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1 Clinical Article The Korean Journal of Sports Medicine 2019;37(2):54-59 pissn eissn 동계종목엘리트선수들의상기도감염경험과상기도감염이훈련, 경기참가에미치는영향 대한체육회국가대표선수촌의과학부 배문정 김세준 윤정중 The Experience of the Upper Respiratory Infection of the Elite Winter Sports Athletes and Its Effect on Training and Competition Moonjung Bae, Sejun Kim, Jungjoong Yun Department of Medicine and Science, National Training Center, Korean Sport and Olympic Committee, Jincheon, Korea Purpose: This study aimed to investigate the experience of the upper respiratory infection of the elite winter sports athletes and its effect on training and competition. Methods: We conducted survey on elite athletes preparing for the 2018 PyeongChang Winter Olympic Games. The general characteristics, training and competition loss due to upper respiratory infection were analyzed by descriptive statistics. Multiple regression analysis was performed to find out the factors that influence on training loss due to upper respiratory infection. A p-value less than 0.05 was considered statistically significant and data were analyzed using SPSS ver Results: A total 65 players answered the questionnaire. Sixteen players (24.7%) reported that they got an upper respiratory infection more than three times a year. The month mainly affected by upper respiratory infection was September to November. Main symptom of upper respiratory infection was rhinorrhea mostly, followed by sore throat, cough, sputum. Six players (9.2%) answered that they were excluded from training more than three times due to upper respiratory infection for 1 year. Seven players (10.7%) answered that they were excluded from competition one time due to upper respiratory infection for 1 year. The factors that influence on training loss due to upper respiratory syndrome were the numbers of getting upper respiratory infection for 1 year and age. Conclusion: Elite winter athletes are vulnerable to upper respiratory and it has a bad effect on training and competition. So we need to take care of elite athletes illness like upper respiratory infection. Keywords: Athletes, Common cold, Disease, Sports medicine Received: February 1, 2019 Revised: April 24, 2019 Accepted: May 7, 2019 Correspondence: Moonjung Bae Department of Medicine and Science, National Training Center, Korean Sport and Olympic Committee, 105 Seonsuchon-ro, Gwanghyewon-myeon, Jincheon 27809, Korea Tel: , Fax: , mjbae81@sports.or.kr Copyright 2019 The Korean Society of Sports Medicine CC This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 54 대한스포츠의학회지

2 배문정외. 동계종목엘리트선수들의상기도감염경험과상기도감염이훈련, 경기참가에미치는영향 서 론 2. 자료수집 엘리트선수들은시합과훈련상황에서많은부상과질병을경험한다. 국제올림픽위원회 (International Olympic Committee [IOC]) 에서는선수들의부상과질병을예방하기위하여국제대회의부상과질병에대한역학조사를시행하고있다 1,2. 이러한역학조사에따르면선수들은훈련과시합상황에서상기도감염과같은질병에많이걸린다. 2010년밴쿠버동계올림픽에참여한 2,567명의선수들중 185명이대회기간중질병으로의무실을방문하였다 년소치동계올림픽기간동안에는 2,780명의선수들중 249명이질병으로의무실을방문하였고, 그중 64.0% 가호흡기계질병이었다 년리우하계올림픽대회기간동안에는대한민국국가대표선수 204명중 73명이질병으로한국대표팀의무실을방문하였고, 그중 75.9% 가호흡기계질병이었다 5. 이와같이국제대회나훈련기간중질병에걸리는선수들이많음에도불구하고엘리트선수들의질병에대한연구가부족한것으로생각된다. 따라서본연구는 2018년평창동계올림픽을준비하고있는동계종목선수들을대상으로질병발생경향, 특히많은빈도를보이는상기도감염의발생경향과상기도감염이훈련과시합에미치는영향에대하여알아보고자하였다. 연구방법 1. 대상본연구는 2018년평창동계올림픽을준비하는대한민국국가대표선수 65명 ( 남자 41명, 여자 24명 ) 을대상으로설문조사를시행하였다. 종목별참가자는봅슬레이 16명, 스켈레톤 8명, 스키 15명, 스노보드 5명, 크로스컨트리 9명, 바이애슬론 12명이었다. 모든선수들은가정의학과전문의에게연구의목적에대하여충분한설명을들었으며연구에참여하기로동의한경우에만설문을작성하였다. 설문내용은 IOC의 Daily Report on Injuries and Illnesses의내용을참고하여본연구의취지에부합하도록제작하였다 6. 설문내용은참가자의일반적인특성으로운동경력, 영양제복용여부, 질병의과거력, 지난 1년간상기도감염에걸린횟수, 상기도감염이자주걸리는달, 주요증상등으로구성하였다. 상기도감염이경기력에주는영향을알아보기위하여상기도감염으로인하여훈련과시합에참여하지못했던경험에대한질문을포함하였다. 상기도감염은증상으로인해병원이나약국을방문한경우만포함하였고증상이경한경우는제외하였다. 3. 자료처리방법상기도감염으로인해훈련및시합에제외된경험에대하여종목별로빈도분석을시행하였다. 그리고상기도감염으로인한훈련제외에영향을주는요인을알아보기위하여종목, 나이, 성별, 운동경력, 영양제복용여부, 1년간감기에걸린횟수를변수로하여다중회귀분석 (multiple regression analysis) 을시행하였다. 상기도감염으로인해시합에제외된경험은빈도가많지않아분석하지못하였다. 지난 1년간상기도감염에걸린횟수, 자주걸리는시기, 주요증상, 영양제복용여부등에대해서는기술적통계분석인빈도분석을시행하였다. 통계적유의수준은 p<0.05로설정하였으며 IBM SPSS ver (IBM Corp., Armonk, NY, USA) 을이용하여자료를분석하였다. 결과총 65명의선수가설문에응답하였다. 바이애슬론, 봅슬레이, 스켈레톤, 스키, 스노보드, 크로스컨트리 6종목의선수들 Table 1. General characteristics of elite winter sports athletes Variable Bobsleigh Skeleton Ski Snowboard Cross country Biathlon Total Number (male:female) 16 (11:5) 8 (4:4) 15 (11:4) 5 (4:1) 9 (5:4) 12 (6:6) 65 (41:24) Age (yr) 26.8± ± ± ± ± ± ±4.5 Career (yr) 4.4± ± ± ± ± ± ±6.5 Use of supplement 13 (81.3) 6 (75.0) 12 (80.0) 2 (40.0) 6 (66.7) 10 (83.3) 49 (75.4) Values are presented as mean±standard deviation or number (%). 제 37 권제 2 호

3 M Bae, et al. The Experience of the Upper Respiratory Infection of the Elite Winter Sports Athletes and Its Effect on Training and Competition 이설문에응답하였으며평균연령은 25.5±4.5세, 평균경력은 10.5±6.5년이었다. 영양제를복용하고있냐는질문에 49명 (75.4%) 의선수가복용하고있다고대답하였다 (Table 1). 근골격계부상이외에자주걸리는질병이있냐는질문에 15명이그렇다고대답하였다. 자주걸리는질병으로는상기도감염이가장많았으며위장염, 알러지비염, 아토피피부염등이있다고대답하였다. 가장발생빈도가높았던상기도감염에대한설문결과총 16명 (24.7%) 의선수가 1년에 3회 Table 2. General characteristics of URI* for 1 year Variable Biathlon Bobsleigh Snowboard Skeleton Ski Cross country Total No. of getting URI 0 2 (16.7) 0 2 (40.0) (6.2) 1 6 (50.0) 6 (37.5) 0 2 (25.0) 3 (20.0) 4 (44.4) 21 (32.3) 2 2 (16.7) 7 (43.8) 2 (40.0) 2 (25.0) 9 (60.0) 2 (22.2) 24 (36.9) 3 1 (8.3) 3 (18.8) 0 1 (12.5) 3 (20.0) 2 (22.2) 10 (15.4) 4 1 (8.3) 0 1 (20.0) 2 (25.0) 0 1 (11.1) 5 (7.7) (12.5) (1.5) Total 12 (100) 16 (100) 5 (100) 8 (100) 15 (100) 9 (100) 65 (100) Month mainly affected by URI (38.8) 1 (20.0) 3 (25.0) 7 (50.0) 4 (40.0) 22 (31.4) (45.4) 1 (5.5) 2 (40.0) 3 (25.0) 3 (21.4) 3 (30.0) 17 (24.2) (9.0) 1 (5.5) 0 2 (16.6) 3 (21.4) 1 (10.0) 8 (11.4) (45.4) 9 (50.0) 2 (40.0) 4 (33.3) 1 (7.1) 2 (20.0) 23 (32.8) Total 11 (100) 18 (100) 5 (100) 12 (100) 14 (100) 10 (100) 70 (100) Main symptom Rhinorrhea 6 (21.4) 12 (26.0) 4 (33.3) 7 (29.1) 9 (19.5) 6 (22.2) 44 (24.0) Sore throat 8 (28.5) 13 (28.2) 2 (16.6) 3 (12.5) 7 (15.2) 7 (25.9) 40 (21.8) Cough 4 (14.2) 9 (19.5) 3 (25.0) 6 (25.0) 10 (21.7) 7 (25.9) 39 (21.3) Sputum 4 (14.2) 2 (4.3) 1 (8.3) 4 (16.6) 8 (17.3) 4 (14.8) 23 (12.8) Myalgia 2 (7.1) 6 (13.0) 2 (16.6) 2 (8.3) 8 (17.3) 2 (7.4) 22 (12.0) Fever 4 (14.2) 4 (8.6) 0 2 (8.3) 4 (8.6) 1 (3.7) 15 (8.1) Total 28 (100) 46 (100) 12 (100) 24 (100) 46 (100) 27 (100) 183 (100) Values are presented as number (%). URI: upper respiratory infection. *Only the case when athletes visited medical clinic due to URI. Table 3. Training and event loss due to URI* Variable Biathlon Bobsleigh Snowboard Skeleton Ski Cross country Total No. of training losses 0 5 (41.7) 8 (50.0) 4 (80.0) 5 (62.5) 9 (60.0) 6 (66.7) 37 (56.9) 1 1 (8.3) 5 (31.2) 1 (20.0) 2 (25.0) 3 (20.0) 0 12 (18.4) 2 4 (33.3) 1 (6.3) 0 1 (12.5) 3 (20.0) 1 (11.1) 10 (15.3) 3 2 (16.7) 2 (12.5) (22.2) 6 (9.2) Total 12 (100) 16 (100) 5 (100) 8 (100) 15 (100) 9 (100) 65 (100) No. of event losses 0 10 (83.3) 16 (100.0) 5 (100.0) 8 (100.0) 13 (86.7) 6 (66.7) 58 (89.2) 1 2 (16.7) (13.3) 3 (33.3) 7 (10.7) Total 12 (100) 16 (100) 5 (100) 8 (100) 15 (100) 9 (100) 65 (100) Values are presented as number (%). URI: upper respiratory infection. *Only the case when athletes visited medical clinic due to URI. 56 대한스포츠의학회지

4 배문정외. 동계종목엘리트선수들의상기도감염경험과상기도감염이훈련, 경기참가에미치는영향 Table 4. Factors that associated with training loss due to URI* Variable Unstandardized coefficient Standardized coefficient t p-value Collinearity statistic B SE Beta Tolerance VIF No. of getting URI Age URI: upper respiratory infection, B: unstandardized regression coefficients, SE: standard error, Beta: standardized regression coefficients, VIF: variance inflation factor. *Only the case when athletes visited medical clinic due to URI. 이상상기도감염에걸린다고대답하였으며 24명 (36.9%) 이 2회, 21명 (32.3%) 이 1회정도의빈도로상기도감염에걸린다고대답하였다. 상기도감염이자주걸리는달이언제냐는질문에 23명 (32.8%) 이 9 11월에가장많이걸린다고대답하였고 12 2월에 22명 (31.4%), 3 5월에 17명 (24.2%), 6 8월에 8명 (11.4%) 이자주걸린다고대답하여주로겨울철에상기도감염에자주걸린다는것을알수있었다. 상기도감염의주요증상으로는콧물이 44명 (24.0%) 으로가장많았고인후통 (40 명 ), 기침 (39명), 가래 (23명), 몸살 (22명), 열 (15명) 순이었다 (Table 2). 지난 1년동안상기도감염으로인해훈련에빠진적이있냐는질문에 6명 (9.2%) 의선수가 3회이상빠진적이있다고대답하였고 10명 (15.3%) 의선수가 2회, 12명 (18.4%) 이 1회훈련에빠진적이있다고대답하였다. 37명 (56.9%) 의선수는상기도감염으로인해훈련에빠진적이없다고대답하였다. 지난 1년동안상기도감염으로인해시합을빠진적이있냐는질문에 7명 (10.7%) 의선수가 1번시합에빠진적이있다고대답하였다 (Table 3). 상기도감염으로인한훈련제외에영향을주는요인을분석한결과나이, 1년동안감기에걸린횟수가유의한영향을미치는것으로분석되었다 (Table 4). 나이가많을수록, 감기에걸린횟수가많을수록상기도감염으로인한훈련제외에유의한영향을미치는것으로나타났다. 종목, 성별, 영양제복용여부, 운동경력의변수는통계학적으로유의하지못하여제외하였다. 고찰본연구에서는엘리트동계종목선수들이상기도감염에걸렸던경험과그로인해훈련과시합에서제외된경험에대하여알아보았다. 대부분의선수들이지난 1년동안최소 1번이상상기도감염으로인해병원혹은약국을방문하였다. 그리고일부선수들은상기도감염으로인해훈련이나시합에제외된경험을하였다. 나이와상기도감염에걸린횟수가상기도감염으로인하여훈련에제외되는것에유의한영향을미쳤다. 선행연구에따르면엘리트선수와비활동적인일반인이취미수준의선수에비하여상기도감염의유병률이높았다 7. 이결과는적당한강도의운동을하면상기도감염의위험이감소하다가고강도운동을하게되면상기도감염의위험이증가하게된다는 J-shape relationship 이론으로설명할수있다 8. 본연구에서도대부분의선수들이 1년에 1번이상병원혹은약국을방문할정도의상기도감염을경험하였는데이는고강도훈련과연관이있을수있다. J-shape relationship 이론에따르면적당한수준의운동은상기도감염등의질병의위험을감소시키지만고강도운동을지속하게되면면역력이감소하여상기도감염의위험이증가하게된다 8. 선행연구에따르면고강도훈련후엘리트선수들의구강점막 immunoglobulin A (IgA), IgM 수치가감소하였고이는상기도감염의위험과연관이있다고고찰하였다 9. 적절한휴식이동반된다면초과회복을하여경기력향상에도움이되겠지만 10 그렇지못한경우에는면역력이감소하여상기도감염등의질병에걸릴확률이높아진다. 하지만상기도감염은집단유행시기, 위생등의다양한요인의영향을받기때문에고강도운동이본연구의결과에영향을주었다고결론내리기에는근거가부족할것으로생각된다. 그리고많은시합과해외원정경기를위한비행또한급성감염성질환의위험을증가시킨다 11. 본연구의대상자들은평창올림픽을준비하고있었고해외전지훈련과많은시합을소화해냈다. 이또한선수들의상기도감염발생에영향을주었다고추정할수도있다. 급성감염성질병은선수들의경기력을저하시킨다. 급성열성감염은근소실을유발하고, 순환계기능을저하시키며운동협응력을감소시키며다시정상으로회복하는데많은 제 37 권제 2 호

5 M Bae, et al. The Experience of the Upper Respiratory Infection of the Elite Winter Sports Athletes and Its Effect on Training and Competition 시간이소요된다 12. 본연구에서도엘리트동계종목선수들이상기도감염으로인해훈련과시합에제외되었는데이또한경기력저하에영향을주었을것으로생각된다. 급성감염성질병은선수들의경기력을저하를시킬수있으므로질병예방을위한많은노력을해야한다. 앞서고찰한내용에따르면고강도운동이면역력을저하시킬수있으므로운동의강도조절이필요할것이다. 지도자혹은선수는신체컨디션을잘파악하여운동강도와양을적절히조절해야한다. IOC는운동선수들의질병예방을위한가이드라인을제시하였는데운동강도는주 10% 가넘지않게서서히증가시키는것을권장하였다 13. 본연구에서는 75.4% 의선수들이경기력향상, 질병예방등의이유로비타민 C, 비타민 D, 아연등의영양제를복용하고있었다. 하지만영양제섭취는상기도감염으로인한훈련제외에영향을미치지않았다. 마라톤선수들을대상으로한 randomized controlled trial (RCT) 연구에서는비타민 C를복용한그룹이그렇지않은그룹에비하여상기도감염의발생이 50% 가량낮게보고되었다 14. 청소년수영선수들을대상으로한연구에서는비타민 C를복용한남자선수들이여자선수들에비하여상기도감염의기간이짧았고증상이약하게나타난것으로나타났다. 하지만비타민 C의복용이감기유병률에는영향을주지않았다 명의일반인을대상으로한 RCT 연구에서는비타민 C 복용군이위약군에비하여상기도감염에덜걸리고감염의기간도짧았다 16. IOC는식이보충제 (dietary supplement) 와관련된합의 (consensus) 에서아연을복용하는것이상기도감염의기간을단축시킬수있다고복용을권장하고있다 17. 아연과상기도감염과관련된 Cochrane Review에서는상기도감염초기에아연로젠즈를 75 mg/day 복용하면상기도감염의기간을줄일수있다고보고하고있다 18. 하지만대부분의연구들이일반인을대상으로한연구이고엘리트선수들을대상으로한연구가거의없다. 따라서엘리트선수들의상기도감염예방을위하여비타민 C, 아연등의영양제를보충해야하는지는아직명확하지않은것으로생각되고더연구가필요할것으로생각된다. 상기도감염은바이러스혹은박테리아의감염으로인해발생한다. 상기도감염의주된원인인 rhinovirus는주로 aerosol 의형태로전파된다 19. 선수들은단체생활을하고신체접촉이많다. 따라서기침등의증상이있는선수는마스크를사용하여다른선수들에게전파를차단해야할것이다. 그리고 rhinovirius는타인과의손접촉을통해서도전염될수있다 20. 따라서손씻기를잘하는것이상기도감염의위험을줄이는데도움을줄것으로생각된다. 본연구에서는동계엘리트선수들의상기도감염경험이경기력에주는영향에대하여알아보았다. 선수의연령과 1년간상기도감염에걸린횟수가훈련제외에영향을주었다. 하지만대상자수가적고데이터가연구대상자의경험에의존하여수집되었다는점을비추어볼때일반화하기에는어려울것으로생각된다. 따라서향후더많은엘리트선수들을대상으로한연구가필요할것이며선수들의질병예방전략에대한연구도필요할것으로생각한다. Conflict of Interest No potential conflict of interest relevant to this article was reported. ORCID Moonjung Bae Sejun Kim Jungjoong Yun References Engebretsen L, Soligard T, Steffen K, et al. Sports injuries and illnesses during the London Summer Olympic Games Br J Sports Med 2013;47: Soligard T, Steffen K, Palmer D, et al. Sports injury and illness incidence in the Rio de Janeiro 2016 Olympic Summer Games: a prospective study of athletes from 207 countries. Br J Sports Med 2017;51: Engebretsen L, Steffen K, Alonso JM, et al. Sports injuries and illnesses during the Winter Olympic Games Br J Sports Med 2010;44: Soligard T, Steffen K, Palmer-Green D, et al. Sports injuries and illnesses in the Sochi 2014 Olympic Winter Games. Br J Sports Med 2015;49: Yoon J, Bae M, Kang H, Kim T. Descriptive epidemiology of sports injury and illness during the Rio 2016 Olympic Games: a prospective cohort study for Korean team. Int J Sports Sci Coach 2018;13: International Olympic Committee. Daily report on injuries and illnesses [Internet]. Lausanne (CH): International Olympic Committee; c2012 [cited 2019 Jan 3]. Available from: 58 대한스포츠의학회지

6 배문정외. 동계종목엘리트선수들의상기도감염경험과상기도감염이훈련, 경기참가에미치는영향 picorg/games/summer-games/games-london-2012-olympic- Games/Anti-doping-and-Medical-Rules/Daily-Report-on-Injurie s-and-illnesses-london-2012.pdf#_ga= Spence L, Brown WJ, Pyne DB, et al. Incidence, etiology, and symptomatology of upper respiratory illness in elite athletes. Med Sci Sports Exerc 2007;39: Shephard RJ, Shek PN. Exercise, immunity, and susceptibility to infection: a j-shaped relationship? Phys Sportsmed 1999; 27: Gleeson M. Mucosal immunity and respiratory illness in elite athletes. Int J Sports Med 2000;21 Suppl 1:S Meeusen R, Duclos M, Foster C, et al. Prevention, diagnosis, and treatment of the overtraining syndrome: joint consensus statement of the European College of Sport Science and the American College of Sports Medicine. Med Sci Sports Exerc 2013;45: Svendsen IS, Taylor IM, Tonnessen E, Bahr R, Gleeson M. Training-related and competition-related risk factors for respiratory tract and gastrointestinal infections in elite crosscountry skiers. Br J Sports Med 2016;50: Friman G, Wesslen L. Special feature for the Olympics: effects of exercise on the immune system: infections and exercise in high-performance athletes. Immunol Cell Biol 2000;78: Schwellnus M, Soligard T, Alonso JM, et al. How much is too much? (Part 2) International Olympic Committee consensus statement on load in sport and risk of illness. Br J Sports Med 2016;50: Peters EM, Goetzsche JM, Grobbelaar B, Noakes TD. Vitamin C supplementation reduces the incidence of postrace symptoms of upper-respiratory-tract infection in ultramarathon runners. Am J Clin Nutr 1993;57: Constantini NW, Dubnov-Raz G, Eyal BB, Berry EM, Cohen AH, Hemila H. The effect of vitamin C on upper respiratory infections in adolescent swimmers: a randomized trial. Eur J Pediatr 2011;170: Van Straten M, Josling P. Preventing the common cold with a vitamin C supplement: a double-blind, placebo-controlled survey. Adv Ther 2002;19: Maughan RJ, Burke LM, Dvorak J, et al. IOC consensus statement: dietary supplements and the high-performance athlete. Br J Sports Med 2018;52: Singh M, Das RR. Zinc for the common cold. Cochrane Database Syst Rev 2013;(6):CD Jennings LC, Dick EC. Transmission and control of rhinovirus colds. Eur J Epidemiol 1987;3: Gwaltney JM Jr, Moskalski PB, Hendley JO. Hand-to-hand transmission of rhinovirus colds. Ann Intern Med 1978;88: 제 37 권제 2 호

서론 34 2

서론 34 2 34 2 Journal of the Korean Society of Health Information and Health Statistics Volume 34, Number 2, 2009, pp. 165 176 165 진은희 A Study on Health related Action Rates of Dietary Guidelines and Pattern of