1. 노인의 체중감량에서 근육량 유지, 어떻게 운동할 것인가? Wook Song, Ph.D.
Health and Exercise Science Laboratory
Institute of Sports Science, Institute on Aging
Seoul National University

2. 성인 (19세 이상) 비만율 (1988~2010)
(보건복지부, 2011)
연령별 비만율 (2010)
(보건복지부, 2011)

3. Question 1
체중 조절은 어떻게 하나요? or
운동?
식이조절?

4. 체중 감량 체중 조절의 원리 에너지 소비량 > 에너지 섭취량
Diet restriction remains the most common method of obesity reduction.
(Williamson DF et al., 1992)
The observation that low levels of physical activity are a major cause of obesity.
(Schulz LO and Schoeller DA, 1994)
Increased physical activity alone is not thought to be a useful strategy for obesity reduction.
(National Institutes of Health, 1998)
Changes in weight are affected by the amount of energy expended versus the amount of energy consumed. If the energy expenditure remains low, but dietary consumption levels are in excess, weight gain will occur.
(Thomas DM et al., 2012)
에너지 소비량 > 에너지 섭취량
체중 감량

5. 유산소운동 VS 식이조절 Groups Objective
To determine the effects of equivalent diet- or exercise-induced weight loss and exercise without loss on subcutaneous fat, visceral fat, skeletal muscle mass, and insulin sensitivity in obese men.
Groups
weight maintenance diet for a 4- to 5-week baseline period
Persons contacted for participation (n=611)
식이 그룹은 식단으로 700kcal/day, 운동그룹은 운동으로 700kcal/day 소비 => 전체 칼로리를 맞춤.
Screened (n=238), Not randomly assigned (n=137)
Randomly assigned (n=101)
Control
식이조절
유산소운동
비체중감량
유산소운동
Control
(n=8)
식이조절
(n=14)
유산소운동
(n=16)
비체중감량
(n=14)
approximately 700 kcal ↓

6. 운동 비만 인슐린 저항성 ANSWER Weight (8% ↓) Total fat mass ↓ Visceral fat ↓
Control
식이조절
유산소운동
비체중감량
유산소운동
Weight (8% ↓)
Total fat mass ↓
Visceral fat ↓
Glucose disposal ↑
Weight (8% ↓)
Total fat mass ↓↓↓
Visceral fat ↓
Glucose disposal ↑
심폐체력 ↑
Visceral fat ↓
심폐체력 ↑
Conclusions
Weight loss induced by increased daily physical activity without caloric restriction substantially reduces obesity (particularly abdominal obesity) and insulin resistance in men. 운동
ANSWER 비만
인슐린 저항성

7. Question 2
체중 조절, 어떤 운동을 해야 하나요?
유산소운동 VS 저항성운동?

8. 유산소운동과 저항성운동이란? Dumbbell curl Running [유/무산소 정의]
보통, 유/무산소 운동의 경계점을 걷기, 달리기, 수영 등은 유산소, 근력운동은 무산소운동으로 분류하는 경향이 있지만, 이는 잘못 된 것.
Dumbbell curl
Running

9. 유산소운동은 심혈관계 적응을 유도하여 근육에 산소공급을 증가시킨다.
(Exercise Physiology, McArdle et al., 4th edition, 2001)

10. 유산소운동을 통한 심혈관계 적응의 효과
Overall Physiologic Change of Body Followed by Exercise
[유산소 운동의 효과]
(Exercise Physiology, McArdle et al., 4th edition, 2001)

11. 저항성운동을 통한 적응의 효과 Adaptation due to Resistance Exercise
Increase of Anaerobic Enzymes Due to Resistance Exercise
[무산소 운동의 효과]
(Exercise Physiology, McArdle et al., 4th edition, 2001)

12. 일반적으로, 유산소운동이 지방량 감소에 탁월하다고 생각했다.
일반적으로, 유산소운동이 지방량 감소에 탁월하다고 생각했다.
ANSWER

13. 듀크 대학 연구 비교 (유산소 VS 저항성) 논문
유산소운동
저항성운동
Subjects Phone Screened (n=3,145)
Phone Screened out (n=2,661), Screen (n=288)
Randomized 8 Month Exercise Intervention (n=196)
Body weight ↓↓
Peak VO2 ↑↑↑
Fat mass ↓↓
Fat % ↓↓
허리둘레 ↓
Body weight ↑
Peak VO2 ↑↑
Strength ↑↑↑
Lean body mass ↑
Fat % ↓
The traditional answer: Cardiovascular training.
Exercise Dropouts and Excluded from Analysis
Resistance
(n=66)
Aerobic
(n=73)
Aerobic training alone is the optimal mode of exercise for reducing fat mass and total body mass.

14. 그렇지만, 최근에는 저항성운동이 지방량 감소에 유익하다고 보고되고 있다.
그렇지만, 최근에는 저항성운동이 지방량 감소에 유익하다고 보고되고 있다.
ANSWER

15. NEAT(일상 생활 속에서 몸을 움직일 때 나는 열),
Randomly assigned ,
women (n=140), ages of years
유산소운동
+식이조절
저항성운동을 통한
AEE(활동시에너지소비량),
NEAT(일상 생활 속에서 몸을 움직일 때 나는 열),
그리고 PAL(신체활동수준)은
요요현상을 예방하는데 중요하다.
ANSWER
Weight, BMI, % fat, fat mass ↓
휴식시에너지소비량 ↓
저항성운동
+식이조절
Weight, BMI, % fat, fat mass ↓
휴식시에너지소비량 ↓
활동시에너지소비량 ↑
ARTE index (minutes/day) ↑
PAL (TEE/REE) ↑
NEAT: non-exercise activity thermogenesis : 일상 생활 속에서 몸을 움직일 때 나는 열.
TEE: Total energy expenditure
REE: Resting energy expenditure
AEE: Activity-related energy expenditure
NEAT: non-exercise activity thermogenesis
ARTE: Activity-related time equivalent
PAL: Physical activity level

16. 유산소운동과 저항성운동을 정리하자면? 근감소 대사 ↓(단백질소실,기초대사율) 근육량증가 인슐린 민감성 ↑, 전당뇨 위험 ↓
Aerobic exercises
Anaerobic exercises
Presence of oxygen
Moderate intensity
Long duration
Develops stamina
Burns calories during the activity
Absence of oxygen
High intensity
Short duration
Develops force
Burns calories even when the body is at rest
(Abhijit Naik, 2014)
In overweight and obese individuals attempting to lose weight, decreases in muscle mass may down-regulate metabolic processes, such as protein turnover and basal metabolic rate, thus compromising healthy weight management.
(Ravussin E et al., 1988; Stein TP et al., 1991)
근감소
대사 ↓(단백질소실,기초대사율)
Higher muscle mass (relative to body size) is associated with better insulin sensitivity and lower risk of prediabetes.
(Srikanthan P and Karlamangla AS, 2011)
근육량증가
인슐린 민감성 ↑, 전당뇨 위험 ↓

17. Question 3
어르신의 체중 감량은
어떻게 다를까요?

18. Population of 65 and Older
Proportion of People 65 and Older in a Country’s Population, Estimates for 2010 and 2050
(%)

19. 65세 이상 고령자의 비만에 대한 위험성 고령자 비만의 잠재적 위험성 고령자 비만율 증가 추세
U.S. Department of Health and Human Services, 2008

20. “Your choice. Spend half an hour a day exercising or 24 hours a day dead.”
(Michael Colgan, 2008)
Resistance training not only deceases fat mass and central obesity, but also enhances insulin sensitivity in obesity and advanced age.
(Sundell J, 2011)

21. Inter-relationships between adipose tissue and muscle
Inter-relationships between adipose tissue and muscle. A mechanism leading to sarcopenic obesity.
(Zamboni et al., 2008)

22. Relationship among sarcopenia and obesity
(Zamboni et al., 2008)

23. 노화로 인한 근감소(Sarcopenia)의 증상
Symptoms of loss of skeletal muscle in aging
Immune
function
Brain
Inflammation
Sarcopenia
TNF-alpha and its soluble receptors were strongly associated with the decline in muscle mass and strength in a sample of more than 2000 subjects of the Health Aging and Body Composition study, with a 5 years of follow-up.
(Schaap et al., 2009)
Loss of muscle causes a loss of immune function.
(Colgan, 1993)
Sarcopenia is linked to death of brain cells and loss of cognition and memory with age.
(Johnston et al., 2008)

24. Changed body composition in elderly
(대퇴근육의 횡단면 MRI 사진)
33 year old
Male
BMI: 24.5 kg/m2
Muscle: cm3
Subcutaneous fat: cm3
Intermuscular fat: 78.7 cm3
73 year old
SPPB: 11
Gait speed: 1.15 m/sec
BMI: 24.9 kg/m2
Muscle: cm3
Subcutaneous fat: cm3
Intermuscular fat: cm3
84 year old
SPPB: 6
Gait speed: 0.49 m/sec
BMI: 26.9 kg/m2
Muscle: cm3
Subcutaneous fat: cm3
Intermuscular fat: cm3
young
high-functioning older,
low-functioning older study groups
* lose 10% per decade after 50 years
(Buford TW et al., 2012)
(Lexell et al., 1988)

25. 어르신(elderly) 비만(obesity) 치료의 목적
(Eiman Jahangir et al., 2014)

26. 어르신(elderly) 비만(obesity)의 체중 감량시 잠재적 이익과 위험 요인
Potential Benefits and Risks Related to Weight Loss in the Elderly
제2형 당뇨 완화
혈당, 지질, 혈압 조절 개선
심혈관계 질환으로 인한
잠재적인 사망률 감소
호흡기능 및 수면장애 개선
신체활동의 기능적 능력 향상
근골격계 질환 감소
우울증 감소
삶의 질 향상 이익
의도치 않은 체중감소로
인한 사망위험 증가
근육량 감소 (규칙적인
운동을 하지 않고)
골밀도 감소
골다공증 발병
골절 증가
특정 단백질 및 비타민 부족
담석증 발병률 증가
(급격한 체중감소시)
위험요인
(Mathus-Vliegen EM, 2012)

27. 체중 조절을 도와줄 수 있는 기타 다른 방법 1 보수계를 이용한 체중 조절, 어느 정도가 적당한가? Purpose
The purpose of this article is to review the rationale and evidence for general pedometer-based indices for research and practice purposes.
A value of 10,000 steps/day seems to be a reasonable estimate of daily activity for apparently healthy adults.
(Tudor-Locke C and Myers AM, 2001)
건강한 성인 대상 1일 적절한 활동량으로 10,000보가 적당하다.

28. Sedentary Behavior: less than 5,000 steps/day
Swartz and Thompson examined the effects of a 10,000 steps/day intervention in overweight, sedentary women with a family history of type 2 diabetes.
(Swartz AM and Thompson DL, 2002)
과체중과 제2형 당뇨 가족력이 있는 여성대상으로 1일 10,000보가 당대사에 효과가 있다.
Sugiura reported the results of a 24-month study in which 32 women (aged years) were asked to self-monitor their activity using a pedometer and increase their steps/day by at least 2,000-3,000 steps/day.
(Sugiura et al., 2002)
1일 2,000-3,000보 걸음수를 증가시켜 활동량을 늘리는 것이 심혈관계 기능 개선에 효과가 있다.
Sedentary Behavior: less than 5,000 steps/day
Active lifestyle: 8,000~10,000 steps/day
체중조절을
위한 권장량 제시
10,000 steps/day
or 기본 보수 + 2,000 ~ 4,000 steps/day

29. 체중 조절을 위한 기타 다른 방법 2 허리 둘레 감소 체중 감량 5-10%
Whole Body Vibrator를 이용한 체중 유지 방법
식이조절
식이조절
+유산소
식이조절
+Vibration
허리 둘레 감소
체중 감량 5-10%

30. Whole Body Vibrator를 이용한 체중 유지 방법

31. Acknowledgment Our Crew:
Funded by the Korean Government, Ministry of Education, Science, and Technology via Korea Research Foundation
Our Crew:
Kim Heejae
Yoon Donghyun
Kim Janghoe
So Byunghun
Son Junseok
Kim Jinsoo
Song Hansol
Kim Daeyoung
Hwang Suseung
Lee Dongwon
Kang Minji
Choi Mijung
Kang Donghun
Kim Jiyeon
Lee Hyojoo
Woo Shinae
Oh Seunglyul (post-doc)
Kim Yongan (post-doc)

32. 경청해 주셔서 감사합니다