비특이성 만성요통 유무에 따른 무산소성 역치수준 비교

Comparison of the Anaerobic Threshold Level Between Subjects With and Without Non-Specific Chronic Low Back Pain

  • 성준혁 (연세대학교 보건환경대학원 인간공학치료학과) ;
  • 권오윤 (연세대학교 보건과학대학 물리치료학과, 보건환경대학원 인간공학치료학과) ;
  • 이충휘 (연세대학교 보건과학대학 물리치료학과, 보건환경대학원 인간공학치료학과) ;
  • 신헌석 (연세대학교 보건과학대학 물리치료학과, 보건환경대학원 인간공학치료학과) ;
  • 조영기 (서울아산병원 재활의학팀)
  • Seong, Jun-Hyuk (Dept. of Ergonomic Therapy, The Graduate School of Health and Environment, Yonsei University) ;
  • Kwon, Oh-Yun (Dept. of Physical Therapy, College of Health Science, Yonsei University, Dept. of Ergonomic Therapy, The Graduate School of Health and Environment, Yonsei University) ;
  • Yi, Chung-Hwi (Dept. of Physical Therapy, College of Health Science, Yonsei University, Dept. of Ergonomic Therapy, The Graduate School of Health and Environment, Yonsei University) ;
  • Cynn, Heon-Seock (Dept. of Physical Therapy, College of Health Science, Yonsei University, Dept. of Ergonomic Therapy, The Graduate School of Health and Environment, Yonsei University) ;
  • Cho, Young-Ki (Team of Physical Medicine & Rehabilitation, Asan Medical Center)
  • 투고 : 2011.01.04
  • 심사 : 2011.02.05
  • 발행 : 2011.02.19

초록

The purpose of this study was to compare the anaerobic threshold (AT) between subjects with and without non-specific chronic low back pain (NCLBP). The patient group included 15 women with NCLBP. The normal group included 15 women without NCLBP who were age-, height-, weight-, and activity level-matched. The subjects performed a Balke treadmill protocol which was symptom-limited progressive loading test. Their heart rate (HR), ventilatory gas and metabolic equivalents (METs) were measured using the automatic breath gas analyzing system. After the test, each subjects' ratings of perceived exertion (RPE) were evaluated. The visual analog scale (VAS) was assessed pre- and post-test. The independent t-test and Wilcoxon's signed-rank test were used for analysis of the data. Time, HR, the volume of oxygen consumption ($VO_2$), relative $VO_2$, and METs at the AT level of the patient group were significantly lower than those of the healthy group (p<.05). However, there were no significant differences in RPE, VAS, and breathing frequency at the AT level (p>.05). The findings of this study indicate that patients with NCLBP had a lower aerobic fitness than healthy subjects. Thus, implementation of rehabilitation program to increase aerobic fitness may be considered in patietns with NCLBP, and further studies are required to determine the etiological factors of decreased aerobic fitness.

키워드

참고문헌

  1. Beaver WL, Wasserman K, Whipp BJ. A new method for detecting anaerobic threshold by gas exchange. J Appl Physiol. 1986;60(6):2020-2027. https://doi.org/10.1152/jappl.1986.60.6.2020
  2. Biederman HJ, Shanks GL, Forrest WJ, et al. Power spectrum analyses of electromyographic activity: Discriminators in the differential assessment of patients with chronic low back pain. Spine (Phila Pa 1976). 1991;16(10):1179-1184. https://doi.org/10.1097/00007632-199110000-00009
  3. Bruce RA, Blackmon, JR, Jones JW, et al. Exercising testing in adult normal subjects and cardiac patients. Pediatrics. 1963;32:742-756.
  4. Bortz WM. The disuse syndrome. West J Med. 1984;141(5):691-694.
  5. Crombez G, Vlaeyen JW, Heuts PH, et al. Pain-related fear is more disabling than pain itself: Evidence on the role of pain-related fear in chronic back pain disability. Pain. 1999;80(1-2):329-339. https://doi.org/10.1016/S0304-3959(98)00229-2
  6. Davis JA. Anaerobic threshold: Review of the concept and directions for future research. Med Sci Sports Exerc. 1985:17(1):6-21.
  7. Davis JA, Frank MH, Whipp BJ, et al. Anaerobic threshold alterations caused by endurance training in middle-aged men. J Appl Physiol. 1979;46(6):1039-1046. https://doi.org/10.1152/jappl.1979.46.6.1039
  8. De Meirleir K, Naaktgeboren N, Van Steirteghem et al. Beta-endorphin and ACTH levels in peripheral blood during and after aerobic and anaerobic exercise. Eur J Appl Physiol. 1986;55(1):5-8. https://doi.org/10.1007/BF00422884
  9. Dickstein K, Barvik S, Aarsland T, et al. A comparison of methodologies in detection of the anaerobic threshold. Circulation. 1990;81(1 Suppl):II38-46.
  10. Duque I, Parra JH, Duvallet A. Physical deconditioning in chronic low back pain. J Rehabil Med. 2009;41(4):262-266. https://doi.org/10.2340/16501977-0324
  11. Duque I, Parra JH, Duvallet A. Physical deconditioning in chronic low back pain. J Rehabil Med. 2009;41(4):262-266. https://doi.org/10.2340/16501977-0324
  12. Hansen JE, Sue DY, Wasserman K. Predicted values for clinical exercise testing. Am Rev Respir Dis. 1984;129(2 Pt 2):S49-55. https://doi.org/10.1164/arrd.1984.129.2P2.S49
  13. Itoh H, Taniguchi K, Koike A, et al. Evaluation of severity of heart failure using ventilatory gas analysis. Circulation. 1990;81(1 Suppl):II31-37.
  14. Kindermann W, Simon G, Keul J. The significance of the aerobic-anaerobic transition for the determination of work load intensities during endurance training. Eur J Appl Physiol Occup Physiol. 1979;42(1):25-34. https://doi.org/10.1007/BF00421101
  15. Korea Occupational Safety and Health Agency. Industrial disaster present situation statistics. Available: http://www.kosha.or.kr/.
  16. Laasonen EM. Atrophy of sacrospinal muscle groups in patients with chronic, diffusely radiating lumbar back pain. Neuroradiology. 1984:26(1):9-13. https://doi.org/10.1007/BF00328195
  17. Laasonen EM. Atrophy of sacrospinal muscle groups in patients with chronic, diffusely radiating lumbar back pain. Neuroradiology. 1984:26(1):9-13. https://doi.org/10.1007/BF00328195
  18. Mathews DK, Fox EL. The Physiological Basis of Physical Education and Athletics. Philadelphia, Saunders, 1976.
  19. Melzack R, Wall PD. Pain mechanisms: A new theory. Science, 1965;150(699):971-979. https://doi.org/10.1126/science.150.3699.971
  20. Mucci P, Blondel N, Fabre C, et al. Evidence of exercise-induced O2 arterial desaturation in non-elite sportsmen and sports women following high-intensity interval-training. Int J Sports Med. 2004;25(1):6-13. https://doi.org/10.1055/s-2003-45225
  21. Nielens H, Plaghki L. Cardiorespiratory fitness, physical activity level and chronic pain: Are men more affected than women? Clin J Pain. 2001;17(2):129-137. https://doi.org/10.1097/00002508-200106000-00005
  22. Nikooie R, Gharakhanlo R, Rajabi H, et al. Noninvasive determination of anaerobic threshold by monitoring the %SpO2 changes and respiratory gas exchange. J Strength Cond Res. 2009;23(7):2107-2113. https://doi.org/10.1519/JSC.0b013e3181b73bc2
  23. Oren A, Sue DY, Hansen JE, et al. The role of exercise testing in impairment evaluation. Am Rev Respir Dis. 1987;135(1):230-235.
  24. Picavet HS, Schuit AJ, Physical inactivity: A risk factor for low-back pain in the general population? J Epidemiol Community Health, 2003;57(7):517-518. https://doi.org/10.1136/jech.57.7.517
  25. Rasmussen-Barr E, Lundqvist L, Nilsson-Wikmar L, et al. Aerobic fitness in patients at work despite recurrent low back pain: A cross-sectional study with healthy age- and gender-matched controls. J Rehabil Med. 2008;40(5):359-365. https://doi.org/10.2340/16501977-0176
  26. Reinhard U, Muller PH, Schmulling RM. Determination of of anaerobic threshold by the ventilation equivalent in normal individuals. Respiration. 1979;38(1):36-42. https://doi.org/10.1159/000194056
  27. Rusko H, Rahkila P, Karvinen E. Anaerobic threshold, skeletal muscle enzymes and fiber composition in young female cross-country skiers. Acta Physiol Scand. 1980;108(3):263-268. https://doi.org/10.1111/j.1748-1716.1980.tb06532.x
  28. Sieben JM, Vlaeyen JW, Tuerlinckx S, et al. Pain-related fear in acute low back pain: The first two weeks of a new episode. Eur J Pain. 2002;6(3):229-237. https://doi.org/10.1053/eujp.2002.0341
  29. Sihvonen T, Lindgren KA, Airaksinen O, et al. Movement disturbances of the lumbar spine and abnormal back muscle electromyographic findings in recurrent low back pain. Spine (Phila Pa 1976), 1997;22(3):289-295. https://doi.org/10.1097/00007632-199702010-00012
  30. Smeets RJ, Wittink H, Hidding A, et al. Do patients with low back pain have a lower level of aerobic fitness than healthy controls?: Are pain, disability, fear of injury, working status, or level of leisure time activity associated with the difference in aerobic fitness level? Spine (Pilla Pa 1976). 2006;31(1):90-97. https://doi.org/10.1097/01.brs.0000192641.22003.83
  31. Smeets RJ, van Geel KD, Verbunt JA. Is the fear avoidance model associated with the reduced level of aerobic fitness in patients with chronic low back pain? Arch Phys Med Rehabil. 2009;90(1):109-117. https://doi.org/10.1016/j.apmr.2008.07.009
  32. Solberg G, Robstad B, Skjonsberg O, et al. Respiratory gas exchange indices for estimating the anaerobic threshold. J Sport Sci Med. 2005;4:29-36.
  33. Van Daele U, Hagman F, Truijen S, et al. Differences in balance strategies between nonspecific chronic low back pain patients and healthy control subjects during unstable sitting. Spine (Phila Pa 1976). 2009;34(11):1233-1238. https://doi.org/10.1097/BRS.0b013e31819ca3ee
  34. Verbunt JA, Seelen HA, Vlaeyen JW, et al. Disuse and deconditioning in chronic low back pain: Concepts and hypothesis on contributing mechanisms. Eur J Pain. 2003;7(1):9-21. https://doi.org/10.1016/S1090-3801(02)00071-X
  35. Verbunt JA, Westerterp KR, van der Heijden GJ, et a. Physical activity in daily life in patients with chronic low-back pain. Arch Phys Med Rehabil. 2001;82(6):726-730. https://doi.org/10.1053/apmr.2001.23182
  36. Vlaeyen JW, Linton SJ. Fear-avoidance and its consequences in chronic muscloskeletal pain: A state of the art. Pain. 2000;85(3):317-332. https://doi.org/10.1016/S0304-3959(99)00242-0
  37. Waddell G, Newton M, Henderson I, et al. A fear-avoidance-beliefs questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain. 1993;52(2):157-168. https://doi.org/10.1016/0304-3959(93)90127-B
  38. Waddell G. The back pain revolution. Edinburgh. Churchill Livingstone. 1938.
  39. Wasserman K. The anaerobic threshold measurement to evaluate exercise performance. Am Rev Respir Dis. 1984;129:S35-40. https://doi.org/10.1164/arrd.1984.129.2P2.S35
  40. Wittink H, Michel TH, Kulich R, et al. Aerobic fitness testing in patients with chronic low back pain: Which test is best? Spine (Phila Pa 1976). 2000;25(13):1704-1710. https://doi.org/10.1097/00007632-200007010-00015
  41. Wittink H, Michel TH, Sukiennik A, et al. The association of pain with aerobic fitness in patients with low-back pain. Arch Phys Med Rehabil. 2002;83(10):1467-1471. https://doi.org/10.1053/apmr.2002.34597
  42. Wittink H, Rogers W, Gascon C, et al. Relative contribution of mental health and exercise-related pain increment to treadmill test intolerance in patients with chronic low back pain. Spine (Phila Pa 1976). 2001;26(21):2368-2374. https://doi.org/10.1097/00007632-200111010-00014
  43. Yeh MP, Gardner RM, Adams TD, et al. "Anaerobic threshold": Problems of determination and validation. J Appl Physiol. 1983;55(4):1178-1186. https://doi.org/10.1152/jappl.1983.55.4.1178
  44. Yoshida T. Effect of exercise duration during incremental exercise on the determination of anaerobic threshold and the onset of blood lactate accumulation. Eur J Appl Physiol Occup Physiol. 1984;53(3):196-199. https://doi.org/10.1007/BF00776589
  45. Yoshida T, Nagata A, Muro M, et al. The validity of anaerobic threshold determination by a Douglas bag method compared with arterial blood lactate concentration. Eur J Appl Physiol 1981;46(4):423-430. https://doi.org/10.1007/BF00422129