A: 35, 1995

26 T.P. White, in Exercise in Older Adults

30 최근변화되고있는운동의페러다임 Churilla et al. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 6 (2012) 42 47

31 저항성운동으로인한적응 Resistance Training Effect

32 근손실의변화 15 명의노인에서의저항성운동 26 주후의변화 N=15 (age 61-77), 26 weeks 기간 : 26주, 주 3회 45분실시 저강도의 Bicycle ergometer or Treadmill 5분간준비운동후저항성운동실시 (Elbow flextion, Elbow extension, lateral pulldown, seated row, chest press, leg extension, leg curl, seated press, back extensions, bent-leg sit-up 회반복실시 ) Resistance training increases total energy expenditure J Appl Physiol, Gary R. hunter et al., 2000, 88,

33 혈중지질변화 RCT N=22 (mean age 56.2 ), 4-month 제 2 형당뇨환자에서 4 주간의저항성운동 ( 검은색 ), 유산소성운동 ( 흰색 ) 의대사적지표변화 The relative benefits of endurance and strength training on the metabolic factors and muscle function of people with type 2 diabetes mellitues Archives of physical medicine and rehabilitation, Edmund Cauza et al., 86:8,

34 안정시대사량의변화 N=15 (age 61-77), 26 weeks 26 주저항성운동프로그램전과운동마지막 2 주동안일상생활에서의총에너지소비량비교 대상 : 61-77세의노인. EE, energy expenditure * Post-training significantly different from pre-training, P<0.05 Resistance training increases total energy expenditure J Appl Physiol, Gary R. hunter et al., 2000, 88,

과운동시작 (Pre-intervention), 10 주간의운동이완전히끝나는 (Post intervention) 으로나타내었다.

35 2 형당뇨에서당화혈색소조절 N=20 (mean age 53.5), 10 weeks 2 형당뇨환자에서운동이당화혈색소 (HbA1C) 수준에미치는영향 (A) HbA1C 값은운동시작 12 주전 (baseline) 과운동시작 (Pre-intervention), 10 주간의운동이완전히끝나는 (Post intervention) 으로나타내었다. 10 주간의차이 (*, p<0.05). 운동그룹간의차이 (#, p<0.0008) (B) 트레드밀운동그룹과저항성운동그룹과의사전과사후의당화혈색소 (HbA1C) 백분위수준의변화 (*, p<0.01) Diabetology & Metabolic Syndrome 2009, 1:27

36 보행속도의변화 RC N=12 (age 61-87), 8 weeks 최대보행속도의변화 Effect of Intense Strength Training on Standing Balance, Walking Speed, and Sit-to-Stand Performance in Older Adults, Journal of Gerontology, Jeffery Schlicht et al., 2001, 56A, 5, M281-M286

낙상위험변화 RCT N=98 (age 75-85), 25 weeks 민첩성, 저항성, 스트레칭운동에서낙상위험수준의변화 *Significantly different from the stretching group, P =.005. +Significantly different from the stretching group, P =.001.

37 낙상위험변화 RCT N=98 (age 75-85), 25 weeks 민첩성, 저항성, 스트레칭운동에서낙상위험수준의변화 *Significantly different from the stretching group, P = Significantly different from the stretching group, P =.001. Error bars represent 95% confidence intervals. SD = standard deviation. Resistance and Agility Training Reduce Fall Risk in Women Aged 75 to 85 with Low bone mass : A 6-month randomized, controlled trial, JAGS, Teresa Liu-Ambrose et al., 2004, 52 :

38 우울증의감소 RCT N=32 (age 60-84), 10 weeks Notes : BDI = Beck Depression Inventory; HRSD = Hamilton Rating Scale of Depression; GDS = Geriatric Depression Scale; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders (4 th ed.). *Means and (SD) A Randomized Controlled Trial of Progressive Resistance Training in Depressed Elders, Journal of Gerontology, Nalin A. Singh et al., 1997, 52A, 1, M27-M35

39 기초대사량증가 복부피하지방 내장지방 근육량근육기능 인슐린저항성대사적이상 저항성운동 심혈관계질환제 2 형당뇨 대사증후군 International Association for the study of obesity 2009, 11,

40 과학적인운동처방 Evidence-based Exercise Prescription

41 운동프로그램의구성 1. 준비운동 warm-up 2. 심폐지구력 Cardiovascular endurance (aerobic) exercise stimulus 3. 저항운동 Resistance exercise 4. 유연성훈련 Flexibility training 5. 정리운동 Cool-down

42 유산소운동의종목선택 1) 전신운동이되고쉽게시작할수있는종목선택 2) 운동할때산소를많이이용해서에너지를많이사용할수있는유산소운동 - 빠르게걷기 ( 조깅 ) - 고정식자전거 - 수영 ( 수중체조 ) - 가벼운등산, 댄스스포츠등등 3) 연령, 당뇨병과관련된합병증및다른질병유무, 선호도등

43 운동강도 강도 100 % 최대심박수 = 220- 나이 80 % 50 % 안정시심박수범위 60~100 회 / 분 시간

44 운동강도 ( 목표심박수 ) 계산법 최대심박수 =220- 나이 목표심박수 (Target heart rate) = ( 최대심박수 - 안정시심박수 ) 운동강도 + 안정시심박수 < 실습 > 운동시나의목표심박수는?

45 운동강도 ( 목표심박수 ) 계산법 안정시심박수범위 60~100회 / 분최대심박수 =220-나이목표심박수 = ( 최대심박수 - 안정시심박수 ) 운동강도 + 안정시심박수 * 운동강도 : 50% (0.5) 70% (0.7) 안정시심박수 =70회 / 분최대예측심박수 = 세 = 160회 / 분목표심박수 = ( ) X 회 =115회

46 6 7 매우가볍다 8 9 가볍다 보통이다 약간힘들다 힘들다 매우힘들다 아주힘들다 20 자각인지도 (RPE)

47 운동강도 운동자각도 ( 약간숨이차는정도 > 이마에땀이흐르는정도 ) 옆사람하고의사소통이가능한숨찬정도

48 가장좋은운동시간대는? 당뇨환자 : 저혈당예방시간 ( 식후 1~3 시간사이 ) 고혈압환자 : 기온변화급격한시간대피하기 비만환자 : 공복운동권장

49 운동빈도 주 3 회격일이상 당조절개선효과기간 : 시간 혈압강하지속시간 : 12~24 시간 운동후대사항진지속시간 : ~ 48 시간주 5 회이상 ( 적극적인체중조절이필요한경우 ) 인슐린 감수성 향상 월화수목금토일 체중조절

50 근력강화운동 분 적은무게에서시작하여점진적으로증가가능 각동작 10-15회반복 1RM의 50~70% 운동시호흡조절 좋은자세유지 무리한무게증가금물 근력, 근지구력향상 (1) 어깨와팔, (2) 가슴, 배, 허리 (core), (3) 하체로나눠실시

51 유연성 유연성이떨어지면몸을굽히기, 들기, 뻗기, 걷기, 계단오르기등의동작기능이나빠짐 하체유연성, 특히엉덩이관절및무릎관절의유연성은요통과근골격계의손상, 비정상적인보행을예방하고낙상의위험을감소시키는데중요 상체유연성 : 머리빗기, 등뒤의지퍼올리기, 머리위로옷벗기, 지갑을뒷주머니에넣기, 안전벨트착용하기

52 준비운동, 정리운동의중요성 관절의가동범위 체온 심박수 대사작용 피로회복 ( 젖산 )

53 운동에따른심박수변화 ( 준비운동 유산소운동 정리운동 회복기 )

54 Hypokinetic Diseases ( 비활동성으로인한질환 ; Top 5 killer 와직접관련 ) 심혈관계질환 암 요통 비만 당뇨 골다공증 정신건강 ( 우울증 )

55 Physical Inactivity ( 신체적비활동성 ) increases the incidence of these 26 unhealthy conditions: 협심증, 관상동맥질환 관절염 유방암 대장암 울혈성심부전증 우울증 소화계문제 담석 위 / 식도성질병 고중성지방 고콜레스테롤증 고혈압 인지능력저하 Low blood HDL 폐경증후군 비만 골다공증 췌장암 말초혈관질환 Physical frailty 전립선암 호흡기문제 무호흡증 뇌졸중 제 2 형당뇨병

56 만성질환의유병율과운동수준 비활동성과비만동시에 만성질환발병의출발점 오랜시간앉아있는생활습관 권장되는신체활동을하고있음 운동을규칙적으로꾸준히 Nature, 2009

57 유산소운동과저항성운동효과를한번에 Circuit Training

58 Circuit Training: One Form of Combination Training Incorporates Both Multi joint Resistance Training and Callisthenic Exercise that Keeps Heart Rate Elevated for the Duration of the Training Session. (Pal et al. 2003) 심박수를높게유지함 Consisting of Aerobic and Resistance Exercises Preferred rather than Focusing on a Single Mode. (Park et al. 2003, O Leary et al. 2006) 유산소운동과저항성운동의복합운동

Fat Tissue % BMI (kg/m 2 ) Resting Heart Rate (bpm) Diastolic Blood

Body Fat (%) Circuit Training Heart Rate Decreased through out the

Diastolic Blood Pressure 이완기혈압감소 Body Fat % Decreased 체지방량감소 Fat

59 Fat Tissue % BMI (kg/m 2 ) Resting Heart Rate (bpm) Diastolic Blood Pressure (mmhg) Lean Tissue % Heart Rate (bpm) Heart Rate (bpm) Body Fat (%) Circuit Training Heart Rate Decreased through out the Exercise Period Decreased Resting Heart Rate 안정시심박수감소 Decreased Diastolic Blood Pressure 이완기혈압감소 Body Fat % Decreased 체지방량감소 Fat Mass and Fat Tissue Decreased 지방량의감소 Lean Tissue and Increased 제지방량 ( 근육량 ) 증가

60 Circuit Training Vs. Endurance Training Only 12 Weeks of High Intensity Circuit Training (HICT) VS. Endurance Training Decreased Body weight, Fat Mass, Decreased Lean Body Mass Decreased Diastolic Blood Pressure Decreased Total Cholesterol, LDL Increased HDL

61 국민건강지식센터 - 직장인대상대사증후군예방을위한 허리둘레 5% 줄이기사업 - 프로그램개발 의학적자문전략 : 내분비내과, 가정의학과, 국민건강지식센터 영양평가 : 식품영양학과 운동 Intervention : 체육교육과 홍보및전략 : 조선일보 App 등기술지원전략 : HealthConnect 대상기업선정 유니베라 ( 민간, 100명 ) - 연령대 : 30대초반 ( 성비 6:4) 중구청 ( 공공기간, 500~1000명 ) - 연령대 : 40~50대 한국공항공사 ( 공기업, 700명 ) - 연령대 : 46세 ( 성비 8:2)

62 일번일주에일 Dynamic Stretching CIRCUIT TRAINING

63 CIRCUIT TRAINING WITH WEIGHT LIFT MACHINES CIRCUIT TRAINING WITH KETTLE BELL & WEIGHT BEARING

64 30min Machines Circuit Training 1 2 Warm up - Jumping rope - Mountain climbing Push up 상체 4 Jumping jack Cool down Shoulder press Sit up Arm curl Leg extension Lat pull down Circuit Training? 낮은강도의순환반복운동 체지방연소및기초근력강화에효과적 Weight training 초보자를위한운동 Leg curl Leg press 3 하체 Fly 근력과심폐지구력향상을목적

65 30min Kettlebell + Weight Bearing Circuit Training 1 Around-the-Body Pass Deadlift 2 1 Crunch Push up 2 5 Snatch Pull & Push-Press 4 Bent Row Kettlebell Station 3 Swing 5 Plank Weight-bearing Station Leg Raise 4 1 Set = 10 min = Kettlebell (30 sec Exercise + 15 sec Rest) x 5 + Station Change + Weight-bearing (30 sec Exercise + 15 sec Rest) x min 30 sec Rest 1 set x 3 = 30 min!! Bridge 3

66 경청해주셔서감사합니다

67 American College of Sports Medicine recommendations for resistance training ( 저항성근력운동가이드라인 ) American College of Sports Medicine. ACSM s Guidelines for Exercise Testing and Precription. 8 th p 71. Training exercises ( 저항성운동 ) Perform 8 to 10 multi-joint exercise that address the major muscle groups (chest, shoulders, back, abdomen, arms, hips, legs) 주요근육군을다루는 8~10 개정도의다관절운동을수행합니다. ( 가슴, 어깨, 등, 복부, 팔, 엉덩이, 다리 ) Training frequency ( 저항성운동의빈도 ) Training Sets ( 저항성운동의셋트 ) Training resistance and Repetitions ( 저항성운동의반복 ) Training technique ( 저항성운동의기술 ) Train each major muscle group two or three nonconsecutive days per week 각각근육군의운동은주당 2~3 일이연속으로이루어지지않도록합니다. Perform two to four sets of resistance training for each major muscle group 주요근육군을위한저항성운동의셋트는 2~4 회수행합니다. Use a resistance that can be performed for 8 to 12 repetitions 저항성운동시 8~12 회반복수행합니다. Perform each repetition in a controlled manner through a full range of motion 운동의반복수행시최대각도를통한방법으로수행합니다. Exhale during lifting actions and inhale during lowering actions 숨은들어올릴때내쉬고내릴때들이쉽니다.

68 운동처방시주의사항 연령고려 만성질환고려 관절염, 당뇨병, 고혈압등 약물복용고려 개인의체력수준에맞게 Follow-up 의중요성 결국은생활습관의변화가관건

Endurance Training Increased Blood Lactate Reduction Greater Body Weight Reduction Greater Waist Line Reduction

69 Waistline Decrease (cm) FM Reduction (%) Blood Lactate Reduction (mmol/l) Pre-Post Body Weight Decrease (kg) Circuit Training Vs. Endurance Training Only 12 weeks of High Intensity Circuit Training (HICT) VS. Endurance Training Increased Blood Lactate Reduction Greater Body Weight Reduction Greater Waist Line Reduction Greater Fat Mass Reduction CG- (Control Group) EG- (Endurance Group) CLG- (Circuit Low Intensity Group) CHG- (Circuit High Intensity Group)

DIABETES FACT SHEET IN KOREA 2012 SUMMARY About 3.2 million Korean people (10.1%) aged over 30 years or older had diabetes in 2010. Based on fasting g

DIABETES FACT SHEET IN KOREA 2012 Korean Diabetes Association (KDA) / Korea Centers for Disease Control and Prevention (CDC) DIABETES FACT SHEET IN KOREA 2012 SUMMARY About 3.2 million Korean people (10.1%)