Journal of The Korean Society of Integrative Medicine
/
v.12
no.1
/
pp.49-62
/
2024
Purpose : This study was conducted to compare two non-face-to-face exercise interventions depending on whether mobile applications and wearable exercise aids are used to find out which interventions are more effective in improving senile sarcopenia. Ultimately, it was conducted to provide basic data for developing non-face-to-face intervention methods to improve sarcopenia. Method : In this study, 18 elderly sarcopenia and possible sarcopenia aged 65 or older were randomly assigned to the digital and self-exercise intervention groups. The digital exercise intervention group performed eight exercise programs with mobile applications and wearable exercise aids to record and manage the elderly performing the programs in real time. And the self-exercise intervention group performed the same program on its own as implemented in the digital exercise group. The intervention was applied for 8 weeks, and before and after the intervention, sarcopenia evaluation and physical function evaluation were performed. Results : In the digital exercise intervention group, arm muscle mass, skeletal muscle index, SPPB, 5TSTS, and BBS were improved, and in the self-exercise intervention group, grip strength, SPPB, 5TSTS, and BBS were improved. Conclusion : It was confirmed that both groups are effective in improving physical performance and physical function, the digital exercise intervention is effective in improving muscle mass and self-exercise intervention is effective in improving muscle strength. Therefore, this study proposes to apply intervention methods separately according to the indicators to improve and prevent sarcopenia, and also simplify the instructions of applications used to improve sarcopenia and to create an environment where users can be trained regularly on how to use it. And, In the future, studies for the development of devices to be designed to help non-face-to-face exercise interventions or studies on the differences between face-to-face and non-face-to-face exercise interventions should be conducted in terms of the effect of improving sarcopenia.
International Journal of Internet, Broadcasting and Communication
/
v.15
no.2
/
pp.187-195
/
2023
Sarcopenia is a phenomenon in which muscle function, including muscle strength, deteriorates as muscle mass decreases in the process of increasing age. The diagnosis of sarcopenia utilizes total muscle mass and limb muscle mass, and limb muscle mass is expressed as height squared, body weight, and BMI. Each divided value is used as an index, mainly less than 7.23 kg/m2 for men and less than 5.67 kg/m2 for women. Grip strength, standing up from a chair, and walking speed were mainly used as physical function factors, and grip strength less than 27 kg for men and less than 16 kg for women were used as indicators. The limb muscle mass showed a decreasing trend after peaking in the mid-20s in men, and maintaining a gradual peak in women from the mid-20s to the mid-40s, showing a more rapid decline in men. The rate of decrease in muscle mass and strength continues to increase after the age of 20, and muscle strength rapidly decreases after the age of 80. In Korean men, total muscle mass and limb muscle mass show a decreasing trend from the mid-30s, and a more markedly rapid decrease from the age of 60. For women, it remains constant from the age of 30 to the age of 50, then gradually decreases after the mid-50s, and shows a rather rapid decrease after the mid-70s, showing a more gradual decrease than that of men. Men show a sharp decrease from the mid-40s when limb muscle mass is divided by height squared, and women show a marked decrease after 70 years old when limb muscle mass is divided by height squared. Exercise for the prevention and treatment of sarcopenia results in an increase in protein assimilation hormone, an increase in antioxidant activity, a decrease in inflammation, an increase in muscle insulin sensitivity, and an increase in protein synthesis. Resistance exercise is basically used, and aerobic exercise and equilibrium A combination of exercises is effective. In addition, for a more efficient effect of sarcopenia through resistance exercise, it is necessary to supplement nutrition including protein.
Kim, Hyung-Kook;Lee, You Jin;Lee, Young-Kyun;Kim, Hongji;Koo, Kyung-Hoi
Journal of Bone Metabolism
/
v.25
no.4
/
pp.219-226
/
2018
Background: Although studies and interest in sarcopenia have increased, it is still a matter of debate which muscle mass index better represents the aging process. We compared 3 indices for muscle mass (appendicular skeletal muscle mass [ASM]/weight, $ASM/height^2$, and the body mass index [BMI]-adjusted muscle mass index [ASM/BMI]) to determine which better reflected the aging process in terms of the decline in bone mineral density (BMD), visual acuity (VA), hearing power, renal function, pulmonary function, and handgrip strength. Methods: We performed a retrospective cross-sectional study using the Korea National Health and Nutrition Examination Survey in the Korean population. Between 2008 and 2011, a total of 14,415 men and 17,971 women aged 10 years or older participated in the study. We plotted the changes in the 3 indices of muscle mass and compared these with changes in BMD, VA, hearing power, renal function, pulmonary function, and handgrip strength according to each age group. Results: The ASM/BMI showed similar changes in terms of surrogate markers of the aging process, while the ASM/weight and $ASM/height^2$ showed no correlation. Conclusions: Among muscle indices for sarcopenia, only the ASM/BMI represented the aging process.
Kim, Myungchul;Kim, Haein;Park, Sangwoong;Cho, Ilhoon;Yu, Wonjong
Journal of The Korean Society of Integrative Medicine
/
v.8
no.2
/
pp.199-209
/
2020
Purpose : This study used a sarcopenia diagnostic algorithm proposed by the Asia working group in adults over 50 to diagnose sarcopenia and analyze body function. The purpose of this study is to prepare basic data for the management and prevention of sarcopenia. Methods : We performed a diagnostic evaluation of sarcopenia in 97 adults over the age of 50 years with the cooperation of the Seongnam senior experience complex in Seongnam-si, Gyeonggi-do. As a result of the diagnostic process, 24 subjects were placed into the sarcopenia group, while 73 subjects were placed into the normal group. We measured each subject's body, performed the timed up and go test to evaluate functional mobility, and conducted a questionnaire on the pre-symptom of locomotive syndrome and locomotive syndrome. Results : There were statistically significant differences in height, weight, and skeletal muscle mass between the two groups. There was also a statistically significant difference in the timed up and go test, which confirmed the difference in functional mobility between the two groups. In addition, there was a statistically significant difference between the two groups in the proportion and the mean score of subjects with pre-symptom of locomotive syndrome and locomotive syndrome. In the correlation analysis, grip strength was statistically significantly correlated with height, weight, skeletal muscle mass, waist circumference, timed up and go test, pre-symptom of locomotive syndrome and locomotive syndrome. Gait speed was significantly correlated with the timed up and go test and locomotive syndrome. Appendicular skeletal muscle index was significantly correlated with height, weight, waist circumference, hip circumference, and the pre-symptom of locomotive syndrome. Conclusion : In conclusion, sarcopenia is closely related to height, weight, skeletal muscle mass and functional mobility, as well as the pre-symptom of locomotive syndrome and, locomotive syndrome. In consideration of this, the prevention and management of sarcopenia should be made accordingly.
Journal of the Korean Society of Physical Medicine
/
v.19
no.1
/
pp.43-51
/
2024
PURPOSE: Sarcopenic obesity (SO) is a clinical condition that combines sarcopenia and obesity. This study examined the frequency of SO in young Korean females between 20 and 29 years of age. METHODS: The study involved 1,000 participants. The height, weight, body mass index (BMI), waist circumference, skeletal muscle mass index, fasting glucose, triglyceride, total cholesterol levels, systolic and diastolic blood pressure, alcohol consumption, and smoking status were the research variables. The skeletal muscle mass index was calculated as appendicular skeletal muscle mass (ASM) divided by the BMI. The ASM was assessed using dual X-ray absorptiometry. Complex sampling analysis and multiple logistic regression were used for analysis. RESULTS: A .74(.30-1.80) frequency of SO was observed. The statistically significant risk factors in females were height, weight, BMI, waist circumference, skeletal muscle mass index, total cholesterol, systolic blood pressure, and diastolic blood pressure (p < .05). CONCLUSION: Young Korean adults with SO have a .74(.30-1.80) frequency of occurrence that is linked to specific risk factors. Hence, primary care clinicians and health care professionals should consider these factors when patients require a referral for early detection and treatment. Healthcare professionals and clinicians can identify potential SO patients by acknowledging these risk factors.
[Purpose] We aimed to identify the effects of marine oligomeric polyphenol (MOP) intake in elderly individuals with sarcopenia. [Methods] Older adults (aged 65 years or older) were recruited based on the diagnostic criterion for sarcopenia and were randomly assigned to the MOP intake group (n=10) or the placebo (PBO) intake group (n=10). To determine the effect of MOP intake received for four weeks, the pre- and post-intake body composition (weight, skeletal muscle mass, and bone density) and senior fitness tests were assessed. [Results] Our results showed there were significant differences in the skeletal muscle mass (p=0.039), bone density (p=0.020), fat-free mass index (p=0.026), and 2.4 m up and go test (p=0.001) between pretest and post-test. There was a significant difference between the pre-test and post-test and an interaction effect for the one-leg stand test (p=0.010 and p=0.049, respectively). However, there were no significant differences in body fat percentage, calf circumference, grip strength, or the chair rise test. [Conclusion] Some variables exhibited significant differences in the pre- and post-assessments, and there was an interaction effect for the one-leg stand. However, this was insufficient to prove the effectiveness of MOP intake in improving sarcopenia. Therefore, additional studies are essential to examine the effects of MOP intake and exercise intervention on the body composition and fitness of patients over a longer period.
Palmela, Carolina;Velho, Sonia;Agostinho, Lisa;Branco, Francisco;Santos, Marta;Santos, Maria Pia Costa;Oliveira, Maria Helena;Strecht, Joao;Maio, Rui;Cravo, Marilia;Baracos, Vickie E.
Journal of Gastric Cancer
/
v.17
no.1
/
pp.74-87
/
2017
Purpose: Neoadjuvant chemotherapy has been shown to improve survival in locally advanced gastric cancer, but it is associated with significant toxicity. Sarcopenia and sarcopenic obesity have been studied in several types of cancers and have been reported to be associated with higher chemotherapy toxicity and morbi-mortality. The aim of this study was to assess the prevalence of sarcopenia/sarcopenic obesity in patients with gastric cancer, as well as its association with chemotherapy toxicity and long-term outcomes. Materials and Methods: A retrospective analysis was performed using an academic cancer center patient cohort diagnosed with locally advanced gastric cancer between January 2012 and December 2014 and treated with neoadjuvant chemotherapy. We analyzed body composition (skeletal muscle and visceral fat index) in axial computed tomography images. Results: A total of 48 patients met the inclusion criteria. The mean age was $68{\pm}10years$, and 33 patients (69%) were men. Dose-limiting toxicity was observed in 22 patients (46%), and treatment was terminated early owing to toxicity in 17 patients (35%). Median follow-up was 17 months. Sarcopenia and sarcopenic obesity were found at diagnosis in 23% and 10% of patients, respectively. We observed an association between termination of chemotherapy and both sarcopenia (P=0.069) and sarcopenic obesity (P=0.004). On multivariate analysis, the odds of treatment termination were higher in patients with sarcopenia (odds ratio=4.23; P=0.050). Patients with sarcopenic obesity showed lower overall survival (median survival of 6 months [95% confidence interval {CI}=3.9-8.5] vs. 25 months [95% CI=20.2-38.2]; log-rank test P=0.000). Conclusions: Sarcopenia and sarcopenic obesity were associated with early termination of neoadjuvant chemotherapy in patients with gastric cancer; additionally, sarcopenic obesity was associated with poor survival.
Kim, Dong Uk;Park, Hyung Ki;Lee, Gyeoung Hae;Chang, Jae Chil;Park, Hye Ran;Park, Sukh Que;Cho, Sung Jin
Journal of Korean Neurosurgical Society
/
v.64
no.6
/
pp.995-1003
/
2021
Objective : People are living longer and the elderly population continues to increase. The incidence of degenerative spinal diseases (DSDs) in the elderly population is quite high. Therefore, we are facing more cases of DSD and offering more surgical solutions in geriatric patients. Understanding the significance and association of frailty and central sarcopenia as risk factors for spinal surgery in elderly patients will be helpful in improving surgical outcomes. We conducted a retrospective cohort analysis of prospectively collected data to assess the impact of preoperative central sarcopenia, frailty, and comorbidity on surgical outcome in elderly patients with DSD. Methods : We conducted a retrospective analysis of patients who underwent elective spinal surgery performed from January 1, 2019 to September 30, 2020 at our hospital. We included patients aged 65 and over who underwent surgery on the thoracic or lumbar spine and were diagnosed as DSD. Central sarcopenia was measured by the 50th percentile of psoas : L4 vertebral index (PLVI) using the cross-sectional area of the psoas muscle. We used the Korean version of the fatigue, resistance, ambulation, illnesses, and loss of weight (K-FRAIL) scale to measure frailty. Comorbidity was confirmed and scored using the Charlson Comorbidity Index (CCI). As a tool for measuring surgical outcome, we used the Clavien-Dindo (CD) classification for postoperative complications and the length of stay (LOS). Results : This study included 85 patients (35 males and 50 females). The mean age was 74.05±6.47 years. Using the K-FRAIL scale, four patients were scored as robust, 44 patients were pre-frail and 37 patients were frail. The mean PLVI was 0.61±0.19. According to the CD classification, 50 patients were classified as grade 1, 19 as grade 2, and four as grade 4. The mean LOS was 12.35±8.17 days. Multivariate stepwise regression analysis showed that postoperative complication was significantly associated with surgical invasiveness and K-FRAIL scale. LOS was significantly associated with surgical invasiveness and CCI. K-FRAIL scale showed a significant correlation with CCI and PLVI. Conclusion : The present study demonstrates that frailty, comorbidity, and surgical invasiveness are important risk factors for postoperative complications and LOS in elderly patients with DSD. Preoperative recognition of these factors may be useful for perioperative optimization, risk stratification, and patient counseling.
Purpose: The purpose of this study was to develop family support oriented physical activity program for the male elderly with sarcopenia based on social cognitive theory. Methods: This program was developed through an analysis of 18 related intervention literatures, results of a focus group interview with 5 elderly men with sarcopenia and the content validity index of the program content adequacy and applicability by 6 experts. The combined exercise with resistance exercise and aerobic exercise was constructed in accordance with the recommendations of the American College of Sports Medicine (ACSM) and experts' opinions. Results: The program consists group education sessions (5 times, 60 minutes for each) for 12 weeks and family support oriented physical activity program composed of individual intervention (sending alarm for physical activity for 10 times and telephone monitoring for 2 times). The program also reflects the concept of self-efficacy and self-regulation, which are important factors for continuing physical activity through family support. The progressive resistance exercise was developed by composing 5-6 systemic movement forms that repeat 2-3 days a week and 2-5 sets at least. Conclusion: It is proposed to standardize the family support oriented physical activity program through the further studies so that the program can be utilized for the various groups of people who need increased level of physical activities.
Background/Aims: Since the usefulness of neoadjuvant chemo(radiation) therapy (NAT) for pancreatic cancer has been demonstrated, recurrent biliary obstruction (RBO) in patients with pancreatic cancer with a fully covered self-expandable metal stent (FCSEMS) during NAT is expected to increase. This study investigated the impact of sarcopenia on RBO in this setting. Methods: Patients were divided into normal and low skeletal muscle index (SMI) groups and retrospectively analyzed. Patient characteristics, overall survival, time to RBO (TRBO), stent-related adverse events, and postoperative complications were compared between the two groups. A Cox proportional hazard model was used to identify the risk factors for short TRBO. Results: A few significant differences were observed in patient characteristics, overall survival, stent-related adverse events, and postoperative complications between 38 patients in the normal SMI group and 17 in the low SMI group. The median TRBO was not reached in the normal SMI group and was 112 days in the low SMI group (p=0.004). In multivariate analysis, low SMI was the only risk factor for short TRBO, with a hazard ratio of 5.707 (95% confidence interval, 1.148-28.381; p=0.033). Conclusions: Sarcopenia was identified as an independent risk factor for RBO in patients with pancreatic cancer with FCSEMS during NAT.
본 웹사이트에 게시된 이메일 주소가 전자우편 수집 프로그램이나
그 밖의 기술적 장치를 이용하여 무단으로 수집되는 것을 거부하며,
이를 위반시 정보통신망법에 의해 형사 처벌됨을 유념하시기 바랍니다.
[게시일 2004년 10월 1일]
이용약관
제 1 장 총칙
제 1 조 (목적)
이 이용약관은 KoreaScience 홈페이지(이하 “당 사이트”)에서 제공하는 인터넷 서비스(이하 '서비스')의 가입조건 및 이용에 관한 제반 사항과 기타 필요한 사항을 구체적으로 규정함을 목적으로 합니다.
제 2 조 (용어의 정의)
① "이용자"라 함은 당 사이트에 접속하여 이 약관에 따라 당 사이트가 제공하는 서비스를 받는 회원 및 비회원을
말합니다.
② "회원"이라 함은 서비스를 이용하기 위하여 당 사이트에 개인정보를 제공하여 아이디(ID)와 비밀번호를 부여
받은 자를 말합니다.
③ "회원 아이디(ID)"라 함은 회원의 식별 및 서비스 이용을 위하여 자신이 선정한 문자 및 숫자의 조합을
말합니다.
④ "비밀번호(패스워드)"라 함은 회원이 자신의 비밀보호를 위하여 선정한 문자 및 숫자의 조합을 말합니다.
제 3 조 (이용약관의 효력 및 변경)
① 이 약관은 당 사이트에 게시하거나 기타의 방법으로 회원에게 공지함으로써 효력이 발생합니다.
② 당 사이트는 이 약관을 개정할 경우에 적용일자 및 개정사유를 명시하여 현행 약관과 함께 당 사이트의
초기화면에 그 적용일자 7일 이전부터 적용일자 전일까지 공지합니다. 다만, 회원에게 불리하게 약관내용을
변경하는 경우에는 최소한 30일 이상의 사전 유예기간을 두고 공지합니다. 이 경우 당 사이트는 개정 전
내용과 개정 후 내용을 명확하게 비교하여 이용자가 알기 쉽도록 표시합니다.
제 4 조(약관 외 준칙)
① 이 약관은 당 사이트가 제공하는 서비스에 관한 이용안내와 함께 적용됩니다.
② 이 약관에 명시되지 아니한 사항은 관계법령의 규정이 적용됩니다.
제 2 장 이용계약의 체결
제 5 조 (이용계약의 성립 등)
① 이용계약은 이용고객이 당 사이트가 정한 약관에 「동의합니다」를 선택하고, 당 사이트가 정한
온라인신청양식을 작성하여 서비스 이용을 신청한 후, 당 사이트가 이를 승낙함으로써 성립합니다.
② 제1항의 승낙은 당 사이트가 제공하는 과학기술정보검색, 맞춤정보, 서지정보 등 다른 서비스의 이용승낙을
포함합니다.
제 6 조 (회원가입)
서비스를 이용하고자 하는 고객은 당 사이트에서 정한 회원가입양식에 개인정보를 기재하여 가입을 하여야 합니다.
제 7 조 (개인정보의 보호 및 사용)
당 사이트는 관계법령이 정하는 바에 따라 회원 등록정보를 포함한 회원의 개인정보를 보호하기 위해 노력합니다. 회원 개인정보의 보호 및 사용에 대해서는 관련법령 및 당 사이트의 개인정보 보호정책이 적용됩니다.
제 8 조 (이용 신청의 승낙과 제한)
① 당 사이트는 제6조의 규정에 의한 이용신청고객에 대하여 서비스 이용을 승낙합니다.
② 당 사이트는 아래사항에 해당하는 경우에 대해서 승낙하지 아니 합니다.
- 이용계약 신청서의 내용을 허위로 기재한 경우
- 기타 규정한 제반사항을 위반하며 신청하는 경우
제 9 조 (회원 ID 부여 및 변경 등)
① 당 사이트는 이용고객에 대하여 약관에 정하는 바에 따라 자신이 선정한 회원 ID를 부여합니다.
② 회원 ID는 원칙적으로 변경이 불가하며 부득이한 사유로 인하여 변경 하고자 하는 경우에는 해당 ID를
해지하고 재가입해야 합니다.
③ 기타 회원 개인정보 관리 및 변경 등에 관한 사항은 서비스별 안내에 정하는 바에 의합니다.
제 3 장 계약 당사자의 의무
제 10 조 (KISTI의 의무)
① 당 사이트는 이용고객이 희망한 서비스 제공 개시일에 특별한 사정이 없는 한 서비스를 이용할 수 있도록
하여야 합니다.
② 당 사이트는 개인정보 보호를 위해 보안시스템을 구축하며 개인정보 보호정책을 공시하고 준수합니다.
③ 당 사이트는 회원으로부터 제기되는 의견이나 불만이 정당하다고 객관적으로 인정될 경우에는 적절한 절차를
거쳐 즉시 처리하여야 합니다. 다만, 즉시 처리가 곤란한 경우는 회원에게 그 사유와 처리일정을 통보하여야
합니다.
제 11 조 (회원의 의무)
① 이용자는 회원가입 신청 또는 회원정보 변경 시 실명으로 모든 사항을 사실에 근거하여 작성하여야 하며,
허위 또는 타인의 정보를 등록할 경우 일체의 권리를 주장할 수 없습니다.
② 당 사이트가 관계법령 및 개인정보 보호정책에 의거하여 그 책임을 지는 경우를 제외하고 회원에게 부여된
ID의 비밀번호 관리소홀, 부정사용에 의하여 발생하는 모든 결과에 대한 책임은 회원에게 있습니다.
③ 회원은 당 사이트 및 제 3자의 지적 재산권을 침해해서는 안 됩니다.
제 4 장 서비스의 이용
제 12 조 (서비스 이용 시간)
① 서비스 이용은 당 사이트의 업무상 또는 기술상 특별한 지장이 없는 한 연중무휴, 1일 24시간 운영을
원칙으로 합니다. 단, 당 사이트는 시스템 정기점검, 증설 및 교체를 위해 당 사이트가 정한 날이나 시간에
서비스를 일시 중단할 수 있으며, 예정되어 있는 작업으로 인한 서비스 일시중단은 당 사이트 홈페이지를
통해 사전에 공지합니다.
② 당 사이트는 서비스를 특정범위로 분할하여 각 범위별로 이용가능시간을 별도로 지정할 수 있습니다. 다만
이 경우 그 내용을 공지합니다.
제 13 조 (홈페이지 저작권)
① NDSL에서 제공하는 모든 저작물의 저작권은 원저작자에게 있으며, KISTI는 복제/배포/전송권을 확보하고
있습니다.
② NDSL에서 제공하는 콘텐츠를 상업적 및 기타 영리목적으로 복제/배포/전송할 경우 사전에 KISTI의 허락을
받아야 합니다.
③ NDSL에서 제공하는 콘텐츠를 보도, 비평, 교육, 연구 등을 위하여 정당한 범위 안에서 공정한 관행에
합치되게 인용할 수 있습니다.
④ NDSL에서 제공하는 콘텐츠를 무단 복제, 전송, 배포 기타 저작권법에 위반되는 방법으로 이용할 경우
저작권법 제136조에 따라 5년 이하의 징역 또는 5천만 원 이하의 벌금에 처해질 수 있습니다.
제 14 조 (유료서비스)
① 당 사이트 및 협력기관이 정한 유료서비스(원문복사 등)는 별도로 정해진 바에 따르며, 변경사항은 시행 전에
당 사이트 홈페이지를 통하여 회원에게 공지합니다.
② 유료서비스를 이용하려는 회원은 정해진 요금체계에 따라 요금을 납부해야 합니다.
제 5 장 계약 해지 및 이용 제한
제 15 조 (계약 해지)
회원이 이용계약을 해지하고자 하는 때에는 [가입해지] 메뉴를 이용해 직접 해지해야 합니다.
제 16 조 (서비스 이용제한)
① 당 사이트는 회원이 서비스 이용내용에 있어서 본 약관 제 11조 내용을 위반하거나, 다음 각 호에 해당하는
경우 서비스 이용을 제한할 수 있습니다.
- 2년 이상 서비스를 이용한 적이 없는 경우
- 기타 정상적인 서비스 운영에 방해가 될 경우
② 상기 이용제한 규정에 따라 서비스를 이용하는 회원에게 서비스 이용에 대하여 별도 공지 없이 서비스 이용의
일시정지, 이용계약 해지 할 수 있습니다.
제 17 조 (전자우편주소 수집 금지)
회원은 전자우편주소 추출기 등을 이용하여 전자우편주소를 수집 또는 제3자에게 제공할 수 없습니다.
제 6 장 손해배상 및 기타사항
제 18 조 (손해배상)
당 사이트는 무료로 제공되는 서비스와 관련하여 회원에게 어떠한 손해가 발생하더라도 당 사이트가 고의 또는 과실로 인한 손해발생을 제외하고는 이에 대하여 책임을 부담하지 아니합니다.
제 19 조 (관할 법원)
서비스 이용으로 발생한 분쟁에 대해 소송이 제기되는 경우 민사 소송법상의 관할 법원에 제기합니다.
[부 칙]
1. (시행일) 이 약관은 2016년 9월 5일부터 적용되며, 종전 약관은 본 약관으로 대체되며, 개정된 약관의 적용일 이전 가입자도 개정된 약관의 적용을 받습니다.