Clinical Article The Korean Journal of Sports Medicine 2017;35(1):15-24 pissn 1226-3729 eissn 2288-6028 https://doi.org/10.5763/kjsm.2017.35.1.15 요부안정화운동프로그램이좌식생활여성의요천추부각도, 근력, 체력및통증에미치는영향 서울대학교체육교육과 1, 경희대학교체육학과 2, 서울대학교스포츠과학연구소 3 오지선 1 ㆍ최동균 2 ㆍ김연수 1,3 The Effect of Lumbar Stability Exercise Program on Sedentary Life Female, Lumbosacral Region Angle, Muscular Strength, Physical Fitness and Pain Scale Ji-Sun Oh 1, Dong-Gyun Choi 2, Yeon-Soo Kim 1,3 1 Department of Physical Education, Seoul National University, Seoul, 2 Department of Physical Education, Kyung Hee University, Seoul, 3 Institute of Sport Science, Seoul National University, Seoul, Korea The purpose of this study is to evaluate the effect of lumbar stabilization exercise on lumbosacral region angle, lumbar strength, lower muscle strength, physical fitness, and low back pain of sedentary women. Twenty females who spend more than 6 hours a day as sedentary at working were recruited. The subjects were assigned to two different groups which are exercise group (n=10) and non-exercise group (n=10). Exercise program was consisted with Swiss ball and lumber stability exercise, and it was performed 60 min/day and 3 times/wk for 8 weeks. Two-way analysis of variance was conducted to analyze experimental data. As a result, there was no significant difference between groups in lumbar lordosis angle and lumbar sacral angle. However, Isometric lumbar extension strength, isokinetic knee flexion and extension peak torque in angular velocity were significantly different between groups, and the pain was reduced. To conclude, this study identified the effectiveness of lumbar stabilization exercise on lumbar muscular, strength, Sargent jump, sit and reach test and reduced pain. Keywords: Sedentary lifestyle, Lumbar stabilization exercise, Lumbar muscle strength, Physical fitness, Low back pain 서 론 Received: October 6, 2016 Revised: December 10, 2016 Accepted: December 15, 2016 Correspondence: Yeon-Soo Kim Department of Physical Education, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Korea Tel: +82-2-880-7794, Fax: +82-2-886-7804 E-mail: kys0101@snu.ac.kr Copyright 2017 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 (http://creativecommons.org/ licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 최근통계청조사에따르면 1), 우리나라여성의 52.2% 가경제활동에참여하고있으며, 출산이후에직장생활을하는여성들이증가하고있다. 현대의직업들은과거와비교하여신체활동이축소되는좌식형태의근무여건을형성하고있으며이러한급격한생활습관의변화는승용차의보급과자동화된장비를집과직장에서이용하면서부터시작되어성인뿐만아니라어린이의생활도좌식생활형태로확대시켜나갔다 2). 장시간지속되는좌식생활로인하여복근을중심으로한근력의저하가누적되어한쪽으로치우친체형불균형이발생 제 35 권제 1 호 2017 15
JS Oh, et al. The Effect of Lumbar Stability Exercise Program on Sedentary Life Female, Lumbosacral Region Angle, Muscular Strength, Physical Fitness and Pain Scale 하고있다. 장시간앉아서공부하는시간의증가, 신체의활동량부족, 불량한자세유지및신체불균형에대한자각도부족, 하체에가해지는부하의감소등의이유로발생하는척추변형은심각한건강문제로대두되고있고 3), 운동부족은체력을저하시키며, 근력및유연성약화, 골밀도감소등으로인해근골격계질환의발생률을증가시킨다 4). 요부안정화운동에관하여보면요부에집중된연구가대부분이다. 요통은요부근력뿐만아니라하지근력도밀접한관련이있는데허리근육의근력저하및불균형과함께하지의넙다리네갈래근과뒤넙다리근의근력저하및근력비율불균형이요통발생에중요한역할을한다 5). 최근 Swiss ball 을이용한요부안정화운동에관한연구들을살펴보면 Jeong 등 6) 은 Swiss ball 요부안정화운동이척주주위근육을강화시키고, 척주관의압력을감소시켜배근력, 민첩성, 평형능력을상승시킨다고하였고, Lee 등 7) 에의하면 Swiss ball을이용한요통관리프로그램의실험적자료는입원중이거나내원하는요부관련질환을가진사람들을대상으로운동효과에대한실험이진행되어, 요통이진행되지않은일반인의근력향상결과에대한객관적자료가미비하므로이를위한다양한시도가필요하다. Heo 등 8) 은흉추안정화운동을같이한요부안정화운동은만성요통환자들의요통을감소시키는데중요한역할을한다고하였고, Jeong 등 6) 에따르면요부안정화운동과둔부근육강화운동은요통을감소시켰으며요부근육강화, 균형감이증가하였다. 이는단순히한가지운동에만국한시킬것이아니라두가지운동을동시에수행할경우요부안정성, 근력및통증제어에긍정적인작용을했다. Swiss ball을이용한운동의효과에대해첫째, Swiss ball을통하여복부, 등, 둔부, 내외측다리등의스트레칭효과를통한근육의긴장을완화시키며, 둘째, 낮은충격의근력운동을할수있어신체에무리를주지않고필요한부위의근력을강화시킬수있다고하였다. Cho 등 4) 의연구에서는좌업생활자의운동실천에따라동일연령대일반인수준에는미치지못하지만체중, 체지방률, waist-hip ratio, body mass index (BMI), 노력성폐활량, 근지구력, 심폐지구력에미치는결과가긍정적으로나타났다. 이는오랜좌식생활을수반하는직업일수록규칙적인신체활동을통해신체구성을적정수준으로유지하고체력을향상시키는것이중요하다는것을보여준다. 지금까지의연구들을보면운동선수, 질환자들의만성요통에관한연구들이대부분이었으나좌식생활을하는일반인을대상으로한연구는단순한체력향상, 운동실천유무에따른 신체구성, 폐기능, 기초체력에대한연구 4) 로써기초체력, 평상시신체활동의중요성에대해서언급한것일뿐좌식생활하는여성에대한요천추부각도, 요부근력, 하지근력, 통증에대한연구는상대적으로미흡한실정이다. 이에본연구는장시간좌식생활하는여성의요부안정화운동을통한요천추부각도, 근력, 체력, 그리고통증을분석하여건강한삶을영위하기위한운동실천과운동지도에필요한기초자료를제시하는데그목적이있다. 연구방법 1. 연구대상 이연구의대상자는 S대학교연구실에있는 20 30대여성연구원을대상으로하였고좌식생활실천형태로서일일 6시간이상의좌식근무를하는대상자들로요부안정화운동에참여하는 10명의운동집단과운동을실시하지않는 10명의통제집단으로나누어총 20명을대상으로실시하였다. 연구대상자들의신체적특성은 Table 1과같다. 2. 연구절차및방법 1) 키, 몸무게및신체조성 키와몸무게는자동신장, 체중계 (DS-102; Dong Sahn Jenix, Seoul, Korea) 를사용하여측정하였고, 신체조성은체성분검사기 (HIM-20; Bizmedic, Seoul, Korea) 를사용하여피험자의연령, 신장, 성별등을입력하고기계의전극발판에맨발로올라서서직립자세를취한뒤좌, 우측전극손잡이를잡은후체지방률 (% body fat) 을측정하고 BMI를산출하였다. 2) 방사선촬영및요천추부각도측정 진단용엑스선모델 (R-630-125) 을사용하여동일한방사선기사가시상면상의요천추부사진을촬영하였고, 척추만곡 Table 1. General characteristics Variable Exercise group (n=10) Control group (n=10) Age (yr) 35±2.56 30.20±2.7 Height (cm) 156.70±3.20 163.90±3.93 Weight (kg) 55.90±6.17 56.10±5.99 Body fat (%) 28.30±4.64 25.90±4.80 16 대한스포츠의학회지
오지선외. 요부안정화운동프로그램이좌식생활여성의요천추부각도, 근력, 체력및통증에미치는영향 및분절의각도분석은 Yang 등 9) 이사용한 Cobb s 방법에의거하여실시하였다. 요추전만각은제1 요추상면을이은선과천추의상면을이은선이만나이루는각도, 요천추각은제5 요추의하면을이은선과천추의상면을이은선이만나이루는각도, 천골각은제1 천추상면을이은선과수평면을연결했을때형성되는각도를각도계를이용하여측정하였다. 3) 등척성요부신전근력미국메덱스사와플로리다의과대학척추건강연구소에서개발및실험을하였으며요부기능의검사와진단이가능하고요부의기능테스트 (static, dynamic test) 에의한요추신전근만을측정하고강화시킬수있는특징을갖고있는 Medx lumbar extension machine (Medx 96, Ocala, FL, USA) 을이용하여요부의전체가동범위를 72 o 에서 0 o 까지 12 간격으로 7등분하여 0 o, 12 o, 24 o, 36 o, 48 o, 60 o, 72 o 로각각의측정각도를표준화하였고, 각측정각도에서정적등척성근력 (static isometric strength) 을산출하였다. 4) 등속성근기능측정슬관절의근력과근지구력을측정하기위하여좌, 우슬관절의신근과굴근의최대토크와총운동량을측정하였다. 이를위하여등속성근력측정장비인 isokinetic rehabilitation testing system (Biodex System 3 pro; Biodex Medical Systems, Shirley, NY, USA) 을이용하였다. 사전에 2 3회의예비운동을실시하고, 5분경과후본검사를실시하였으며, 근력과근지구력측정사이에 5분의휴식시간을주었고부하속도 60 o /s에서 5회, 180 o /s에서 20회하였으며신호와함께최대한힘차게굴곡과신전운동을하였고각검사때마다강력한구두자극을주어최대능력이나오도록독려하였다. 5) 체력체력은근력 ( 악력, grip strength), 근지구력 ( 윗몸일으키기, sit up), 순발력 ( 서전트점프, Sargent jump), 민첩성 ( 사이드스텝, side step), 유연성 ( 앉아윗몸앞으로굽히기, sit and reach) 을측정하였다. 악력계 (T.K.K.5401; Takei, Tokyo, Japan) 를사용하여최대로발휘한힘을 2회측정하여최고기록을측정치 ( 단위, 0.1 kg) 로하였다. 근지구력은피험자가매트위에등을대고편안히누운자세에서무릎각도가약 90 o 가되도록무릎을굽혀발바닥을바닥에붙인후양손을 X자로교차시켜가슴에올리도록하였다. 배에힘을주어윗몸을일으키면서양팔꿈치가무릎에닿는것을 1회로하여 60초간최대한빠른속도로반복한횟수를측정하였다. 순발력은제자리높이뛰기 (T.K.K.5406, Takei) 에서 2회측정하여최고기록을측정치 ( 단위, 0.1 mm) 로하였다. 민첩성은사이드스텝보드에서 20초간실시한후총횟수를측정하였다. 유연성은앉아윗몸앞으로굽히기측정기 (ST-18; Expert, Seoul, Korea) 에서 2회측정하여최고기록을측정치 ( 단위, 0.1 cm) 로하였다. 6) 요부통증검사통증정도측정을위해 Wang과 Kim 10) 에의해수정된주관적통증평가표를사용하였다. 높이 50 mm, 가로 100 mm인가로막대모양에통증이없는경우인 0 에서부터통증이아주심한경우 10 까지표시해둔뒤환자가직접통증정도를표시할수있도록하였다. 3. 운동프로그램이연구는좌식생활을하는여성에있어중요한요부근력, 하지근력, 통증및체력증진을위하여운동군집단에게 Swiss ball 운동과요부안정화운동을실시하였는데준비운동, 본 Table 2. Exercise program Stage Time/frequency Program ETC Warm-up 10 min Stretching 3 times/wk Main exercise 40 min Swiss ball exercise: basic bouncing, pelvic tilt, pelvic circle, ball reverse bridge, supine bridge one leg dips, hip lifting and knee bending, sitting on a ball and marching, ball crunch, arching, leg tilt, ball bridge, side stretching Lumbal stabilization: superman, leg lifting in prone position, arm lifting in prone position, quadruped arm/leg raise, bridge, bridge and leg lifting, bow position 1 Set 10 rep Cool-down 10 min Stretching rep: repetition. 제 35 권제 1 호 2017 17
JS Oh, et al. The Effect of Lumbar Stability Exercise Program on Sedentary Life Female, Lumbosacral Region Angle, Muscular Strength, Physical Fitness and Pain Scale 운동의운동강도, 정리운동은다음과같은방법으로실시하였다 (Table 2). 본연구에서자각적운동강도 (rating of perceived exertion, RPE) 는미국스포츠의학회 (American College of Sports Medicine) 에서권장하는 11 13의운동강도로시행하도록하였고 11), 11 13은 가볍거나보통이다 에서 약간힘들다 의의미로, 심박수의 60% 70% 강도를말한다. (1) 준비운동 : 긴장완화를위한스트레칭구성, (2) 본운동의 RPE는 11 13으로구성, (3) 정리운동 : 근육이완과피로회복을위해간단한스트레칭으로구성 1) 운동도구 (1) Swiss ball 운동 : 볼운동은 Jespersen과 Potvin 12) 의볼의기본원리프로그램을인용하고, 볼위에앉았을때, 대퇴부위가반드시바닥과평행을이루게하고무릎은 90 o 를유지하게하였다. 운동속도는공운동일정계획을통해최적의결과를얻기위해서운동내내일정한속도를유지하도록하였다. 세트 (set) 간에는 15 20초정도의휴식을취하게하고, 빠르게다음운동으로넘어가게하였으며, 신장에따른볼의크기와색상을선택하였다. (2) 요부안정화운동 : 요부안정화운동프로그램은준비운동, 본운동, 정리운동으로구성하여실시하였다. 본운동으로 Mckenzie exercise 13) 의연구등을참고로응용하여구성된종목을운동프로그램으로사용하였다. 좌식생활여성들은허리뿐만아니라하체근력이약하므로허리, 하체근력을강화하는운동프로그램을설정하였다. 4. 자료처리방법이연구에서얻어진모든자료는 SPSS ver. 18.0 (SPSS Inc., Chicago, IL, USA) 통계프로그램을이용하여분석하였다. 요부안정화운동집단과비운동집단의운동전, 후결과에대해이원변량분석을사용하였고, 상호작용효과가나타날경우 t-검증을실시하였다. 통계학적인유의수준은 p<0.05로설정하였다. 결과 1. 요부안정화운동실시유, 무에따른요천추부각도의변화요부안정화운동실시유, 무에따른요추전만각, 요천추각, 천골각에미치는효과를분석한결과유의한차이가없는것으로나타났으며, 운동전, 후및운동집단에따라서도상호작용효과가없는것으로나타났고, 운동유, 무에따른집단간에도유의한차이가없는것으로나타났다 (Table 3). 2. 요부안정화운동실시유, 무에따른등척성요부신전근력의변화요부안정화운동실시유, 무에따른등척성요부신전근력변화에미치는효과를분석한결과 60 o 에서 p<0.5 수준의유의한차이가있는것으로나타났으며, 12 o, 24 o, 72 o 에서 p <0.01 수준의유의한차이가있는것으로나타났고, 0 o, 36 o 에서 p<0.001 수준의유의한차이가있는것으로나타났다. 48 o 에서는유의한차이가없는것으로나타났고 60 o 에서운동전, 후및처치집단에따라 p<0.05 수준의상호작용효과가있는것으로나타났으며, 12 o, 24 o, 72 o 에서 p<0.01 수준의상호작용효과가있는것으로나타났고, 0 o, 36 o 에서 p<0.001 수준의상호작용효과가나타났다. 48 o 에서는유의한차이가나타나지않았다. 0 o 를제외한모든각도에서운동유, 무에따른 Table 3. The result of variable analysis about angle according to existence and nonexistence of exercise Angle Time CG EG Source F Sig Lumbar lordosis angle Pre 33.60±9.49 40.80±13.42 Group 2.52 0.130 Post 31.30±9.83 37.90±11.35 Time 1.14 0.299 Group time 0.02 0.903 Lumbosacral angle Pre 8.60±3.75 8.70±2.41 Group 1.45 0.244 Post 7.00±1.16 9.10±3.38 Time 0.45 0.510 Group time 1.26 0.277 Sacral angle Pre 34.60±11.37 39.40±8.20 Group 0.50 0.490 Post 35.20±11.01 35.40±8.04 Time 0.44 0.515 Group time 0.81 0.381 18 대한스포츠의학회지
오지선외. 요부안정화운동프로그램이좌식생활여성의요천추부각도, 근력, 체력및통증에미치는영향 집단간에는유의한차이가없는것으로나타났다 (Table 4). 3. 요부안정화운동실시유, 무에따른등속성슬관절신전과슬관절굴곡최대우력의변화요부안정화운동실시유, 무에따른등속성슬관절신전최대우력에미치는효과를분석한결과각속도 60 o /s 좌, 우, 180 o /s 우에서운동전, 후및운동집단에따라 p<0.05 수준, 180 o /s 좌에서 p<0.001 수준의상호작용효과가있는것으로나타났다. 또한등속성슬관절굴곡최대우력에미치는효과를분석한결과는요부안정화운동실시유, 무에따른각속도 180 o /s 우에서는 p<0.01이었으며 60 o /s 우, 180 o /s 좌에서는 p< 0.001 수준의유의한차이가있는것으로나타났다. 각속도 60 o /s 우에서는 p<0.05, 60 o /s 좌, 180 o /s 좌, 우에서는 p<0.001 수준의상호작용효과가있는것으로나타났으며운동유무에따른집단간에도유의한차이가없는것으로나타났다 (Table 5). 4. 요부안정화운동실시유, 무에따른등속성신전과슬관절굴곡전체일량의변화 전체일량에미치는효과를분석한결과 60 o /s 좌, 우, 180 o /s 좌는 p<0.01 수준의유의한차이가있는것으로나타났으며등속성슬관절굴곡전체일량에서보면 60 o /s 좌, 우에서는 p<0.01 수준의유의한차이가있는것으로나타났고 180 o /s 좌, 우에서는 p<0.001 수준의유의한차이가나타났다. 또한 180 o /s 우에서는 p<0.05 수준, 60 o /s 좌, 180 o /s 좌에서는 p<0.01 수준의상호작용효과가있는것으로나타났다. 60 o /s 우에서유의한차이가나타나지않았으며모든각도에서운동유, 무에따른집단간에는유의한차이는없는것으로나타났다 (Table 6). 5. 요부안정화운동실시에따른통증의변화요부안정화운동실시에따른시각적사상척도변화를보면 p<0.05에서유의한차이가나타났으며운동전, 후및운동집단에따라서도 p<0.05 수준의상호작용효과가있는것으로나타났으나집단간에는유의한차이가없는것으로나타났다 (Table 7). 요부안정화운동실시유, 무에따른등속성슬관절신전 Table 4. The result of variable analysis about isometric lumbar extension muscle strength according to existence and nonexistence of exercise Angle Time CG EG Source F Sig 0 o Pre 52.90±28.50 49.90±19.91 Group 14.01 0.001* Post 50.70±23.19 119.70±20.15 Time 38.21 0.000*** Group time 43.35 0.000*** 12 o Pre 74.40±33.25 65.20±28.13 Group 3.27 0.087 Post 72.30±23.83 118.30±23.34 Time 13.88 0.002** Group time 16.27 0.001** 24 o Pre 84.60±30.79 80.90±26.48 Group 3.97 0.062 Post 92.60±28.43 133.60±21.03 Time 16.09 0.001** Group time 8.73 0.008** 36 o Pre 99.80±33.03 84.20±27.65 Group 1.80 0.197 Post 99.00±32.64 145.30±23.34 Time 21.52 0.000*** Group time 22.68 0.000*** 48 o Pre 107.30±40.61 94.80±27.14 Group 1.48 0.239 Post 106.90±33.84 151.00±28.63 Time 15.84 0.001** Group time 16.29 0.001** 60 o Pre 117.60±27.36 107.50±29.65 Group 0.75 0.397 Post 123.90±46.16 155.80±28.89 Time 10.40 0.005* Group time 6.15 0.023* 72 o Pre 136.50±37.19 122.10±17.82 Group 0.302 0.589 Post 143.30±37.87 171.20±18.53 Time 16.75 0.001** Group time 9.59 0.006** *p<0.05, **p<0.01, ***p<0.001. 제 35 권제 1 호 2017 19
JS Oh, et al. The Effect of Lumbar Stability Exercise Program on Sedentary Life Female, Lumbosacral Region Angle, Muscular Strength, Physical Fitness and Pain Scale Table 5. The result of variable analysis about isokinetic knee joint flexion and extension peak torque according to existence and nonexistence of exercise Variable Angle Time CG EG Source F Sig Extension 60 o Left Pre 106.10±26.21 85.00±16.13 Group 1.52 0.234 Post 109.90±31.20 108.30±16.75 Time 7.32 0.014 Group time 3.79 0.067 Right Pre 104.90±30.26 82.20±23.11 Group 0.61 0.444 Post 102.70±30.72 108.20±24.06 Time 5.08 0.037* Group time 7.13 0.016* 180 o Left Pre 67.40±17.88 51.60±9.95 Group 1.63 0.218 Post 69.50±23.51 67.00±15.26 Time 8.74 0.008** Group time 5.05 0.037** Right Pre 64.80±16.08 51.50±11.18 Group 0.74 0.400 Post 66.70±20.29 68.40±17.52 Time 8.94 0.008* Group time 5.69 0.028* Flexion 60 o Left Pre 48.70±16.43 41.10±15.06 Group 0.17 0.683 Post 52.40±14.20 64.50±8.75 Time 19.79 0.000** Group time 10.46 0.005** Right Pre 43.10±13.27 41.50±12.36 Group 1.04 0.321 Post 53.20±16.75 66.10±14.59 Time 28.63 0.000*** Group time 4.99 0.038* 180 o Left Pre 37.40±8.29 31.20±7.76 Group 0.017 0.898 Post 39.60±9.61 44.90±7.55 Time 31.35 0.000*** Group time 16.40 0.001** Right Pre 36.00±8.15 32.30±8.08 Group 0.09 0.757 Post 40.00±10.99 45.90±9.06 Time 17.23 0.001** Group time 5.13 0.036** *p<0.05, **p<0.01, ***p<0.001. 6. 요부안정화운동시체력변화 고 찰 요부안정화운동에따른체력의변화를보면순발력 (Sargent Jump) 은 p<0.01에서유의한차이를보였으며유연성 (sit and reach) 에서 p<0.05 유의한차이를보였으나악력 (grip strength), 평형성 (standing on one leg), 근지구력 (sit up), 순발력 (side step), 윗몸버티기 (sit up and stop) 에서집단간에는유의한차이가없는것으로나타났다. 또한평형성, 유연성, 윗몸버티기에서는 p<0.05에서운동전, 후및운동집단에따라상호작용이있는것으로나타났으며순발력에서는 p<0.001 수준의상호작용이있는것으로나타났다. 평형성, 순발력에서는 p <0.05에서집단간유의한차이가나타났으며악력, 근지구력, 민첩성, 유연성, 윗몸버티기에서는유의한차이가없는것으로나타났다 (Table 8). 이연구에서는좌식생활을하는중년여성을대상으로 8주간의요부안정화운동프로그램이요천추부각도, 근력, 통증, 체력에미치는영향을검토한결과, 요부안정화운동프로그램이요천추부각도에서는변화가없었으며근력, 체력의증가및통증을감소시킨다는것을확인하였다. 1. 요천추부각도여러선행연구에서는직업에따른각도의변화및 8주간의요부재활운동이요천추각에영향을미치지않았다고보고하였다 14). 이러한결과는요골반운동이부족하였기때문인것으로생각한다. Jackson과 McManus 15) 는요부전만의 2/3가요천추각에서이루어지며이각도의회복이요부전만의회복에중요한역할을한다고보고하였고, 또한 Sung 16) 은만성요통이있는사람에게요추와골반의조화로운움직임을위해서는요천추의움직임이중요하다고보고하였다. 그러나본연구에 20 대한스포츠의학회지
오지선외. 요부안정화운동프로그램이좌식생활여성의요천추부각도, 근력, 체력및통증에미치는영향 Table 6. The result of variable analysis about isokinetic knee point flexion and extension total work according to existence and nonexistence of exercise Variable Angle Time CG EG Source F Sig Extension 60 o Left Pre 517.30±158.70 312.30±104.40 Group 4.03 0.06 Post 515.80±181.89 512.00±72.87 Time 9.61 0.006** Group time 9.90 0.006** Right Pre 493.30±155.74 388.20±126.00 Group 0.43 0.523 Post 490.10±178.63 515.00±133.05 Time 5.45 0.031** Group time 6.03 0.024** 180 o Left Pre 1,214.80±343.18 859.40±155.28 Group 3.13 0.094 Post 1,219.30±408.53 1,110.40±293.86 Time 6.43 0.021** Group time 5.98 0.025** Right Pre 1,219.90±339.48 905.90±198.71 Group 2.63 0.123 Post 1,192.60±360.48 1,111.30±275.62 Time 2.52 0.130 Group time 4.29 0.053 Flexion 60 o Left Pre 274.90±109.67 236.40±80.30 Group 0.00 0.954 Post 290.20±93.58 333.00±57.94 Time 15.38 0.001** Group time 8.12 0.011** Right Pre 241.20±95.71 239.80±76.27 Group 2.63 0.123 Post 286.40±127.22 311.70±92.18 Time 2.52 0.130 Group time 4.29 0.053 180 o Left Pre 601.30±274.58 569.90±202.84 Group 0.32 0.579 Post 698.20±219.37 832.20±166.34 Time 23.68 0.000*** Group time 5.02 0.038** Right Pre 597.00±248.99 565.00±174.95 Group 0.430 0.520 Post 730.00±274.90 879.20±161.95 Time 28.79 0.000*** Group time 4.73 0.043* *p<0.05, **p<0.01, ***p<0.001. Table 7. The result of variable analysis about pain according to existence and nonexistence of exercise Time CG EG Source F Sig Pre 5.10±4.82 6.70±0.823 Group 0.665 0.426 Post 5.00±3.27 3.00±1.054 Time 9.625 0.006** Group time 9.156 0.008** **p<0.01. 서실시된 Swiss ball, 요부안정화운동은요천추각에영향을미치지않았으며힘의적절한분배가이루어지지않았고요천추각의구조적인위치가개선되지않았을것으로생각한다. 2. 요부신전근력 American College of Sports Medicine 17) 에서는만성요통환자를위한치료적운동으로복부와요부의근력강화운동을주 2회이상, 유연성운동은가동범위향상을위한목적으로 1회 10초간 3회반복하고체간과하지의유연성운동이근력운동보다우선시되어야한다고권장하고있다. 그리고현재의요부안정화운동은근력의강화만을강조하던과거운동에서기능적인운동을통한좌, 우균형의강화와함께이루어져야더욱효과적이라는견해가지배적이다 18). 요부신전근력및균형능력변화에서 Park 등 19) 은운동전에비해 8주간의운동후모든그룹에서정해진 7개의모든각도에서통계적인유의성을보여요부신전근력의향상을 제 35 권제 1 호 2017 21
JS Oh, et al. The Effect of Lumbar Stability Exercise Program on Sedentary Life Female, Lumbosacral Region Angle, Muscular Strength, Physical Fitness and Pain Scale Table 8. Physical fitness according to exercise Variable Time CG EG Source F Sig Grip strength (kg) Pre 24.20±4.89 24.00±4.35 Group 0.01 0.928 Post 25.60±4.88 25.40±6.26 Time 4.08 0.058 Group time 0.00 1.000 Standing on one leg (s) Right Pre 43.20±30.57 53.40±37.17 Group 5.40 0.032* Post 36.30±24.46 95.70±57.09 Time 3.71 0.070 Group time 7.16 0.015* Left Pre 46.60±39.44 57.10±39.09 Group 2.39 0.139 Post 27.70±30.50 66.10±43.98 Time 0.52 0.482 Group time 4.10 0.058 Sit-up (n) Pre 38.50±13.67 26.20±12.21 Group 2.54 0.129 Post 38.80±9.48 34.90±14.19 Time 3.67 0.071 Group time 3.20 0.090 Sargent jump (cm) Pre 44.20±6.81 33.20±8.43 Group 4.88 0.040* Post 36.40±6.92 33.70±6.52 Time 17.25 0.001** Group time 22.29 0.000*** Side step (n) Pre 19.10±4.33 16.90±1.85 Group 1.12 0.305 Post 18.50±3.70 17.90±2.33 Time 0.14 0.717 Group time 2.17 0.158 Sit and reach (cm) Pre 20.10±7.75 17.20±5.16 Group 0.32 0.578 Post 19.90±9.32 19.30±4.64 Time 4.61 0.046* Group time 6.75 0.018* Sit up & stop (s) Pre 55.40±49.04 36.50±28.08 Group 0.08 0.778 Post 42.50±21.81 53.70±24.34 Time 0.14 0.711 Group time 6.93 0.017 *p<0.05, **p<0.01, ***p<0.001. 가져왔다고보고하였다. Kim 등 20) 의여성요통환자 11명을대상으로한연구에서는 12주간저항운동처치후전체적으로평균 56.53% 높은근력증가와함께 0 o 82.33%, 12 o 72.22%, 24 o 58.45%, 36 o 52.93%, 60 o 51.64%, 72 o 43.53% 의근력이증가했다고보고하였다. 본연구에서는 48 를제외하고 0 o, 12 o, 24 o, 36 o, 60 o, 72 o 에서요부근력이통계적으로유의하게증가했으며이는신체균형과관련된요부주위의소근육과대근육을사용함으로써협응능력향상과최대신전근력이더향상되었기때문이라고본다. 3. 슬관절의굴곡과신전인체의중심부에위치한요부부위는체간에서생성된힘을슬관절로전달하는운동수행통로역할을담당하는동시에 21), 슬관절의안정적이고균형적인근력발현의유지와하지의효율적파워를생산하기위한필수역할을담당하게된다. 요추부위의통증은하지의근기능안정성에영향을미친다고보고된다 22). 본연구의결과 8주간의 Swiss ball, 요부안정화운동은좌식생활하는여성의슬관절등속성근력을유의하게향상시킨것으로나타났다. 따라서슬관절최대근력은좌식생활을하는여성의하지근력향상에충족되어야하며올바른자세로 Swiss ball, 요부안정화운동프로그램을실천하여야할것으로생각한다. 이와같은연구결과를볼때슬관절최대근력은 8주간 Swiss ball, 요부안정화운동과체력향상운동을병행하고허리주변근육의근력발달, 허리유연성증가, 협응력향상, 허리지구력증가, 고유수용기촉진, 심혈관계의운동효과등을기대할수있을것이다. 4. 체력본연구에서체지방률은운동집단이 28.30%±4.64%, 통제집단이 25.90%±4.80% 로국민체력실태조사 23) 의 35 39세 25.3±6.15보다높은수준으로두집단모두비만으로나타났으며본연구에서좌식생활과운동을실시하고있는운동집단에서비만으로나타났다. 이는 Hu 등 24) 의주장과일치하고있으 22 대한스포츠의학회지
오지선외. 요부안정화운동프로그램이좌식생활여성의요천추부각도, 근력, 체력및통증에미치는영향 며, 좌식생활은중요한비만결정요인임을증명하고있다. 본연구에서악력은운동집단이사전 24.00±4.35 kg, 사후 25.40±6.26 kg으로국민체력실태조사 23) 35 39세의 26.4±5.59 kg과비교하여평균보다낮았고 3등급 (22.8 28.9) 에해당되었으며, 윗몸일으키기는운동집단이 26.20±12.21회에서사후 34.90±14.19회로국민체력실태조사 23) 의 35 39세가 24.1±10.92회이므로평균보다높은수준을나타냈으며 3등급 (20.1 30.5) 에서 1등급 (38.1 이상 ) 으로수준이향상되었다. 앉아윗몸앞으로굽히기는운동집단이사전 17.20±5.16 cm, 사후 19.30±4.64 cm로국민체력실태조사 23) 의 35 39세 13.9±8.19 cm와비교하여평균보다높았고 3등급 (12.3 18.9) 에서 2등급 (19.0 23.3) 으로수준이향상되었다. 제자리높이뛰기는운동집단이사전 33.20±8.43 cm, 사후 33.70±6.52 cm로 Lee 25) 의연구의한국성인여성체력기준치 30대 25.63±6.41 cm보다높은것으로나타났다. 사이드스텝은운동집단이사전 16.90±1.85회, 사후에서 17.90±2.33회로 Lee 25) 의연구에서의한국성인여성체력기준치 30대 30.37±4.66회보다낮게나타났다. 본연구에서윗몸일으키기, 앉아윗몸앞으로굽히기, 제자리높이뛰기는동일한연령대의평균보다높았으며악력, 사이드스텝은동일한연령대의평균보다낮게나타났다. 이상과같이본연구의대상집단들이동일한연령대의일반성인과비교하여낮은체력수준을나타내고있는것은장시간의좌식생활로인한체지방과체단백질의재분포와근육을이용한동작의부족으로제지방량의감소에의한것으로생각한다. 좌식생활하는중년여성에게있어요부안정화운동은 Kim 26) 의연구에서는유연성향상이되지않은것으로나타났으나다른연구들에서는유연성 27), 근지구력이향상되었으며, 이는본연구에서유연성을대표하는앉아윗몸앞으로굽히기가동일한연령대의평균보다높은결과와일치한다. 신체활동이부족하거나근육을사용하지않으면관절의구조나형태, 건그리고이들의탄력성등에영향을받는다. 그렇기때문에좌식생활하는여성의장시간의자사용은특정부위에부하를증가시켜통증이나불편함을유발시키게되며, 이러한상태가장기간지속되면근골격계의손상으로연결될것이다. 운동집단의경우에도장시간의좌식생활로인해일반성인과차이를나타내며높은신체구성, 체력의증가를나타냈으며규칙적인운동의필요성을보여주고있다. 5. 통증의변화 Kang과 Choi 28) 는만성요통환자 27명을대상으로한 6주간 골반안정화운동프로그램결과, 처치전요통장애지수가 25.3점에서운동처치후 21.44점으로감소하였고, Kim 등 20) 도만성디스크변성증환자 33명을대상으로 8주간재활운동처치후통증지수가 5.48에서 1.48점으로감소하여통계적으로유의한차이의효과가있었다고보고했다. 본연구에서도 Visual Analogue Scale을이용한주관적통증정도의변화에서는사전에 6.70±0.823을나타냈으나 Swiss ball, 요부안정화운동으로사후에 3.00±1.054로써요통을호소하는좌식생활여성에게허리주변근육의강화와근기능을향상시킴으로써척추에가해지는부하를감소시켜기능향상에영향을미친것으로보인다. 결론적으로본연구에서는요부안정화운동프로그램이좌식생활하는여성에게있어요천추각에영향을미치지않았으며이는힘의적절한분배가이루어지지않은것으로보고있고요부근력이통계적으로유의하게증가했으며슬관절기능의향상, 체력의향상, 통증의감소로나타났다이를통해 Swiss ball과요부안정화운동은좌식생활하는여성에게있어안정적이며체력유지및증진, 근골격질환의감소를시키는데도움이되는핵심적인프로그램으로고려되어야한다고생각한다. Conflict of Interest No potential conflict of interest relevant to this article was reported. References 1. Statistics Korea. Economically active population survey. Daejeon: Statistics Korea; 2016. 2. Salmon J, Tremblay MS, Marshall SJ, Hume C. Health risks, correlates, and interventions to reduce sedentary behavior in young people. Am J Prev Med 2011;41:197-206. 3. Lee JS, So YS, Kim MJ, Moon SJ, Jang SD, Kim YJ. Effects of the lumbar stabilization exercise on scoliosis, local muscle area, VAS and muscle function in female university students. Exerc Sci 2011;20:61-70. 4. Cho SW, Shim SY, Nam SN. The effect of body composition, pulmonary function, and physical fitness in sedentary office worker by exercise. J Korean Soc Living Environ Syst 2012;19:336-43. 5. Bu KH, Oh TY. Effects of visual information on joint angular velocity of trunk and lower extremities in sitting and 제 35 권제 1 호 2017 23
JS Oh, et al. The Effect of Lumbar Stability Exercise Program on Sedentary Life Female, Lumbosacral Region Angle, Muscular Strength, Physical Fitness and Pain Scale squat motion. J Korean Phys Ther 2015;27:89-95. 6. Jeong UC, Sim JH, Kim CY, Hwang-Bo G, Nam CW. The effects of gluteus muscle strengthening exercise and lumbar stabilization exercise on lumbar muscle strength and balance in chronic low back pain patients. J Phys Ther Sci 2015; 27:3813-6. 7. Lee HK, Cho YH, Lee JC. The effect of improve the waist flexibility, the waist muscular strength and the waist balance which grafted in William & Mckenzie exercise with swiss ball. J Korean Soc Phys Med 2013;8:479-87. 8. Heo MY, Kim K, Hur BY, Nam CW. The effect of lumbar stabilization exercises and thoracic mobilization and exercises on chronic low back pain patients. J Phys Ther Sci 2015;27:3843-6. 9. Yang KH, Kim NK, Kim YS, et al. Lumbar spinal instability and its radiologic findings. J Korean Neurosurg Soc 2000; 29:78-86. 10. Wang JM, Kim DJ. Assessment of the spinal pain using visual analogue scale (VAS). J Korean Soc Spine Surg 1995;2:177-84. 11. Badics JA. American College of Sports Medicine: health and physical activity reference database. Choice Curr Rev Acad Libr 2008;46:657-8. 12. Jespersen M, Potvin AN. The great body ball handbook. Blaine: Productive Fitness Publishing; 2000. 13. McKenzie RA. Prophylaxis in recurrent low back pain. N Z Med J 1979;89:22-3. 14. Kim BG, Yi SJ, Kang JD, Park RJ. Difference of lumbar lordosis in patients with low back pain and controls. J Korean Soc Phys Ther 2000;12:185-90. 15. Jackson RP, McManus AC. Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex, and size: a prospective controlled clinical study. Spine (Phila Pa 1976) 1994;19:1611-8. 16. Sung PS. A compensation of angular displacements of the hip joints and lumbosacral spine between subjects with and without idiopathic low back pain during squatting. J Electromyogr Kinesiol 2013;23:741-5. 17. American College of Sports Medicine. ACSM's guidelines for exercise testing and prescription. 8th ed. Indianapolis: American College of Sports Medicine; 2008. 18. Lee KK, Pak JY. The effects of elastic band, Swiss ball, lumbar stabilizing exercise on weight distribution, lumbar strength and pain degree in middle-aged women with chronic lower back. Korea J Sports Sci 2010;19:1155-65. 19. Park SY, Lim DC, Jeon KK. Effects of exercise pattern on lumbar extension strength and balance in patients with chronic low back pain. Korean J Exerc Rehabil 2011;7:227-37. 20. Kim GD, So IY, Han GS. Effects of rehabilitation training on lumbar extension strength, ratio of lumbar flexion/extension and VAS in HNP group & DDD group among LBP patients. J Coach Dev 2013;15:77-86. 21. Sato K, Mokha M. Does core strength training influence running kinetics, lower-extremity stability, and 5000-M performance in runners? J Strength Cond Res 2009;23:133-40. 22. McGill S. Low back disorders: evidence-based prevention and rehabilitation. Champaign: Human Kinetics; 2002. 23. Ministry of Culture, Sports and Tourism. Korean physical fitness survey. Sejong: Ministry of Culture, Sports and Tourism; 2015. 24. Hu FB, Li TY, Colditz GA, Willett WC, Manson JE. Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women. JAMA 2003;289:1785-91. 25. Lee CH. A study on the determination of criteria for physical fitness and obesity factors in Korean adults. Korean J Phys Educ 2003;42:629-37. 26. Kim SB. Effect of manual adjustment and gym-ball exercise on semg, Cobb s angle, VAS, flexibility, and strength in elderly women with low back pain symptom [dissertation]. Seoul: Kyung Hee University; 2012. 27. Song RY, Ahn SH. Effect of lumbar stabilization exercise on back pain, physical fitness, sleep, and depression in middle-aged women with chronic back pain. Korean J Adult Nurs 2008;20:269-79. 28. Kang JI, Choi H. The effect of pelvic stability exercise program on pain and hip joint of patients with chronic low back pain involving sacroiliac joint pain. J Digit Converg 2013;11:331-8. 24 대한스포츠의학회지