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Systematic Review and Meta-analysis of Exercise for the Prevention of Musculoskeletal Injuries in Soldiers
Korean J Sports Med 2024;42:1-11
Published online March 1, 2024;  https://doi.org/10.5763/kjsm.2024.42.1.1
© 2024 The Korean Society of Sports Medicine.

Hoyong Sung1, Geon Hui Kim2, On Lee3, Jaewoo Kim1, Kyoung Bae Kim1, Hyo Youl Moon4, Yeon Soo Kim4,5

1Department of Physical Education, Korea Military Academy, Seoul, 2Department of Aero Fitness, Korea Air Force Academy, Cheongju, 3Korea Institute of Sport Science, Seoul, 4Department of Physical Education, Seoul National University, Seoul, 5Institute of Sport Science, Seoul National University, Seoul, Korea
Correspondence to: Yeon Soo Kim
Department of Physical Education, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Korea
Tel: +82-2-880-7794, Fax: +82-2-872-2867, E-mail: kys0101@snu.ac.kr
Received November 22, 2023; Revised January 13, 2024; Accepted January 23, 2024.
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: This study aimed to conduct a systematic literature review and meta-analysis of the exercise intervention effects for the prevention of musculoskeletal injuries in military personnel.
Methods: Among studies that included military personnel as participants, we identified randomized controlled trials (RCTs) and cluster-RCT studies that used exercise interventions as a method for injury prevention. Exercise encompassed all types of physical activity, and the effect size was determined by the ratio of injuries between groups. Literature searches were conducted with search terms modified to ensure common inclusion of keywords such as “Soldier,” “Injury prevention,” and “Exercise.” For the analysis of potential factors, variables selected for group differentiation included gender, risk of bias, exercise volume, injury location, exercise type, and study design.
Results: Among a total of 8,598 search results, 10 papers were finally confirmed. The meta-analysis of all 10 papers showed that there was no statistically significant injury prevention effect, and significant heterogeneity was observed among the studies (incidence rate ratio, 0.82; 95% confidence interval, 0.62–1.09, I2=83%). Subgroup analysis revealed a significant 44% reduction in injuries in studies where exercise volume for injury prevention was relatively high. However, no significant injury prevention effects were observed in other potential factors between groups.
Conclusion: The results of this study suggest that the effectiveness of injury prevention exercises in military settings was not statistically significant. However, through the analysis of potential factors, it was confirmed that increasing the time spent on injury prevention exercises may have a preventive effect on injuries.
Keywords : Exercise, Wounds and injuries, Military personnel, Public health, Meta-analysis
꽌 濡

援곗씤뱾쓽 遺긽 삁諛⑹ 쟾닾뿉 以鍮꾨릺뼱 엳뒗 蹂묐젰 쑀吏瑜 쐞빐 以묒슂븯떎. 2019뀈, 븳援援 蹂묒썝 엯썝 吏꾨즺(쇅옒 吏꾨즺)뒗 궓援 36,079嫄(1,577,575), 뿬援 352嫄(46,842)씠뿀떎1. 븳援 援곗씤뱾쓽 誘쇨컙 諛 援 蹂묒썝 엯썝 쇅옒 吏꾨즺 媛꾨쓽 寃쎌슦瑜 젣쇅븯怨 2015뀈 69,479嫄댁뿉꽌 2019뀈 72,523嫄댁쑝濡 뒛뼱궗떎. 誘쇨컙 쐞긽 吏꾨즺 슏닔룄 2015뀈 3,939嫄댁뿉꽌 2019뀈 4,589嫄댁쑝濡 뒛뼱궗떎1. 鍮꾩슜쟻쑝濡쒕뒗 2015뀈 빟 514뼲 썝뿉꽌 2019뀈 빟 805뼲 썝쑝濡 빟 300뼲 썝 젙룄쓽 援媛 嫄닿컯蹂댄뿕 遺떞븸씠 利앷븯떎1. 븳援援 쁽뿭蹂 옄썝 2015뀈 328,974紐낆뿉꽌 2019뀈 263,338紐낆쑝濡 빟 6留뚯뿬 紐낆씠 異뺤냼릺뿀쓬뿉룄 吏꾨즺 슏닔뒗 뒛뼱궗떎2,3.

쑁援곗궗愿븰援 깮룄 긽 1뀈媛 諛쒖깮븳 洹쇨낏寃⑷퀎 吏덊솚 꽕臾몄뿉꽌 862紐낆쓽 깮룄 以 30.2% (260紐)媛 援곗궗썕젴 諛 泥대젰 떒젴쑝濡 씤빐 쟻뼱룄 1쉶 씠긽 遺긽 寃쏀뿕씠 엳뿀떎4. 遺긽 遺쐞濡쒕뒗 諛쒕ぉ怨 臾대쫷씠 빟 50% 젙룄 李⑥븯怨, 遺긽 쑀삎쑝濡쒕뒗 씤 諛 嫄 뿼醫뚭 57%, 洹쇱쑁 諛뺤긽씠 15.2%瑜 李⑥븯떎4. Chang 벑5 2뀈媛 빐뼇쓽猷뚯썝 젙삎쇅怨 솚옄 湲곕줉쓣 넻빐 엯썝솚옄 741紐낆쓽 洹쇨낏寃⑷퀎 遺긽쓣 遺꾩꽍븯떎. 뒪룷痢 솢룞쑝濡 엯썝븳 寃껋씠 39.8%濡 二쇱슂 씠쑀怨 뾽臾(27.9%), 泥대젰 떒젴(21.1%) 닚쑝濡 鍮꾩쑉씠 넂븯떎. 臾대쫷怨 諛쒕ぉ씠 媛곴컖 29.7%, 25.5%濡 媛옣 留롮씠 諛쒖깮븳 遺긽 遺쐞뒗뜲 Kim 벑4쓽 寃곌낵 쑀궗뻽떎.

듅젙 湲곌컙 븳援援곗뿉꽌 諛쒖깮븳 珥 23,687紐낆쓽 怨⑥젅 솚옄瑜 遺꾩꽍븳 뿰援ъ뿉꽌뒗, 援 蹂묐젰 빟 60留 紐낆쓣 湲곗쑝濡 뻽쓣 븣 1뀈媛 1,000紐 以(1,000 person-year) 궓옄媛 12.96紐, 洹몃━怨 뿬옄媛 0.19紐낆쓽 怨⑥젅 諛쒖깮 鍮꾩쑉쓣 蹂댁떎6. 媛옣 留롮 遺쐞媛 넀(8.38紐)씠뿀怨 洹 떎쓬쑝濡 諛(3.91紐), 븯吏(3.33紐) 닚쑝濡 넂븯떎6.

븳援援 꽑뻾뿰援ъ 誘멸뎔 遺긽뿭븰 옄猷뚮 李멸퀬뻽쓣 븣, 쟾諛섏쟻쑝濡 援곗씤 二쇰줈 洹쇨낏寃⑷퀎 遺긽쓣 떦븳떎7,8. 援곗씤 遺긽 삁諛⑹뿉 븳 泥닿퀎쟻 臾명뿄怨좎같 뿰援ъ뿉꽌뒗 怨쇳썕젴쓣 諛⑹븯뒗 寃껋씠 媛옣 슚怨쇱쟻씠怨 愿젴 꽑뻾뿰援ш 留롮븘 利앷굅 닔以씠 넂 삁諛 쟾왂쑝濡 異붿쿇븯怨, 떎諛⑺뼢꽦쓽 洹 떊寃(neuromuscular) 諛 怨좎쑀 닔슜꽦(proprioception) 誘쇱꺽꽦 듃젅씠떇쓣 떎쓬쑝濡 異붿쿇븯떎9.

Wardle怨 Greeves10쓽 泥닿퀎쟻 臾명뿄怨좎같 뿰援ъ뿉꽌뒗 泥대젰 뼢긽, 吏쐶愿 씤떇 蹂솕, 떊泥 솢룞웾 媛먯냼瑜 슚怨쇱쟻씤 遺긽 삁諛⑸쾿쑝濡 媛뺤“븯쑝硫, 泥대젰 떒젴쓣 넻빐 遺긽쓣 삁諛⑺븯뒗 뿰援щ뱾씠 꽌濡 씪愿릺吏 븡 寃곌낵瑜 蹂댁씠誘濡 異붽쟻씤 뿰援ш 븘슂븯떎怨 뼵湲됲븯떎.

븵꽌 젣떆맂 泥닿퀎쟻 臾명뿄怨좎같 뿰援ъ뿉꽌 紐⑤뱺 媛뒫븳 遺긽 삁諛 諛⑸쾿뿉 빐 떎琉섎떎硫, 理쒓렐 諛쒓컙맂 泥닿퀎쟻 臾명뿄怨좎같 諛 硫뷀 遺꾩꽍 뿰援ъ뿉꽌뒗 洹쇨낏寃⑷퀎 遺긽 쐞뿕쓣 삁諛⑺븯湲 쐞븳 슫룞 봽濡쒓렇옩쓽 슚怨쇱뿉 愿빐꽌 궡렣蹂댁븯떎11. 빐떦 뿰援ъ뿉꽌뒗 3媛쒖쓽 뒪듃젅移 슫룞 뿰援щ쭔쑝濡 硫뷀 遺꾩꽍쓣 떎떆븯쑝굹 쑀쓽븯吏 븡븯떎(relative risk, 0.93, 95% confidence interval [CI], 0.79–1.09). 삉븳 뒪듃젅移 諛⑸쾿 쇅 떎瑜 슫룞쓣 쟻슜븳 뿰援ъ쓽 遺긽 삁諛 슚怨쇱뿉 빐꽌뒗 슫룞 諛⑸쾿蹂꾨줈 왂쟻씤 꽕紐낅쭔 엳쓣 肉, 뵾뿕옄 듅꽦, 뿰援 솚寃, 슫룞 媛뺣룄, 슫룞 鍮덈룄 벑 遺긽 삁諛 슚怨쇱뿉 誘몄튌 닔 엳뒗 옞옱쟻 슂씤뱾뿉 빐꽌 꽭遺쟻쑝濡 遺꾩꽍븯吏뒗 븡븯떎. 삉븳 臾댁옉쐞 議곗뿰援(randomized controlled trial, RCT)留 議곗궗븯뒗뜲, 援 듅꽦긽 援 솚寃쎌뿉꽌쓽 遺긽뿰援ъ뿉꽌 洹몃9쓣 臾댁옉쐞濡 諛곗튂븯湲곌 뼱졄湲 븣臾몄뿉 臾댁옉쐞 諛곗튂맂 뿰援ш 븘땶 寃껊룄 룷븿븯뿬 遺꾩꽍빐 蹂 븘슂媛 엳떎.

슫룞쓣 넻븳 遺긽 삁諛⑹ 떎瑜 諛⑸쾿뿉 鍮꾪빐 떆媛꾧낵 鍮꾩슜씠 쟻寃 뱾뼱 쁽떎쟻쑝濡 븳援 援 솚寃쎌뿉꽌 利됯컖쟻씤 쟻슜씠 슜씠븳 諛⑸쾿씠떎. 쁽옱源뚯 援 遺긽 삁諛⑹쓣 쐞븳 슫룞쓽 슚怨쇱 愿젴맂 泥닿퀎쟻 臾명뿄怨좎같 諛 硫뷀 遺꾩꽍 뿰援ш 遺議깊븯硫, 遺긽 삁諛⑹쓣 쐞븳 슫룞쓽 슚怨쇱 愿젴맂 泥닿퀎쟻 臾명뿄怨좎같 諛 硫뷀 遺꾩꽍 뿰援щ뒗 嫄곗쓽 뾾뒗 떎젙씠떎. 蹂 뿰援ъ쓽 紐⑹쟻 泥닿퀎쟻 臾명뿄怨좎같 諛 硫뷀 遺꾩꽍쓣 쟻슜빐 슫룞쓣 넻븳 遺긽 삁諛 諛⑸쾿쓽 슚怨쇰 솗씤븯怨 슚怨쇱뿉 誘몄튌 닔 엳뒗 옞옱 슂씤뱾쓽 쁺뼢쓣 遺꾩꽍븯뒗 寃껋씠떎.

뿰援 諛⑸쾿

泥닿퀎쟻 臾명뿄怨좎같 PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) 吏移⑥쓣 以닔븯떎12. 蹂 뿰援щ 쐞븳 끉臾 寃넗 봽濡쒗넗肄쒖 PROSPERO (International Prospective Register of Systematic Reviews; CRD42021271757)뿉 벑濡앸릺뿀떎.

1. 臾명뿄 꽑깮 湲곗

臾명뿄 꽑깮 PICOS (Participants, Intervention, Control, Outcome, Study design)瑜 湲곗쑝濡 븯떎. 뿰援 긽옄(participants)뒗 紐⑤뱺 援곗씤 諛 깮룄瑜 룷븿븯떎. 遺긽 삁諛 봽濡쒓렇옩(intervention) 紐⑤뱺 삎깭쓽 슫룞쓣 룷븿븯떎. 遺긽 삁諛 紐⑹쟻쑝濡 援ъ꽦맂 썙諛띿뾽, 뒪듃젅移, 洹 떊寃, 誘쇱꺽꽦, 洹쇰젰, 怨좎쑀 닔슜꽦 媛먭컖 듃젅씠떇, 蹂듯빀 슫룞怨 媛숈 쑀삎쓽 슫룞쓣 紐⑤몢 룷븿븯떎. 봽濡쒓렇옩 以묒옱뒗 썕젴 쟾 삉뒗 썕젴 以 벑쓽 떆媛 닚꽌뿉 愿怨꾩뾾씠 紐⑤몢 룷븿븯떎. 蹂꾨룄쓽 슫룞쓣 븯吏 븡 洹몃9, 吏냽쟻쑝濡 빐삤怨 엳뜕 諛⑹떇쓽 슫룞쓣 븳 洹몃9(usual care, standard exercise), 遺긽 삁諛⑹뿉 쁺뼢쓣 誘몄튂吏 븡쓣 닔 엳뒗 떎瑜 遺쐞쓽 슫룞(masking group)怨 媛숈 紐⑤뱺 寃쎌슦瑜 鍮꾧탳 洹몃9(control group)쑝濡 룷븿븯떎. 二쇱슂 寃곌낵(outcome)뒗 꽕臾몄쑝濡 議곗궗릺뿀嫄곕굹 쟾臾 쓽猷뚯쭊뿉寃 吏꾨떒諛쏅뒗 삎떇 벑 紐⑤뱺 諛⑸쾿쓣 넻빐 쉷뱷븳 遺긽 젙蹂대 룷븿븯떎. 蹂 뿰援ъ쓽 슚怨 겕湲곗씤 遺긽 鍮꾩쑉쓽 鍮(incidence rate ratio, IRR)瑜 怨꾩궛븷 닔 엳뒗 뿰援щ뱾쓣 紐⑤몢 룷븿븯떎. IRR쓣 怨꾩궛븷 닔 뾾쓣 寃쎌슦뿉뒗 빐떦 뿰援 옄뱾뿉寃 뿰씫븯怨, 뜲씠꽣瑜 솗蹂댄븷 닔 엳뒗 끉臾몃뱾留 룷븿븯떎. IRR 怨꾩궛쓣 쐞빐꽌 媛 洹몃9蹂 쟾泥 遺긽 슏닔媛 젣떆릺뿀嫄곕굹 怨꾩궛븷 닔 엳뒗 젙蹂닿 룷븿맂 뿰援щ뱾쓣 遺꾩꽍븯떎. 삉븳 媛 洹몃9蹂 理쒖쥌 遺꾩꽍뿉 궗슜맂 씤썝닔 썕젴 끂異쒖떆媛꾩씠 紐낆떆맂 뿰援щ뱾쓣 룷븿븯떎. 媛 洹몃9蹂 遺긽 슏닔뿉꽌 썕젴 끂異 떆媛꾧낵 씤썝닔쓽 怨(person-month)쓣 굹늻뼱 怨꾩궛븳 媛 洹몃9蹂 鍮꾩쑉(incidence rate, IR)怨 IR쓣 洹몃9媛 꽌濡 굹늻뼱 怨꾩궛븳 IRR씠 吏곸젒 젣떆맂 뿰援щ뱾룄 紐⑤몢 遺꾩꽍뿉 룷븿릺뿀떎. 뿰援 뵒옄씤(study design) 쟾뼢쟻쑝濡 꽕怨꾪븯쑝硫, 鍮꾧탳 긽씠 議댁옱븯怨 以묒옱媛 룷븿맂 삎깭쓽 RCT 諛 cluster-RCT 뿰援щ뱾쓣 紐⑤몢 룷븿븯떎. 삉븳 援 솚寃 듅꽦긽 셿쟾븳 臾댁옉쐞 諛곗젙씠 뼱졄湲 븣臾몄뿉 quasi-RCT 뿰援щ뱾룄 룷븿븯뿬 遺꾩꽍븯떎. 쁺뼱濡 벐뿬吏 끉臾몃쭔 룷븿븯쑝硫 珥덈줉, 븰쉶 諛쒗몴 蹂닿퀬꽌 벑怨 媛숈씠 룞猷뚯떖궗(peer review)瑜 嫄곗튂吏 븡 끉臾몃뱾 젣쇅븯떎.

2. 臾명뿄 寃깋 諛 꽑깮 諛⑸쾿

臾명뿄 寃깋 諛 꽑깮 諛⑸쾿 Cochrane 吏移⑥쓣 李멸퀬븯떎13. 癒쇱 2紐낆쓽 뿰援ъ옄(HS, GHK)媛 寃깋븳 끉臾몄쓽 젣紐 諛 珥덈줉쓣 솗씤븯뿬 臾명뿄 꽑깮 湲곗뿉 쓽빐 옞옱쟻쑝濡 룷븿 媛뒫븳 끉臾몄쓣 꽑蹂꾪븯怨, 씠 怨쇱젙뿉꽌 젣紐 諛 珥덈줉쑝濡쒕쭔 꽑蹂꾪븯湲 뼱젮슫 寃쎌슦 쟾泥 蹂몃Ц 궡슜쓣 솗씤븯떎. 빐떦 뿰援ъ옄뱾 媛 끉臾몄쓽 옄紐, 냼냽쓣 媛由щ뒗 諛⑸쾿쓣 궗슜븯吏뒗 븡븯떎.

臾명뿄 寃깋 2021뀈 7썡遺꽣 8썡源뚯 5媛吏 뜲씠꽣踰좎씠뒪(PubMed/MEDLINE, EMBASE, CINAHL, SPORTDiscus, Cochrane Library)뿉꽌 寃깋븯떎. 씠 쇅뿉룄 씠쟾 泥닿퀎쟻 臾명뿄怨좎같 뿰援ъ쓽 李멸퀬臾명뿄 紐⑸줉쓣 異붽濡 솗씤븯떎11.

寃깋뼱뒗 援곗씤(Soldier), 遺긽 삁諛(Injury prevention), 슫룞(Exercise) 3媛吏 떒뼱媛 怨듯넻쟻쑝濡 룷븿릺룄濡 援ъ꽦븯떎.

3. 옄猷 닔吏 諛 異붿텧

寃깋맂 臾명뿄쓣 젙由ы븯怨 옄猷뚮 닔吏묓븯湲 쐞븳 怨쇱젙뿉꽌 Endnote version 20 (Clarivate Corp.) 봽濡쒓렇옩쓣 솢슜븯떎. 議곗궗맂 끉臾 以 以묐났맂 끉臾몄쓣 癒쇱 젣嫄고븯怨, 끉臾 젣紐⑷낵 珥덈줉쓣 솗씤븯뿬 臾명뿄 꽑깮 湲곗뿉꽌 踰쀬뼱굹뒗 끉臾몃뱾쓣 젣쇅븯떎. 洹 씠썑 꽑깮맂 끉臾몃뱾쓽 蹂몃Ц쓣 솗씤븯뿬, 臾명뿄 꽑깮 湲곗뿉꽌 踰쀬뼱굹뒗吏 寃넗븯떎. 理쒖쥌 끉臾 꽑젙뿉꽌 2紐낆쓽 뿰援ъ옄媛 씠寃ъ씠 엳뒗 寃쎌슦뿉뒗 긽샇 넗쓽瑜 嫄곗퀜 끉臾 룷븿 뿬遺瑜 솗젙븯怨, 븘슂떆 젣3쓽 뿰援ъ옄媛 븿猿 쓽끉븯뿬 솗젙븯떎.

理쒖쥌 꽑젙맂 뿰援щ뱾쓽 젙蹂대 젙由ы븯湲 쐞빐 옄, 뿰援ш 씠猷⑥뼱吏 援媛, 뵾뿕옄 듅꽦(꽦蹂, 굹씠), 썕젴 듅꽦 諛 湲곌컙, 以묒옱 洹몃9 슫룞(슫룞 쑀삎, 슫룞웾), 넻젣 洹몃9 슫룞 뿬遺, 寃곌낵 蹂닔 듅꽦, 遺긽 異붿쟻湲곌컙, 뿰援 뵒옄씤, 以묒옱 슫룞 以닔 鍮꾩쑉, 以묐룄 깉씫 鍮꾩쑉쓣 솗씤븯떎. 슂빟맂 궡슜뱾 1紐낆쓽 二 뿰援ъ옄媛 옉꽦븳 씠썑 떎瑜 뿰援ъ옄媛 솗씤븯怨 遺덉씪移섑븯뒗 遺遺꾩씠 엳쑝硫 긽샇 넗쓽븯뿬 寃곗젙븯怨, 삊쓽媛 뼱젮슱 寃쎌슦 젣3쓽 뿰援ъ옄媛 븿猿 쓽끉븯뿬 솗젙븯떎.

4. 鍮꾨슕由 쐞뿕(risk of bias) 룊媛

臾명뿄 吏 룊媛 湲곗 12媛 吏덈Ц쑝濡 援ъ꽦맂 Furlan 벑14쓽 諛⑸쾿쓣 쟻슜븯떎. 鍮꾨슕由 쐞뿕 2紐낆쓽 뿰援ъ옄媛 룊媛븯쑝硫, 媛 湲곗뿉 遺빀븯뒗 寃쎌슦 ‘竊’濡, 遺빀븯吏 븡뒗 寃쎌슦 ‘–’濡, 遺덊솗떎븳 寃쎌슦 ‘?’濡 몴떆븯뒗 諛⑹떇쑝濡 옉꽦븯떎. 鍮꾨슕由 쐞뿕쓣 룊媛븯뒗 寃껋씠 遺덊솗떎븳 寃쎌슦뿉 蹂꾨룄濡 옄뿉寃 愿젴 젙蹂대 쉷뱷븯湲 쐞빐 뿰씫븯吏뒗 븡븯떎. 理쒖쥌 젏닔瑜 쐞빐 12媛 以 紐 媛쒓 遺빀븯뒗吏瑜 鍮꾩쑉(%)濡 怨꾩궛븯떎.

5. 硫뷀 遺꾩꽍(meta-analysis)

紐⑤뱺 遺꾩꽍쓣 쐞빐 R software ver. 4.0.3 (The R Foundation)쓣 궗슜븯떎. 硫뷀 遺꾩꽍 以묒옱 슚怨 겕湲곕뒗 IRR 媛믨낵 95% CI濡 젣떆븯떎. 슚怨 겕湲 怨꾩궛쓣 쐞빐 R-package쓽 ‘metainc’瑜 궗슜븯떎. 洹몃9蹂 遺긽 諛쒖깮瑜좉낵 IRR 떎쓬 怨듭떇쓣 넻빐 怨꾩궛븯떎.

IR (100 person-month)=[遺긽슏닔/{씤썝 닔×썕젴 諛 遺긽 異붿쟻湲곌컙(썡)}]×100

IRR=以묒옱 洹몃9쓽 IR/鍮꾧탳 諛 넻젣 洹몃9쓽 IR

쐞 넻怨꾩튂쓽 쓽誘몃뒗 留뚯빟 IRR씠 0.80씤 寃쎌슦, 以묒옱 洹몃9 鍮꾧탳 洹몃9뿉 鍮꾪빐 遺긽瑜좎씠 20% 媛먯냼뻽떎뒗 쑜씠떎. 媛 뿰援ъ뿉 룷븿맂 뵾뿕옄뱾 蹂몃옒 븳 紐⑥쭛떒뿉 냽빐 엳吏 븡怨 媛곸옄 떎뼇븳 듅꽦怨 솚寃쎌쓣 媛吏 떎瑜 꽦寃⑹쓽 紐⑥쭛떒쑝濡쒕꽣 삩 寃껋쑝濡 媛젙븯뿬 옖뜡 슚怨(random-effects) 紐⑤뜽쓣 쟻슜븯떎.

뿰援 媛 씠吏덉꽦 댉 洹몃┝(forest plot)쓽 紐⑥뼇, I2 넻怨꾩튂瑜 솢슜븯뿬 遺꾩꽍뻽떎. I2 50% 誘몃쭔씪 寃쎌슦 異⑸텇엳 뿰援 媛 룞吏덉꽦씠 엳떎怨 媛꾩<븯떎.

븯쐞 洹몃9 遺꾩꽍(subgroup analysis)쓣 넻빐 뿰援 媛 씠吏덉꽦쓽 썝씤쓣 깘깋쟻쑝濡 遺꾩꽍븯떎. 븯쐞 洹몃9 遺꾩꽍 씠吏덉꽦씠 媛 뿰援ъ쓽 뼱뼚븳 듅吏뺤뿉꽌 鍮꾨’맂 寃껋씤吏瑜 깘깋븯뒗 怨쇱젙쑝濡, IRR뿉 쁺뼢쓣 誘몄튂뒗 옞옱쟻씤 議곗젅 씤옄媛 臾댁뾿씤吏 媛뒥빐蹂닿린 쐞빐 吏꾪뻾븯떎. 깘깋쟻씤 븯쐞 洹몃9 遺꾩꽍쓣 쐞빐 옖뜡 슚怨 紐⑤뜽쓣 쟻슜븳 븯쐞 洹몃9蹂 硫뷀 遺꾩꽍쓣 떎떆븯뿬 媛 遺꾩꽍蹂 넻빀 IRR쓣 젣떆븯떎.

븯쐞 洹몃9 遺꾩꽍쓣 쐞빐 꽦蹂, 쐞뿕 룊媛 젏닔, 以묒옱 슫룞웾, 遺긽 遺쐞, 슫룞 삎깭, 뿰援 뵒옄씤쓣 옞옱 議곗젅 씤옄濡 怨좊젮븯떎. 굹씠, 뵾뿕옄쓽 泥대젰 긽깭 벑怨 媛숈 媛뒫꽦 엳뒗 떎瑜 옞옱 議곗젅 슂씤 끉臾몄뿉꽌 援ъ껜쟻쑝濡 援щ텇븯湲곌 젣븳릺誘濡 怨좊젮븯吏 븡븯떎.

6. 異쒗뙋 렪뼢(publication bias)

源붾븣湲 룄몴(funnel plot)瑜 씠슜븯뿬 異쒗뙋 렪뼢쓣 솗씤븯떎. 異붽쟻쑝濡 Egger 寃젙쓣 넻빐 룄몴쓽 렪뼢꽦쓣 솗利앺븯怨15, ‘trim and fill’ 諛⑸쾿16쓣 씠슜븯뿬 룷븿릺吏 븡 뿰援щ뱾쓣 洹쇨굅濡 븳 쟾泥댁쟻씤 IRR媛믪쓽 議곗젙씠 븘슂븳吏瑜 솗씤븯떎.

寃 怨

1. 臾명뿄 寃깋 寃곌낵

뜲씠꽣踰좎씠뒪 寃깋 寃곌낵 珥 8,598嫄댁쓽 뿰援ш 솗씤릺뿀떎. 뿰援 꽑깮 怨쇱젙 Fig. 1뿉 젣떆븯떎.

Fig. 1. Flow diagram of included studies.

以묐났 끉臾몃뱾쓣 젣嫄고븳 씠썑 6,112嫄댁쓽 뿰援щ뱾씠 궓븯떎. 씠 뿰援щ뱾쓽 젣紐⑷낵 珥덈줉쓣 솗씤븯뿬 6,074嫄댁쓽 뿰援щ 젣쇅븯怨, 쟾臾(full-text)쓣 솗씤빐빞 븯뒗 뿰援щ뱾 理쒖쥌 38嫄댁쑝濡 솗씤릺뿀떎(k agreement, 98.68%; standard error [SE], 0.0128). 쟾臾 솗씤 썑 22嫄댁쓽 끉臾 以 븘슂븳 젙蹂 遺議(3嫄), 룷븿 湲곗뿉 遺빀븯吏 븡뒗 뿰援 꽕怨(10嫄), 寃곌낵 蹂닔(4嫄) 諛 以묒옱 諛⑸쾿(5嫄)쑝濡 씤빐 젣쇅븯뿬 理쒖쥌쟻쑝濡 10嫄댁쓽 뿰援щ 遺꾩꽍뿉 룷븿븯떎. 理쒖쥌쟻쑝濡 遺꾩꽍븳 뿰援щ뱾쓽 PICOS 젙蹂대뒗 Table 117-26뿉 젣떆븯떎.

Table 1 . PICOS of included studies

StudyParticipants (baseline characteristics)Training (duration)InterventionControlOutcome (follow-up duration)Study design
Brush첩j et al.17Denmark army recruits (intervention: 507 [male], control: 513 [male], age: 19닋26 yr)Basic military training (12 wk)Strengthening and stretching (lower body)Strengthening and stretching (upper body)Any musculoskeletal injuries (12 wk)Quasi-RCT
Burley et al.18Australia army recruits (intervention: 117 [male, 87; female, 30], control: 97 [male, 75; female, 22], age: 21.7 yr)Basic military training (12 wk)Strengthening, stretching and aerobicStandard running and circuit trainingAny musculoskeletal injuries (12 wk)RCT
Carow et al.19U.S. military new cadets (total: 1,313 [male, 1,070; female, 243], intervention: 654, control: 659, age: 18닋22 yr)Cadet basic training (6 wk)Strengthening and stretchingActive warm-upLower-limb musculoskeletal injuries (10.5mths)Cluster RCT
Childs et al.20U.S. army soldiers (intervention: 2,153, control: 2,160, age: 18닋35 yr)Combat medic training (16 wk)Strengthening and balanceUpper body strengtheningAny musculoskeletal injuries (16 wk)Cluster RCT
Coppack et al.21U.K. army recruits (intervention: 759 [male, 556; female, 203], control: 743 [male, 536; female, 207], age: 19.6 yr)Basic military training (14 wk)Strengthening and stretchingTraditional trainingAnterior knee pain (12 wk)Cluster RCT
Goodall et al.22Australia army recruits (total: 867 [male, 815; female, 52], intervention: 380, control: 487, age: 17닋50 yr)Basic military training (12 wk)Balance and agility with normal physical trainingControl (only normal physical training)Lower-limb musculoskeletal injuries (12 wk)Cluster RCT
Hartig and Henderson23U.S. army recruits (intervention: 150 [male], control: 148 [male], age: 20 yr)Basic military training (13 wk)Additional stretching with normal routine of stretchingControl (only normal routine of stretching)Lower-limb musculoskeletal injuries (13 wk)Quasi-RCT
Knapik et al.24U.S. army recruits (intervention: 829 [male, 486; female, 343], control: 1,138 [male, 656; female, 482], age: 21.8 yr)Basic combat training (9 wk)Strengthening, stretching and aerobicTraditional trainingAny injuries (9 wk)Quasi-RCT
Pope et al.25Australia army recruits (intervention: 549 [male], control: 544 [male], age: 17닋35 yr)Recruit training (12 wk)Stretching (lower body)Stretching (upper body)Lower-limb musculoskeletal injuries (12 wk)Quasi-RCT
Pope et al.26Australia army recruits (intervention: 735 [male], control: 803 [male], age: 17닋35 yr)Recruit training (12 wk)Stretching (lower body)Warm-upLower-limb musculoskeletal injuries (12 wk)Quasi-RCT

PICOS: Participants, Intervention, Control, Outcome, Study design; RCT: randomized controlled trial.



2. 뿰援 듅꽦

洹몃9蹂 꽦蹂 뵾뿕옄 닔뿉 븳 젙蹂닿 뾾뒗 뿰援щ뒗 뿰援ъ뿉 젣떆맂 濡 옉꽦븯떎. 굹씠뒗 룊洹 삉뒗 踰붿쐞濡 젣떆븯떎. 以묒옱맂 遺긽 삁諛 슫룞 醫낅쪟뒗 洹쇰젰 슫룞, 쑀궛냼꽦 슫룞, 뒪듃젅移쑝濡 援щ텇븯怨, 洹 쇅 뿰援щ퀎濡 듅蹂꾪엳 떎瑜닿쾶 紐낆떆맂 슫룞 뿰援ъ뿉 紐낆떆맂 濡 옉꽦븯떎. 넻젣 洹몃9怨 以묒옱 洹몃9씠 議곗쟻쑝濡 슫룞 遺쐞媛 긽吏 諛 븯吏濡 援щ텇맂 寃쎌슦뿉 븳빐 긽吏 諛 븯吏 슫룞씠씪뒗 寃껋쓣 異붽濡 몴湲고븯떎. 媛 뿰援ъ뿉꽌 뼵湲됲븳 넻젣 洹몃9쓽 슫룞紐낆묶쓣 洹몃濡 紐낆떆븯떎. 슫룞웾쓽 寃쎌슦 븳 떖쓣 4二쇰줈 솚궛븯뿬 以묒옱 湲곌컙 怨꾩궛뿉 諛섏쁺븯떎. 뿰援 뵒옄씤쓽 寃쎌슦, 옄媛 cluster-RCT씪怨 紐낆떆븯吏留 臾댁꽑 몴吏 諛⑸쾿씠 옒紐삳맂 寃쎌슦뒗 quasi-RCT濡 怨좎퀜 젙쓽븯떎. 슫룞웾씠 以묒옱 諛 넻젣 洹몃9 媛 꽌濡 떎瑜대㈃ 蹂꾨룄濡 몴떆븯怨, 媛숈 寃쎌슦 븯굹濡 몴떆븯떎. 슫룞웾 꽭뀡(session) 슏닔 꽭뀡蹂 떆媛꾩쓣 怨깊븯뿬 遺꾩쑝濡 솚궛븯떎.

理쒖쥌 遺꾩꽍뿉 룷븿맂 끉臾몄 紐⑤몢 湲곗큹 援곗궗썕젴 媛 떎떆맂 뿰援ъ떎. 뵲씪꽌 뵾뿕옄쓽 굹씠뒗 二쇰줈 20媛 遺遺꾩씠뿀떎. 꽦蹂꾧낵 愿젴븯뿬, 궓옄 援곗씤留 룷븿맂 뿰援(4嫄) 궓옄 諛 뿬옄 援곗씤뱾씠 븿猿 룷븿맂 뿰援(6嫄)媛 엳뿀떎. 룷븿맂 뿰援щ뱾 샇二(4嫄)瑜 젣쇅븯怨 誘멸뎅(4嫄) 諛 쑀읇沅(2嫄)뿉꽌 吏꾪뻾릺뿀떎. 썕젴 湲곌컙쓽 쟾泥 룊洹좎 11.8二쇱怨, 吏㏐쾶뒗 6二쇰꽣 湲멸쾶뒗 16二쇨퉴吏 엳뿀떎. 以묒옱 遺긽 삁諛 슫룞 봽濡쒓렇옩뱾 뒪듃젅移留 븳 뿰援щ뱾씠 엳뿀怨(3嫄), 굹癒몄 뿰援ъ뿉꽌뒗 洹쇰젰 슫룞쓣 鍮꾨’븳 諛몃윴뒪, 誘쇱꺽꽦 諛 쑀궛냼 슫룞쓣 蹂듯빀쟻쑝濡 떎떆븯떎. 넻젣 洹몃9쓽 寃쎌슦 以묒옱 洹몃9씠 遺긽 삁諛 슫룞쓣 븯뒗 룞븞 蹂꾨룄 슫룞쓣 븯吏 븡 뿰援(2嫄)媛 엳뿀怨, 솗씤븯怨좎옄 븯뒗 遺긽 遺쐞 떎瑜 遺쐞쓽 슫룞(masking)쓣 븯嫄곕굹(3嫄), 湲곗〈뿉 븯뜕 諛⑹떇쓽 슫룞(5嫄)쓣 떎떆븳 뿰援щ뱾씠 엳뿀떎. 遺긽 紐⑤뱺 洹쇨낏寃⑷퀎 遺긽쓣 솗씤븳 뿰援(4嫄), 븯吏 遺긽留 솗씤븳 뿰援(5嫄), 洹몃━怨 듅젙 臾대쫷 遺긽留 솗씤븳 뿰援(1嫄)媛 엳뿀떎. 遺긽 솗씤 異붿쟻 湲곌컙 遺遺 썕젴 湲곌컙怨 룞씪뻽吏留, 븳 렪쓽 뿰援ъ뿉꽌留 썕젴 湲곌컙 씠썑 10.5媛쒖썡 룞븞 遺긽쓣 異붿쟻븯떎. 뿰援 뵒옄씤 quasi-RCT (5嫄), cluster RCT (4嫄), RCT (1嫄)濡 援щ텇릺뿀떎.

Table 217-26뒗 以묒옱 遺긽 삁諛 슫룞쓣 援ъ껜쟻쑝濡 遺꾩꽍븯뿬 슫룞 쑀삎, 슫룞웾쓣 젣떆븯떎. 슫룞 媛쒖닔濡쒕쭔 젙웾쟻쑝濡 怨꾩궛븯쓣 븣 젙蹂닿 遺議깊븯뿬 솗씤븷 닔 뾾뒗 뿰援 븳 嫄댁쓣 젣쇅븳 굹癒몄 뿰援ъ뿉꽌뒗 쟻寃뚮뒗 2媛, 留롪쾶뒗 39媛쒖쓽 슫룞源뚯 以묒옱븯쑝硫, 룊洹좎쟻쑝濡 빟 14.3媛쒖쓽 슫룞쓣 以묒옱븯떎. 슫룞웾 媛뺣룄 援щ텇 뾾씠 슫룞 떆媛꾩쑝濡 怨꾩궛븳 寃곌낵 룊洹좎쟻쑝濡 922.5遺 슫룞븳 寃껋쑝濡 굹궗怨, 쟻寃뚮뒗 51遺, 留롪쾶뒗 3,005遺꾧퉴吏룄 떎떆븯떎. Table뿉 젣떆릺뼱 엳吏 븡吏留 슫룞 李몄뿬쑉怨 以묐룄 깉씫瑜좎쓣 異붽濡 遺꾩꽍븯떎. 슫룞 李몄뿬쑉 젙蹂닿 뾾뒗 뿰援 븳 렪쓣 젣쇅븯怨, 75% 씠긽씠 1嫄, 91% 씠긽씠 1嫄, 100%媛 7嫄댁쑝濡 굹궗떎. 以묒옱 湲곌컙 以묐룄 깉씫瑜좎 룊洹 19.2% 닔以씠뿀怨, 쟻寃뚮뒗 0%, 留롪쾶뒗 73.5%源뚯 깉씫븳 뿰援щ뱾룄 엳뿀떎.

Table 2 . Characteristics of included studies

StudyType of exercise (No. of exercises)Volume of exercise
Brush첩j et al.17Intervention: lower-body strengthening (4), dynamic lower-body stretching (1), static lower-body stretching (1)
Control: upper-body strengthening (4), static upper-body stretching (1)
36 sessions (15 min for 1 session, total 540 min)
Burley et al.18Intervention: warm-up (12), cool-down stretching (4), lower-body resistance (4), upper-body resistance (4), high-intensity interval (1), load-carriage (1)
Control: high-intensity running (1), circuit training (1), load-carriage (1)
Intervention (total 3,005 min):
- Warm-up and cool-down: 40 sessions
- Resistance: 17 sessions
- High-intensity interval: 8 sessions
- Load-carriage: 2 sessions
Control (total 3,010 min):
- Moderate to high intensity running: 9 sessions
- Circuit training: 7 sessions
- Load-carriage: 7 sessions
Carow et al.19Intervention: lower-body strengthening (5),upper-body strengthening (3), dynamic lower-body stretching (1)
Control: lower-body strengthening (3), upper-body strengthening (4), dynamic whole-body stretching (2)
18 sessions (10 min for 1 session, total 180 min)
Childs et al.20Intervention: lower-body strengthening (1),upper-body strengthening (3), whole-body strengthening (1)
Control: upper-body strengthening (5)
48 sessions (5 min for 1 session, total 240 min)
Coppack et al.21Intervention: lower-body strengthening (4), static lower-body stretching (4)
Control: upper-body strengthening (2), upper and lower body stretching, aerobic (1)
98 sessions (15 min for 1 session, total 1,470 min)
Goodall et al.22Intervention: normal physical training (8), balance (18), agility (13)
Control: normal physical training (8)
43 sessions for balance, 13 sessions for agility (5 min for 1 session, total 280 min)
Hartig and Henderson23Intervention: normal routine of stretching (not specified), stretching (1)
Control: normal routine of stretching (not specified)
273 sessions (2.5 min for 1 session, total 682.5 min)
Knapik et al.24Intervention: conditioning drill (13), movement drills (3),aerobic (2), stretching drills (10)
Control: stretching, upper-body strengthening (2), aerobic (1)
45 sessions (60 min for 1 session, total 2,700 min)
Pope et al.25Intervention: static lower-body stretching (2)
Control: static upper-body stretching (2)
38 sessions (80 secs for 1 session, total 51 min)
Pope et al.26Intervention: static lower-body stretching (6)
Control: normal warm-up
38 sessions (2 min for 1 session, total 76 min)


3. 鍮꾨슕由 쐞뿕 룊媛

몢 紐낆쓽 뿰援ъ옄媛 룆由쎌쟻쑝濡 媛 뿰援щ뱾뿉 븳 鍮꾨슕由 쐞뿕룊媛瑜 12媛쒖쓽 湲곗쓣 李멸퀬븯뿬 떎떆븯떎. 쟾泥댁쟻쑝濡 룊洹 53.7%쓽 젏닔瑜 蹂댁怨, 궙寃뚮뒗 25%, 넂寃뚮뒗 75% 젏닔쓽 뿰援ш 엳뿀떎.

4. 쟾泥 以묒옱 슚怨 諛 씠吏덉꽦

硫뷀 遺꾩꽍 寃곌낵 넻怨꾩쟻쑝濡 쑀쓽븳 遺긽 삁諛 슚怨쇰뒗 굹굹吏 븡븯떎(IRR, 0.82; 95% CI, 0.62–1.09) (Fig. 2). 뿰援ш컙 씠吏덉꽦 넂 寃껋쑝濡 굹궗떎(I2, 83%).

Fig. 2. Forest plot of included studies. IRR: incidence rate ratio, CI: confidence interval. *Unit: person-months.

5. 異쒗뙋 렪뼢

Funnel plot 遺꾩꽍 寃곌낵 슦痢 븯떒遺뿉 鍮꾨移꽦씠 굹궗떎(Fig. 3). 븯吏留 Egger test 寃곌낵 쑀쓽꽦 굹굹吏 븡븯떎(intercept, 0.26; SE, 0.19; p=0.12). 鍮꾨줉 쑀쓽꽦 굹굹吏 븡븯吏留, 옉 깦뵆 닔瑜 궗슜븯뿬 쑀쓽븯吏 븡 뿰援щ뱾씠 異쒗뙋릺吏 븡븯嫄곕굹 蹂 뿰援ъ쓽 寃깋 諛⑸쾿쓣 넻빐 寃깋릺吏 븡븯쓣 媛뒫꽦씠 엳떎. ‘Trim and fill’ 諛⑸쾿쓣 궗슜빐 2媛쒖쓽 뿰援ш 異붽릺뼱 蹂댁젙맂 IRR 0.97씠뿀떎(95% CI, 0.65–1.44). 蹂댁젙맂 媛믪 썝옒 媛믨낵 嫄곗쓽 쑀궗븯떎.

Fig. 3. Funnel plot.

6. 븯쐞 洹몃9 遺꾩꽍

紐⑤뱺 븯쐞 洹몃9 遺꾩꽍 寃곌낵뒗 Table 3뿉 젣떆븯떎. 뿰援 李몄뿬옄뱾쓽 꽦蹂꾩쓣 怨좊젮뻽쓣 븣 쑀쓽븳 寃곌낵뒗 뾾뿀吏留 궓옄濡쒕쭔 씠猷⑥뼱吏 뿰援щ낫떎(IRR, 0.95; 95% CI, 0.77–1.18), 꽦蹂꾩씠 샎빀맂 뿰援ъ뿉꽌(IRR, 0.72; 95% CI, 0.43–1.20) 삁諛 슚怨쇨 겕寃 굹궗떎.

Table 3 . Subgroup analysis

SubgroupCategoryIRR (95% CI)I2 (%)
SexOnly male0.95 (0.77닋1.18)41
Mixed0.72 (0.43닋1.20)89
Risk of bias≤50%0.83 (0.63닋1.10)82
>50%0.79 (0.40닋1.59)86
Exercise volume≤Median1.09 (0.98닋1.23)16
>Median0.56 (0.32닋0.97)84
InjuryAny0.85 (0.55닋1.32)89
Lower limb0.79 (0.52닋1.20)80
Exercise typeOnly stretching0.87 (0.67닋1.12)28
Mixed0.78 (0.50닋1.21)88
Study designRCT0.70 (0.36닋1.36)86
Quasi-RCT0.87 (0.69닋1.08)68

IRR: incidence rate ratio, CI: confidence interval, RCT: randomized controlled trial.



鍮꾨슕由 룊媛 寃곌낵媛 50% 씠븯씤 뿰援щ뱾(IRR, 0.83; 95% CI, 0.63–1.10)怨 珥덇낵씤 뿰援щ뱾(IRR, 0.79; 95% CI, 0.40–1.59)뿉꽌뒗 遺긽 삁諛 슚怨쇱쓽 쑀쓽븳 李⑥씠媛 굹굹吏 븡븯떎.

슫룞웾씠 以묒쐞닔 誘몃쭔씤 뿰援щ뱾(IRR, 1.09; 95% CI, 0.98–1.23)뿉꽌뒗 遺긽 삁諛 슚怨쇨 쑀쓽븯吏 븡븯떎. 븯吏留, 슫룞웾씠 以묒쐞닔 珥덇낵씤 뿰援щ뱾(IRR, 0.56; 95% CI, 0.32–0.97)뿉꽌뒗 遺긽씠 44% 쑀쓽븯寃 媛먯냼븯뒗 寃곌낵瑜 蹂댁떎.

紐⑤뱺 遺긽쓣 怨좊젮븳 뿰援щ뱾(IRR, 0.85; 95% CI, 0.55–1.32)怨 븯吏 遺긽留 怨좊젮븳 뿰援щ뱾(IRR, 0.79; 95% CI, 0.52–1.20)뿉꽌 쑀쓽븳 遺긽 삁諛 슚怨쇰뒗 뾾뿀떎.

뒪듃젅移 슫룞留 以묒옱븳 뿰援щ뱾(IRR, 0.85; 95% CI, 0.55–1.32)怨 蹂듯빀쟻씤 슫룞쓣 以묒옱븳 뿰援щ뱾(IRR, 0.78; 95% CI, 0.50–1.21)뿉꽌룄 紐⑤몢 쑀쓽븳 遺긽 삁諛 슚怨쇰뒗 뾾뿀떎.

쑀쓽븳 寃곌낵뒗 븘땲뿀吏留 RCT 삉뒗 cluster RCT 뿰援щ뱾(IRR, 0.70; 95% CI, 0.36–1.36) quasi-RCT 뿰援щ낫떎(IRR, 0.87; 95% CI, 0.69–1.08) 遺긽 삁諛 슚怨쇨 겕寃 굹궗떎.

怨 李

蹂 뿰援ъ쓽 紐⑹쟻 泥닿퀎쟻 臾명뿄怨좎같 諛 硫뷀 遺꾩꽍쓣 넻빐 슫룞쓽 遺긽 삁諛 슚怨 諛 슚怨쇱뿉 쁺뼢쓣 誘몄튌 닔 엳뒗 옞옱 슂씤뱾쓣 遺꾩꽍븯뒗 寃껋씠뿀떎. 泥닿퀎쟻 臾명뿄怨좎같쓣 넻빐 理쒖쥌쟻쑝濡 꽑젙븳 10媛 뿰援ъ쓽 硫뷀 遺꾩꽍 寃곌낵, 遺긽 삁諛 슫룞 18% 젙룄 遺긽쓣 媛먯냼븯뒗 슚怨쇱쓽 寃쏀뼢꽦쓣 蹂댁떎. 븯쐞 洹몃9 遺꾩꽍 寃곌낵 슫룞웾씠 留롮븯뜕 뿰援щ뱾뿉꽌 遺긽씠 44% 쑀쓽븯寃 媛먯냼븯뒗 슚怨쇨 엳뿀떎. 븯吏留 洹 쇅 옞옱 슂씤뱾濡 遺꾩꽍븳 뿰援 媛 쑀쓽븳 遺긽 삁諛 슚怨쇰뒗 굹굹吏 븡븯떎.

遺遺꾩쓽 뿰援ъ뿉꽌 슚怨쇱쟻씠吏 븡븯뜕 寃껋 슫룞웾씠 쟻嫄곕굹, 以묒옱 湲곌컙씠 삁諛 슚怨쇨 굹굹湲곗뿉뒗 꼫臾 吏㏃븯湲 븣臾몄씠씪 깮媛곷맂떎. 꽑뻾뿰援ъ뿉꽌 遺긽 삁諛 슫룞쓣 鍮꾧탳쟻 삤옒 吏냽빐빞 삁諛 슚怨쇨 굹궃떎怨 뼵湲됲븯떎19.

遺꾩꽍맂 紐⑤뱺 뿰援ъ뿉꽌쓽 썕젴 긽솴 湲곗큹 援곗궗썕젴씠뿀떎. 뵲씪꽌 蹂 뿰援 寃곌낵뒗 떊蹂묎낵 媛숈 吏묐떒뿉 븳븯뿬 쟻슜븯뒗 寃껋씠 뜑 쟻젅븷 寃껋씠떎. 떎瑜 吏묐떒뿉 쟻슜븯뒗 寃껋뿉 빐꽌뒗 젣븳쟻씤 寃곌낵 빐꽍씠 븘슂븯떎. 湲곗큹 援곗궗썕젴 뵾뿕옄뱾쓣 넻젣븯湲 슜씠븯怨 以묐룄 깉씫옄瑜 異붿쟻븯湲곕룄 돩슦硫, 遺긽씠 옄二 諛쒖깮븯湲 븣臾몄뿉 遺긽 삁諛 뿰援ъ뿉 솢슜븯湲 쟻젅븳 썕젴 솚寃쎌씠떎. 遺遺꾩쓽 援곗궗썕젴 湲곌컙 12二쇱뿉꽌 16二쇱뒗뜲 씠 湲곌컙 遺긽 삁諛⑹쓣 쐞빐 異⑸텇븳 슫룞 슚怨쇨 굹굹湲 뼱젮슫 湲곌컙씠씪怨 깮媛곷맂떎. 듅엳, 썕젴뿉꽌 泥 4二쇨컙 留롮 遺긽씠 諛쒖깮븯뒗 寃껋 썕젴 珥덈컲뿉뒗 슫룞 봽濡쒓렇옩씠 異⑸텇븳 遺긽 삁諛 슚怨쇰 二쇱 븡쓣 寃껋씠湲 븣臾몄씠떎17.

븳렪, Coppack 벑21쓽 뿰援ш 以묒옱 洹몃9씠 넻젣 洹몃9뿉 鍮꾪빐 77% 쑀쓽븯寃 遺긽씠 媛먯냼븯뿬 紐⑤뱺 뿰援 以묒뿉꽌 媛옣 遺긽 삁諛 슚怨쇨 넂寃 굹궗떎. 빐떦 뿰援ъ옄뱾 슫룞웾씠 留롮븯뜕 寃껋씠 遺긽 삁諛 슚怨쇱쓽 以묒슂븳 씠쑀씪怨 뼵湲됲븯떎. 븯吏留 씠 뿰援щ뒗 떎瑜 뿰援ъ 떖由 쟾諛 臾대쫷 넻利앸쭔쓣 遺긽쓽 踰붿<濡 怨좊젮븯떎. 씠윭븳 씠쑀濡 뿰援 媛 鍮꾧탳媛 뼱졄吏留, 쟾諛 臾대쫷 넻利앹씠 援곗궗썕젴 以 鍮덈쾲엳 諛쒖깮븷 닔 엳뒗 遺긽씠씪뒗 젏쓣 媛먯븞븳떎硫 異⑸텇엳 李멸퀬븷 닔 엳뒗 洹쇨굅씪怨 깮媛곷맂떎. 삉븳, Coppack 벑21 떎瑜 뿰援ъ뿉 鍮꾪빐 援ъ껜쟻씤 遺긽쓣 븳젙븯怨, 愿젴븳 遺긽뿉 吏곸젒쟻쑝濡 룄쓣 以 닔 엳뒗 슫룞 諛⑸쾿 媛쒕컻뿉 吏묒쨷뻽떎. 遺긽怨 愿젴맂 눜궗몢洹(quadriceps), 怨⑤컲(pelvis), 몦遺(hip)쓽 洹쇱쑁 룞썝뿉 吏묒쨷븯뒗 슫룞쓣 넻빐 븯以묒씠 遺븯릺뒗 솢룞 媛 몦遺 臾대쫷쓽 슫룞 젣뼱媛 뼢긽맆 寃껋쓣 湲곕븯떎. 뼢긽맂 슫룞 젣뼱 룞옉 援곗씤뱾쓽 援곗궗썕젴 媛 吏곸엫 뙣꽩쓣 슚쑉쟻쑝濡 븯뿬 뒳媛쒕눜(patellofemoral) 愿젅뿉 遺븯릺뒗 뒪듃젅뒪瑜 以꾩뿬以떎怨 깮媛곹븯떎. 씠泥섎읆 슫룞웾肉먮쭔 븘땲씪 遺긽湲곗쟾쓣 怨좊젮븳 留욎땄삎 슫룞 諛⑸쾿쓣 怨좎븞뻽뜕 寃껋씠 遺긽 삁諛⑹뿉 以묒슂븳 쁺뼢쓣 二쇱뿀쓣 寃껋씠씪 깮媛곷맂떎.

쁽옱 遺긽 삁諛 슫룞쑝濡 씪諛섏쟻쑝濡 留롮씠 솢슜릺怨 엳뒗 뒪듃젅移 嫄곗쓽 紐⑤뱺 뿰援ъ뿉 룷븿릺뿀떎25,27,28. 뒪듃젅移 슫룞留 떎떆븳 뿰援щ뒗 3렪 엳뿀뒗뜲 쑀쓽븳 遺긽 삁諛 슚怨쇨 뾾뿀떎. 뒪듃젅移 슫룞쓽 遺긽 삁諛 슚怨쇰뒗 쑀뿰꽦씠 遺긽 쐞뿕쓽 媛뺣젰븳 삁痢 씤옄濡 옉슜븷 닔 엳湲 븣臾몄씤 寃껋쑝濡 깮媛곷릺吏留, Pope 벑25 쑀뿰꽦 옄泥댁쓽 臾몄젣蹂대떎뒗 쑀뿰꽦 遺議깆쑝濡 씤븳 솢룞 뒫젰 媛먯냼媛 遺긽쓽 吏곸젒쟻씤 썝씤씠씪怨 뙋떒븯떎. 뵲씪꽌 援곗씤뱾 썕젴 媛 吏곸엫뿉 븘슂븳 젙룄쓽 媛룞 踰붿쐞留 蹂댁쑀븯뜑씪룄 遺긽 삁諛⑺븷 닔 엳쓣 寃껋씠떎. 援곗궗썕젴 媛 吏곸엫뱾씠 넂 쑀뿰꽦쓣 슂援ы븯吏뒗 븡湲 븣臾몄뿉 뒪듃젅移 슫룞쓽 슚怨쇨 쑀쓽븯寃 굹삤吏 븡븯뜕 寃껋쑝濡 깮媛곷맂떎. Pope 벑26 쑀뿰꽦 슫룞쓣 260떆媛꾩 빐빞 寃⑥슦 븯굹쓽 遺긽쓣 삁諛⑺븷 닔 엳떎뒗 넻怨꾩쟻 怨꾩궛 寃곌낵瑜 넻빐 슫룞 삁諛 슚怨쇱쓽 슚쑉꽦쓣 媛뺤“븯떎. 뒪듃젅移留 떎떆뻽뜕 뿰援 以 쑀씪븯寃 Hartig怨 Henderson23뿉꽌留 39% 쑀쓽븳 遺긽 媛먯냼瑜 굹깉떎. 빐떦 뿰援ъ뿉꽌뒗 뻹뒪듃留(hamstring) 뒪듃젅移留 븯猷 3踰 떎떆뻽뒗뜲, 씠寃껋 뻹뒪듃留곴낵 뮘轅덉튂(heel cord)쓽 六k빰븿(tightness)씠 援 蹂대퀝 湲곗큹 援곗궗썕젴뿉꽌쓽 븯吏 怨쇱궗슜 遺긽 썝씤쑝濡 옉슜븷 닔 엳떎뒗 깮媛곸쑝濡 吏꾪뻾븳 寃껋씠뿀떎.

Burley 벑18 슫룞웾 以꾩씠뒗 떊 媛뺣룄瑜 넂뿬 66%쓽 遺긽 삁諛 슚怨쇰 뼸뿀떎. 씠뱾 異뺢뎄뿉꽌 궗슜븯뒗 遺긽 삁諛 봽濡쒓렇옩씤 ‘FIFA11竊’瑜 援 솚寃쎌뿉꽌 씠猷⑥뼱吏뒗 솢룞쓣 怨좊젮븯뿬 룞옉쓣 닔젙븯뿬 쟻슜븯떎. 吏곸엫 遺꾩꽍쓣 諛섏쁺븳 寃껋 넂 遺긽 삁諛 슚怨쇱쓽 씠쑀 以 븯굹씪 寃껋쑝濡 깮媛곷맂떎.

Carow 벑19 슫룞 以묒옱 媛 媛먮룆(supervision) 뿬遺媛 遺긽 삁諛 슚怨쇱뿉 뼱뼚븳 쁺뼢쓣 二쇰뒗吏瑜 솗씤븯怨좎옄 븯떎. 씠뱾 젙솗븳 룞옉쑝濡 슫룞븯吏 븡븯쓣 寃쎌슦뿉뒗 삤엳젮 뜑 겙 遺긽 쐞뿕쓣 빞湲고븷 닔 엳떎怨 깮媛곹븯떎. 뵲씪꽌 媛먮룆쓽 議댁옱 옄泥닿 遺긽 삁諛⑹뿉 쁺뼢쓣 以떎湲곕낫떎뒗 젙솗븳 슫룞 옄꽭瑜 씡엳뒗 寃껉낵 뜑遺덉뼱 넂 李몄뿬쑉쓣 씠걣뼱궡뒗 寃껋씠 吏곸젒쟻씤 썝씤씪 寃껋씠씪怨 깮媛곷맂떎. Carow 벑19 떎瑜 뿰援ъ 떖由 뿰援 긽옄媛 쑁援 궗愿 깮룄씠떎. 궗愿븰援먮뒗 씪諛 썕젴 떆꽕怨쇰뒗 떎瑜닿쾶 옄移 吏쐶 洹쇰Т젣룄瑜 넻빐 긽湲 깮룄뱾씠 븯湲 깮룄뱾쓽 슫룞쓣 吏룄븯怨 媛먮룆빐빞 븳떎. 떎瑜 援 솚寃쎌뿉꽌룄 슫룞쓣 삱諛붾Ⅴ寃 쟻슜븷 닔 엳뒗 媛먮룆옄쓽 뒫젰씠 以묒슂븯떎. 궃씠룄 넂 슫룞 셿쟾엳 닕떖릺湲곌퉴吏 뿰뒿떆媛꾩쓣 蹂댁옣빐빞 븳떎. 슫룞씠 삱諛붾Ⅴ寃 닔뻾릺吏 븡쑝硫 紐⑺몴븳 吏곸엫濡 떒젴릺吏 븡쑝誘濡 怨꾪쉷뻽뜕 遺긽 삁諛 슚怨쇰 뼸吏 紐삵븷 닔 엳떎. Carow 벑19 쟻뼱룄 6二 젙룄뒗 슫룞 룞옉뿉 씡닕빐吏뒗 떆媛꾩씠 븘슂븯떎怨 蹂닿퀬븯떎. 뵲씪꽌, 泥 6二 湲곌컙 룞븞뿉뒗 삤엳젮 씡닕븯嫄곕굹 돩슫 쟾넻쟻씤(traditional) 슫룞쓣 븯뒗 洹몃9뿉꽌 뜑 遺긽옄 닔媛 쟻뿀떎怨 蹂닿퀬븯떎. Coppack 벑21 媛먮룆쓽 븘슂꽦 李몄뿬쑉쓣 넂씠湲 쐞븳 寃껋뿉 以묒젏쓣 몢뿀떎.

룊삎꽦(stability)怨 誘쇱꺽꽦(agility) 듃젅씠떇 怨좎쑀 닔슜꽦 媛먭컖 뼢긽 諛 洹 떊寃 議곗젅 뼢긽怨 愿젴씠 엳쑝誘濡 븯吏 遺긽 삁諛⑹뿉 以묒슂븳 슫룞쑝濡 媛꾩<릺뼱 솕떎29. 븯吏留 Goodall 벑22쓽 뿰援щ뒗 Hrysomallis30媛 뼵湲됲븳 濡 룊삎꽦 諛 誘쇱꺽꽦 듃젅씠떇쑝濡 젙쓽맂 썕젴뱾씠 룊삎꽦 諛 誘쇱꺽꽦 슫룞肉 븘땲씪 떎뼇븳 슫룞 諛⑸쾿쓣(multifaceted) 븿猿 룷븿븯怨 엳떎. 뵲씪꽌, 룊삎꽦 諛 誘쇱꺽꽦 슫룞留뚯씠 遺긽 삁諛⑹뿉 룄씠 릺뿀뒗吏 솗씤븯뒗 寃껋 떎젣쟻쑝濡 뼱졄떎. 삤엳젮, Goodall 벑22씠 뼵湲됲븳 濡 Batterham怨 Hopkins31뒗 씠윭븳 룊삎꽦 諛 誘쇱꺽꽦 썕젴씠 삤엳젮 븯吏 遺긽쓣 25% 利앷떆궗 닔 엳떎怨 븯떎. Goodall 벑22쓽 뿰援 寃곌낵룄 以묒옱 洹몃9쓽 遺긽씠 넻젣 洹몃9뿉 鍮꾪빐 24% 쑀쓽븯寃 利앷븯떎.

Brushøj 벑17怨 Childs 벑20쓽 寃쎌슦뿉뒗 넻젣 洹몃9뿉꽌 긽泥 슫룞씠 뵆씪떆蹂 슫룞쑝濡 쟻슜릺뿀떎. 洹몃윴뜲 二쇱슂 寃곌낵 蹂닔뒗 紐⑤뱺 洹쇨낏寃⑷퀎 遺긽씠뿀떎. 뵲씪꽌 넻젣 洹몃9뿉꽌 떎떆븳 긽泥 슫룞씠 긽泥 洹쇨낏寃⑷퀎 遺긽쓣 삁諛⑺뻽쓣 媛뒫꽦씠 議댁옱븳떎. 씠윭븳 넻젣 洹몃9뿉 떎떆맂 슫룞뱾씠 삤엳젮 遺긽 삁諛 슚怨쇰 蹂댁뿬 쑀쓽븳 遺긽 삁諛 슚怨쇱쓽 李⑥씠瑜 蹂댁씠吏 븡 寃껋씪吏룄 紐⑤Ⅸ떎.

蹂 泥닿퀎쟻 臾명뿄怨좎같 諛 硫뷀 遺꾩꽍 뿰援ъ뿉뒗 紐 媛吏 젣븳젏씠 엳떎. 癒쇱, 援 뿰援 솚寃 듅꽦 긽 삱諛붾Ⅸ 諛⑸쾿쑝濡 臾댁꽑 븷떦맂 RCT 뿰援ш 嫄곗쓽 뾾뿀떎. 뵲씪꽌 quasi-RCT瑜 룷븿븯湲곗뿉 뿰援 寃곌낵뿉 삤瑜섍 議댁옱븷 닔 엳떎. 씠윭븳 젣븳젏 鍮꾨슕由 쐞뿕 룊媛뿉 諛섏쁺븯怨, 媛 뿰援 삤瑜 媛뒫꽦쓣 遺꾩꽍븯뿬 젣떆븯떎.

몮吏, 蹂 뿰援ъ뿉꽌뒗 궗쟾 뿰援32瑜 李멸퀬븯뿬 以묐룄 깉씫맂 궗엺뱾 遺꾩꽍뿉 룷븿븯吏 븡븯떎. 떒, Pope 벑25쓽 뿰援щ뒗 以묐룄 깉씫맂 궗엺쓽 遺긽 슏닔媛 理쒖쥌 遺꾩꽍뿉 諛섏쁺릺뿀怨 깉씫옄쓽 遺긽 슏닔뿉 븳 젙蹂닿 뾾뿀湲 븣臾몄뿉 遺긽씠 怨쇱텛젙릺뿀쓣 닔 엳떎. 洹 쇅 뿰援ъ뿉꽌뒗 以묐룄깉씫옄쓽 遺긽 젣쇅릺뿀떎怨 媛젙븯떎. 誘쇨컧룄 遺꾩꽍 寃곌낵 Pope 벑25쓣 젣쇅븯뜑씪룄 쟾泥 슚怨 겕湲 蹂솕뿉 겙 쁺뼢씠 뾾뿀떎(IRR, 0.80; 95% CI, 0.58–1.10). 삉븳 Childs 벑20쓽 寃쎌슦뿉뒗 寃곗륫移섍 엳뒗 긽옄룄 以묐룄 깉씫뿉 룷븿븯湲곗뿉 以묐룄 깉씫瑜좎씠 넂떎. 씠윭븳 寃쎌슦 以묐룄 깉씫맂 궗엺 以 遺긽쑝濡 깉씫맂 鍮꾩쑉씠 몢 洹몃9 媛 떖옄떎硫 寃곌낵 빐꽍뿉 삤瑜섍 엳쓣 寃껋씠떎.

뀑吏, 遺긽 湲곗쟾씠 궗엺쓽 젒珥됯낵 媛숈 쇅긽꽦(traumatic) 슂씤씤吏 븘땶吏뿉 븳 援щ텇씠 뼱졄떎. 씠윭븳 젒珥 諛 쇅긽꽦 遺긽 슫룞쑝濡 삁諛⑺븷 닔 엳뒗 遺긽씠씪怨 媛꾩<븯湲 뼱젮슱 寃껋씠떎. 蹂 뿰援ъ뿉꽌뒗 洹몃윭븳 젒珥 諛 쇅긽꽦 遺긽씠 씪諛섏쟻쑝濡 쓷븯吏 븡븯怨, 以묒옱 諛 넻젣 洹몃9 媛 鍮꾩듂븳 솗瑜좎쓽 긽솴씠 諛쒖깮븯쓣 寃껋쑝濡 媛꾩<븯떎. 씠 遺遺꾩 異뷀썑 뿰援ш 뜑 늻쟻맂 씠썑 솗씤빐 蹂댁븘빞 븷 寃껋씠떎. 삉븳 遺긽 씤젙 湲곗怨 愿젴븯뿬, Pope 벑25쓽 뿰援ъ뿉꽌뒗 ‘援곗궗썕젴뿉 3씪 뿰냽 젙긽쟻 李몄뿬 遺덇’濡 洹 湲곗쓣 꽕젙븯떎. 뵲씪꽌 1씪쓣 湲곗쑝濡 꽕젙븳 떎瑜 뿰援ъ뿉 鍮꾪빐 遺긽 슏닔媛 怨쇱냼 異붿젙릺뿀쓣 媛뒫꽦씠 議댁옱븳떎. 븯吏留 븵꽌 솗씤븳 諛, 誘쇨컧룄 遺꾩꽍 寃곌낵 쟾泥 슚怨 겕湲곗뿉 쁺뼢쓣 誘몄튂吏 븡븯떎.

떎꽢吏, Carow 벑19쓽 뿰援щ뒗 깮룄뱾쓽 븰湲 以 遺긽쓣 異붿쟻븯떎. 紐⑤뱺 깮룄뱾씠 鍮꾩듂븳 젙룄쓽 떊泥댄솢룞쓣 븳떎怨 媛젙븯吏留, 떎젣濡쒕뒗 깮룄蹂꾨줈 吏꾪뻾븳 뒪룷痢 醫낅ぉ 듅꽦 諛 떊泥댄솢룞씠 떖옄쓣 媛뒫꽦씠 겕떎.

떖媛곹븳 遺긽 援 엯쓽 轅덉쓣 룷湲고븯寃 븷 닔 엳怨, 媛쒖씤 嫄닿컯뿉룄 吏냽쟻쑝濡 뼱젮쓣 븞寃⑥쨪 닔 엳떎. 떖媛곹븳 遺긽씠 븘땲뜑씪룄 뒪룷痢 諛 슫룞쓽 吏냽쟻씤 李몄뿬瑜 뼱졄寃 븷 닔 엳怨, 떎떆 遺긽떦븷 쐞뿕씠 엳떎. 쑀궗떆 쟾닾뿉 李몄뿬빐빞 븯뒗 援곗씤뱾 遺긽쓽 寃쎌쨷뿉 愿怨꾩뾾씠 遺긽쓣 떦븯吏 븡뒗 寃껋씠 以묒슂븯떎.

蹂 뿰援щ 넻빐 궡렣蹂 寃곌낵 援 遺긽 삁諛 슫룞쓣 怨좎븞븷 븣 슫룞웾 利앷 쇅 援곗씠씪뒗 듅닔쟻씤 솚寃쎌쓣 怨좊젮븯뿬 븘옒 媛숈 궗빆쓣 異붽濡 怨좊젮빐빞 븷 븘슂媛 엳떎.

泥レ㎏, 援곕뿉꽌 씠猷⑥뼱吏뒗 吏곸엫 뙣꽩쓣 젙솗엳 씠빐빐빞 븳떎. 븘슂 遺꾩꽍쓣 넻빐 옄二 벐씠뒗 吏곸엫쓣 븣븘빞 빐떦릺뒗 遺긽 삁諛 슫룞쓽 吏곸엫쓣 룄異쒗빐 궪 닔 엳떎.

몮吏, 援 솚寃쎌 떆媛꾩씠 븳젙릺뼱 엳吏留 떒湲곌컙뿉 遺긽쓣 理쒖냼솕븯硫댁꽌 泥대젰 諛 닔뻾젰쓣 뼢긽떆耳쒖빞 븯뒗 긽솴쟻 젣빟怨 媛숈씠 援 듅쑀쓽 臾명솕媛 議댁옱븳떎. 뵲씪꽌 슫룞 떆媛 슚쑉쟻씠硫, 泥대젰 諛 닔뻾젰쓽 젙泥대굹 븯瑜 蹂댁씠吏 븡뒗 踰붿쐞뿉꽌 媛쒕컻릺뼱빞 븳떎. 遺긽 媛먯냼븯吏留 닔뻾젰 뿭떆 젙泥대릺嫄곕굹 媛먯냼븳떎硫, 洹멸쾬 룓湲곕릺뼱빞 븷 슫룞쑝濡 媛꾩<븷 닔 엳떎.

뀑吏, 援곗씤뱾쓽 슫룞 닔以뿉 留욎텛뼱 슫룞 諛⑸쾿 궃씠룄瑜 議곗젙빐빞 븳떎. 援곗씤뱾 쟻젅븳 궃씠룄쓽 슫룞뿉 뜑 鍮⑤━ 씡닕빐吏 닔 엳쑝硫, 삱諛붾Ⅸ 諛⑸쾿쓽 슫룞쓣 넻빐 遺긽 삁諛 슚怨쇰 議곌린뿉 떖꽦븷 닔 엳쓣 寃껋씠떎.

꽬吏, Knapik 벑24씠 媛뺤“븳 寃껋쿂읆 슫룞쓽 醫낅쪟媛 떎뼇빐빞 븳떎.

븵꽌 뼵湲됲뻽뜕 誘 쑁援 떊泥 利됱쓳 썕젴씠굹 ETAP (Eagle Tactical Athlete Program)뒗 쐞 슂냼뱾씠 諛섏쁺릺뼱 醫낇빀븳 셿꽦삎 紐⑤쾾궗濡씠떎. 븳援援곗 븘吏 沅뚭퀬븯嫄곕굹 怨듭떇쟻쑝濡 궗슜븯뒗 遺긽 삁諛 봽濡쒓렇옩씠 뾾떎. 蹂 뿰援щ뒗 쁽옱源뚯 援 솚寃쎌뿉꽌 씠猷⑥뼱吏 遺긽 삁諛 슫룞 뿰援щ 醫낇빀븯뿬 옞옱 슂씤蹂 遺긽 삁諛 슚怨쇱쓽 李⑥씠젏쓣 遺꾩꽍븯떎. 삉븳, 쁽옱源뚯 吏꾪뻾맂 뿰援щ뱾쓽 꽭遺쟻씤 遺꾩꽍怨 젣븳젏뱾쓣 젙由ы븯떎. 씠윭븳 遺꾩꽍 궡슜 李⑦썑 援 솚寃쎌뿉꽌 遺긽 삁諛 슫룞쓣 怨좊젮븷 븣 以묒슂븳 湲곗큹 옄猷뚮줈 솢슜맆 寃껋씠떎.

Conflict of Interest

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

Author Contributions

Conceptualization: HS, OL, JK, KBK, HYM, YSK. Data curation, Formal analysis, Investigation, Resources: HS, GHK. Methodology: all authors. Project administration: HS, OL, JK, KBK, YSK. Supervision: OL, JK, KBK, HYM, YSK. Validation: YSK. Visualization: HS. Writing–original draft: HS. Writing–review & editing: OL, JK, KBK, HYM, YSK.

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