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Effects of Isometric Handgrip Exercise on Carotid Arterial Function and Cardiovascular Vasoreactivity Response to Sympathetic Stress in Young Adults
Korean J Sports Med 2024;42:38-45
Published online March 1, 2024;  https://doi.org/10.5763/kjsm.2024.42.1.38
© 2024 The Korean Society of Sports Medicine.

Yun Wook Kim1, Joon Youp Seong1, Ho Jeong Min1, Tae Gu Choi1, Yong Joon Jung1, Min Jeong Cho1, Hyun Jeong Kim1, Sae Young Jae1,2

1Department of Sport Science, University of Seoul, Seoul, 2Graduate School of Urban Public Health, University of Seoul, Seoul, Korea
Correspondence to: Sae Young Jae
Department of Sport Science, University of Seoul, 163 Seoulsiripdae-ro, Dongdaemun-gu, Seoul 02504, Korea
Tel: +82-2-6490-2953, Fax: +82-2-6490-2949, E-mail: syjae@uos.ac.kr
Received October 30, 2023; Revised January 18, 2024; Accepted January 22, 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: Isometric handgrip exercise (IHE) has a favorable cardiovascular effect and improves hemodynamic responses. Whether IHE attenuates stress-related hemodynamic reactivity assessed during a sympathetic challenge remains unexplored. We tested the hypothesis that an acute bout of IHE would improve carotid arterial function and attenuate cardiovascular vasoreactivity response to sympathetic stress in healthy adults.
Methods: In a randomized cross-over design, sixteen healthy adults (aged 21.8±3.1 years) were enrolled. Participants completed two testing sessions, separated by 1 week. Trials were either a control trial or performed IHE for two sets of 2 minutes at 30% of maximal voluntary contraction for each hand. The participant’s hand was immersed in an ice water bath (4 꼦) up to the wrist for 2 minutes. Carotid artery diameter, β-stiffness index, and compliance using ultrasound machine and brachial blood pressure (BP), heart rate (HR) were measured as indices of vasoreactivity at baseline, during, and recovery from cold pressor testing (CPT).
Results: The BP, HR, carotid artery diameter, and β-stiffness index increased similarly during CPT in both trials (p<0.001), without any interaction effect. Compared with the IHE trial, arterial compliance decreased in the control groups at 120 seconds during recovery with a significant interaction effect (p=0.02).
Conclusion: These findings suggest that an acute IHE did not attenuate BP, HR, carotid artery diameter and β-stiffness index vasoreactivity, but improved carotid artery compliance to sympathetic activation in healthy young adults.
Keywords : Exercise, Carotid arteries, Cardiovascular, Vasoreactivity
꽌 濡

떖삁愿 諛섏쓳꽦(cardiovascular reactivity)씠 젙떊쟻, 깮由ы븰쟻 뒪듃젅뒪 옄洹뱀쑝濡 씤빐 떖삁愿怨꾩뿉 굹굹뒗 諛섏쓳쓣 씪而ル뒗떎1. 씠뒗 씪떆쟻씤 뒪듃젅뒪 긽솴뿉꽌 떖諛뺤닔 諛 삁븬 利앷, 삁愿쓽 솗옣 諛 닔異 벑怨 媛숈 깮由ъ쟻씤 諛섏쓳쓣 룷븿븯硫, 씠윭븳 諛섏쓳 옄쑉떊寃쎄퀎쓽 議곗젅븯뿉 씠猷⑥뼱吏꾨떎2. 씪떆쟻씤 뒪듃젅뒪 옄洹뱀쑝濡 씤빐 援먭컧떊寃쎌씠 怨쇰룄븯寃 솢꽦솕릺硫 떖삁愿 諛섏쓳꽦씠 怨쇰룄븯寃 利앷븯뒗뜲, 씠뒗 뼢썑 怨좏삁븬, 뿀삁꽦 떖옣 吏덊솚, 遺젙留, 떖遺쟾 벑怨 媛숈 떖삁愿 吏덊솚 諛쒖깮 쐞뿕 利앷 뿰愿엳뒗 寃껋쑝濡 젣떆릺怨 엳떎3. 뵲씪꽌 援먭컧떊寃쎌쓽 怨쇳솢꽦솕濡쒕꽣 굹굹뒗 怨쇰룄븳 떖삁愿 諛섏쓳꽦쓣 愿由ы븯뒗 寃껋씠 떖삁愿 吏덊솚 삁諛⑹뿉 以묒슂븯떎.

깋븬諛뺢궗뒗 援먭컧떊寃쎌쓣 怨쇰룄븯寃 솢꽦솕븯뿬 떖삁愿 諛섏쓳꽦쓣 룊媛븯뒗 諛⑸쾿 以 븯굹씠硫4, 깋븬諛뺢궗 以 怨쇰룄븳 愿긽룞留μ쓽 諛섏쓳 룆由쎌쟻쑝濡 뼢썑 떖삁愿 吏덊솚 諛쒖깮쓣 삁痢≫븳떎怨 젣떆븯怨 엳떎5. 洹몃윭굹 愿긽룞留μ쓽 諛섏쓳쓣 痢≪젙븯湲 쐞빐 삁愿議곗쁺닠怨 媛숈 移⑥뒿쟻씤 諛⑸쾿씠 벐씠硫6, 痢≪젙 愿젴 鍮꾩슜, 떆媛 諛 븞쟾꽦쓽 씠쑀濡쒕룄 옒 씠슜릺吏 븡뒗떎. 씎誘몃∼寃뚮룄 寃쎈룞留μ 빐遺븰쟻 援ъ“굹 湲곕뒫씠 愿긽룞留κ낵 쑀궗븯硫, 깋븬諛뺢궗瑜 넻븳 寃쎈룞留 삁愿 諛섏쓳꽦룄 愿긽룞留μ뿉꽌쓽 諛섏쓳怨 쑀궗븯떎7. 寃쎈룞留 삁愿 옱諛섏쓳 珥덉쓬뙆瑜 넻븯뿬 鍮꾩묠뒿쟻쑝濡 痢≪젙븷 닔 엳怨 鍮꾧탳쟻 痢≪젙씠 媛꾨떒븯떎. 깋븬諛뺢궗濡 씤븳 湲됱꽦 뒪듃젅뒪뿉 븳 諛섏쓳쑝濡 寃쎈룞留μ 젇怨 嫄닿컯븳 궗엺뿉꽌 삁愿씠 솗옣릺吏留 떖삁愿 吏덊솚옄뿉꽌뒗 삁愿쓽 닔異뺤씠 諛쒖깮븳떎8. 씠윭븳 諛섏쓳뿉 븳 湲곗쟾 紐낇솗븯寃 諛앺吏吏 븡븯吏留, Peace 벑6 湲됱꽦 뒪듃젅뒪 옄洹뱀쓣 二쇰㈃ 꽭룷 쇅뵾뿉 쐞移섑븳 α1-닔슜泥(α1-receptors)뿉 븳 끂瑜댁뿉뵾꽕봽由(norepinephrine) 諛⑹텧쓽 삁愿 닔異 옉슜怨 β-닔슜泥(β-receptors)뿉 쓽븳 삁愿 솗옣 옉슜씠 꽌濡 긽뇙븯뒗뜲, 떖삁愿 吏덊솚 쐞뿕씠 겙 궗엺 씠윭븳 긽諛섎맂 슚怨쇱뿉꽌 삁愿 솗옣 諛섏쓳씠 븯맆 닔 엳떎怨 젣떆븯怨 엳떎. 뵲씪꽌 깋븬諛뺢궗瑜 넻븳 寃쎈룞留 삁愿 옱諛섏쓳 痢≪젙 寃쎈룞留 궡뵾꽭룷 湲곕뒫쓣 痢≪젙븯뒗 吏몴濡쒕룄 궗슜맂떎7.

벑泥숈꽦 븙젰슫룞 떖삁愿 吏덊솚쓽 쐞뿕怨 삁븬쓣 궙異붾뒗 깉濡쒖슫 삎깭쓽 슫룞씠硫9, 떆媛꾩쟻쑝濡쒕룄 슚쑉쟻씤 슫룞諛⑸쾿쑝濡 쁽옱 遺긽븯怨 엳떎. 븳 硫뷀 遺꾩꽍 뿰援ъ뿉 뵲瑜대㈃, 벑泥숈꽦 븙젰슫룞씠 젙긽 삁븬怨 怨좏삁븬쓣 媛吏 궗엺 紐⑤몢뿉꽌 닔異뺢린 씠셿湲 삁븬쓣 쑀쓽븯寃 媛먯냼떆궎뒗 寃껋쑝濡 굹궗떎10. 듅엳 씪떆쟻씤 벑泥숈꽦 븙젰슫룞쑝濡쒕룄 삁븬씠 媛먯냼븳떎怨 젣떆븯떎11. 肉먮쭔 븘땲씪 븙젰슫룞씠 옄쑉떊寃쎄퀎 媛쒖꽑뿉룄 슚怨쇰 誘몄튇떎뒗 뿰援ш 蹂닿퀬릺뿀떎12. 뵲씪꽌 븙젰슫룞쑝濡 씤빐 옄쑉떊寃쎄퀎쓽 媛쒖꽑 뒪듃젅뒪뿉 븳 援먭컧떊寃쎌쓽 솢꽦솕瑜 뼲젣븷 닔 엳쓣 寃껋쑝濡 삁긽맂떎. 씪遺 꽌援ъ뿉꽌 吏꾪뻾맂 꽑뻾뿰援ъ뿉꽌 벑泥숈꽦 븙젰슫룞 以묒옱瑜 넻븯뿬 젙떊쟻 뒪듃젅뒪濡 씤븳 떖諛뺤닔굹 삁븬怨 媛숈 吏몴쓽 떖삁愿 諛섏쓳꽦쓣 셿솕븷 닔 엳떎怨 젣떆븯떎1,9. 洹몃윭굹 씠뒗 벑泥숈꽦 븙젰슫룞 以묒옱뿉 쓽븳 湲곗 삁븬 媛먯냼쓽 쁺뼢쑝濡 뿬寃⑥쭊떎13. Hamer 벑14쓽 硫뷀 遺꾩꽍뿉꽌, 留뚯꽦슫룞肉 븘땲씪 씪떆쟻 슫룞룄 뒪듃젅뒪뿉 븳 떖삁愿 諛섏쓳꽦 셿솕뿉 슚怨쇱쟻씤 寃껋쑝濡 굹궗떎. 洹몃윭굹 援먭컧떊寃 솢꽦솕뿉 븳 벑泥숈꽦 븙젰슫룞쓽 삁븬 諛섏쓳 셿솕 슚怨쇱뿉 븳 뿰援щ뒗 뿬쟾엳 遺議깊븯硫, 듅엳 寃쎈룞留 湲곕뒫쓣 룊媛븳 뿰援щ뒗 뾾떎. 씠뿉 蹂 뿰援ъ뿉꽌뒗 깋븬諛뺢궗瑜 씠슜븯뿬, 떖삁愿 諛섏쓳꽦뿉 엳뼱 씪떆쟻 벑泥숈꽦 븙젰슫룞씠 寃쎈룞留 삁愿 湲곕뒫怨 삁븬 셿솕뿉 誘몄튂뒗 쁺뼢뿉 빐꽌 븣븘蹂닿퀬옄 븳떎.

뿰援 諛⑸쾿

1. 뿰援 긽

蹂 뿰援щ뒗 20쓽 嫄닿컯븳 꽦씤 16紐(굹씠, 21.8±3.1; 泥댁쭏웾吏닔, 22.0±2.9 kg/m2; 궓옄 8紐, 뿬옄 8紐)쓣 꽌슱떆由쎈븰援먯뿉꽌 愿묎퀬瑜 넻빐 紐⑥쭛븯떎. 紐⑤뱺 떎뿕 李몄뿬옄뱾 떖삁愿怨 吏덊솚, 궗꽦 吏덊솚 諛 洹쇨낏寃⑷퀎 吏덊솚쓣 吏꾨떒諛쏄굅굹 愿젴 빟臾쇱쓣 蹂듭슜븯吏 븡븯쑝硫 떊泥댄솢룞 李몄뿬뿉 젣븳씠 뾾뿀떎. 李몄뿬옄뱾쓽 듅꽦 Table 1怨 媛숇떎. 蹂 뿰援щ뒗 꽌슱떆由쎈븰援 깮紐낆쑄由ъ쐞썝쉶쓽 듅씤쓣 諛쏆븯쑝硫(No. UOS IRB 2022-08-003), 떎뿕 李몄뿬옄뱾뿉寃 뿰援ъ쓽 紐⑹쟻怨 궡슜쓣 異⑸텇엳 꽕紐낇븯怨 떎뿕 李멸 룞쓽꽌瑜 諛쏆 썑뿉 떎뿕쓣 吏꾪뻾븯떎.

Table 1 . Characteristics of the subjects

CharacteristicData
No. of subjects16
Age (yr)21.8±3.1
Height (cm)170.2±8.7
Weight (kg)64.5±14.2
BMI (kg/m2)22.0±2.9
Body fat (%)18.1±5.9
Resting HR (beats/min)61.1±9.8

Values are presented as number only or mean±standard deviation.

BMI: body mass index, HR: heart rate.



2. 떎뿕 꽕怨

蹂 뿰援щ뒗 뿰援 李몄뿬옄뱾씠 벑泥숈꽦 븙젰슫룞 泥섏튂 넻젣 泥섏튂뿉 紐⑤몢 李몄뿬븯뒗 臾댁옉쐞 援먯감꽕怨(randomized cross-over design)濡 吏꾪뻾븯떎. 뿰援 李몄뿬옄뒗 珥 2쉶 떎뿕떎뿉 諛⑸Ц븯怨, 泥섏튂 닚꽌뒗 젣鍮꾨퐨湲곕 넻븯뿬 臾댁옉쐞濡 꽑젙븯떎. 씠쟾 泥섏튂쓽 쁺뼢쓣 理쒖냼솕븯湲 쐞빐 몢 泥섏튂 궗씠 媛꾧꺽(wash-out time)쓣 理쒖냼 1二쇱씪濡 꽕젙븯떎. 떖삁愿 諛섏쓳꽦 寃궗뒗 깋븬諛뺢궗14瑜 씠슜븯쑝硫 벑泥숈꽦 븙젰슫룞怨 넻젣 泥섏튂 30遺 썑뿉 떎떆븯떎. 떎뿕 李몄뿬 쟾 8떆媛 씠긽 湲덉뿰怨 怨듬났 긽깭瑜 쑀吏븯怨, 24떆媛 룞븞 移댄럹씤, 븣肄붿삱, 鍮꾪誘 꽠痍 諛 寃⑸젹븳 떊泥댄솢룞 李몄뿬瑜 궪媛룄濡 슂泥븯떎. 삉븳 紐⑤뱺 떎뿕 삤쟾 9떆뿉꽌 11떆뿉 떎떆븯떎. 蹂 뿰援ъ쓽 떎뿕 꽕怨꾨뒗 Fig. 1뿉 젣떆븯떎.

Fig. 1. Experimental design. CON: control, IHE: isometric handgrip exercise, CPT: cold pressor test.

3. 깋븬諛뺢궗

援먭컧떊寃 솢꽦솕뿉뒗 꽑뻾뿰援ъ뿉꽌 二쇰줈 씠슜릺뒗 깋븬諛뺢궗瑜 궗슜븯떎15. 떎뿕 李몄뿬옄뒗 븞젙 떆 삁븬怨 떖諛뺤닔瑜 痢≪젙븳 뮘, 늻슫 옄꽭뿉꽌 쇊넀쓣 넀紐⑷퉴吏 닔삩 4 ℃쓽 뼹쓬臾쇱뿉 3遺꾧컙 떞媛붾떎媛 3遺 썑 利됱떆 뼹쓬臾쇱뿉꽌 넀쓣 鍮쇨퀬 2遺꾧컙 쉶蹂듦린 룞븞쓽 떖삁愿 吏몴뱾쓽 蹂솕瑜 痢≪젙븯떎. 떖삁愿 諛섏쓳꽦 痢≪젙 吏몴濡쒕뒗 떖諛뺤닔 닔異뺢린 諛 씠셿湲 삁븬쓣 痢≪젙븯쑝硫, 깋븬諛뺢궗 쟾, 깋븬諛뺢궗 以 30珥, 깋븬諛뺢궗 以 120珥, 쉶蹂듦린 30珥, 洹몃━怨 쉶蹂듦린 120珥덉뿉 痢≪젙븯떎. 닔삩 쟾옄삩룄怨꾨 씠슜븯뿬 솗씤븯쑝硫, 깋븬諛뺢궗 룞븞 諛쒖궡諛 샇씉(Balsalva maneuver)쓣 뵾븯怨 젙긽 샇씉 뙣꽩쓣 쑀吏븯룄濡 떎뿕 李몄뿬옄뿉寃 슂泥븯떎.

4. 벑泥숈꽦 븙젰슫룞 諛 넻젣 泥섏튂

벑泥숈꽦 븙젰슫룞 泥섏튂뒗 븙젰슫룞 湲곌뎄(Zona plus; Zona HEALTH)瑜 씠슜븯뿬 醫뚯슦 理쒕 닔쓽쟻 洹쇰젰 寃궗瑜 븯怨, 理쒕 洹쇰젰쓽 30% 슫룞 媛뺣룄濡 2遺꾧컙 벑泥숈꽦 닔異 썑, 1遺꾧컙 쑕떇쓣 痍⑦븯떎. 씠瑜 醫뚯슦 踰덇컝븘 2쉶뵫, 珥 4쉶 11遺꾧컙 떎떆븯떎. 씠윭븳 슫룞 봽濡쒗넗肄쒖 怨좏삁븬 솚옄쓽 벑泥숈꽦 븙젰슫룞 泥섎갑쑝濡 옄二 씠슜맂떎9. 理쒕 븙젰 寃궗 諛 슫룞 젅李⑤뒗 슫룞湲곌뎄 궡뿉 봽濡쒓렇옒諛 릺뼱엳쑝硫 떆媛곸쟻쑝濡 슫룞媛뺣룄瑜 솗씤븯硫댁꽌 닔뻾븯떎. 벑泥숈꽦 븙젰슫룞 泥섏튂 諛 넻젣 泥섏튂 醫낅즺 30遺 썑뿉 깋븬諛뺢궗 쟾(pre-CPT)쓣 痢≪젙븯怨 씠썑 깋븬諛뺢궗瑜 吏꾪뻾븯떎.

5. 痢≪젙 빆紐 諛 諛⑸쾿

1) 떊泥댁“꽦

媛踰쇱슫 蹂듭옣쓣 李⑹슜븳 긽깭뿉꽌 떊옣(cm) 떊옣痢≪젙湲곕 씠슜븯뿬 痢≪젙븯怨, 泥댁쨷(kg) 泥댁쨷怨꾨 씠슜븯뿬 痢≪젙븯떎. 洹쇱쑁웾 諛 泥댁諛⑸쪧 泥댁꽦遺 遺꾩꽍湲(Inbody BWA 2.0; Inbody) 瑜 씠슜븯뿬 痢≪젙븯떎. 泥댁쭏웾吏닔뒗 泥댁쨷(kg)/떊옣(m2) 怨듭떇쓣 씠슜븯뿬 궛異쒗븯떎.

2) 삁븬 諛 떖諛뺤닔

븞젙 떆 삁븬 10遺꾧컙 늻슫 긽깭뿉꽌 異⑸텇븳 쑕떇쓣 痍⑦븳 썑 옄룞삁븬怨(JPN601; Omeron)瑜 씠슜븯뿬 슦痢 긽셿뿉꽌 痢≪젙븯떎. 2遺 媛꾧꺽쑝濡 珥 2쉶 痢≪젙븯뿬 룊洹좉컪쓣 궗슜븯怨 1李⑥ 2李 痢≪젙 媛 삤李④ 10 mm Hg 씠긽씪 寃쎌슦 븳 踰 뜑 痢≪젙븯떎. 긽셿룞留 삁븬 諛 떖諛뺤닔룄 깋븬諛뺢궗 쟾, 깋븬諛뺢궗 30珥, 깋븬諛뺢궗 120珥, 쉶蹂듦린 30珥, 쉶蹂듦린 120珥덉뿉 옄룞삁븬怨꾨 씠슜븯뿬 슦痢 긽셿뿉꽌 媛곴컖 痢≪젙븯떎.

3) 寃쎈룞留 삁愿 湲곕뒫

寃쎈룞留 吏곴꼍 닔異뺢린(理쒕 吏곴꼍) 씠셿湲(理쒖냼 吏곴꼍)瑜 9–4 MHz 醫낆텞 깘珥됱옄(L441; Hitachi Aloka Medical)瑜 씠슜븯뿬 寃쎈룞留 醫낅떒硫댁쑝濡 珥 寃쎈룞留(common carotid)뿉꽌 痢≪젙븯쑝硫, 룄뵆윭 珥덉쓬뙆 옣鍮(Arietta 60; Hitachi Aloka Medical)濡 愿李고븯떎. 깋븬諛뺢궗 쟾, 깋븬諛뺢궗 30珥, 깋븬諛뺢궗 120珥, 쉶蹂듦린 30珥, 쉶蹂듦린 120珥덉쓽 媛곴컖 떆젏뿉꽌 빟 12쉶 留λ컯씠 쎇뒗 룞븞 珥덉쓬뙆 옣鍮꾩쓽 냼봽듃썾뼱媛 B-mode뿉꽌 삁愿 踰쎌쓽 吏곸엫쓣 異붿쟻븯뿬 吏곴꼍 蹂솕쓽 룊洹 媛믪씠 젣怨듬릺뿀떎. 寃쎈룞留 깂꽦룄(arterial compliance, AC)뒗 痢≪젙맂 吏곴꼍怨 삁븬쑝濡쒕꽣 떎쓬怨 媛숈씠 젙쓽맂떎: AC=π (D1×D1–D0×D0)/4 (P1×P0). 寃쎈룞留 寃쎌쭅룄쓽 젙룄(寃쎈룞留 吏닔)瑜 굹궡뒗 踰좏 뒪떚봽땲뒪 吏닔(β-stiffness index)뒗 룞留 吏곴꼍쓽 蹂솕뿉 븳 븬젰 李⑥씠쓽 鍮꾩꽑삎쟻씤 쁺뼢쓣 蹂댁젙븯뿬 AC瑜 룊媛븯뒗 諛⑸쾿씠硫, 떎쓬怨 媛숈씠 젙쓽맂떎: β=(logP1/P0)/(D1–D0/D0). 뿬湲곗꽌 D1怨 D0뒗 理쒕(닔異뺢린) 理쒖냼(씠셿湲)吏곴꼍쓣 쓽誘명븯硫, P1怨 P0 理쒓퀬(닔異뺢린) 理쒖냼(씠셿湲) 삁븬쓣 굹궦떎16.

6. 옄猷 泥섎━

紐⑤뱺 옄猷뚮뒗 룊洹좉낵 몴以렪李⑤줈 몴湲고븯떎. 뜲씠꽣쓽 젙洹쒖꽦쓣 솗씤븯湲 쐞빐 Shapiro-Wilk 寃궗瑜 떆뻾븯떎. 벑泥숈꽦 븙젰슫룞쓽 援먭컧떊寃 옄洹뱀뿉 븳 寃쎈룞留 삁愿 湲곕뒫怨 삁븬 셿솕 슚怨쇰 洹쒕챸븯湲 쐞빐 泥섏튂(벑泥숈꽦 븙젰슫룞, 넻젣) 痢≪젙 떆湲(湲곗, 깋븬諛뺢궗 쟾, 깋븬諛뺢궗 以 30珥, 깋븬諛뺢궗 以 120珥, 쉶蹂듦린 30珥, 쉶蹂듦린 120珥)瑜 룆由 蹂씤쑝濡 븯뒗 2×6 諛섎났痢≪젙 씠썝諛곗튂 遺꾩궛遺꾩꽍(two-way analysis of variance with repeated measures)쓣 떎떆븯떎. 긽샇옉슜 슚怨쇨 굹궃 蹂닔뿉 빐꽌뒗 Bonferroni瑜 쟻슜븳 궗썑遺꾩꽍쓣 떎떆븯떎. 紐⑤뱺 넻怨 泥섎━뒗 IBM SPSS PC version 27.0 (IBM Corp.)쓣 씠슜븯쑝硫, 쑀쓽 닔以 α<0.05쑝濡 꽕젙븯떎.

寃 怨

깋븬諛뺢궗 以 벑泥숈꽦 븙젰슫룞 泥섏튂 넻젣 泥섏튂 紐⑤몢 긽셿룞留 삁븬(닔異뺢린 諛 씠셿湲)怨 떖諛뺤닔媛 쑀쓽븯寃 利앷븯쑝硫, 쉶蹂듦린 120珥덉뿉뒗 깋븬諛뺢궗 쟾 긽깭 媛믪쑝濡 룎븘삤뒗 寃껋쓣 愿李고븯떎(time effect p<0.001). 몢 泥섏튂 媛 긽샇옉슜 슚怨쇰뒗 굹굹吏 븡븯떎(interaction effect p=0.497, p=0.853, p=0.379) (Table 2, Fig. 2). 깋븬諛뺢궗 以 벑泥숈꽦 븙젰슫룞 泥섏튂 넻젣 泥섏튂 紐⑤몢 寃쎈룞留 理쒕, 理쒖냼 吏곴꼍 紐⑤몢 쑀쓽븯寃 솗옣릺뿀쑝硫, 쉶蹂듦린뿉뒗 깋븬諛뺢궗 쟾 긽깭 媛믪쑝濡 룎븘삤뒗 寃껋쓣 愿李고븯떎(time effect p<0.001). 몢 泥섏튂 媛 긽샇옉슜 슚怨쇰뒗 굹굹吏 븡븯떎(interaction effect p=0.201, p=0.08) (Fig. 3). 깋븬諛뺢궗 以 120珥덉뿉꽌 벑泥숈꽦 븙젰슫룞 泥섏튂 넻젣 泥섏튂 紐⑤몢 寃쎈룞留 寃쎌쭅룄 吏닔媛 利앷븯쑝硫, 쉶蹂듦린 120珥덉뿉꽌 媛먯냼븯뒗 寃껋쓣 愿李고븯떎(time effect p=0.025). 몢 泥섏튂 媛 긽샇옉슜 슚怨쇰뒗 굹굹吏 븡븯떎(interaction effect p=0.89) (Table 2). 寃쎈룞留ν깂꽦룄뒗 깋븬諛뺢궗 쟾, 깋븬諛뺢궗 以 30珥, 쉶蹂듦린 120珥덉뿉 洹몃9 媛 李⑥씠媛 굹궗떎(trial effect p=0.012). 넻젣 泥섏튂뒗 깋븬諛뺢궗 以 120珥덉뿉 媛먯냼븯뿬 쉶蹂듦린 120珥덉뿉 떎떆 利앷븯뒗 寃껋쓣 愿李고븯쑝硫, 벑泥숈꽦 븙젰슫룞 泥섏튂뒗 슫룞 썑 깋븬諛뺢궗 쟾뿉 利앷븯떎(time effect p<0.001). 몢 泥섏튂 媛 긽샇옉슜 슚怨쇨 굹궗떎(interaction effect p=0.02) (Table 2).

Table 2 . Effects of isometric hand grip on cardiovascular reactivity during CPT and recovery

VariableTrialBaselineCPTRecoveryp-value
Pre30 sec120 sec30 sec120 secTimeTrialInteraction
HR (beats/min)CON62.2±9.261.2±9.167.9±14.465.9±11.459.9±9.061.1±8.2<0.0010.4270.38
IHE62.9±11.761.0±10.771.4±15.166.8±13.460.8±9.661.8±11.0
AC (mm2/mm Hg)CON1.108±0.2411.120±0.2601.059±0.2690.989±0.303*1.024±0.2661.064±0.289<0.0010.0120.02
IHE1.098±0.2431.231±0.277*,1.174±0.2761.076±0.3581.043±0.2691.175±0.334
Carotid β-stiffness (U)CON4.5±0.94.4±0.94.9±0.85.4±1.24.9±0.84.6±0.8<0.0010.0250.89
IHE4.4±0.94.0±0.94.2±0.85.3±1.64.7±1.14.0±1.0

Values are presented as mean±standard deviation.

CPT: cold pressor test, HR: heart rate, CON: control, IHE: isometric handgrip exercise, AC: arterial compliance.

*p<0.05 vs. baseline, p<0.05 vs. CON.


Fig. 2. Blood pressure reactivity and recovery in response to cold pressor test. CON: control, IHE: isometric handgrip exercise, CPT: cold pressor test, Rec: recovery, SBP: systolic blood pressure, DBP: diastolic blood pressure. *p<.05 vs baseline.
Fig. 3. Carotid diameter reactivity and recovery in response to cold pressor test. max: maximum, min: minimum, CON: control, IHE: isometric handgrip exercise, CPT: cold pressor test, Rec: recovery. *p<.05 vs baseline.
怨 李

蹂 뿰援щ뒗 씪떆쟻 벑泥숈꽦 븙젰슫룞씠 援먭컧떊寃 솢꽦솕뿉 븳 寃쎈룞留 삁愿怨 떖삁愿 옱諛섏쓳뿉 誘몄튂뒗 쁺뼢뿉 빐꽌 븣븘蹂닿퀬옄 븯떎. 벑泥숈꽦 븙젰슫룞 泥섏튂 넻젣 泥섏 紐⑤몢 긽셿룞留 삁븬, 寃쎈룞留 吏곴꼍(理쒕, 理쒖냼)怨 寃쎌쭅룄 紐⑤몢 援먭컧떊寃 솢꽦솕瑜 쐞븳 깋븬諛뺢궗 以묒뿉 利앷븯떎媛 쉶蹂듦린뿉 깋븬諛뺢궗 쟾 긽깭媛믪쑝濡 룎븘삤뒗 寃껋쓣 愿李고븯떎. 씠뒗 꽑뻾뿰援щ뱾怨 씪移섑븯硫1,17, 깋븬諛뺢궗媛 援먭컧떊寃쎌쓣 솢꽦솕븯떎怨 븷 닔 엳떎. 洹몃윭굹 벑泥숈꽦 븙젰슫룞 泥섏튂 넻젣 泥섏튂뿉꽌 긽샇옉슜 슚怨쇰뒗 寃쎈룞留 깂꽦룄瑜 젣쇅븳 紐⑤뱺 蹂씤뿉꽌 굹굹吏 븡븯떎. 씠윭븳 뿰援 寃곌낵뒗, 씪떆쟻 벑泥숈꽦 븙젰슫룞씠 寃쎈룞留 깂꽦룄뿉 湲띿젙쟻씤 쁺뼢쓣 誘몄튌 닔 엳吏留 媛 媛쒖씤쓽 깋븬諛뺢궗濡 씤븳 援먭컧떊寃 솢꽦솕뿉 븳 寃쎈룞留 吏곴꼍, 寃쎌쭅룄 諛 긽셿룞留 삁븬뿉뒗 쁺뼢쓣 誘몄튂吏 븡쓣 닔 엳떎뒗 寃껋쓣 젣떆븳떎.

씠誘 꽑뻾뿰援ъ뿉꽌 쑀궛냼 슫룞 諛 빆 슫룞 援먭컧떊寃 솢꽦솕뿉 븳 怨쇰룄븳 삁븬 諛섏쓳쓣 셿솕븳떎怨 蹂닿퀬븯怨 엳쑝굹14, 援먭컧떊寃 솢꽦솕뿉 궗슜맂 痢≪젙 諛⑸쾿쓽 李⑥씠뿉 뵲씪 떎뼇븳 寃곌낵뱾쓣 젣떆븯怨 엳떎18. Millar 벑1 8二쇨컙 벑泥숈꽦 븙젰슫룞 媛쒖엯뿉 븳 媛 媛쒖씤쓽 떖삁愿 諛섏쓳꽦씠 援먭컧떊寃쎄퀎 솢꽦솕 諛⑸쾿쑝濡 궗슜븳 뿰냽鍮쇨린옉뾽뿉꽌뒗 삁븬 셿솕 슚怨쇨 엳뿀吏留, 깋븬諛뺢궗뿉꽌뒗 슚怨쇨 뾾뿀떎怨 蹂닿퀬븯떎. 留덉갔媛吏濡 Badrov 벑9쓽 뿰援ъ뿉꽌룄 10二쇨컙 벑泥숈꽦 븙젰슫룞 媛쒖엯뿉 븳 떖삁愿 諛섏쓳꽦씠 뿰냽鍮쇨린옉뾽怨 벑泥숈꽦 븙젰뀒뒪듃뿉꽌뒗 삁븬 셿솕 슚怨쇨 엳뿀吏留, 깋븬諛뺢궗뿉꽌뒗 슚怨쇨 뾾뿀떎怨 蹂닿퀬븯怨 엳떎. 삁옣 끂瑜댁뿉뵾꽕봽由 냽룄 삁븬 닔以씠 援먭컧떊寃 솢꽦솕 젙룄 긽愿愿怨꾧 엳쑝硫, 援먭컧떊寃 솢꽦솕뒗 끂瑜댁뿉뵾꽕봽由곗쓽 遺꾨퉬瑜 利앷떆궓떎19. 끂瑜댁뿉뵾꽕봽由곗 삁愿 룊솢洹쇱뿉꽌 α1-닔슜泥대 솢꽦솕떆耳 삁愿 닔異뺤쓣 옄洹뱁븯뿬 씠濡 씤빐 珥 留먯큹 빆怨 룊洹 룞留 븬젰쓣 利앷떆궓떎20. 諛섎㈃뿉 슫룞 援먭컧떊寃 솢꽦솕濡쒕꽣 蹂댄샇쟻씤 뿭븷쓣 븯硫, 끂瑜댁뿉뵾꽕봽由곗쓽 媛먯냼 β-닔슜泥댁쓽 諛섏쓳꽦 利앷濡 뒪듃젅뒪뿉 븳 삁뿭븰쟻 諛섏쓳쓣 셿솕븯뒗 寃껋쑝濡 븣젮졇 엳떎21. 蹂 뿰援ъ뿉꽌뒗 援먭컧떊寃 솢꽦솕 諛⑸쾿쑝濡 깋븬諛뺢궗瑜 궗슜뻽쑝硫, 씪떆쟻 벑泥숈꽦 븙젰슫룞뿉 뵲瑜 슚怨쇰 愿李고븯吏 紐삵븯떎. 뵲씪꽌 꽑뻾뿰援щ뱾怨 遺덉씪移섑븳 뿰援 寃곌낵瑜 蹂댁씠뒗 寃껋쑝濡 깮媛곷릺硫, 뿰냽鍮쇨린옉뾽怨 媛숈 젙떊쟻 뒪듃젅뒪뒗 떖옣꽦 삁븬 諛섏쓳쑝濡, 깋븬諛뺢궗 媛숈 떊泥댁쟻 뒪듃젅뒪뒗 삁愿꽦 삁븬 諛섏쓳쑝濡 遺꾨쪟븷 닔 엳떎1. 媛곴컖 떖삁愿 諛섏쓳꽦뿉 븳 湲곗쟾 紐낇솗븯吏뒗 븡吏留 꽑뻾뿰援ъ뿉꽌 뿰냽鍮쇨린옉뾽怨 媛숈씠 젙떊쟻 뒪듃젅뒪濡 씤븳 利앷맂 삁븬 二쇰줈 떖諛뺤닔쓽 긽듅뿉 쓽빐 諛쒖깮븯硫, 씠뒗 깮由ы븰쟻 諛섏쓳씠 떖洹쇱꽦쑝濡 二쇰줈 以묒텛떊寃쎄퀎쓽 踰좏 븘뱶젅궇由곌퀎 議곗젅뿉 쓽빐 以묒옱맆 닔 엳떎怨 젣떆븯怨 엳떎17,22. 삉븳 理쒓렐 뿰援ъ뿉 뵲瑜대㈃ 벑泥숈꽦 븙젰슫룞쓽 슫룞 媛뺣룄뿉 뵲씪 삁븬 媛먯냼쓽 젙룄媛 떖옄쑝硫, 媛뺣룄媛 넂쓣닔濡 삁븬쓽 媛먯냼 슚怨쇨 겕寃 굹궗떎23. 異뷀썑 뿰援ъ뿉꽌뒗 떎뼇븳 뒪듃젅뒪 諛⑸쾿怨 슫룞 媛뺣룄瑜 씠슜븯뿬 븙젰슫룞쓽 떖삁愿 옱諛섏쓳 슚怨쇰 寃利앺븯뒗 寃껋씠 븘슂븷 寃껋씠떎.

援먭컧떊寃 怨쇳솢꽦솕濡 씤븳 삁愿 湲곕뒫 옣븷뒗 愿긽룞留μ쓣 넀긽떆궎硫, 愿긽룞留 넀긽 떖삁愿 궗嫄 利앷 諛젒븳 愿젴씠 엳뒗 寃껋쑝濡 븣젮졇 엳떎5. 洹몃윭굹 愿긽룞留 湲곕뒫쓣 吏곸젒쟻쑝濡 룊媛븯湲곗뿉뒗 쐞뿕遺떞룄 겕怨 痢≪젙씠 돺吏 븡湲 븣臾몄뿉 씠 援ъ“쟻∙湲곕뒫쟻쑝濡 쑀궗븳 寃쎈룞留μ뿉꽌 삁愿 湲곕뒫쓣 痢≪젙븯뒗 寃껋씠 以묒슂븯떎7. 寃쎈룞留 삁愿 湲곕뒫쓣 룊媛븷 닔 엳뒗 吏몴濡쒕뒗 寃쎈룞留 깂꽦룄 寃쎌쭅룄 吏닔, 洹몃━怨 吏곴꼍씠 엳떎. 씠뒗 꽌濡 愿怨꾧 엳쑝硫, 寃쎈룞留μ쓽 깂꽦룄 寃쎌쭅룄뒗 寃쎈룞留 吏곴꼍쓽 쁺뼢쓣 諛쏅뒗떎16. 깋븬諛뺢궗 媛숈 湲됱꽦 뒪듃젅뒪뿉 븳 諛섏쓳쑝濡 寃쎈룞留μ 젇怨 嫄닿컯븳 궗엺뿉꽌 삁愿씠 솗옣릺吏留 떖삁愿 吏덊솚옄뿉꽌뒗 삁愿쓽 닔異뺤씠 諛쒖깮븳떎8. 寃쎈룞留μ 꽭룷 쇅뵾뿉 쐞移섑븳 α-닔슜泥댁뿉 븳 끂瑜댁뿉뵾꽕봽由 諛⑹텧쓽 삁愿 닔異 옉슜怨 삁以묒쓽 移댄뀒肄쒖븘誘(catecholamines)뿉 쓽븳 삁愿 솗옣 옉슜씠 꽌濡 긽뇙릺뒗뜲, 떖삁愿 吏덊솚 쐞뿕씠 겙 궗엺뱾뿉꽌뒗 씠윭븳 긽諛섎맂 솗옣 슚怨쇨 뜙븯嫄곕굹 뾾뼱꽌 솗옣 諛섏쓳씠 븯릺嫄곕굹 닔異 諛섏쓳쑝濡 諛섏쟾릺湲 븣臾몄씠떎6. 蹂 뿰援ъ뿉꽌 깋븬諛뺢궗 룞븞 넻젣 泥섏튂 븙젰슫룞 泥섏튂 紐⑤몢 쑀쓽븯寃 寃쎈룞留 吏곴꼍씠 利앷뻽떎. 洹몃윭굹 넻젣 泥섏튂 븙젰슫룞 泥섏튂 媛 긽샇옉슜 슚怨쇰뒗 굹굹吏 븡븯떎. 뿬윭 꽑뻾뿰援ъ뿉꽌 슫룞 썑 궛솕吏덉냼(nitric oxide, NO)媛 利앷븳떎怨 젣떆븯떎24,25. 븙젰슫룞 援냼쟻쑝濡 삁瑜섎 利앷떆耳 씠濡 씤빐 利앷맂 쟾떒 쓳젰 NO쓽 諛⑹텧쓣 옄洹뱁븳떎26. Sessa27뒗 쟾떒 쓳젰쓽 利앷媛 븘꽭떥肄쒕┛(acetylcholine)쑝濡쒕꽣 옄洹밸맂 NO쓽 諛⑹텧濡 씠뼱吏뒗 삁愿 궡뵾 궛솕吏덉냼 슚냼(endothelial NO synthase, eNOS) 쑀쟾옄쓽 諛쒗쁽쓣 媛뺥솕븳떎怨 젣떆뻽떎. Higashi Yoshizumi25뒗 eNOS 떒諛깆쭏 닔以쓽 利앷뒗 NO 깮꽦쓣 利앷븯뿬 씠瑜 넻빐 궡뵾 湲곕뒫 媛쒖꽑뿉 湲곗뿬븷 닔 엳떎怨 蹂닿퀬븯떎. 洹몃윭굹 蹂 뿰援ъ뿉꽌뒗 넻젣 泥섏튂 벑泥숈꽦 븙젰슫룞 泥섏튂뒗 李⑥씠媛 뾾뿀떎. 泥 踰덉㎏濡 븙젰슫룞쓣 넻빐 利앷맂 NO뒗 援냼쟻씠硫26, 깋븬諛뺢궗뿉 쓽븳 援먭컧떊寃 옄洹뱀뿉 븳 寃쎈룞留 吏곴꼍 諛섏쓳쓣 媛쒖꽑븯湲곗뿉뒗 쑀궛냼 슫룞怨 鍮꾧탳븯뿬 遺議깊뻽쓣 닔 엳떎. 몢 踰덉㎏濡 깋븬諛뺢궗瑜 넻븳 삁愿 닔異뺣젰씠 븙젰슫룞쓣 넻븳 삁愿 솗옣젰蹂대떎 뜑 而몄쓣 닔 엳떎. 異뷀썑뿉뒗 떎瑜 삎깭쓽 슫룞씠굹 떎瑜 諛⑸쾿쓽 援먭컧떊寃 솢꽦솕 諛⑸쾿룄 媛숈씠 鍮꾧탳빐蹂대뒗 寃껋씠 븘슂븯떎怨 뿬寃⑥쭊떎.

寃쎈룞留 깂꽦룄쓽 媛먯냼 寃쎌쭅룄 吏닔쓽 利앷뒗 떖삁愿 궗嫄 쐞뿕룄瑜 利앷떆궗 닔 엳떎28. 뵲씪꽌 寃쎈룞留 깂꽦룄瑜 利앷떆궎怨 寃쎌쭅룄 吏닔瑜 媛먯냼떆궎뒗 寃껋씠 以묒슂븯寃 뿬寃⑥쭊떎. 湲됱꽦 諛 留뚯꽦 뒪듃젅뒪濡 씤븳 援먭컧떊寃 솢꽦솕뒗 룞留 깂꽦룄瑜 媛먯냼떆궎怨 寃쎌쭅룄 吏닔瑜 利앷떆궗 닔 엳떎29. 씠뿉 諛섑빐 슫룞 寃쎈룞留 깂꽦룄瑜 利앷떆궎怨 寃쎌쭅룄 吏닔瑜 媛먯냼떆궓떎怨 젣떆릺怨 엳떎30. 寃쎈룞留 寃쎌쭅룄 吏닔뒗 寃쎈룞留 吏곴꼍怨 삁븬쓽 쁺뼢쓣 諛쏆쑝硫, 寃쎈룞留 吏곴꼍怨 삁븬씠 利앷븿뿉 뵲씪 寃쎈룞留μ뿉꽌쓽 뿕씪뒪떞 꽟쑀媛 떒떒븳 肄쒕씪寃 꽟쑀濡 諛붾뚯뼱 삁愿 寃쎌쭅룄瑜 利앷떆궓떎16. 蹂 뿰援ъ뿉꽌 寃쎈룞留 寃쎌쭅룄 吏닔뒗 슫룞 썑 넻젣 泥섏튂뿉 鍮꾪빐 깋븬諛뺢궗 以묎낵 쉶蹂듦린뿉 궙 寃쏀뼢씠 굹궗쑝굹, 긽샇옉슜 슚怨쇰뒗 굹굹吏 븡븯떎. 씠뒗 삁븬怨 寃쎈룞留 吏곴꼍쓽 쁺뼢쓣 諛쏆 寃껋쑝濡 깮媛곷릺硫, 삁븬怨 寃쎈룞留 吏곴꼍 삉븳 넻젣 泥섏튂 슫룞 泥섏튂 媛꾩쓽 긽샇옉슜 슚怨쇨 뾾뿀떎. 洹몃윭굹 寃쎈룞留 깂꽦룄뒗 넻젣 泥섏튂 벑泥숈꽦 븙젰슫룞 泥섏튂뿉꽌 긽샇옉슜 슚怨쇨 굹궗怨, 벑泥숈꽦 븙젰슫룞 泥섏튂뿉꽌 슫룞 썑 깋븬諛뺢궗 쟾뿉 寃쎈룞留 깂꽦룄媛 쑀쓽븯寃 利앷븯쑝硫, 깋븬諛뺢궗 以 120珥덉뿉 넻젣 泥섏튂뒗 湲곗 긽깭蹂대떎 깂꽦룄媛 뼥뼱議뚯留 벑泥숈꽦 븙젰슫룞 泥섏튂뒗 깋븬諛뺢궗 以 120珥덉뿉룄 깂꽦룄媛 뼥뼱吏吏 븡븯怨, 깋븬諛뺢궗 以 30珥덉뿉 넻젣 泥섏튂 洹몃9 媛 李⑥씠媛 굹궗떎. 씠윭븳 寃곌낵뒗 씪떆쟻 벑泥숈꽦 븙젰슫룞쓽 슫룞 슚怨쇨 엳뒗 긽깭濡 쑀吏릺뼱 援먭컧떊寃 怨쇳솢꽦솕濡쒕꽣 슫룞씠 뼱뒓 젙룄 蹂댄샇 뿭븷쓣 븳 寃껋쑝濡 깮媛곷맂떎.

蹂 뿰援ъ뿉뒗 紐 媛吏 젣븳젏씠 엳떎. 泥 踰덉㎏濡 嫄닿컯븳 꽦씤쓣 긽쑝濡 吏꾪뻾븳 뿰援ъ씠湲 븣臾몄뿉 떎瑜 긽옄뱾뿉寃 쟻슜븯湲 뼱젮슱 닔 엳떎. 뵲씪꽌 異뷀썑 뿰援ъ뿉꽌 끂씤씠굹 湲고 吏덊솚씠 엳뒗 떎뿕 李몄뿬옄瑜 긽쑝濡 븳 뿰援ш 븘슂븷 寃껋쑝濡 깮媛곷맂떎. 몢 踰덉㎏濡 씪떆쟻 벑泥숈꽦 븙젰슫룞씠 援먭컧떊寃 솢꽦솕뿉 뵲瑜 寃쎈룞留 삁愿 湲곕뒫怨 떖삁愿 옱諛섏쓳 셿솕뿉 誘몄튂뒗 쁺뼢쓣 솗씤븯湲 븣臾몄뿉 옣湲곗쟻씤 벑泥숈꽦 븙젰슫룞 以묒옱쓽 슚怨쇱뿉 빐꽌룄 솗씤븷 븘슂媛 엳쓣 寃껋쑝濡 깮媛곷맂떎. 꽭 踰덉㎏濡 蹂 뿰援щ뒗 벑泥숈꽦 븙젰슫룞 泥섏튂 넻젣 泥섏튂留 鍮꾧탳븯떎. 뵲씪꽌 異뷀썑 뿰援ъ뿉꽌뒗 떎瑜 삎깭쓽 슫룞쓣 異붽븯뿬 鍮꾧탳빐蹂 븘슂媛 엳떎. 꽕 踰덉㎏濡 蹂 뿰援щ뒗 깋븬諛뺢궗留뚯쓣 씠슜븳 떊泥댁쟻 뒪듃젅뒪 諛뽰뿉 二쇱 紐삵븯떎. 뵲씪꽌 異뷀썑뿉뒗 뿰냽鍮쇨린옉뾽씠굹 벑泥숈꽦 븙젰 뀒뒪듃 벑 떎瑜 諛⑸쾿쑝濡 뒪듃젅뒪瑜 二쇱뿀쓣 븣쓽 援먭컧떊寃 솢꽦솕뿉 븳 떖삁愿 諛섏쓳꽦뿉 븳 뿰援ш 븘슂븷 寃껋쑝濡 깮媛곷맂떎. 留덉留됱쑝濡 씪떆쟻 븙젰슫룞쓽 슚怨쇰 쉶蹂듦린 120珥덇퉴吏留 솗씤븯떎. 깂꽦룄 寃쎌쭅룄 吏닔뒗 떆媛꾩씠 吏궓뿉 뵲씪 議곌툑 뜑 利앷븯嫄곕굹 媛먯냼븷 닔 엳뒗 寃껋쑝濡 蹂댁씠誘濡 異뷀썑 뿰援ш 븘슂븯떎.

蹂 뿰援щ뒗 씪떆쟻 벑泥숈꽦 븙젰슫룞씠 援먭컧떊寃 솢꽦솕뿉 븳 寃쎈룞留 吏곴꼍, 寃쎌쭅룄 諛 긽셿룞留 삁븬 諛섏쓳 셿솕뿉 쁺뼢쓣 誘몄튂吏 븡븯吏留 寃쎈룞留 깂꽦룄瑜 利앷떆耳곗쑝硫, 떖삁愿 諛섏쓳꽦쓣 寃쎈룞留 삁愿 湲곕뒫뿉꽌 룊媛뻽떎뒗 뿰援щ씪뒗 젏뿉꽌 媛移섍 엳떎.

Conflict of Interest

Sae Young Jae is the Editor-in-Chief of The Korean Journal of Sports Medicine and was not involved in the review process of this article. All authors have no other conflicts of interest to declare.

Author Contributions

Conceptualization, Formal analysis, Validation, Visualization: YWK. Data curation: YWK, JYS, HJM, TGC, YJJ, MJC, HJK, SYJ. Investigation, Methodology: YWK, JYS, HJM, TGC, YJJ, MJC, HJK. Project administration, Supervision: YWK, SYJ. Resources: SYJ. Writing–original draft: YWK. Writing–review & editing: YWK, MJC, HJK, SYJ.

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