호흡중재를 적용한 체간안정화운동(TSEEB; Trunk Stabilization Exercise with Expansion Breathing)이 만성요통 노인의 수면, 신체 및 심리 요인에 미치는 영향

다국어 초록 (Multilingual Abstract)

This study aims to investigate the effects of the TSEEB(Trunk Stabilization Exercise with Expansion Breathing) program, which is a breathing intervention exercise program for improving sleep, on the factors of sleep, both physical and psychological, of the elderly suffering from chronic low back pain.
In order to develop a TSEEB program to improve sleep in the elderly suffering from chronic back pain, prior studies examined the effects of breathing exercises on sleep and the effect of trunk stabilization exercise on the elderly with chronic back pain. Based on the results of a review of 10 studies on the effect of breathing exercises on sleep, the breathing intervention method of the TSEEB program utilized abdominal expansion breathing maneuvers used in dynamic neuromuscular stabilization exercises. Abdominal expansion breathing maneuver is a breathing intervention method that continuously maintains intra-abdominal pressure with diaphragm activation during exercise. Based on previous studies, the TSEEB program is composed of 1st-phase static trunk stabilization exercise and 2nd-phase dynamic trunk stabilization exercises, and based on previous studies, 8 weeks, 3 times a week, 50 minutes per session, 60 seconds inter-set rest, 1st-phase RPE 10-11 and HRR% 50-55% and 2nd-phase RPE 12-13 and HRR% 55-60%.
In order to verify the effectiveness of the TSEEB program, of the 28 elderly persons with chronic low back pain, 14 were assigned to the TSEEB group and 14 to the TSE group respectively. TSEEB group applied the TSEEB program, and TSE group applied only the trunk stabilization exercises without instructions for breathing intervention. Measurements included sleep patterns (sleep latency, wake after sleep onset, total sleep time, sleep efficiency), quality of sleep, physical activity (amount of physical activity, physical activity energy expenditure, sedentary behavior, light physical activity and moderate to vigorous physical activity), and physical strength (lower body strength and endurance, upper body strength and endurance, lower body flexibility, upper body flexibility, agility and dynamic balance, and cardiovascular resistance). Two-way repeated measurement variance analysis was performed to verify the effectiveness of TSEEB program, and all statistical significance levels were p<.05.
In the results, the measurement of the ActiGraph, which confirms changes in sleep latency, wake after sleep onset, total sleep time, and sleep efficiency before and after the application of the TSEEB program, showed a significant interaction effect in changes over time and differences between the groups. However there was no significant interaction effect in the quality of sleep measured by Pittsburgh sleep quality index.
In the results, the measurement of the ActiGraph, which confirms changes in amount of physical activity, physical activity energy expenditure, sedentary behavior, light physical activity and moderate to vigorous physical activity before and after the application of the TSEEB program, did not show any significant interaction between groups and time.
In the results, the measurement of the Senior fitness test, which confirms changes in lower body strength and endurance, upper body strength and endurance, lower body flexibility, upper body flexibility, agility and dynamic balance, and cardiovascular resistance before and after the application of the TSEEB program, did not show any significant interaction between the groups and time.
In the results, the measurement of the Visual Analogue Scale, which confirms changes in pain before and after the application of the TSEEB program, showed a significant interaction effect in changes over time and differences between groups.
In the results, the measurement of the Oswestry Disability Index, which checks the changes in back pain function before and after the application of the TSEEB program, showed no significant interaction effect in the changes over time and the difference between groups.
In the results, the measurement of the Fate Severity Scale, which confirms changes in pain before and after the application of the TSEEB program, showed a significant interaction effect in changes over time and differences between groups.
In the results, the measurement of the Geriatric Depression Scale Short Form Korean Version, which confirms changes in depression before and after the application of the TSEEB program, showed a significant interaction effect between groups and changes over time.
Overall, it was discovered that the application of the TSEEB program had a positive effect on sleep improvement in the elderly suffering from chronic low back pain. TSEEB was also found to have a positive effect on the improvement of pain, fatigue, and depression. Therefore, the TSEEB program may be widely used in clinical practice as an effective exercise program to improve sleep in the elderly with chronic low back pain suffering from sleep disorders.

목차 (Table of Contents)

• Ⅰ. 서 론 1
• 1. 연구의 필요성 1
• 2. 연구의 목적 5
• 3. 연구의 가설 6
• 4. 연구의 제한점 7
• 5. 용어의 정의 7
• Ⅱ. 이론적 배경 9
• 1. 만성요통 9
• 1) 노인과 만성통증 9
• 2) 노인과 만성요통 10
• 2. 수면 12
• 1) 노인과 수면 12
• 2) 만성요통과 수면 14
• 3) 운동과 수면 16
• 3. 신체 요인과 수면 18
• 1) 신체활동 18
• 2) 기능장애 19
• 4. 심리 요인과 수면 20
• 1) 피로 20
• 2) 우울 21
• Ⅲ. TSEEB 프로그램 개발 23
• 1. TSEEB 프로그램 개발 절차 23
• 2. 호흡운동이 수면에 미치는 영향 검토 24
• 3. 체간안정화운동이 만성요통 노인의 통증 및 체력 개선에 미치는 영향 검토 27
• 4. TSEEB 프로그램의 호흡중재법 설정 30
• 5. TSEEB 프로그램의 체간안정화운동 구성 33
• 6. 전문가 검토를 통한 TSEEB 프로그램 평가 및 재구성 39
• 7. TSEEB 프로그램 40
• 8. TSEEB 프로그램 소개 및 운동의 세부 내용 설명 41
• 1) TSEEB 프로그램 소개 41
• 2) TSEEB 프로그램의 호흡 중재법 46
• 3) TSEEB 프로그램 1단계 : 정적 체간 안정화 단계 48
• 4) TSEEB 프로그램 2단계 : 동적 체간 안정화 단계 52
• Ⅳ. 연구방법 56
• 1. 연구 설계 56
• 2. 연구대상 57
• 3. 측정도구 59
• 4. 측정항목 및 방법 60
• 1) 수면 요인 60
• 2) 신체 요인 62
• 3) 심리 요인 69
• 5. 자료처리 70
• Ⅴ. 결과 71
• 1. TSEEB 프로그램 적용에 따른 수면 요인의 변화 71
• 1) 수면잠복기 71
• 2) 수면 중 깨어있는 시간 72
• 3) 총 수면 시간 73
• 4) 수면 효율 74
• 5) 수면의 질 75
• 2. TSEEB 프로그램 적용에 따른 신체 요인의 변화 76
• 1) 신체활동 76
• 2) 체력 81
• 3) 통증 87
• 4) 요통 기능장애 88
• 3. TSEEB 프로그램 적용에 따른 심리 요인의 변화 89
• 1) 피로 89
• 2) 우울 90
• Ⅵ. 논 의 91
• 1. 수면 요인 91
• 2. 신체 요인 95
• 1) 신체활동 95
• 2) 체력 96
• 3) 통증 99
• 4) 요통 기능장애 102
• 3. 심리 요인 103
• 1) 피로 103
• 2) 우울 106
• Ⅶ. 결론 및 제언 108
• 참 고 문 헌 110
• ABSTRACT 149
• 부록 154

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