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The Effects of Coordinative Locomotor Training Program for Life-Care Promotion on Balance of Obese Elderly Women

라이프케어 증진을 위한 협응적 이동훈련 프로그램이 비만 여성노인의 균형에 미치는 영향

  • 이동률 (호남대학교 물리치료학과)
  • Received : 2019.12.20
  • Accepted : 2020.01.28
  • Published : 2020.01.31

Abstract

The purpose of this study was to examine the effects of coordinative locomotor training (CLT) program on the balance for the promotion of life care of elderly obese women. Ten participants of elderly obese women who were able to walk independently without surgery experience of lumbar, hip or knee joint within the past year were recruited and under went the pretest, CLT (20 sessions), followed by the post-test. The test included BMI test using In-body, joint kinematics using myoVIDEO, muscle activation using surface EMG test (erector spinae (ER), external oblique abdominalis (EO), quadriceps femoris (Quad), hamstring muscle (Ham)) and balance tests including dynamic balance test using forced treadmill, Berg balance scale (BBS) and timed up go (TUG). The CLT program was conducted 60 minutes a day, 5 days a week, over 4 weeks period. As a result of this study, The the trunk and hip joints kinematics during the stance and swing phases of gait were a statistical significance levels were set at p <0.05. The ER and EO muscle activation were significantly improved after intervention (p <0.05). The length of gait line and single support line of change of center of pressure (COP) were significantly increased after intervention (p <0.05). The BBS and TUG were also significantly enhanced after intervention (p <0.05). The results of this study showed that CLT program for the improvement of life care had significant effects on improving postural instability, muscle weakness, reduced balance ability and falling risk of obese elderly women. Therefore, it is recommended to apply CLT program to improve life-care through improving balance ability and preventing fall of obese elderly women.

본 연구는 라이프케어 증진을 위한 협응적 이동훈련 프로그램이 비만 여성노인의 균형에 미치는 영향을 알아보았다. 본 연구의 대상자는 비만 여성노인 10명으로, 최근 1년 이내 허리나 엉덩관절 및 무릎관절 수술경험이 없고 독립보행이 가능한 자로 선정하였다. 협응적 이동훈련을 일일30분씩 2회, 주5회, 4주간 총 20회 실시하였다. 협응적 이동훈련 프로그램의 효과를 알아보기 위해 인바디 BMI검사, myoVIDEO를 이용한 관절가동범위검사, 표면근전도 검사(척추세움근, 배바깥빗근, 넙다리네갈래근, 넙다리뒤근육), 힘판 트레드밀을 통한 동적 균형검사, 버그 균형 척도(BBS)와 일어서서 걷기 검사(TUG)를 중재전후 시행하였다. 본 연구의 연구결과, 보행 시 디딤기 및 흔듦기 시기에 몸통과 엉덩관절의 관절가동범위 전-후 비교에서 통계학적으로 유의한 차이가 있었으며(p<0.05), 표면근전도를 통한 근 활성도검사에서는 척추세움근과 배바깥빗근의 중재 전-후 비교에서 통계학적으로 유의한 차이가 있었다(p<0.05). 보행 시 동적균형검사에서는 보행선길이와 한발지지선의 중재 전-후 비교에서 유의한 차이가 있었으며(p<0.05), 버그 균형 척도(BBS)와 일어서서 걷기검사(TUG)에서도 중재 전-후 비교에서 유의한 차이가 있었다(p<0.05). 본 연구결과를 통해 라이프케어 증진을 위한 협응적 이동훈련 프로그램이 비만 여성노인의 자세불안정과 근 약화, 균형능력감소 및 낙상위험도를 개선에 유의한 영향을 주는 것을 알 수 있었다. 따라서 비만 여성노인의 균형능력 개선 및 낙상방지를 통한 라이프케어증진을 위해 이동적 협응훈련 프로그램 적용을 권장한다.

Keywords

References

  1. 대한비만학회, 2018년에 개정된 "비만진료지침 2018" 출간, e-Newsletter, (No. 7), 2019.
  2. J-S. Petrofsky, M. Cuneo, R. Dial, A. Morris, A-K. Pawley, and J-J. Hill, Core Strengthening and Balance in the Geriatric Population, Journal of Applied Research, Vol. 5, No. 3, pp. 423-433, 2005.
  3. G-D. Kim, and M. Heo, Effectes of swiss ball exercise program for improvement of life care on balance and gait in local community elderly, Journal of the Korea Entertainment Industry Association, Vol. 12, No. 7, pp. 353-359, 2018.
  4. M. Cruz-Jimenez, Normal Changes in Gait and Mobility Problems in the Elderly, Physical Medicine and Rehabilitation Clinics of North America, Vol. 28, No. 4, pp. 713-725, 2017. https://doi.org/10.1016/j.pmr.2017.06.005
  5. D. Scott, K-M. Sanders, D. Aitken, A. Hayes, P-R. Ebeling, and G. Jones, Sarcopenic obesity and dynapenic obesity: 5-year associations with falls risk in middle-aged and older adults, Obesity, Vol. 22, No. 6, pp. 1568-1574, 2014. https://doi.org/10.1002/oby.20734
  6. T. Al-Aama, Falls in the elderly, Canadian Family Physician, Vol. 57, No. 7, pp. 771- 776, 2011.
  7. B-C. Clark, and T-M. Manini, Functional consequences of sarcopenia and dynapenia in the elderly, Current Opinion in Clinical Nutrition and Metabolic Care, Vol. 13, No. 3, pp. 271-276, 2010. https://doi.org/10.1097/MCO.0b013e328337819e
  8. P-P. Lai, A-K. Leung, A-N. Li, and M. Zhang, Three-dimensional gait analysis of obese adults, Clinical biomechanics (Bristol, Avon), Vol. 23, Suppl 1, pp. S2-6, 2008. https://doi.org/10.1016/j.clinbiomech.2008.02.004
  9. M. Madigan, N-J. Rosenblatt, and M-D. Grabiner, Obesity as a Factor Contributing to Falls by Older Adults, Current Obesity Reports, Vol. 3, No. 3, pp. 348-354, 2014. https://doi.org/10.1007/s13679-014-0106-y
  10. I-H. Kim, H. Chun, and J-W. Kwon, Gender differences in the effect of obesity on chronic diseases among the elderly Koreans, Journal of Korean Medical Science, Vol. 26, No. 2, pp. 250-257, 2011. https://doi.org/10.3346/jkms.2011.26.2.250
  11. C-L. Arfken, H-W. Lach, S-J. Birge, and J-P. Miller, The prevalence and correlations of fear of falling in elderly persons living in the community, American Journal of public health, Vol. 84, No. 4, pp. 565-570, 1994. https://doi.org/10.2105/AJPH.84.4.565
  12. K-S. Kang, The effects of the fall prevention exercise program focussed on activity of daily living, fear of fall and quality of life for the senior citizen center elderly, Journal of the korea academia-industrial cooperation society, Vol. 17, No. 8, pp. 267-272, 2016. https://doi.org/10.5762/KAIS.2016.17.8.267
  13. V. Shier, E. Trieu, and D-A. Ganz, Implementing exercise programs to prevent falls: systematic descriptive review, Injury Epidemiolog, Vol. 3, No. 1, pp. 1-18, 2016. https://doi.org/10.1186/s40621-015-0066-z
  14. C. Sherrington, J-C. Whitney, S-R. Lord, and R-D. Herbert, Effective exercise for the prevention of falls: a systematic review and meta-analysis, Journal of American Geriatircs Society, Vol. 56, No. 12, pp. 2234-2243, 2008. https://doi.org/10.1111/j.1532-5415.2008.02014.x
  15. C-J. Kwak, Y-L. Kim, and S-M. Mee, Effects of elastic-band resistance exercise on balance, mobility and gait function, flexibility and fall efficacy in elderly people, Journal of Physical Therapy Science, Vol. 28, No. 11, pp. 3189-3196, 2016. https://doi.org/10.1589/jpts.28.3189
  16. L. Thiamwong, and J. Suwanno, Effects of Simple Balance Training on Balance Performance and Fear of Falling in Rural Older Adult, International Journal of Gerontology, Vol. 8, No. 3, pp. 143-146, 2014. https://doi.org/10.1016/j.ijge.2013.08.011
  17. T-J. Susnana, Falls and fall prevention in comuunity-dwelling older adults, Uppsala: Acta Universitatis Upsaliensis, 2018.
  18. J-K. Jeon, The effects of combination patterns exercise of proprioceptive neuromuscular facilitation on balance in chronic low back pain elderly patients, Journal of Digital Convergence, Vol. 11, No. 4, pp. 361-368, 2013. https://doi.org/10.14400/JDPM.2013.11.4.361
  19. B. Dietz, Let's sprint, let's skate. Innovationen im PNF-Konzept, Springer, Berlin, Heidelberg, 2009.
  20. J. Wicke, K. Gainey, and M. Figueroa, A comparison of self-administered proprioceptive neuromuscular facilitation to static stretching on range of motion and flexibility, Journal of Strength and Conditioning Research, Vol. 28, No. 1, pp. 168-172, 2014. https://doi.org/10.1519/jsc.0b013e3182956432
  21. W. Park, J. Ramachandran, P. Weisman, and E-S. Jung, Obesity effect on male active joint range of motion, Ergonomics, Vol. 53, No. 1, pp. 102-108, 2010. https://doi.org/10.1080/00140130903311617
  22. C-C. Norkin, and D-J. White, Measurement of joint motion: a guide to goniometry (3rd ed), Philadelphia : F.A. Davis Co., 2003
  23. E. Criswell, and JR Cram, Cram's Introduction to surface electromyography (2nd ed), Oritario: Jones and Bartlett publishers, 2011.
  24. A. Kalron, and L. Frid, The "butterfly diag ram": A gait marker for neurological and cerebellar impairment in people with multiple sclerosis, Journal of the neurological sciences, Vol. 358, No. 1, pp. 92-100, 2015. https://doi.org/10.1016/j.jns.2015.08.028
  25. K-O. Berg, S-L. Wood-Dauphinee, J-I. Williams, and B. Maki, Measuring balance in the elderly: validation of an instrument, Canadian journal of public health, Vol. 83, Suppl 2, pp. S7-11, 1992.
  26. S-W. Muir, K. Berg, B. Chesworth, and M. Speechley, Use of the Berg Balance Scale for Predicting Multiple Falls in Community-Dwelling Elderly People: A Prospective Study, Physical Thearpy, Vol. 88, No. 4, pp. 449-459, 2008. https://doi.org/10.2522/ptj.20070251
  27. D. Podsiadlo, and S. Richardson, The timed "Up & Go": A test of basic functional mobility for frail elderly persons, Journal of the American Geriatrics Society, Vol. 39, No. 2, pp. 142-148, 1991. https://doi.org/10.1111/j.1532-5415.1991.tb01616.x
  28. D-A. Klein, W-J. Stone, W-T, Phillips, J. Gangi, and S. Hartman, PNF training and physical function in assisted-living older adults, Journal of aging and physical activity, Vol. 10, No. 4, pp. 476-488, 2002. https://doi.org/10.1123/japa.10.4.476
  29. J. Cholewicki, and J-J. VanVliet, Relative contribution of trunk muscles to the stability of the lumbar spine during isometric exertions, Clinical biomechanics (Bristol, Avon), Vol. 17, No. 2, pp. 99-105, 2002. https://doi.org/10.1016/S0268-0033(01)00118-8
  30. S-G. White, and P-J. McNair, Abdominal and erector spinae muscle activity during gait: the use of cluster analysis to identify patterns of activity, Clinical biomechanics (Bristol, Avon), Vol. 17, No. 3, pp. 177-184, 2002. https://doi.org/10.1016/S0268-0033(02)00007-4
  31. S-V. Brooks, and J-A. Faulkner, Skeletal muscle weakness in old age: underlying mechanisms, Medicine & Science in Sports & Exercise, Vol. 26, No. 4, pp, 432-439, 1994.
  32. V. Akuthota, and S-F. Naddler, Core Strengthening, Archives of Physical Medicine and Rehabilitation, Vol. 85, No. 3, Suppl. 1, pp. S86-92, 2004.
  33. Y-S. Park, M-Y. Kim, S-W. Park, and O-J. Lee, Identify the type of exercise to prevent falls for healthy elderly life, Journal of the Korea Entertainment Industry Association, Vol. 13, No. 7, pp. 361-373, 2019. https://doi.org/10.21184/jkeia.2019.10.13.7.361