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Wook Song, Ph.D. Health and Exercise Science Laboratory Institute of Sports Science, Institute on Aging Seoul National University , ?

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(19 ) (1988~2010) (2010) ( , 2011)

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? ? ? or

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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) Diet restriction remains the most common method of obesity reduction. (Williamson DF et al., 1992) Increased physical activity alone is not thought to be a useful strategy for obesity reduction. (National Institutes of Health, 1998) The observation that low levels of physical activity are a major cause of obesity. (Schulz LO and Schoeller DA, 1994) >

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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. VS Control weight maintenance diet for a 4- to 5-week baseline period approximately 700 kcal Groups Persons contacted for participation (n=611) Screened (n=238), Not randomly assigned (n=137) Control (n=8) (n=14) (n=16) (n=14) Randomly assigned (n=101)

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Conclusions Weight loss induced by increased daily physical activity without caloric restriction substantially reduces obesity (particularly abdominal obesity) and insulin resistance in men. Control -Weight (8% ) -Total fat mass -Visceral fat -Glucose disposal -Weight (8% ) -Total fat mass -Visceral fat -Glucose disposal -Weight (8% ) -Total fat mass -Visceral fat -Glucose disposal - -Weight (8% ) -Total fat mass -Visceral fat -Glucose disposal - -Visceral fat - -Visceral fat - ANSWER

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VS ? , ?

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? Dumbbell curl Running

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(Exercise Physiology, McArdle et al., 4 th edition, 2001) .

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Overall Physiologic Change of Body Followed by Exercise (Exercise Physiology, McArdle et al., 4 th edition, 2001)

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Adaptation due to Resistance Exercise Increase of Anaerobic Enzymes Due to Resistance Exercise (Exercise Physiology, McArdle et al., 4 th edition, 2001)

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ANSWER , .

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( VS ) -Body weight -Body weight -Peak VO 2 -Strength -Lean body mass -Fat % -Body weight -Body weight -Peak VO 2 -Strength -Lean body mass -Fat % -Body weight -Peak VO 2 -Fat mass -Fat % - -Body weight -Peak VO 2 -Fat mass -Fat % - Aerobic training alone is the optimal mode of exercise for reducing fat mass and total body mass. Subjects Phone Screened (n=3,145) Phone Screened out (n=2,661), Screen (n=288) Resistance (n=66) Aerobic (n=73) Randomized Randomized 8 Month Exercise Intervention (n=196) Exercise Dropouts and Excluded from Analysis

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ANSWER , .

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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 + + -Weight, BMI, % fat, fat mass - - - -ARTE index (minutes/day) -PAL (TEE/REE) -PAL (TEE/REE) -Weight, BMI, % fat, fat mass - - - -ARTE index (minutes/day) -PAL (TEE/REE) -PAL (TEE/REE) -Weight, BMI, % fat, fat mass - -Weight, BMI, % fat, fat mass - Randomly assigned, women (n=140), ages of 22-44 years AEE ( ), NEAT ( ), PAL ( ) . ANSWER

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Aerobic exercises Anaerobic exercises (Abhijit Naik, 2014) Absence of oxygen High intensity Short duration Develops force Burns calories even when the body is at rest Presence of oxygen Moderate intensity Long duration Develops stamina Burns calories during the activity 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) Higher muscle mass (relative to body size) is associated with better insulin sensitivity and lower risk of prediabetes. (Srikanthan P and Karlamangla AS, 2011) ? ( , ) ,

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?

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(%) Proportion of People 65 and Older in a Countrys Population, Estimates for 2010 and 2050 Population of 65 and Older

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U.S. Department of Health and Human Services, 2008 65

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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)

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

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

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Immune function Brain function 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) Symptoms of loss of skeletal muscle in aging (Sarcopenia)

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Changed body composition in elderly ( MRI ) (Buford TW et al., 2012) A)young B)high-functioning older, C)low-functioning older study groups * lose 10% per decade after 50 years 33 year old Male BMI: 24.5 kg/m 2 Muscle: 588.5 cm 3 Subcutaneous fat: 308.4 cm 3 Intermuscular fat: 78.7 cm 3 73 year old Male SPPB: 11 Gait speed: 1.15 m/sec BMI: 24.9 kg/m 2 Muscle: 461.3 cm 3 Subcutaneous fat: 194.7 cm 3 Intermuscular fat: 113.8 cm 3 84 year old Male SPPB: 6 Gait speed: 0.49 m/sec BMI: 26.9 kg/m 2 Muscle: 364.7 cm 3 Subcutaneous fat: 339.3 cm 3 Intermuscular fat: 131.7 cm 3 (Lexell et al., 1988)

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(Eiman Jahangir et al., 2014) (elderly) (obesity)

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(Mathus-Vliegen EM, 2012) (elderly) (obesity) 2 , , ( ) ( ) Potential Benefits and Risks Related to Weight Loss in the Elderly

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, ? 1 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) 1 10,000 .

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Sedentary Behavior: less than 5,000 steps/day Active lifestyle: 8,000~10,000 steps/day 10,000 steps/day or + 2,000 ~ 4,000 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) Sugiura reported the results of a 24-month study in which 32 women (aged 40-60 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) 2 1 10,000 . 1 2,000-3,000 .

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2 Whole Body Vibrator + +Vibration 5-10%

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Whole Body Vibrator

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Acknowledgment 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) Funded by the Korean Government, Ministry of Education, Science, and Technology via Korea Research Foundation

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