지속적인관리와주의가필요하다는것을의미한다. 전립선암을치료하는방법은수술적요법과비수술적요법으로나뉜다. 수술적요법으로는개복술, 전립선적출술, 로봇수술등이있고비수술적요법으로는방사선치료, 호르몬치료,

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1 Exercise Science Vol.26, No.2, May 2017: ISSN(Print) ISSN(Online) ORIGINAL ARTICLE 전립선암환자들의치료후부작용을완화시키기위한운동중재프로그램의실제 한가영 ¹, 송욱 ¹, ² ¹ 서울대학교스포츠과학연구소건강운동과학연구실, ² 서울대학교노화고령사회연구소 Practical Exercise Intervention to Reduce Adverse Effects for Prostate Cancer Patients Ga-Young Han¹, Wook Song¹, ² ¹Health and Exercise Science Laboratory, Institute of Sport Science, Seoul National University, Seoul; ²Institute on Aging, Seoul National University, Seoul, Korea. PURPOSE: This study is to review previous exercise intervention studies for prostate cancer patients to ease the adverse effects after Prostatectomy and Androgen Deprivation Therapy (ADT). We aim to suggest practical exercise interventions for prostate cancer patients. METHODS: We examined previous literatures published within 10 years at PubMed, RISS and KISS focusing on various exercise intervention to reduce adverse effects. This study reviewed exercise intervention of Prostatectomy and ADT respectively. Adverse effects of each treatment are urinary incontinence of Prostatectomy and the risk factors of metabolic syndrome of ADT. RESULTS: For the patients undergoing prostatectomy, the types, intensity and appropriate timing of exercise intervention to train pelvic floor muscle was suggested. Also, the frequency, intensity, type and duration of exercise intervention for ADT patients were recommended. CONCLUSIONS: It is effective exercise intervention based on Kegel for patients undergoing prostatectomy start before the surgery. For ADT patients, combined exercise including resistance, aerobic and flexibility exercise is recommended. Key words: Prostate cancer, Prostatectomy, Adverse effect, Exercise 서론 암가운데전립선암은서구사람들에게많이발생하는질환으로미국과영국에서는발생률이가장높은암이다. 2013년국가암등록통계에따르면국내에선남성주요암발생 5위이지만 1999년부터 2014년까지 15년간의전립선암연평균증가율은 13.4% 로 2위를차지할만큼최근발생률이급격하게증가하고있다 [1]. 이는서구화된식습관과생활패턴에따른질병발생양상의변화로인한결과이며, 또전립선특이 항원 (Prostate Specific Antigen, PSA) 검사, 경직장초음파등진단기술이발전하면서진단되는환자수가빠르게증가하고있기때문이다. 전립선암은다른암에비해수술후 5년이상의상대생존율이가장높다는점은주목할만하다 [1]. 생존율은수술후부작용이나항암치료의고통등은고려되지않고조사시점의생존여부로만집계되며, 실제로암치료환자가치료후후유증으로얻게되는합병증으로사망하는경우가많은만큼전립선암생존율이높다하더라도암치료후에도수술후유증으로인한합병증때문에환자들이사망하지않도록 Corresponding author: Wook Song Tel Fax * 이논문은 2014 년도보라매비뇨기과연구교실전립선암환자의근치적전립선적출술후단기및장기추적결과분석 ( ), 2013 년도미래창조과학부원천기술개발사업 (NRF-2013M3A9B ) 과 2014 년도교육부이공분야기초연구사업 (NRF-2014R1A1A ) 의지원을받아수행된연구임. Keywords 전립선암, 전립선적출술, 부작용, 운동 Received 3 Apr 2017 Revised 4 May 2017 Accepted 24 May 2017 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 152 Copyright 2017 Korean Society of Exercise Physiology

2 지속적인관리와주의가필요하다는것을의미한다. 전립선암을치료하는방법은수술적요법과비수술적요법으로나뉜다. 수술적요법으로는개복술, 전립선적출술, 로봇수술등이있고비수술적요법으로는방사선치료, 호르몬치료, 약물항암제등이있다. 이중에서도국소전립선암의진단시시행하는전립선적출술은전립선암의초기에주로사용되는수술법으로전립선아래의요도를끊고암이퍼진전립선을포함한주변조직을함께제거한후요도와방광을재연결하는수술이다. 이수술후요실금, 요잔류, 방광염, 발기부전등의합병증이발생하는데대표적인부작용으로는요실금이있다 [2]. 요실금은최근의학술의발달에도불구하고회복속도가더디어환자들의삶의질을떨어뜨리고우울함을가중시킨다는점에서적출술의가장만연하고임상적으로중요한합병증이다 [3]. 비수술적요법으로는전립선암이상당기간진행된환자들에게암의진행을억제시키기위해남성호르몬을차단하는치료법인 Androgen Deprivation Therapy (ADT) 가있다. ADT후에는질병이없는건강한사람들에비해연령과관련된골밀도의감소를 10배나가속화시켜골절과골다공증의위험성을증가시킨다 [4,5]. 또한공복시혈당은증가하고인슐린에대한민감성이감소하면서신진대사와심혈관계합병증등이나타나기도한다 [5,6]. 뿐만아니라제지방량은감소하고체지방량은증가하여신체조성을변화시키며근육량이감소함에따라근력또한줄어들어낙상과골절의위험이커지는등평상시신체수행능력이떨어져일상생활에서불편을겪게된다 [7]. 이와더불어 ADT 환자의삶의질을저하시키는데큰영향을미치는것이만성피로이다. 장기간 ADT 를받은 40% 이상의환자가피로로인해일상생활에불편함을겪고있다고보고된바있다 [8]. 지난수년간이루어진암환자에대한운동중재의효과를보고한연구들에따르면암치료중혹은치료후에운동프로그램을적용할경우암치료후부작용을완화시켜주고신체활동량증진, 합병증발생감소등의효과가있으며운동은안전하고수행이용이하다는점에서암환자들에게가장효과적인비약물적처치라고보고되었다 [9,10]. Courneya et al. [11] 은화학치료를받은유방암환자들에게유산소와저항성운동을복합적으로중재하여신체기능이향상하였음을보고하였다. 또한 Lin et al. [12] 은항암화학요법을받은대장암환자들을대상으로유산소운동과저항성운동을함께처치하였을때근력이향상하고불면증이감소하였음을보고하는등운동을통해암생존자들의수술후삶의질과각종합병증을개선시킨다고보고된바있다. 국내에서역시항암화학요법을받은대장암환자에게운동프로그램을중재하였을때신체적, 정진적인부분에서긍정적인효과를보고하였으며문헌고찰을통해유방암환자들을위한운동중재프로그램의효과를보고하기도하였다 [13,14]. 전립선암역시국외는물론이고국내에서도발생증가율이높은암 으로후유증의치료및회복방법에대해많은사람들이높은관심을갖고있음에도불구하고수술후생존자들의부작용을좀더빠르게혹은완전하게회복시킬수있는치료방법이정립되어있지않은실정이다. 운동은전립선암생존자들의수술후부작용을제한할수있는잠재성을갖고있다는점에서삶의주요중재도구로제안되고있음에도불구하고국내에서는특히 ADT 환자들의수술후운동중재의효과에관한보고가미비한실정이며전립선적출술을받은환자대상의운동중재는연구마다제한적인효과만을보고하고있다 [15,16]. 이에그동안보고된전립선적출술후부작용의회복을위한운동의적용시기, 빈도및강도와 ADT 후부작용완화를위한운동의종류, 강도빈도와시간을살펴보고수술후각각의수술방법에적합한운동치료자료를제시하고자한다. 본론 1. 전립선적출술을받은환자들을위한골반저근강화운동근치적전립선적출술은전립선아래의요도를끊고종양을제거한후요도와방광을재연결하기때문에수술후배뇨장애와성기능장애가발생할수있다. 특히수술후짧은기간안에발생하는요실금으로인해환자들이상당한고통을받는다고알려짐에따라적출술의주요부작용인요실금을완화시키기위한저항성운동의중재가많이보고되었다 [17,18]. 골반저근은대상자스스로수축의정도를느끼기어렵기때문에과거에는 BIOFEEDBACK, 자기장치료등외부의자극을이용한침습적치료를많이활용하였다 [3,19]. 그러나침습적이라는것과비용적인문제그리고치료지속성어려움등부정적인효과를동반하였다 [20]. 이에최근엔침습적치료없이운동만을통해요실금회복의정도를평가하기위한연구가시도되고있다. 운동중재의방법으로는 1954년 Kegel에의해개발된케겔운동을기반으로조금씩변형, 혹은발전된형태의중재방법을사용하고있다. 케겔운동은방광, 직장등을지지하는골반저근의수축과이완을반복수행하여해당근육을강화시켜주는운동으로, 경제적이고부작용의위험이적으면서도요실금치료효과가뛰어나다는장점을갖고있어많은연구에서선호되고있는운동방법이다 [20-24]. 케겔운동은골반저근을강화시킨다는점에서골반저근육운동 (pelvic floor muscle exercise) 이라고명명하기도한다. 전립선적출술을받은전립선암환자들을대상으로케겔운동을기반으로한운동중재방법은 Table 1과같다. 1) 운동중재적용시기수술후운동을한그룹과아무런처치도하지않은그룹간에요실금의개선정도는 1년이지난후에유의한차이를나타냈다 [23]. 이는 한가영외 전립선환자를위한운동중재프로그램 153

3 Vol.26, No.2, May 2017: Table 1. A description of the exercise intervention studies for prostate cancer patients undergoing prostatectomy Study Participants Timing of PFME Exercise details Duration Frequency Outcomes Overgard et al. [23] Centemero et al. [21] Exercise (preoperative PFME plus Postoperatively PFME) n = 59 Control (postoperative PFME only) n=59 Park et al. [24] Patel et al. [22] Exercise (Instructed Postoperative PFME 3 sets of 10 contractions daily at home by a physiotherapist) n = 42 C ontrol (Training on their own) n=43 Exercise (combined exercise intervention) n = 33 C ontrol (Kegel exercise only) n=33 Exercise (preoperative PFME plus Postoperatively PFME) n = 152 Control (postoperative PFME only) n = 132 Eva M. Zopf et al. [25] Exercise n = 56 Control n=29 4 weeks preoperatively 4 weeks postoperatively 12 weeks postoperatively 4 weeks preoperatively 6 weeks postoperatively Postoperative H olding contraction for 6-8 s, 3 or 4 fast contractions at the end of each contractions L asting as long as the patient used pads or chose to continue training 4 5 minutes per session once a week P FME alternating maximal and submaximal contractions in lying down, sitting or standing 8 weeks 30 minutes per session 2 times per week P FME with a ball/45-75% of HRRmax/9-13 RPE P FME with an elastic band/50-70% of 1 RM/9-13 RPE Repeated activations (10 contractions of 10 s) of the pelvic floor muscles in each of sitting, standing and lying positions. E ncouraged to practice while carrying out activities of daily living 12 weeks 6 0 minutes per session 2 times per week L asting until continence returned Daily at home A erobic (Nordic walking)/50-70% HRmax RPE resistance (with equipment or machines)/2-3 sets, 8-15 rep, 30-50% MVC P elvic floor exercises/1-2 sets/8-10 rep/30% MVC 15 months 60 minutes per week Self-reported continence rates 24-h pad test weight Self-reported continence rates 24-h pad test weight Pads per day or week 24-h pad test weight 20 minutes pad test UI, urinary incontinence; PFME, pelvic floor muscle exercise; MET, metabolic equivalent of task per hour; PFME, pelvic floor muscle exercise; RM, repetition maximum; RPE, borg rating of perceived exertion scale [26]; HRR, heart rate reserve; MVC, maximal voluntary contraction. 운동의효과라기보다는시간의흐름에따른자연스러운회복으로사료된다. 수술전부터운동중재를시작한그룹과수술후운동중재를시작한그룹간에는수술전운동을시작한그룹에서 1개월에서 3개월사이요실금개선의유의한효과가나타났으나시간이흐름에따라그효과는점차감소되었다 [21,22]. 15개월이상운동중재를시킨그룹 효과역시떨어지는것을알수있었다. 또한수술후에운동을시작하는것과술전에시작하는것이요실금개선정도에미치는영향이큰차이는없으나수술전에운동을시작하는것이운동동작에대한이해와수행적응기간을가질수있다는점에서수술전에운동을시작하는것이운동중재의효율성이높아질것으로사료된다. 과아무처지도하지않은그룹을비교한연구에서는운동그룹내운 동전과후의처지효과는유의하게나타났지만비처치그룹과의그룹간차이에선유의한효과가나타나지않았다 [25]. 이러한결과들로미루어보았을때운동중재기간이비교적짧은경우대상자들의운동참여순응도를높여서수술후요실금의초기회복을기대할수있으나시간이지나면서순응도가떨어지고운동의 2) 복합운동모델 Park et al. [24] 은소도구를이용한복합운동중재를통해요실금의효과를포함한삶의질, 운동능력등을평가하였다. 공과탄력밴드를이용한저항성, 골반유연성그리고케겔운동을복합적으로활용한운동중재방법을사용하였으며 Zopf et al. [25] 또한멀티모델운동프 154 Ga-Young Han, et al. Exercise Intervention Program for Prostate Cancer Patients

4 Cardiovascular fitness Lean body mass Fat mass Fatigue Physical active level The risk of metabolic syndrome Falls incidence The risk of osteoporosis Cardiovascular disease Type 2 diabetes Fig. 1. Adverse effects of prostate cancer patients after ADT. Table 2. A description of the exercise intervention studies for prostate cancer patients undergoing ADT Study Participants (E/C), (RE/AE/C) Galvao et al. [28] 57 (29/28) RE: Incorporating major muscle groups/ 12RM-6RM/2-4 sets AE: minutes of cycling and walking/ jogging 65-85% of HRmax/11-13 of RPE Culos-Reed et al. [29] 100 (53/47) Group sessions: 60 minutes of walking, stretching and resistance exercise with elastic band and ball/moderate intensity Bourke et al. [30] 50 (25/25) RE: Targeting large muscle groups/2-4 sets AE: 30 minutes of brisk walking, cycling and gym exercise/55-85% of HRmax/11-15 of RPE Alberga et al. [31] 74 (23/25/26) RE: Targeting Large muscle groups/ 8-12 repetitions at 70-80% of 1RM /2 sets AE: Increasing from minutes of cycling, walking or jogging on treadmill at 50-75% of peak oxygen uptake Cormie et al. [32] 63 (32/31) RE: Targeting the major upper and lower body groups/12rm-6rm/1-4 sets AE: minutes of walking or jogging, cycling or rowing 70-85% of HRmax Exercise details Duration Frequency Outcomes 12 weeks 2 times per week Lean body mass Muscle Strength Physical Function QoL C-reactive protein Fatigue 16 weeks 3-5 times per week Physical activity behavior Blood pressure 12 weeks 2 times per week (weeks 1-6) 1 day per week (weeks 7-12) 24 weeks 3 times per week Exercise and dietary behavior Fatigue QoL Muscle Strength Aerobic exercise tolerance Total energy intake Lean body mass (In Aerobic & Control group) 3 months 2 times per week Cardiovascular fitness Muscular Strength Lower body function Total cholesterol Sexual Function QoL Fatigue E, exercise; C, control; RE, resistance exercise; AE, aerobic exercise; HRmax, maximal heart rate; RM, repetition maximum; RPE, borg rating of perceived exertion scale [26]; QoL, quality of life; BMD, bone mineral density. 한가영외 전립선환자를위한운동중재프로그램 155

5 Vol.26, No.2, May 2017: 로그램을사용하였다. 운동프로그램은저항성운동유산소성운동, 골 Table 3. Summary of exercise intervention for ADT patients 반저근운동을기반으로유연성, 협응성, 인지능력, 상호작용, 협력그 Resistance exercise Aerobic exercise 리고커뮤니케이션을촉진할수있는운동과게임으로구성되었다. 연구의목적은근력및유산소성능력등직접적인신체적능력의개선정도를보기보다는비활동적인전립선암환자들의신체활동량을늘리기위한프로그램을개발하는것에두었다. 이처럼복합운동모델은전립선암환자들의운동중재에대한순응도를높이고신체활동량을 Frequency 2-5 per week 2-5 per week Intensity 60-85% of 1RM 50-80% of HRmax Time 8-12 repetitions, 2 sets 20 minutes Type Targeting major muscle groups RM, repetition maximum; HRmax, maximal heart rate. Progressively increased walking, jogging or cycling 증진시키는데기여하는것으로사료된다. 함께복합적으로적용했을때긍정적인효과가있다고사료된다 [31]. 2. ADT 를받은환자들을위한복합운동 호르몬치료후에는심혈관계합병증, 근위축을비롯하여다양한 위의연구결과들을참고하여 ADT 를받은환자들을대상으로한 효과적인운동중재의방법을제시하면 Table 3 과같다. 부작용이나타난다 [27]. Fig. 1 은 ADT 후나타나는부작용을정리한 것이다. 이와같은 ADT 부작용의특성에따라많은연구에서근육량의증가를위한저항성운동과체지방감량을위한유산소성운동을복합적으로처치하였다. Table 2는 ADT를받은전립선암환자들을대상으로복합운동중재연구들을운동의종류, 중재기간, 빈도, 강도그리고주요변인을각각구분하여구체적으로보여주고있다. 3) 라이프스타일중재 ADT를받은환자들에게나타나는부작용은심혈관질환, 신체조성변화그리고대사증후군위험성의증가등신체의전반적인기능에대한영향을준다는특이성으로인해그들을대상으로한운동중재는전반적인라이프스타일을중재하고자하는시도가있었다. Bourke et al. [30] 은대상자들이포화지방의섭취를줄이고정제된탄수화물 1) 운동중재적용시기운동은 1주일에최소 2회에서최대 5회까지실시하며운동기간은최소 12주이상을시행했을때근력, 심폐능력그리고삶의질을포함한여러변인들의유의한효과가있었다고보고되었다 [28,29]. 저항성운동은 6-12회반복하여 2 set 이상실시할때근력이향상되었다. 유산소운동은회당최소 20분이상실시할때최대산소소비량과같은유산소성능력의지표가향상하는것으로보고되었다 [28,30,32]. 의섭취를늘릴수있도록운동처치 12주동안격주로 15-20분간영양세미나를진행하였다. 그러나연구결과대상자들의총음식섭취량은줄어들었지만그로인한연쇄효과로체지방이줄어드는등의효과는없는것으로나타났다. 또다른식이중재를한연구에서는대상자들이균형있는식사를할수있도록 12주동안격주로 20분간영양세미나를진행한결과중재그룹대상자들의지방섭취가유의하게줄은것을확인할수있었다 [33]. 그러나두연구모두식단관리가 ADT를받 은대상자들의신체조성이나신체기능에직접적으로긍정적인효과 2) 운동의종류와적용강도 를주지는않는것으로보인다. ADT 치료를받은환자를대상으로한복합운동으로중재한연구 들에서저항성운동은기계를이용하거나바벨, 덤벨혹은저항밴드등을사용하여 Chest press, seated row, triceps extension, leg press, leg extension 그리고 leg curl 등전신의대근육을동원시킬수있는프로그램으로구성되었다 [28,29,33]. 유산소운동은자전거타기, 빠르게걷기또는조깅을최대심박수의 50-85% 의중강도와고강도사이에서수행하도록하였다 [28,30,33]. 운동중재가중강도로만이루어질경우에는운동중재기간이길다할지라도신체활동량은증가시킬수있지만신체적기능과체성분등에는영향을주지못하는것으로보고됐다 [29]. 따라서운동의강도는중강도에서고강도혹은최대하강도로점진적으로증가시킬경우신체기능에긍정적인효과를줄수있다고사료된다. 더불어저항성운동과유산소성운동중하나의운동만적용시켰을때운동처치를받은각각의그룹에서유의미한효과가없는것으로보아한가지의운동만적용시키기보다는두가지의운동을 결론 현대과학기술의발달로전립선암을조기에발견하고수술과치료를통해암생존자는지속해서늘고있지만이들의운동방법에대한명확한가이드라인은없는실정이다. 또한같은암이라도치료방법에따라필요한운동이다르기때문에개개인의상황과목적에맞는운동처방이필요하다. 이에본종설은전립선적출술과 ADT를받은전립선암환자들을대상으로한최근 10년내에게재된운동중재연구들을통해각치료방법에따른효과적인운동방법을제시하고자하였다. 적출술을받은환자의경우수술후부작용인요실금으로인해움직임에불편함이생기기때문에수술전에운동을시작하여동작의대한이해와올바른운동법을익히면수술후요실금의초기회복에도움이될수있을것으로사료된다. ADT를받은환자들은걷기, 자전 156 Ga-Young Han, et al. Exercise Intervention Program for Prostate Cancer Patients

6 거타기등의유산소운동과하체, 가슴, 배등큰근육을동원한저항성운동을복합적으로주 2-5회이상실시하도록한다. 또한운동강도는점진적으로증가시켜장기간의운동에도정체기를최대한줄이고운동의효과를높일수있도록하며유연성, 균형감각등을증가시킬수있는운동들을추가적으로프로그램에포함시킨다면운동에대한환자들의순응도를높일뿐만아니라평상시신체활동량을증진시켜장기적으로환자들의부작용을완화시켜줄것으로사료된다. REFERENCES 1. National Cancer Information Center. Cancer incidence Rates [cited Dec]; Retrieved from: cancer/subview.jsp?id=cancer_ Steineck G, Helgesen F, Adolfsson J, Dickman PW, Johansson JE, et al. Quality of life after radical prostatectomy or watchful waiting. New England Journal of Medicine 2002;347(11): Van Kampen M, De Weerdt W, Van Poppel H, De Ridder D, Feys H, et al. Effect of pelvic-floor re-education on duration and degree of incontinence after radical prostatectomy: a randomised controlled trial. The Lancet 2000;355(9198): Grossmann M, Hamilton EJ, Gilfillan C, Bolton D, Joon DL, et al. Bone and metabolic health in patients with non-metastatic prostate cancer who are receiving androgen deprivation therapy. The Medical Journal of Australia 2011;194(6): Taylor LG, Canfield SE, Du XL. Review of major adverse effects of androgen-deprivation therapy in men with prostate cancer. Cancer 2009; 115(11): Smith J, Bennett S, Evans L, Kynaston H, Parmar M, et al. The effects of induced hypogonadism on arterial stiffness, body composition, and metabolic parameters in males with prostate cancer. The Journal of Clinical Endocrinology & Metabolism 2001;86(9): Bylow K, Dale W, Mustian K, Stadler WM, Rodin M, et al. Falls and physical performance deficits in older patients with prostate cancer undergoing androgen deprivation therapy. Urology 2008;72(2): Storey D, McLaren D, Atkinson M, Butcher I, Frew L, et al. Clinically relevant fatigue in men with hormone-sensitive prostate cancer on long-term androgen deprivation therapy. Annals of oncology 2012; 23(6): Hayes SC, Spence RR, Galvão DA, Newton RU. Australian Association for Exercise and Sport Science position stand: Optimising cancer outcomes through exercise. Journal of Science and Medicine in Sport 2009;12(4): Shim YJ, Jung SS, Kim AR, Choi SW. A review of literature on cancer and exercise The Korea Journal of Sports Science 2013;22(6): Courneya KS, Mackey JR, Jones LW. Coping with cancer: can exercise help?. The Physician and Sportsmedicine 2000;28(5): Lin YH, Lin VCH, Yu TJ, Wang HP, Lu K. Comparison of health-related quality of life between subjects treated with radical prostatectomy and brachytherapy. Journal of Clinical Nursing 2012;21(13-14): Shim YJ, Lee JY, Choi SW. Effects of exercise on colon cancer patients under chemotherapy. The Korea Journal of Sports Science 2016;25(1): Kim IS. Literature review of exercise thrapy effects in patients with breast cancer. Journal of The Korean Society of Integrative Medicine 2014;2(2): Galvão DA, Newton RU, Taaffe DR, Spry N. Can exercise ameliorate the increased risk of cardiovascular disease and diabetes associated with ADT?. Nature Clinical Practice Urology 2008;5(6): Kim SJ, Lee MC, Kim WJ. The effects of physical activity on cancer prevention. Korean Journal of Health Promotion and Disease Prevention 2008;8(2): Sanda MG, Dunn RL, Michalski J, Sandler HM, Northouse L, et al. Quality of life and satisfaction with outcome among prostate-cancer survivors. New England Journal of Medicine 2008;358(12): Pardo Y, Guedea F, Aguiló F, Fernández P, Macías V, et al. Quality-oflife impact of primary treatments for localized prostate cancer in patients without hormonal treatment. Journal of Clinical Oncology 2010;28(31): Burgio KL, Goode PS, Urban DA, Umlauf MG, Locher JL, et al. Preoperative biofeedback assisted behavioral training to decrease postprostatectomy incontinence: A randomized, controlled trial. The Journal of Urology 2006;175(1): Tienforti D, Sacco E, Marangi F, D Addessi A, Racioppi M, et al. Efficacy of an assisted low-intensity programme of perioperative pelvic floor muscle training in improving the recovery of continence after radical prostatectomy: A randomized controlled trial. BJU international 2012; 110(7): Centemero A, Rigatti L, Giraudo D, Lazzeri M, Lughezzani G, et al. Preoperative pelvic floor muscle exercise for early continence after radical prostatectomy: A randomised controlled study. European Urol- 한가영외 전립선환자를위한운동중재프로그램 157

7 Vol.26, No.2, May 2017: ogy 2010;57(6): Patel MI, Yao J, Hirschhorn AD, Mungovan SF. Preoperative pelvic floor physiotherapy improves continence after radical retropubic prostatectomy. International Journal of Urology 2013;20(10): Overgård M, Angelsen A, Lydersen S, Mørkved S. Does physiotherapist-guided pelvic floor muscle training reduce urinary incontinence after radical prostatectomy?: A randomised controlled trial. European Urology 2008;54(2): Park SH, Cho YS, Kwack MJ, Lee HS, Kang CB. Effect of Kegel exercise on urinary incontinence after radical prostatectomy: Systematic review of randomized controlled trials. Korean Journal of Adult Nursing 2013;25(2): Zopf EM, Bloch W, Machtens S, Zumbé J, Rübben H, et al. Effects of a 15-month supervised exercise program on physical and phychological outcomes in prostate cancer patients following prostatectomy: the prorehab study. Intergrative Cancer Therapies. 2015;14(5): Borg GA. Psychophysical bases of perceived exertion. Medicine & Science in Sports & Exercise 1982;14(5): Keogh JW, MacLeod RD. Body composition, physical fitness, functional performance, quality of life, and fatigue benefits of exercise for prostate cancer patients: a systematic review. Journal of Pain and Symptom Management 2012;43(1): Galvão DA, Taaffe DR, Spry N, Joseph D, Newton RU. Combined resistance and aerobic exercise program reverses muscle loss in men undergoing androgen suppression therapy for prostate cancer without bone metastases: a randomized controlled trial. Journal of Clinical Oncology 2010;28(2): Culos-Reed SN, Robinson JW, Lau H, Stephenson L, Keats M, et al. Physical activity for men receiving androgen deprivation therapy for prostate cancer: benefits from a 16-week intervention. Supportive Care in Cancer 2010;18(5): Bourke L, Doll H, Crank H, Daley A, Rosario D, et al. Lifestyle intervention in men with advanced prostate cancer receiving androgen suppression therapy: A feasibility study. Cancer Epidemiology Biomarkers & Prevention 2011;20(4): Alberga AS, Segal RJ, Reid RD, Scott CG, Sigal RJ, et al. Age and androgen-deprivation therapy on exercise outcomes in men with prostate cancer. Supportive Care in Cancer 2012;20(5): Cormie P, Galvão DA, Spry N, Joseph D, Chee R, et al. Can supervised exercise prevent treatment toxicity in patients with prostate cancer initiating androgen-deprivation therapy: a randomised controlled trial. BJU International 2015;115(2): Bourke L, Gilbert S, Hooper R, Steed LA, Joshi M, et al. Lifestyle changes for improving disease-specific quality of life in sedentary men on long-term androgen-deprivation therapy for advanced prostate cancer: A randomised controlled trial. European Urology 2014;65(5): Ga-Young Han, et al. Exercise Intervention Program for Prostate Cancer Patients

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012임수진 Received : 2012. 11. 27 Reviewed : 2012. 12. 10 Accepted : 2012. 12. 12 A Clinical Study on Effect of Electro-acupuncture Treatment for Low Back Pain and Radicular Pain in Patients Diagnosed with Lumbar