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A Comparison of Physical Activity and Exercise Capacity in Adults with Congenital Heart Disease and Healthy Controls
Korean J Sports Med 2020;38:225-233
Published online December 1, 2020;  https://doi.org/10.5763/kjsm.2020.38.4.225
© 2020 The Korean Society of Sports Medicine.

Hyun Jeong Kim1,2, Ja Kyoung Yoon2, Seong-Ho Kim2, Sae Young Jae1

1Department of Sport Sciences, University of Seoul, Seoul,
2Department of Pediatrics, Sejong Hospital, Bucheon, Korea
Correspondence to: Sae Young Jae
Department of Sport Sciences, University of Seoul, 163 Seoulsiripdae-ro, Dongdaemun-gu, Seoul 02504, Korea
Tel: +82-2-6490-2953, Fax: +82-2-6490-2953, E-mail: syjae@uos.ac.kr

*This study was supported by a grant from the Woochon Cardio-Neuro-Vascular Research Foundation (2018) in Korea.
Received October 29, 2020; Revised November 16, 2020; Accepted November 17, 2020.
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.
 Abstract
Purpose: Advancements in surgical and nonsurgical care for congenital heart disease (CHD) have enabled an increase in survival into adulthood of these children with CHD, thereby contributing to the growth of the aging population, it is important to evaluate these functional outcome measures in adults with CHD. Therefore, this study aimed to compare the subjective and objective assessments of physical activity (PA) and exercise capacity (EC) in adults with CHD and age-matched, healthy controls.
Methods: Forty-six adults with CHD (male, 26; age, 20.6짹1.3 years) and forty-six healthy controls (male, 24; age, 21.2짹1.6 years) underwent an assessment of subjective and objective PA levels using the Global Physical Activity Questionnaire and the accelerometer device (GENEActiv) worn on the wrist for seven consecutive days, respectively. EC was directly measured by peak oxygen uptake (peak VO2) during a graded exercise test.
Results: Subjectively and objectively measured of moderate to vigorous PA in adults with CHD were lower than those with healthy controls (p=0.008, p=0.004), while the majority of adults with CHD have achieved the recommended levels of PA (150 min/wk). In addition, peak VO2 was lower in adults with CHD than in healthy controls (30.8짹8 mL/kg/min vs. 46.7짹10 mL/kg/min, p<0.001).
Conclusion: Although the majority of adults with CHD meet the recommended levels of PA, their overall PA levels and EC are still lower than those of age-matched, healthy adults without CHD.
Keywords : Congenital heart disease, Exercise capacity, Physical activity
꽌 濡

쓽븰 湲곗닠怨 닔닠湲곕쾿쓽 諛쒕떖濡 꽑泥쒖꽦 떖옣蹂 솚옄쓽 깮議댁쑉씠 겕寃 利앷븯뿬 留ㅻ뀈 4,000紐낆뿉꽌 5,000紐낆뵫 꽦씤湲곕줈 젒뼱뱾怨 엳쑝硫, 2020뀈뿉뒗 꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄媛 빟 70,000紐 씠긽 맆 寃껋쑝濡 삁긽븯怨 엳떎1. 씠 媛숈씠 꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄 닔媛 利앷븿뿉 뵲씪 닔닠 諛 빟臾쇱쟻 移섎즺肉먮쭔 븘땲씪 깮솢뒿愿怨 媛숈 鍮꾩빟臾쇱쟻 슂씤뱾쓽 以묒슂꽦씠 젏李 媛뺤“릺怨 엳떎2. 理쒓렐 뿰援ъ뿉꽌 떊泥댄솢룞씠굹 슫룞뒫젰怨 媛숈 슂씤뱾 꽑泥쒖꽦 떖옣蹂 솚옄쓽 궣쓽 吏 뼢긽뿉 以묒슂븯硫, 듅엳 솚옄쓽 깮議닿낵 媛숈 삁썑瑜 寃곗젙吏볥뒗 뜲 以묒슂븳 쁺뼢쓣 誘몄튂뒗 寃껋쑝濡 蹂닿퀬릺怨 엳떎3.

씪諛섏쟻쑝濡 떊泥댄솢룞 슫룞뒫젰怨 洹쇨낏寃⑷퀎 湲곕뒫쓣 뼢긽떆궎硫 떖삁愿 궗留 쐞뿕怨 빀蹂묒쬆쓽 쐞뿕쓣 궙異섎떎4. 洹몃읆뿉룄 遺덇뎄븯怨, 꽑泥쒖꽦 떖옣蹂 솚옄뱾 怨쇱엵蹂댄샇 슫룞怨 愿젴맂 留됱뿰븳 몢젮 븣臾몄뿉 떊泥댄솢룞 李몄뿬蹂대떎뒗 떊泥댄솢룞 젣븳씠 留뚯뿰릺뼱 엳쓣 닔 엳떎5. 뵲씪꽌 꽑泥쒖꽦 떖옣蹂 솚옄뒗 떊泥댄솢룞 沅뚯옣웾쓣 異⑹”븯뒗 鍮꾩쑉씠 궙쓣 寃껋씠硫, 嫄닿컯 議곌뎔뿉 鍮꾪빐꽌 떊泥댄솢룞 닔以룄 궙쓣 寃껋쑝濡 삁긽븯吏留, 씪遺 뿰援ъ뿉꽌뒗 떊泥댄솢룞 닔以씠 궙吏 븡떎뒗 寃곌낵瑜 蹂댁뿬二쇨린룄 븳떎6,7. 씠윭븳 긽諛섎맂 寃곌낵쓽 二쇱슂븳 썝씤 紐낇솗븯吏 븡吏留, 떊泥댄솢룞 룊媛 諛⑸쾿怨 떎뼇븳 湲곗쓽 떊泥댄솢룞 遺꾩꽍諛⑸쾿쓽 李⑥씠 븣臾몄씤 寃껋쑝濡 蹂 닔 엳떎8. 옄媛 吏덈Ц吏瑜 씠슜븳 二쇨쟻씤 떊泥댄솢룞 痢≪젙諛⑸쾿 議곗궗쓽 렪由ы븳 옣젏 엳쑝굹 떊泥댄솢룞웾쓣 怨쇰룊媛븳떎怨 븣젮졇 엳떎7. 씠뿉 諛섑빐, 理쒓렐 썾뼱윭釉(wearable) 옣鍮꾨 李⑹슜븳 媛앷쟻 떊泥댄솢룞 痢≪젙諛⑸쾿 痢≪젙 怨쇱젙쓽 뼱젮 엳쑝굹 떦븳 떊泥댄솢룞 닔以쓣 룊媛븷 닔 엳뒗 諛⑸쾿쑝濡 諛쏆븘뱾뿬吏怨 엳떎8. 뵲씪꽌 二쇨쟻씤 諛⑸쾿怨 媛앷쟻씤 떊泥댄솢룞 痢≪젙諛⑸쾿쓣 룞떆뿉 쟻슜븯뿬 꽑泥쒖꽦 떖옣蹂 솚옄쓽 떊泥댄솢룞 젙룄瑜 蹂대떎 젙솗븯寃 젣떆븯뒗 寃껋 以묒슂븳 씪씠씪 깮媛곷맂떎.

떖룓슫룞遺븯寃궗(cardiopulmonary exercise testing)瑜 넻빐 痢≪젙맂 삁뿭븰쟻 蹂씤 諛 슫룞뒫젰(exercise capacity) 吏몴뱾 꽑泥쒖꽦 떖옣蹂 솚옄쓽 嫄닿컯긽깭瑜 룊媛븯뒗 以묒슂븳 湲곗씠 맂떎9. 슫룞 以 떖諛뺤닔 닔異뺢린 삁븬 긽듅씠 몦솕릺뼱 엳뒗 긽깭뒗 솚옄쓽 옄쑉떊寃쎄린뒫媛먯냼 삉뒗 떖옣湲곕뒫옣븷瑜 븫떆븳떎10. 삉븳 利앷맂 씠궛솕깂냼 솚湲곕떦웾(minute ventilation/carbon dioxide production, VE/VCO2) 룓 솚湲 슚쑉꽦쓽 븯瑜 쓽誘명븯硫11, 듅엳 궙 理쒕 궛냼꽠痍⑤웾(peak oxygen uptake, peak VO2) 닔以 議곌린 궗留앹쓣 삁痢≫븯뒗 媛뺣젰븳 쐞뿕 씤옄濡 젣떆릺怨 엳뼱12 꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄쓽 삁뿭븰쟻 蹂씤씠굹 슫룞뒫젰 닔以쓣 젙솗븯寃 뙆븙븯뒗 寃껋 솚옄쓽 닔닠 떆젏쓣 寃곗젙븯嫄곕굹 삁썑瑜 삁痢≫븯뒗 뜲 留ㅼ슦 以묒슂븯떎怨 븷 닔 엳떎.

洹몃룞븞 援궡 꽑泥쒖꽦 떖옣蹂 솚옄뱾쓽 떊泥댄솢룞怨 슫룞뒫젰뿉 븳 蹂닿퀬媛 엳뿀쑝굹, 遺遺꾩 냼븘⋅泥냼뀈 솚옄瑜 긽쑝濡 씠猷⑥뼱졇 솕떎13. 꽑泥쒖꽦 떖옣蹂 솚옄媛 냼븘⋅泥냼뀈湲곗뿉꽌 꽦씤湲곕줈 쟾솚릺怨 엳뒗 떆젏뿉꽌 꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄쓽 떊泥댄솢룞怨 슫룞뒫젰 닔以쓣 뙆븙븯뒗 寃껋 援궡 꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄쓽 옣湲곗쟻씤 移섎즺굹 嫄닿컯愿由 쟾왂쓣 꽭슦뒗 뜲 엳뼱 以묒슂븳 湲곗큹옄猷뚮 젣怨듯븷 닔 엳쓣 寃껋씠떎. 뵲씪꽌 蹂 뿰援щ뒗 꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄瑜 긽쑝濡 二쇨쟻 諛 媛앷쟻 諛⑸쾿쑝濡 떊泥댄솢룞쓣 痢≪젙븯뿬 떊泥댄솢룞 沅뚯옣웾 湲곗뿉 遺빀븯뒗 鍮꾩쑉쓣 議곗궗븯怨, 슫룞뒫젰 젙룄瑜 嫄닿컯 議곌뎔怨 鍮꾧탳 룊媛븯怨좎옄 븳떎.

뿰援 諛⑸쾿

蹂 뿰援 李몄뿬옄뒗 珥 92紐낆쑝濡 꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄 46紐(궓옄 26紐)怨 嫄닿컯 議곌뎔 46紐(궓옄 24紐)씠떎. 蹂 뿰援ъ뿉 李몄뿬븳 꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄 46紐낆 2018뀈 12썡遺꽣 2019뀈 9썡 궗씠 젙湲 寃吏 諛 吏꾨즺瑜 쐞빐 꽭醫낅퀝썝 냼븘泥냼뀈怨쇰 諛⑸Ц븯뿬 뿰援 李몄뿬뿉 룞쓽븳 솚옄 以 留 19꽭 씠긽씠怨, 엫긽뿉꽌 떖룓슫룞遺븯寃궗瑜 떎떆븳 쟻 엳뒗 솚옄씠떎. 嫄닿컯븳 꽦씤 議곌뎔 2018뀈 12썡遺꽣 2019뀈 9썡源뚯 꽌슱떆由쎈븰援먯쓽 븰援 솃럹씠吏 紐⑥쭛怨듦퀬瑜 넻빐 蹂 뿰援ъ뿉 옄諛쒖쟻쑝濡 李몄뿬븳 옄씠떎. 嫄닿컯븳 꽦씤 議곌뎔쓽 꽑젙湲곗 湲곗큹 嫄닿컯 꽕臾몄瑜 넻빐 쁽옱 移섎즺瑜 쐞빐 蹂듭슜 以묒씤 빟臾쇱씠 뾾뒗 옄, 洹쇨낏寃⑷퀎 諛 궗꽦 吏덊솚씠 뾾뒗 옄濡 븯떎. 꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄 諛 嫄닿컯 議곌뎔쓽 씤援ы넻怨꾩쟻 듅꽦 옄媛-蹂닿퀬 꽕臾몄쑝濡 議곗궗븯쑝硫, 꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄쓽 吏덈퀝 愿젴 듅꽦 쓽猷 吏꾨즺 李⑦듃瑜 넻빐 옄猷뚮 닔吏묓븯떎. 蹂 뿰援щ뒗 꽌슱떆由쎈븰援 깮紐낆쑄由ъ쐞썝쉶쓽 듅씤(2018-032)怨 꽭醫낅퀝썝 엫긽떆뿕쐞썝쉶쓽 듅씤(2019-0385)쓣 諛쏆 썑 吏꾪뻾븯떎.

떊泥댄솢룞 꽕臾몄瑜 씠슜븳 二쇨쟻씤 痢≪젙 諛⑸쾿 諛 떊泥댄솢룞 媛냽룄怨꾨 씠슜븳 媛앷쟻씤 痢≪젙諛⑸쾿쓣 넻빐 룊媛븯떎. 二쇨쟻쑝濡 痢≪젙븳 떊泥댄솢룞 援젣떊泥댄솢룞 꽕臾몄(Global Physical Activity Questionnaire, GPAQ)瑜 씠슜븯뿬 룊媛븯怨, 媛앷쟻쑝濡 痢≪젙븳 떊泥댄솢룞 떊泥댄솢룞 媛냽룄 痢≪젙湲(GENEActiv; Activinsights, Kimbolton, UK)瑜 씠슜븯뿬 룊媛븯떎. GPAQ 50媛쒖쓽 援媛뿉꽌 궗슜븯怨 엳뒗 몴以솕맂 떊泥댄솢룞 痢≪젙 꽕臾몄濡 援궡뿉꽌룄 떦룄媛 寃利앸릺뿀떎14. 媛앷쟻쑝濡 떊泥댄솢룞쓣 痢≪젙븳 GENEActiv 痢≪젙湲곌린뒗 떊泥댄솢룞쓣 媛앷쟻쑝濡 痢≪젙븯湲 쐞빐 떦룄 諛 떊猶곕룄媛 寃利앸맂 媛냽룄怨꾩씠떎15. 떦븳 뜲씠꽣 遺꾩꽍 湲곗 7씪 以 10떆媛(600遺) 씠긽 李⑹슜븳 궇씠 3씪 씠긽씤 옄猷뚮쭔쓣 遺꾩꽍 옄猷뚮줈 꽑젙븯떎16.

슫룞뒫젰 諛 슫룞 以 삁뿭븰쟻 蹂씤 떖룓슫룞遺븯寃궗 옄猷뚮 넻빐 룊媛븯떎. 떖룓슫룞遺븯寃궗뒗 슫룞 以 긽옄쓽 삁뿭븰쟻 긽깭瑜 痢≪젙븯뒗 쑀씪븳 諛⑸쾿씠硫, 떖룓湲곕뒫 諛 궗湲곕뒫쓣 蹂븯硫 슫룞뒫젰쓣 룊媛븯뒗 솴湲덊몴以(gold standard)쑝濡 옒 븣젮졇 엳떎9. 蹂 뿰援ъ뿉꽌 떖룓슫룞遺븯寃궗뒗 Q-Stress TM55 듃젅뱶諛(Quinton Cardiology Systems, Inc., Bothell, WA, USA)怨 媛뒪遺꾩꽍湲(True One 2400; Parvo Medics, Salt Lake City, UT, USA)瑜 씠슜븯뿬 痢≪젙븯떎. 슫룞遺븯寃궗 痢≪젙봽濡쒓렇옩 닔젙맂 釉뚮(뒪 봽濡쒗넗肄(modified Bruce protocol)쓣 씠슜븯뿬 떎떆븯떎. 떖룓슫룞遺븯寃궗뿉꽌 삁뿭븰쟻 蹂씤 以 떖諛뺤닔 諛 삁븬 븞젙 떆 슫룞 以, 洹몃━怨 쉶蹂듦린뿉 痢≪젙븯뿬 룊媛븯떎. 쉶蹂 떆 떖諛뺤닔뒗 슫룞 以묒뿉 룄떖맂 理쒕 떖諛뺤닔뿉꽌 쉶蹂 1遺, 2遺꾨 떖諛뺤닔瑜 類 媛믪쑝濡 怨꾩궛븯怨, 떖諛뺤닔蹂룞遺쟾 吏닔(chronotropic incompetence index)뒗 떎쓬怨 媛숈 諛⑸쾿쑝濡 룊媛븯떎: 理쒕 떖諛뺤닔–븞젙 떆 떖諛뺤닔/(220–굹씠–븞젙 떆 떖諛뺤닔)×100)17. Peak VO2 諛 VE/VCO2뒗 슫룞 以묒뿉 痢≪젙븳 媛뒪 遺꾩꽍 옄猷뚮 넻빐 룊媛븯떎. 理쒕 떖룓슫룞遺븯寃궗 뙋떒 湲곗 슫룞 옄媛곷룄(rating of perceived exertion) Borg scale 17 씠긽 삉뒗 샇씉 援먰솚쑉(respiratory exchange ratio) 1.10 씠긽쑝濡 꽕젙븯뿬 씠뿉 遺빀븯뒗 옄猷뚮쭔쓣 痍⑦빀븯떎.

紐⑤뱺 옄猷뚮뒗 넻怨 泥섎━ 쟾 Kolmogorov-Smirnov test瑜 씠슜븯뿬 젙洹쒕텇룷 뿬遺瑜 寃넗븯쑝硫, 젙洹쒕텇룷瑜 씠猷⑥ 븡 蹂닔뱾 鍮꾨え닔 넻怨 泥섎━瑜 븯떎. 뿰냽蹂닔쓽 寃쎌슦 룊洹좉낵 몴以렪李(mean±standard deviation) 삉뒗 以묒븰媛믨낵 4遺꾩쐞 닔(median [interquartile range])濡, 踰붿<삎 蹂닔뒗 諛깅텇쑉(竊)濡 젣떆븯떎. 꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄 嫄닿컯 議곌뎔쓽 떊泥댄솢룞쓽 李⑥씠瑜 寃利앺븯湲 쐞빐 뿰냽蹂닔뒗 Mann-Whitney U 寃젙쓣 븯怨, 踰붿<삎 蹂닔뒗 移댁씠젣怨 寃젙쑝濡 遺꾩꽍븯떎. 삉 꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄 嫄닿컯 議곌뎔쓽 슫룞뒫젰 李⑥씠瑜 寃利앺븯湲 쐞빐 뿰냽蹂닔뒗 룆由 t-test瑜 넻빐 遺꾩꽍븯怨, 踰붿<삎 蹂닔뒗 移댁씠젣怨 寃젙쑝濡 寃利앺븯떎. 紐⑤뱺 넻怨 泥섎━뒗 IBM SPSS-PC version 25.0 (IBM Corp., Armonk, NY, USA)瑜 씠슜븯뿬 遺꾩꽍븯怨, 쑀쓽닔以(p) <0.05뿉꽌 寃젙븯떎.

寃 怨

1. 씤援ы넻怨꾩쟻 듅꽦

蹂 뿰援ъ쓽 李몄뿬븳 긽옄쓽 듅꽦 Table 1怨 媛숇떎. 꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄 嫄닿컯 議곌뎔쓽 씤援ы넻怨꾩쟻 듅꽦 以 뿰졊, 꽦蹂, 泥댁쭏웾吏닔뒗 李⑥씠媛 뾾뿀떎. 꽑泥쒖꽦 떖옣蹂 솚옄쓽 吏덈퀝 愿젴 듅꽦쑝濡쒕뒗 쁽옱 2/3 씠긽쓽 솚옄媛 1媛 씠긽쓽 빟쓣 蹂듭슜 以묒씠뿀뒗뜲, aspirin 怨꾩뿴 빟臾쇱씠 媛옣 留롪퀬(52.2%) 떎쓬쑝濡 angiotensin-converting enzyme inhibitor 삉뒗 angiotensin receptor blocker 怨꾩뿴 빟臾쇱쓣 留롮씠 蹂듭슜븯怨 엳뿀떎(43.5%). 吏덈퀝 遺꾨쪟뒗 simple 援(3紐), moderate 援(18紐), 洹몃━怨 complex 援(25紐)쑝濡 遺꾨쪟븯怨, Fontan (functional single ventricle) 떆닠쓣 븳 솚옄媛 18紐(39.1%)쑝濡 媛옣 留롮븯쑝硫, 몢 踰덉㎏濡 뙏濡 궗吏(tetralogy of Fallot) 솚옄媛 15紐(32.6%)쑝濡 鍮꾧탳쟻 留롮씠 룷븿릺뿀떎.

Table 1 . Participants characteristics (n=92)

CharacteristicAdult CHD (n=46)Healthy control (n=46)z/χ2p-value
Age (yr)20.6±1.321.2±1.6−1.8680.065
Sex
Male26 (56.5)24 (52.2)0.1750.834
Female20 (43.5)22 (47.8)
Weight (kg)59.2±12.563.1±11.0−1.5840.117
Body mass index (kg/m2)21.9±3.522.0±2.4−0.2210.826
Medications, yes31 (67.4)
No. of medications1.6±1.7
Aspirin24 (52.2)
β-blockers12 (26.1)
ACEI/ARB20 (43.5)
Diuretics5 (10.9)
Anticoagulant1 (2.2)
Left ventricle ejection fraction (%)60.7±8.1
Poor (<30)0 (0)
Mild decreased (30−50)8 (17.4)
Normal (>50)38 (82.6)
Arrhythmia, yes*1 (2.2)
Pacemaker1 (2.2)
Disease type
Simple (n=3)
Aortic valve stenosis1 (2.2)
Atrial septal defect1 (2.2)
Bicuspid aortic valve1 (2.2)
Moderate (n=18)
AVSD1 (2.2)
Coarctation of aorta1 (2.2)
Congenital coronary aneurysm1 (2.2)
Tetralogy of Fallot15 (32.6)
Complex (n=25)
DORV1 (2.2)
Fontan (functional single ventricle)18 (39.1)
PA with VSD4 (8.7)
Persistent truncus arteriosus2 (4.3)

Values are presented as mean±standard deviation or number (%) unless otherwise indicated.

CHD: congenital heart disease, ACEI: angiotensin-converting enzyme inhibitor, ARB: angiotensin receptor blocker, AVSD: atrioventricular septal defect, DORV: double outlet right ventricle, PA: pulmonary atresia, VSD: ventricular septal defect.

*Bradycardia, tachycardia that require treatment, or nonsustain badycardia, tachycardia.



2. 떊泥댄솢룞 鍮꾧탳

二쇨쟻 諛 媛앷쟻쑝濡 痢≪젙븳 以⋅怨좉컯룄 떊泥댄솢룞웾 꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄援곗씠 嫄닿컯 議곌뎔뿉 鍮꾪빐 궙 寃껋쑝濡 굹궗떎(p=0.004, p=0.008). 삉븳 媛앷쟻쑝濡 痢≪젙븳 떊泥댄솢룞뿉꽌 嫄닿컯 議곌뎔 떊泥댄솢룞 沅뚯옣湲곗(씪二쇱씪뿉 150遺 씠긽 以묆냽怨좉컯룄 떊泥댄솢룞쓣 븿)쓣 100% 異⑹”븯怨 엳뒗 諛섎㈃, 꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄뿉꽌뒗 84%留뚯씠 떊泥댄솢룞 沅뚯옣웾쓣 異⑹”븯怨 엳뿀떎(p=0.009) (Table 2, Fig. 1).

Table 2 . Comparison of physical activity variables between adults with CHD and healthy controls (n=92)

VariableAdult CHD (n=46)Healthy control (n=46)z/χ2p-value
Subjectively measured PA*
Total PA (METs-min/wk)1,240.0 (590.0−2,370.0)3,060.0 (1,530.0−4,230.0)−3.773<0.001
MVPA (METs-min/wk)800.0 (90.0−1,860.0)1,920.0 (960.0−3,270.0)−2.6600.008
Travel to and from places PA (METs-min/week)380.0 (105.0−610.0)760.0 (480.0−1,305.0)−3.723<0.001
Sedentary time (hr/day)8.5 (6.0−11.3)8.5 (6.0−12.0)−0.2160.829
Objectively measured PA
MVPA (min/day)70.5 (40.5−123.1)126.0 (96.0−154.1)−2.9050.004
Light PA (min/day)54.5 (34.6−69.7)53.2 (43.0−69.0)−0.4100.682
Sedentary time (min/day)638.9 (573.1−683.1)555.2 (490.8−619.2)7.6800.006
Recommendations for PA ≥150 min/wk
Active27 (84.4)46 (100)−2.6180.009
Inactive5 (15.6)0 (0)

Values are presented as median (interquartile range) or number (%) unless otherwise indicated.

CHD: congenital heart disease, PA: physical activity, MET: metabolic equivalent of task, MVPA: moderate to vigorous physical activity.

*Global Physical Activity Questionnaire; GENEActiv (Activinsights, Kimbolton, UK).


Fig. 1. Moderate to vigorous physical activity (MVPA) distribution among adults with congenital heart disease (CHD) and healty controls.

醫뚯떇깮솢 떆媛꾩 二쇨쟻쑝濡 痢≪젙븳 寃곌낵뿉꽌 몢 洹몃9 媛꾩뿉 李⑥씠媛 蹂댁씠吏 븡 諛섎㈃, 媛앷쟻쑝濡 痢≪젙븳 寃곌낵뿉꽌뒗 꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄媛 嫄닿컯 議곌뎔뿉 鍮꾪빐 븯猷 1떆媛 24遺 젙룄 뜑 留롮씠 븠븘 엳뒗 寃껋쑝濡 굹궗떎(10떆媛 39遺[9떆媛 33遺–11떆媛 23遺] vs. 9떆媛 15遺[8떆媛 10遺–10떆媛 19遺], p=0.006).

3. 삁뿭븰쟻 蹂씤 諛 슫룞뒫젰 鍮꾧탳

삁뿭븰쟻 蹂씤뱾 以 븞젙 떆 떖諛뺤닔뒗 꽑泥쒖꽦 떖옣蹂 솚옄援곗뿉꽌 嫄닿컯 議곌뎔뿉 鍮꾪빐 떎냼 넂寃 굹궗쑝굹(76.6±14.9 beats/min vs. 67.9±16.61 beats/min, p=0.010), 븞젙 떆 닔異뺢린 삁븬, 븞젙 떆 씠셿湲 삁븬, 슫룞 以 理쒕 씠셿湲 삁븬, 슫룞 썑 1遺, 2遺꾨 쉶蹂 떆 떖諛뺤닔뒗 몢 援 媛꾩쓽 李⑥씠媛 뾾뿀떎. 슫룞 以 理쒕 닔異뺢린 삁븬(152.5±23.2 mm Hg vs. 176.3±25.8 mm Hg, p<0.001), 理쒕 떖諛뺤닔(175.5±29.0 beats/min vs. 194.4±12.5 beats/min, p< 0.001), 뿬쑀 떖諛뺤닔(99.0±32.6 vs. 126.5±21.7, p<0.001) 諛 떖諛뺤닔蹂룞遺쟾 吏닔(87.5±27.6 vs. 94.9±16.3, p<0.001)뒗 꽑泥쒖꽦 떖옣蹂 솚옄援곗뿉꽌 嫄닿컯 議곌뎔뿉 鍮꾪빐 紐⑤몢 궙寃 굹궗떎. 븳렪, 꽑泥쒖꽦 떖옣蹂 솚옄뒗 VE/VCO2媛 嫄닿컯 議곌뎔뿉 鍮꾪빐 넂븯怨(33.1±5.3 vs. 27.2±4.3, p<0.001), 슫룞뒫젰(peak VO2) 嫄닿컯 議곌뎔뿉 鍮꾪빐 4.5 METs (15.9 mL/kg/min) 젙룄 궙寃 굹궗떎(30.8±8.2 mL/kg/min vs. 46.7±10.1 mL/kg/min, p<0.001) (Table 3).

Table 3 . Comparison of CPET variables between adults with congenital heart disease and healthy controls (n=92)

VariableAdult CHD (n=46)Healthy control (n=46)t/χ2p-value
Resting
HR (beats/min)76.6±14.967.9±16.612.6440.010
SBP (mm Hg)113.8±17.4113.1±12.40.2190.828
DBP (mm Hg)73.2±9.781.7±98.3−0.5450.587
Peak exercise
Peak predict VO2 (%)67.9±16.2105.0±18.2−10.235<0.001
Peak VO2 (L/min)1.8±0.73.0±1.0−6.825<0.001
Peak VO2 (mL/kg/min)30.8±8.246.7±10.1−8.261<0.001
Peak METs8.9±2.413.4±2.9−8.123<0.001
Peak RPE16.7±1.117.0±1.6−1.3240.191
Peak HR (beats/min)175.5±29.0194.4±12.5−4.046<0.001
Peak SBP (mm Hg)152.5±23.2176.3±25.8−4.662<0.001
Peak DBP (mm Hg)68.1±14.470.9±8.8−1.1110.270
Peak RER1.2±0.11.2±0.11.1180.267
VE/VCO233.1±5.327.2±4.35.812<0.001
Post exercise
ΔHRR 1 (min)20.7±7.223.5±9.9−1.5790.118
ΔHRR 2 (min)41.1±12.844.5±12.6−1.2450.216
Heart rate reserve99.0±32.6126.5±21.7−4.769<0.001
Chronotropic incompetence index87.5±27.694.9±16.3−7.348<0.001
CI <8015 (32.6)3 (6.5)9.9460.002
Total exercise time (sec)987.5±148.71,021.6±118.2−1.2120.229

Values are presented as mean±standard deviation or number (%) unless otherwise indicated.

CPET: cardiopulmonary exercise testing, HR; heart rate, SBP: systolic blood pressure, DBP: diastolic blood pressure, peak VO2: peak oxygen uptake, MET: metabolic equivalent of task, RPE: rating of perceived exertion, RER: respiratory exchange ratio, VE/VCO2: minute ventilation/minute carbon dioxide production, HRR: heart rate recovery, CI: chronotropic incompetence index ([peak heart rate−rest heart rate]/[220−age−rest heart rate]).


怨 李

꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄媛 利앷븯뒗 떆젏뿉꽌 닔닠쟻 以묒옱굹 빟臾쇱쟻 移섎즺 뜑遺덉뼱 삁썑뿉 쁺뼢쓣 誘몄튂뒗 떎뼇븳 슂냼뱾쓣 뙆븙븯뒗 寃껋 옣湲곗쟻씤 移섎즺 쟾왂쓣 寃곗젙븯뒗 뜲 以묒슂븯떎2. 씠뿉 蹂 뿰援щ뒗 꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄쓽 떊泥댄솢룞 닔以怨 슫룞뒫젰 젙룄瑜 뙆븙븯怨, 씠瑜 嫄닿컯 議곌뎔怨 鍮꾧탳븯뿬 꽑泥쒖꽦 떖옣蹂 솚옄쓽 삁썑뿉 쁺뼢쓣 誘몄튂뒗 슂냼뱾쓽 닔以쓣 궡렣蹂댁븯떎.

援궡 꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄쓽 떊泥댄솢룞 沅뚯옣웾 異⑹” 鍮꾩쑉씠 궙쓣 寃껋씠씪뒗 媛꽕怨쇰뒗 떎瑜닿쾶, 蹂 뿰援ш껐怨쇱뿉꽌 媛앷쟻쑝濡 痢≪젙븳 以묆냽怨좉컯룄 떊泥댄솢룞 李몄뿬 떆媛꾩 븯猷 빟 70遺꾩쑝濡 굹궗쑝硫, 84%쓽 솚옄뿉꽌 떊泥댄솢룞 沅뚯옣 湲곗쓣 異⑹”븯怨 엳뒗 寃껋쑝濡 굹궗떎. 씠윭븳 뿰援ш껐怨쇰뒗 5媛 瑜 15媛 굹씪 3,896紐낆쓽 꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄쓽 떊泥댄솢룞 沅뚯옣웾 異⑹” 鍮꾩쑉씠 빟 30% 젙룄씪怨 蹂닿퀬븳 뿰援щ낫떎 넂 닔以씠떎18. 洹몃윭굹 씪遺 꽑뻾 뿰援ъ뿉꽌뒗 꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄쓽 떊泥댄솢룞 沅뚯옣 湲곗 異⑹”瑜좎씠 寃곗퐫 궙吏 븡떎怨 蹂닿퀬븯怨 엳뒗뜲, Muller 벑6쓽 뿰援ъ뿉꽌 以묆냽怨좉컯룄 떊泥댄솢룞 닔以 븯猷 룊洹 59遺 젙룄씠硫, 76%쓽 솚옄뿉꽌 떊泥댄솢룞 沅뚯옣웾쓣 異⑹”븯뒗 떊泥댄솢룞 닔以쓣 蹂댁떎怨 븯떎. 삉 二쇨쟻 諛 媛앷쟻씤 諛⑸쾿쑝濡 떊泥댄솢룞쓣 痢≪젙븳 Larsson 벑7쓽 뿰援ъ뿉꽌룄 떊泥댄솢룞 沅뚯옣웾쓣 異⑹”븯뒗 鍮꾩쑉씠 71% 젙룄씪怨 蹂닿퀬븯떎. 援궡 19–29꽭쓽 씪諛 꽦씤뿉꽌 떊泥댄솢룞 沅뚯옣 湲곗쓣 異⑹”븯怨 엳뒗 鍮꾩쑉씠 63.8% 젙룄씪뒗 궗떎쓣 蹂 븣19 꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄뱾쓽 떊泥댄솢룞 沅뚯옣웾 異⑹” 鍮꾩쑉 삤엳젮 넂떎怨 蹂 닔 엳떎.

洹몃윭굹 꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄쓽 떊泥댄솢룞 닔以쓣 떊泥댄솢룞 沅뚯옣웾쓣 異⑹”븯뒗 鍮꾩쑉濡 궡렣蹂 寃곌낵뒗 떖由, 嫄닿컯 議곌뎔怨 떊泥댄솢룞웾쓣 鍮꾧탳븯쓣 븣뒗 떎瑜 뼇긽쓣 蹂댁떎. 蹂 뿰援ъ뿉꽌 媛뺣룄 떊泥댄솢룞 닔以 嫄닿컯 議곌뎔뿉 鍮꾪빐 겕寃 李⑥씠媛 뾾뒗 寃껋쑝濡 굹궗쑝굹, 二쇨쟻 諛 媛앷쟻쑝濡 痢≪젙븳 以⋅怨좉컯룄 떊泥댄솢룞웾 紐⑤몢 嫄닿컯 議곌뎔뿉 鍮꾪빐 빟 44%뿉꽌 58% 젙룄 궙 닔以쓣 蹂댁떎. 씠윭븳 蹂 뿰援ш껐怨쇰뒗 理쒓렐 援궡뿉꽌 떆뻾맂 꽑泥쒖꽦 떖옣蹂 솚옄 7,305紐낆쓽 닔닠 삁썑瑜 異붿쟻븳 議곗궗 뿰援 寃곌낵룄 씪移섑븳떎20. 긽湲 뿰援ъ뿉꽌 84紐낆쓽 꽦씤쓣 긽쑝濡 븳 뿰援ш껐怨쇱뿉꽌룄 怨좉컯룄쓽 寃⑸젹븳 떊泥댄솢룞 떎泥쒖쑉(理쒓렐 1二쇱씪 룞븞 룊냼蹂대떎 紐몄씠 留ㅼ슦 옒뱾嫄곕굹 닲씠 留롮씠 媛걶 寃⑸젹븳 떊泥댄솢룞쓣 1쉶 20遺 씠긽, 二 3씪 씠긽 떎泥) 20.2%, 以묐벑룄 떊泥댄솢룞 떎泥쒖쑉(理쒓렐 1二쇱씪 룞븞 룊냼蹂대떎 紐몄씠 議곌툑 옒뱾嫄곕굹 닲씠 빟媛 媛걶 以묐벑룄 떊泥댄솢룞쓣 1쉶 30遺 씠긽, 二 5씪 씠긽 떎泥) 8.6%濡 援궡 꽑泥쒖꽦 떖옣蹂 솚옄쓽 以묆냽怨좉컯룄 떊泥댄솢룞 떎泥쒖쑉씠 鍮꾧탳쟻 궙쓬쓣 蹂닿퀬븯떎. 씠뿉 諛섑빐, 씪遺 꽑뻾 뿰援ъ뿉꽌뒗 꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄쓽 以묆냽怨좉컯룄 떊泥댄솢룞 닔以씠 嫄닿컯 議곌뎔뿉 鍮꾪빐 겕寃 李⑥씠媛 뾾떎怨 蹂닿퀬븯湲곕룄 븯떎6.

꽑泥쒖꽦 떖옣蹂 솚옄쓽 떊泥댄솢룞 沅뚯옣웾 異⑹” 鍮꾩쑉怨 嫄닿컯 議곌뎔怨쇱쓽 떊泥댄솢룞웾쓣 鍮꾧탳븳 蹂 뿰援ш 씪遺 꽑뻾 뿰援ъ 遺덉씪移섑븳 寃곌낵媛 굹굹뒗 寃껋 떎뼇븳 썝씤쑝濡 遺꾩꽍븷 닔 엳떎. 遺遺꾩쓽 꽑뻾 뿰援ъ뿉꽌뒗 떎뼇븳 뿰졊쓽 꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄瑜 긽옄濡 룷븿븯쑝굹, 蹂 뿰援ъ뿉꽌뒗 20 珥덈컲쓽 꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄瑜 긽쑝濡 븯湲 븣臾몄뿉 씠뱾쓽 떊泥댄솢룞 沅뚯옣웾 異⑹” 鍮꾩쑉씠 긽쟻쑝濡 넂븯쓣 寃껋쑝濡 깮媛곷맂떎. 삉븳, 蹂 뿰援ъ쓽 嫄닿컯 議곌뎔 紐⑤몢 떊泥댄솢룞 沅뚯옣웾쓣 긽쉶븯뒗 떊泥댄솢룞씠 솢諛쒗븳 꽦씤씠뿀떎. 씠윭븳 씠쑀濡 씤빐 꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄쓽 二쇨쟻 諛 媛앷쟻쑝濡 痢≪젙븳 以⋅怨좉컯룄 떊泥댄솢룞웾 紐⑤몢媛 嫄닿컯 議곌뎔뿉 鍮꾪빐 겕寃 궙 닔以쓣 蹂댁쓣 寃껋씠떎. 뵲씪꽌 꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄뿉꽌 떊泥댄솢룞 沅뚯옣웾쓣 異⑹”븯뒗 鍮꾩쑉씠 鍮꾧탳쟻 궙吏 븡쑝硫, 嫄닿컯 議곌뎔뿉 鍮꾪빐 떊泥댄솢룞 닔以씠 궙떎뒗 寃곕줎쓣 궡由ш린媛 돺吏 븡떎. 異뷀썑 뿰援ъ뿉꽌 떎뼇븳 뿰졊쓽 꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄 씪諛섏쟻씤 떊泥댁쟻 듅꽦쓣 媛吏 議곌뎔쓣 긽쑝濡 떊猶고븷 닔 엳뒗 諛⑸쾿쑝濡 痢≪젙븳 떊泥댄솢룞웾쓣 넻빐 떊泥댄솢룞 젙룄瑜 鍮꾧탳븯뒗 뿰援ш 異붽쟻쑝濡 씠猷⑥뼱졇빞 븷 寃껋씠떎. 洹몃읆뿉룄 遺덇뎄븯怨 蹂 뿰援щ뒗 援궡 꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄瑜 긽쑝濡 二쇨쟻 諛 媛앷쟻씤 諛⑸쾿쑝濡 떊泥댄솢룞 닔以쓣 룞떆뿉 룊媛븯怨, 떊泥댄솢룞 沅뚯옣웾 異⑹” 쑀臾 鍮꾩쑉쓣 젣떆븯쑝硫, 떊泥댄솢룞 닔以쓣 議곌뎔怨 鍮꾧탳븯뿬 떎媛곷룄쓽 뿰援ш껐怨쇰 젣떆븳 泥 踰덉㎏ 뿰援щ씪뒗 痢〓㈃뿉꽌 쓽쓽瑜 媛吏 닔 엳쓣 寃껋씠떎.

븳렪 蹂 뿰援щ 넻빐 꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄쓽 떖룓슫룞遺븯寃궗쓽 삁뿭븰쟻 蹂씤 諛 슫룞뒫젰 닔以씠 嫄닿컯 議곌뎔怨 쑀쓽븳 李⑥씠媛 엳쓬쓣 븣寃 릺뿀떎. 癒쇱, 슫룞 쟾 痢≪젙맂 븞젙 떆 떖諛뺤닔뒗 꽑泥쒖꽦 떖옣蹂 솚옄援곗씠 嫄닿컯 議곌뎔뿉 鍮꾪빐 떎냼 넂븯떎. 븞젙 떆 떖諛뺤닔뒗 옄쑉떊寃쎄퀎 吏몴濡 쓷엳 궗슜릺誘濡 븞젙 떆 떖諛뺤닔媛 넂떎뒗 寃껋 꽑泥쒖꽦 떖옣蹂 솚옄뿉꽌 옄쑉떊寃쎄퀎 湲곕뒫씠 떎냼 媛먯냼릺뼱 엳떎뒗 寃껋쓣 븫떆븳떎. 씠윭븳 뿰援ш껐怨쇰뒗 꽑泥쒖꽦 떖옣蹂 솚옄뱾쓽 옄쑉떊寃쎄퀎 湲곕뒫씠 媛먯냼릺뼱 엳떎怨 蹂닿퀬븳 씪遺 꽑뻾 뿰援ъ 씪移섑븯뒗 뿰援ш껐怨쇱씠떎10. 씠뿉 諛섑빐 슫룞 以 룄떖븳 理쒕 떖諛뺤닔뒗 꽑泥쒖꽦 떖옣蹂 솚옄媛 嫄닿컯 議곌뎔뿉 鍮꾪빐 궙 寃껋쑝濡 굹궗떎. 씪諛섏쟻쑝濡 슫룞 以 떖諛뺤닔 諛섏쓳 슫룞웾씠 利앷븿뿉 뵲씪 鍮꾨쟻쑝濡 利앷븯吏留, 슫룞웾씠 利앷븿뿉룄 遺덇뎄븯怨 젙긽쟻쑝濡 떖諛뺤닔媛 利앷븯吏 紐삵븯뒗 쁽긽쓣 떖諛뺤닔蹂룞遺쟾(chronotropic incompetence)씠씪 븳떎. 떖諛뺤닔蹂룞遺쟾 슫룞 以 굹씠뿉 뵲씪 삁긽릺뒗 理쒕 떖諛뺤닔(220–굹씠)쓽 80% 닔以뿉 룄떖븯吏 紐삵븳 긽깭濡 젙쓽븳떎17. 蹂 뿰援ъ뿉꽌 꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄쓽 슫룞 以 떖諛뺤닔蹂룞遺쟾 鍮꾩쑉씠 32.6%濡 嫄닿컯 議곌뎔쓽 6.5%蹂대떎 넂寃 굹궗떎. 씠윭븳 寃곌낵뒗 꽑泥쒖꽦 떖옣蹂 솚옄뿉 엳뼱 떖諛뺤닔蹂룞遺쟾 鍮꾩쑉씠 씪諛 議곌뎔뿉 鍮꾪빐 넂떎怨 蹂닿퀬븳 꽑뻾 뿰援ъ 씪移섑븯뒗 寃곌낵씠떎21. 꽑泥쒖꽦 떖옣蹂 솚옄뿉꽌 떖諛뺤닔蹂룞遺쟾씠 굹굹뒗 湲곗쟾뿉 빐꽌뒗 紐낇솗븯寃 諛앺졇 엳吏 븡吏留, 떖옣쓽 援ъ“쟻 씠긽怨 닔닠濡 씤븳 룞諛⑷껐젅(sinoatrial node)쓽 넀긽10쑝濡 옄쑉떊寃쎄퀎 씠긽 삉뒗 떆깄뒪 븯遺쓽 踰좏 븘뱶젅궇由 닔슜泥닿 깉媛먭컖솕릺뼱22 굹굹뒗 寃껋쑝濡 븣젮졇 엳떎. 留롮 뿰援ъ뿉꽌 슫룞 以 鍮꾩젙긽쟻씤 떖諛뺤닔 諛섏쓳 꽑泥쒖꽦 떖옣蹂 솚옄쓽 삁썑뿉 遺젙쟻씤 슂냼濡 옉슜븳떎怨 蹂닿퀬븯怨 엳쑝誘濡23, 떖諛뺤닔蹂룞遺쟾쓽 湲곗쟾쓣 紐낇솗븯寃 諛앺엳怨 씠瑜 媛쒖꽑떆궎뒗 移섎즺 쟾왂쓣 꽭슱 븘슂媛 엳떎.

씪諛섏쟻쑝濡 슫룞 떆 닔異뺢린 삁븬 슫룞웾씠 利앷븿뿉 뵲씪 鍮꾨쟻쑝濡 긽듅븯怨, 씠셿湲 삁븬 鍮꾧탳쟻 蹂솕媛 뾾嫄곕굹 빟媛 媛먯냼븯뒗 寃껋씠 젙긽쟻씤 삁뿭븰쟻 諛섏쓳씠떎. 洹몃윭굹 蹂 뿰援ъ뿉꽌 꽑泥쒖꽦 떖옣蹂 솚옄쓽 理쒕 닔異뺢린 삁븬 嫄닿컯 議곌뎔뿉 鍮꾪빐 궙 寃껋쑝濡 굹궗떎. 씠윭븳 寃곌낵뒗 꽑泥쒖꽦 떖옣蹂 솚옄쓽 슫룞 以 理쒕 닔異뺢린 삁븬씠 嫄닿컯 議곌뎔뿉 鍮꾪빐 궙떎怨 蹂닿퀬븳 Ohuchi 벑10쓽 뿰援ъ 씪移섑븳떎. 씪諛섏쟻쑝濡 슫룞 닔뻾 떆뿉뒗 怨④꺽洹쇱쑝濡쒖쓽 삁븸닚솚쓣 利앷떆궎湲 쐞빐 떖諛뺤텧웾씠 利앷릺뼱빞 븯硫 씠뒗 닔異뺢린 삁븬 긽듅쓣 룞諛섑븳떎. 洹몃윭굹 꽑泥쒖꽦 떖옣蹂 솚옄쓽 寃쎌슦 떖옣湲곕뒫 遺吏꾩쑝濡 떖옣洹쇱뿉꽌 異⑸텇엳 諛뺤텧븯湲곌 뼱젮썙 슫룞 以 닔異뺢린 삁븬 긽듅씠 몦솕릺뼱 굹궃 寃껋쑝濡 蹂 닔 엳떎.

떖룓슫룞遺븯寃궗瑜 넻빐 痢≪젙맂 以묒슂븳 샇씉吏몴씤 VE/ VCO2뒗 꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄媛 嫄닿컯 議곌뎔뿉 鍮꾪빐 넂 寃껋쑝濡 굹궗떎. VE/VCO2뒗 씠궛솕깂냼 1 mol 諛곗텧뿉 븘슂븳 솚湲곕웾쑝濡 솚湲곗쓽 슚쑉꽦뿉 븳 痢≪젙吏몴씠떎. 씪諛섏쟻쑝濡 슫룞 以 씠궛솕깂냼 깮궛웾씠 利앷븯硫댁꽌 샇씉웾씠 利앷븯誘濡 VE/VCO2 slope뒗 꽑삎쟻쑝濡 利앷븯寃 맂떎. 깮꽦맂 씠궛솕깂냼뒗 룓닚솚쓣 넻빐 젣嫄곕릺뼱빞 븯吏留 꽑泥쒖꽦 떖옣蹂 솚옄쓽 寃쎌슦 룓瑜 嫄곗퀜 떖옣쑝濡 삁븸쓣 닚솚떆궗 닔 엳뒗 떖떎씠 뾾뒗 湲곕뒫쟻 떒떖떎 솚옄굹 룓삁愿 슦쉶닠쓣 떎떆븳 寃쎌슦 룓 삁瑜 젣븳씠 솚湲곗 愿瑜섏쓽 遺덉씪移섎 빞湲곗떆耳 VE/VCO2 slope媛 媛뙆瑜닿쾶 닔吏 긽듅븯寃 맂떎24. 삉븳 꽑泥쒖꽦 떖옣蹂 솚옄쓽 寃쎌슦 쓨怨⑥젅媛쒖닠 씠썑 쓨怨 넻利앹쑝濡 샇씉씠 뼍븘吏뒗 寃쎌슦룄 VE/VCO2 slope媛 긽듅븯뒗뜲, 씠뒗 씉湲곗뿉 쓽빐 룓룷媛 異⑸텇엳 솗옣릺湲 쟾뿉 샇湲곌 떆옉릺誘濡 媛뒪 援먰솚쑉씠 굹鍮 씪젙븳 씠궛솕깂냼瑜 젣嫄고븯湲 쐞빐 떎웾쓽 솚湲곌 븘슂븯湲 븣臾몄씠떎25.

슫룞뒫젰(peak VO2) 嫄닿컯븳 궗엺肉먮쭔 븘땲씪 꽑泥쒖꽦 떖옣蹂 솚옄뿉꽌 떖룓湲곕뒫쓣 룊媛븯湲 쐞븳 솴湲덊몴以쑝濡 꼸由 궗슜릺怨 엳떎. 슫룞뒫젰쓽 吏몴씤 peak VO2뒗 議곌린 궗留앹쓣 삁痢≫븯뒗 媛뺣젰븳 쐞뿕 씤옄濡 젣떆릺怨 엳떎21. 꽑뻾 뿰援ъ뿉꽌 꽑泥쒖꽦 떖옣蹂 솚옄쓽 슫룞뒫젰 닔닠 썑 삁뿭븰쟻 臾몄젣媛 뿬쟾엳 궓븘 엳怨 吏냽쟻씤 寃궗 諛 쓽븰쟻 以묒옱 닾빟쓣 諛쏄퀬 엳뒗 솚옄肉 븘땲씪 닔닠 썑 쓽븰쟻 臾몄젣媛 뾾怨 씪긽깮솢뿉 쟾 젣븳씠 뾾뒗 솚옄뿉 씠瑜닿린源뚯 紐⑤몢 궙 寃껋쑝濡 蹂닿퀬릺怨 엳떎. 꽑泥쒖꽦 떖옣蹂 솚옄 770紐낃낵 嫄닿컯 議곌뎔 754紐낆씠 룷븿맂 25媛쒖쓽 끉臾몄쓣 怨좎같븳 Schaan 벑26쓽 뿰援ъ뿉꽌뒗 꽑泥쒖꽦 떖옣蹂 솚옄쓽 슫룞뒫젰 9.3 mL/kg/min (95% 떊猶곌뎄媛, –12.5 to –6.1) 젙룄 궙떎怨 蹂닿퀬븯떎. 蹂 뿰援ъ뿉꽌룄 꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄쓽 슫룞뒫젰 嫄닿컯 議곌뎔뿉 鍮꾪빐 궙븯쑝誘濡 씠윭븳 寃곌낵뒗 꽑뻾 뿰援ъ쓽 뿰援ш껐怨쇰 뮮諛쏆묠븳떎怨 븷 닔 엳떎. 洹몃윭굹 蹂 뿰援ъ뿉꽌뒗 꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄쓽 슫룞뒫젰씠 嫄닿컯 議곌뎔뿉 鍮꾪빐 15.9 mL/kg/min (95% 떊猶곌뎄媛, –19.8 to –12.1) 젙룄 궙븯쑝硫, 듅엳 뿰졊 湲곗 삁痢 peak VO2 룄떖 닔以씠 꽑泥쒖꽦 떖옣蹂 솚옄쓽 寃쎌슦 68%濡 嫄닿컯 議곌뎔 105%뿉 鍮꾪빐 겕寃 궙寃 굹궗떎. 꽑뻾 뿰援ъ 떖由 蹂 뿰援ъ뿉꽌 몢 吏묐떒 媛꾩쓽 슫룞뒫젰씠 겕寃 李⑥씠媛 굹궃 씠쑀뒗 泥レ㎏, 꽑뻾 뿰援ъ 蹂 뿰援ъ쓽 긽옄 뿰졊 李⑥씠 븣臾몄쑝濡 蹂 닔 엳떎. 몮吏, 蹂 뿰援ъ쓽 嫄닿컯 議곌뎔 以묆냽怨좉컯룄 떊泥댄솢룞 沅뚯옣웾쓣 100% 異⑹”븯怨 엳쑝誘濡, 떎瑜 뿰援ъ뿉 鍮꾪빐 떊泥댄솢룞씠 留롮 洹몃9씠씪뒗 젏룄 씠윭븳 寃곌낵뿉 쁺뼢쓣 誘몄낀쓣 닔 엳떎. 留롮 슫룞以묒옱 뿰援ъ뿉꽌 以묆냽怨좉컯룄 쑀궛냼 슫룞쓣 넻빐 꽑泥쒖꽦 떖옣蹂 솚옄쓽 슫룞뒫젰씠 뼢긽맂떎怨 蹂닿퀬븯怨 엳뼱, 蹂 뿰援ъ뿉꽌 굹궃 以묆냽怨좉컯룄쓽 떊泥댄솢룞쓽 李⑥씠媛 슫룞뒫젰 李⑥씠뿉 쁺뼢쓣 誘몄낀쓣 媛뒫꽦쓣 諛곗젣븷 닔 뾾떎. 뵲씪꽌 꽑泥쒖꽦 떖옣蹂 솚옄쓽 궙 슫룞뒫젰 留뚯꽦쟻쑝濡 궙 떖諛뺤텧웾, 泥깋利, 洹쇨낏寃⑷퀎 씠긽, 씠쟾쓽 닔닠, 떊寃 씤吏쟻 寃곗넀 벑怨 愿젴27씠 엳湲곕룄 븯吏留, 룊냼 怨쇰낫샇 벑쑝濡 씤븳 怨좉컯룄 떊泥댄솢룞쓣 젣븳븯뒗 깮솢 뒿愿怨쇰룄 愿젴꽦씠 엳쓣 닔 엳떎.

蹂 뿰援щ뒗 떎쓬怨 媛숈 젣븳젏쓣 媛吏怨 엳떎. 泥レ㎏, 긽옄 꽑젙뿉꽌 臾댁옉쐞몴吏 諛⑸쾿쑝濡 몴吏묓븯吏 紐삵븯怨 씪媛 蹂묒썝쓽 쇅옒 솚옄 씪媛 븰쓽 븰깮쓣 긽쑝濡 몴吏묓븯쑝誘濡 꽑깮렪뼢(selection bias)씠 議댁옱븷 媛뒫꽦쓣 諛곗젣븷 닔 뾾쑝硫, 씠 븣臾몄뿉 쟾泥 꽑泥쒖꽦 떖옣蹂 솚옄 嫄닿컯 議곌뎔쓣 몴븷 닔 뾾뒗 젣븳젏씠 엳떎. 몮吏, 蹂 뿰援ъ쓽 嫄닿컯 議곌뎔 怨듦컻 怨듦퀬瑜 넻빐 紐⑥쭛븯쑝굹 떊泥댄솢룞 닔以씠 鍮꾧탳쟻 넂 吏묐떒쑝濡 援ъ꽦맂 젣븳젏씠 엳떎.

씠윭븳 젣븳젏뿉룄 遺덇뎄븯怨 蹂 뿰援щ뒗 援궡 꽦씤 꽑泥쒖꽦 떖옣蹂 솚옄瑜 긽쑝濡 二쇨쟻 諛 媛앷쟻씤 諛⑸쾿쑝濡 떊泥댄솢룞 닔以쓣 룞떆뿉 룊媛븯怨, 떊泥댄솢룞 沅뚯옣웾 異⑹” 쑀臾 鍮꾩쑉쓣 젣떆븯쑝硫, 떊泥댄솢룞 닔以 諛 슫룞뒫젰쓣 嫄닿컯 議곌뎔怨 鍮꾧탳븳 泥 踰덉㎏ 뿰援щ씪뒗 痢〓㈃뿉꽌 쓽쓽瑜 媛吏 닔 엳쓣 寃껋씠떎.

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Author Contributions

Methodology: JKY. Funding acquisition: SHK. Writing–original draft: HJK. Writing–review & editing: SYJ.

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