Annals of Occupational and Environmental Medicine

Research Article

Effect of long term high altitude exposure on cardiovascular autonomic adjustment during rest and post-exercise recovery: Prem Bhattarai, Bishnu H. Paudel, Dilip Thakur, Balkrishna Bhattarai, Bijay Subedi, Rita Khadka; Ann Occup Environ Med 2018;30:34. Published online May 11, 2018; DOI: https://doi.org/10.1186/s40557-018-0240-1

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Background

Despite the successful adaptation to high altitude, some differences do occur due to long term exposure to the hypoxic environment. The effect of long term high altitude exposure on cardiac autonomic adjustment during basal and post-exercise recovery is less known. Thus we aimed to study the differences in basal cardiac autonomic adjustment and its response to exercise in highlanders and to compare it with lowlanders.

Methods

The study was conducted on 29 healthy highlander males who were born and brought up at altitude of 3000 m and above from the sea level, their cardiac autonomic adjustment was compared with age, sex, physical activity and ethnicity-matched 29 healthy lowlanders using Heart Rate Variability (HRV) during rest and recovery from sub-maximal exercise (3 m step test). Intergroup comparison between the highlanders and lowlanders and intragroup comparison between the rest and the postexercise recovery conditions were done.

Results

Resting heart rate and HRV during rest was comparable between the groups. However, heart rate recovery after 3 min step test was faster in highlanders (p < 0.05) along with significantly higher LF power and total power during the recovery phase. Intragroup comparison of highlanders showed higher SDNN (p < 0.05) and lower LF/HF ratio (p < 0.05) during recovery phase compared to rest which was not significantly different in two phases in lowlanders. Further highlander showed complete recovery of RMSSD, NN50, pNN50 and HF power back to resting level within five minutes, whereas, these parameters failed to return back to resting level in lowlanders within the same time frame.

Conclusion

Highlanders completely recovered back to their resting state within five minutes from cessation of step test with parasympathetic reactivation; however, recovery in lowlanders was delayed.

Electronic supplementary material

The online version of this article (10.1186/s40557-018-0240-1) contains supplementary material, which is available to authorized users.

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Effects of Altitude training on Ethiopian endurance athletes recovery heart rate and hematological variables
Tesfaye Moges, Mathivanan Dhamodharan, Mulay Gebretensay, Alemmebrat Kiflu, Efrem Kentiba
Pedagogy of Physical Culture and Sports.2024; 28(3): 213. CrossRef
High-altitude exposure duration dependent global and regional gray matter volume decrease in healthy immigrants: a cross-sectional study
Jie Feng, Weiwei Men, Xiao Yu, Wenjia Liu, Shiyu Zhang, Jie Liu, Lin Ma
Acta Radiologica.2023; 64(2): 751. CrossRef
Cardiorespiratory function, resting metabolic rate and heart rate variability in coal miners exposed to hypobaric hypoxia in highland workplace
Sanjun Yang, Chunhu Tian, Fan Yang, Qi Chen, Ruiyuan Geng, Chunyan Liu, Xinrong Wu, Wing-Kai Lam
PeerJ.2022; 10: e13899. CrossRef
High-altitude Hypoxia Influences the Activities of the Drug-Metabolizing Enzyme CYP3A1 and the Pharmacokinetics of Four Cardiovascular System Drugs
Junbo Zhu, Yabin Duan, Delong Duo, Jianxin Yang, Xue Bai, Guiqin Liu, Qian Wang, Xuejun Wang, Ning Qu, Yang Zhou, Xiangyang Li
Pharmaceuticals.2022; 15(10): 1303. CrossRef
The Use of a Smartphone Application in Monitoring HRV during an Altitude Training Camp in Professional Female Cyclists: A Preliminary Study
Alejandro Javaloyes, Manuel Mateo-March, Agustín Manresa-Rocamora, Santiago Sanz-Quinto, Manuel Moya-Ramón
Sensors.2021; 21(16): 5497. CrossRef
Shortening Work-Rest Durations Reduces Physiological and Perceptual Load During Uphill Walking in Simulated Cold High-Altitude Conditions
Alessandro Fornasiero, Aldo Savoldelli, Federico Stella, Alexa Callovini, Lorenzo Bortolan, Andrea Zignoli, David A. Low, Laurent Mourot, Federico Schena, Barbara Pellegrini
High Altitude Medicine & Biology.2020; 21(3): 249. CrossRef
Values of heart rate at rest in children and adults living at different altitudes in the Andes
Christian R. Mejia, Matlin M. Cárdenas, Dayanne Benites-Gamboa, Armando Miñan-Tapia, Gloria S. Torres-Riveros, Michael Paz, Yomayra Perez, José Rojas-Camayo, Xianwu Cheng
PLOS ONE.2019; 14(2): e0213014. CrossRef

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Research Article

Improved cardiorespiratory fitness after occupational rehabilitation in merged diagnostic groups: Anne Lovise Nordstoga, Paul Jarle Mork, Marius Steiro Fimland; Ann Occup Environ Med 2018;30:16. Published online February 28, 2018; DOI: https://doi.org/10.1186/s40557-018-0227-y

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Background

Various occupational inpatient rehabilitation programs are established in Norway. This study aimed to assess change in cardiorespiratory fitness, pain, anxiety, depression, and quality of life in persons on long-term sick leave due to musculoskeletal-, mental or unspecific disorders after participation in multicomponent inpatient occupational rehabilitation.

Methods

Twenty-five women and five men (mean age 45.2 years, SD 6.7, range 30–57) volunteered to participate in the study. The participants attended either 8 or 17 full days of occupational multicomponent rehabilitation including physical exercise, cognitive behavioral therapy in the form of acceptance and commitment therapy (ACT), and development of a tailored plan for return to work. Cardiorespiratory fitness was assessed by the Åstrand/Ryhming cycle test at the start and end of rehabilitation program, and at one-year follow-up. Changes in somatic and mental health were measured by questionnaires up to 4 months after start of the program.

Results

Linear mixed models showed that the maximal oxygen uptake increased by 1.1 mL°kg-1°min^− 1 during the rehabilitation program and by 3.7 mL°kg-1°min^− 1 at one-year follow-up. There were minor improvements in somatic and mental health, and quality of life.

Conclusions

This study indicates that occupational inpatient multicomponent rehabilitation including physical exercise and ACT may promote a long-term increase in physical exercise that is sufficient to induce a significant increase in cardiorespiratory fitness.

Trial registration

The current study is not registered, but is part of a larger trial registered at clinicaltrials.gov (No.: NCT01926574, registered 21. Aug 2013).

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A Brief Value-based Randomized Intervention to Promote Physical Activity in Patients Attending Cardiac Rehabilitation
Emily Van Wasshenova, Debra Boardley, Andrew Geers, Matthew Tull, Victoria Steiner
American Journal of Health Education.2023; 54(1): 10. CrossRef

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Research Article

Factors increasing the risk for psychosocial stress among Korean adults living in rural areas: using generalized estimating equations and mixed models: Ju-Hyun Nam, Myeong-Seob Lim, Hyun-Kyeong Choi, Jae-Yeop Kim, Sung-Kyeong Kim, Sung-Soo Oh, Sang-Baek Koh, Hee-Tae Kang; Ann Occup Environ Med 2017;29:53. Published online October 31, 2017; DOI: https://doi.org/10.1186/s40557-017-0209-5

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Background

This study was conducted to analyze the distribution of the psychosocial well-being index among adults living in two rural communities in Korea and to examine its correlation with lifestyle variables such as sleep duration, regular exercise, and sedentary time.

Methods

Using the cohort data of the Atherosclerosis Risk of a Rural Area Korean General Population, this study examined 3631 participants living in Wonju and Pyeongchang in Gangwon Province; their preliminary data were established from 2005 to 2007 while their follow-up data were collected 3 years later. This study investigated demographic characteristics, lifestyle habits, disease history, Psychosocial Well-being Index-Short Form (PWI-SF) scores, sleep duration, regular exercise, and sedentary time during work. Using repeated measures ANOVA, this study examined how the variables and PWI-SF scores changed over the course of 3 years and identified the correlation between them based on mixed model analysis. Afterwards, using the generalized estimation equation, this study identified each variable’s risk towards the PWI-SF high-risk group and performed a stratified analysis by occupation after dividing the participants into farmers and non-farmers.

Results

The PWI-SF high-risk group was found to be 18.9% of the participants from preliminary data and 15.5% from follow-up data. The odds ratio towards the PWI-SF high-risk group was 1.503 (95% CI 1.241–1.821) in the short sleep duration group and 1.327 (95% CI 1.136–1.550) in the non-regular exercise group. A stratified analysis by occupation showed that middle and long sedentary time in the white-collar group increased the risk toward the PWI-SF high-risk group.

Conclusions

Short sleep duration, no regular exercise, and long sedentary time in the white-collar group were identified as risk factors toward the PWI-SF high-risk group in the rural communities, and policy interventions are needed to address this issue.

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Sung Wook Song, Hyun Jung Lee, Jeong Rae Yoo, Jung-Hwan Oh
Journal of Sleep Medicine.2023; 20(3): 188. CrossRef
The Association between Psychosocial Stress and Type of Physical Activity in Middle Aged Adult: A Community-based Cohort Study
DooYong Park, Jae-Young Park, EunKyung Kim, YeonSoo Kim
The Korean Journal of Sports Medicine.2023; 41(3): 153. CrossRef
Using Wake-Up Tasks for Morning Behavior Change: Development and Usability Study
Kyue Taek Oh, Jisu Ko, Jaemyung Shin, Minsam Ko
JMIR Formative Research.2022; 6(9): e39497. CrossRef
Mild sleep restriction increases 24-hour ambulatory blood pressure in premenopausal women with no indication of mediation by psychological effects
Marie-Pierre St-Onge, Ayanna Campbell, Brooke Aggarwal, Jasmine L. Taylor, Tanya M. Spruill, Arindam RoyChoudhury
American Heart Journal.2020; 223: 12. CrossRef
Correlation of physical fitness with psychological well-being, stress, and depression in Korean adults
Bogja Jeoung
Journal of Exercise Rehabilitation.2020; 16(4): 351. CrossRef
Stress: Prevalence and correlates among residents of a suburban area
Archana Singh, Manisha Arora, Vishal Sharma, Atul Kotwal
Industrial Psychiatry Journal.2019; 28(1): 98. CrossRef
Difference in health status of Korean farmers according to gender
Ho Lee, Seong-yong Cho, Jin-seok Kim, Seong-yong Yoon, Bu-il Kim, Jong-min An, Ki-beom Kim
Annals of Occupational and Environmental Medicine.2019;[Epub] CrossRef

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Case Report

A case of fitness to work in a worker with COPD using the exercise stress test: Yewon Kim, Kyungyong Jung, Ji Young Ryu, Dae Hwan Kim, Sangyoon Lee; Ann Occup Environ Med 2015;27:26. Published online December 11, 2015; DOI: https://doi.org/10.1186/s40557-015-0074-z

Abstract PDF PubReader ePub: Background
Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease characterized by persistent airflow limitation. Therefore, both work ability and workday length may be affected in individuals with this disease. We studied a worker with suspected COPD and assessed fitness to work using post-bronchodilator spirometry, symptom assessment scales, and the exercise stress test.
Case report
The patient was a 58-year-old man due to work as a field supervisor in the ship construction sector. He had a 40 pack-year smoking history and experienced occasional dyspnea when climbing stairs. He visited this hospital to receive cardiopulmonary function tests and to determine his ability to work. Post-bronchodilator spirometry revealed severe irreversible airway obstruction corresponding to a modified Medical Research Council grade of 2 on the dyspnea scale. His COPD Assessment Test score was 12, placing him in patient group D (high risk, more symptoms) based on the Global Initiative for Chronic Obstructive Lung Disease classification system. His maximum oxygen uptake (VO_2max) was determined to be 19.16 ml/kg/min, as measured by the exercise stress test, and his acceptable workload for 8 h of physical work was calculated to be 6.51 ml/kg/min. His work tasks required an oxygen demand of 6.89 ml/kg/min, which exceeded the acceptable workload calculated. Accordingly, he was advised to adjust the work tasks that were deemed inappropriate for his exercise capacity.
Conclusion
As COPD incidence is expected to rise, early COPD diagnosis and determination of fitness to work is becoming increasingly important. Performing the exercise stress test, to evaluate the functional capacity of workers with COPD, is considered an acceptable solution.

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Research Article

Risk factors of work-related upper extremity musculoskeletal disorders in male cameramen: Jung ho Kim, Byung seong Suh, Soo Geun Kim, Won sool Kim, You il Shon, Hee seung Son; Ann Occup Environ Med 2015;27:5. Published online January 24, 2015; DOI: https://doi.org/10.1186/s40557-014-0052-x

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Objective

The aim of this study is to determine the risk factors related to upper extremities work-related musculoskeletal disorders (WRMSDs) in cameramen.

Methods

A questionnaire survey was performed on 166 cameramen in a broadcasting station. The questionnaire consisted of questions on the general characteristics, the health behavior, work type and duration, physical burden, ergonomic posture, and musculoskeletal symptoms. Definition of musculoskeletal disorders was based on NIOSH criteria.

Results

The positive rate of WRMSDs symptoms by parts of the body was turned out to be the highest in the shoulder (14.5%) and the lowest in arm and elbow (6%). Logistic regression analysis revealed that symptoms in the shoulders increased with BMI (OR = 3.62, 95% CI = 1.03-12.71), physical burden (OR = 9.29, 95% CI = 1.72-61.78 in the very hard group) and ergonomic factors (OR = 4.50, 95% CI = 1.03-19.68). Ergonomic factors were only related to the symptoms of hand and wrist (OR = 10.21, 95% CI = 1.02-102.20). WRMSDs symptoms, in the whole upper extremities, were higher in the 50 or older age group (OR = 5.86, 95% CI = 1.03-33.26), higher BMI group (OR = 3.26, 95% CI = 1.28-13.53), non-exercise group (OR = 2.37, 95% CI = 1.24-12.59), high physical burden group (OR = 7.6, 95% CI = 1.34-52.74), and high grade ergonomic risk group (OR = 4.82, 95% CI = 1.29-16.06).

Conclusion

The most serious musculoskeletal disorders of male cameramen were shoulder pain. Ergonomic factors and physical burden were the most significant factors affecting WRMSDs in cameramen in this study. Cameramen should be educated to be able to improve the ergonomic occupational environment and to set up preventive measures against the risk factors during work.

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Saeid Yazdanirad, Gholamhossein Pourtaghi, Mehdi Raei, Mohammad Ghasemi
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Shoulder pain prevalence by age and within occupational groups: a systematic review
Christopher J. Hodgetts, Charlotte Leboeuf-Yde, Amber Beynon, Bruce F. Walker
Archives of Physiotherapy.2021;[Epub] CrossRef
Comparison of work-related musculoskeletal symptoms between male cameramen and male office workers
Han-Seur Jeong, Byung-Seong Suh, Soo-Geun Kim, Won-Sool Kim, Won-Cheol Lee, Kyung-Hun Son, Min-Woo Nam
Annals of Occupational and Environmental Medicine.2018;[Epub] CrossRef
Scapholunate interosseous ligament dysfunction as a source of elbow pain syndromes: Possible mechanisms and implications for hand surgeons and therapists
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Medical Hypotheses.2018; 110: 125. CrossRef

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Original Article

The Effect of a Stretching Exercise on Myofascial Pain Syndrome Patients in Small and Medium Sized Industries: Jung Wook Lim, Young Jun Kwon, Tae Won Jang, Jong Heon Lee, In Seok Kim, Sang Cheol Ryu, Jae Hoon Roh, Jong Uk Won, Bong Suk Cha, Chul Ho Lee; Korean Journal of Occupational and Environmental Medicine 2010;22(4):307-315. Published online December 31, 2010; DOI: https://doi.org/10.35371/kjoem.2010.22.4.307

Abstract PDF

OBJECTIVES
This study was conducted to identify the effect of a stretching exercise on myofascial pain syndrome patients that work in small and medium-sized industry.
METHODS
Questionnaires surveys including general characteristics, work-related characteristics, and musculoskeletal symptoms on neck and shoulder area was administered to 393 subjects who worked in small and medium sized industries. Symptomatic workers were examined to identify whether they had myofascial pain syndrome (MPS). Of the 393 subjects, 108 MPS patients performed 6 weeks stretching exercise program. Intensity of pain was estimated with visual analogue scales (VAS). All patients were interviewed to estimate their compliance to stretching exercise program.
RESULTS
Of the 393 workers, 119 workers were diagnosed with MPS of the neck and shoulder. Post-exercise VAS was significantly reduced compared to pre-exercise VAS (p<0.05). High compliance patients to stretching exercise were more effective to exercise therapy (OR 2.89, 95% CI 1.19~7.04), and overtime workers were less effective to exercise therapy (OR 0.41, 95% CI 0.17~0.95).
CONCLUSION
The Stretching exercise program was identified to be effective in MPS patients in small and medium-sized industries. It is recommended that workers with MPS in small and medium-sized industries practice a well-designed stretching exercise program, and avoid overtime work.

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Effect of Resistance Exercise Program for Middle-Aged Women with Myofascial Pain Syndrome on Shoulder Pain, Angle of Shoulder Range of Motion, and Body Composition Randomized Controlled Trial, RCT
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The Effects of Stabilization Exercise and Stretching Exercise on Muscle Strength and Pain of Patients with Lower Back Pain
Kwang-Il Kwag, Jae-Heon Lim
Journal of the Korean Academy of Clinical Electrophysiology.2011; 9(2): 39. CrossRef

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Case Report

A Case of Exercise-induced Rhabdomyolysis with Hepatitis: Seong Ah Kim, Sang Je Jung, Chae Yong Lee, Bong Goo Ha, Ki Soo Park; Korean Journal of Occupational and Environmental Medicine 2006;18(1):67-72. Published online March 31, 2006; DOI: https://doi.org/10.35371/kjoem.2006.18.1.67

Abstract PDF

BACKGROUND
Rhabdomyolysis is a relatively rare disease caused by various factors and is characterized by skeletal muscle damage. While crush injury is the most common cause in Korea as well as other countries, overexertion is an important common cause among young men in daily life. Although exercise-induced rhabdomyolysis is already well published among athletes or military persons, there have been few reports in workers.
CASE
REPORT: We observed a 28-year-old male worker who had elevated liver transaminases during a periodic workers' health checkup. Although he did not exhibit the typical pattern of toxic hepatitis, we had to exclude any possibility of dimethylacetamide-induced hepatitis (DIH) because he had worked in a spandex-producing factory, which already had a history of many DIH cases over several years. We performed careful history taking, several laboratory tests, liver ultrasonography and liver biopsy. We also investigated the results of biological monitoring and air concentrations of dimethylacetamide. The findings from these examinations supported the clinical diagnosis of exercise-induced rhabdomyolysis with hepatitis.
CONCLUSION
This case demonstrates that exercise can induce rhabdomyolysis and hepatitis. This disease must be treated by prompt and appropriate management because it might develop more serious complications such as acute renal failure.

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Exercise-induced rhabdomyolysis mechanisms and prevention: A literature review
Jooyoung Kim, Joohyung Lee, Sojung Kim, Ho Young Ryu, Kwang Suk Cha, Dong Jun Sung
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Randomized Controlled Trial

Effect on Active Exercise Programs in Employees with Chronic Low Back Pain: Jin Gang Hur, Jae Cheol Song, Young Man Roh, Dong Sik Park, Young Ae Yang, Yoon Shin Kim; Korean Journal of Occupational and Environmental Medicine 2005;17(1):44-57. Published online March 31, 2005; DOI: https://doi.org/10.35371/kjoem.2005.17.1.44

Abstract PDF

OBJECTIVE: To examine the relative efficacy of three active exercise programs for work-related, chronic low back pain, and to observe to what extent the programs affected the mechanical stability of the lumbar region.
METHODS
The subjects were 64 employees who were randomly divided into three groups to match the three active exercise programs which were performed 3 times a week for 6 months. All subjects were assessed with the same measurements at a pre-study examination, and then were reassessed at 2 weeks, 3 months and 6 months after the study.
RESULTS
The pain intensity didn't show any significant difference among the three groups. However, the Oswestry Disability Index showed significant differences among the three groups at 6 months and the lumbar and thoracic exercise groups showed significant decreases compared to the general physiotherapy group (p<0.05). Maximal stretching with both hands in the overhead direction showed a significant difference among the three groups at 3 months and 6 months, and the thoracic exercise group at 6 months showed a significant increase in overhead stretching compared to the lumbar exercise and general physiotherapy groups (p<0.05). The lumbar region angle of inclination showed significant differences among the three groups at 2 weeks, 3 months and 6 months, with the thoracic exercise group being decreased significantly more than the lumbar exercise and general physiotherapy groups at 6 months (p<0.05).
CONCLUSIONS
Exercise aimed at increasing thoracic mobility has an effect on lumbar stability. Furthermore, it is far more effective for lumbar stabilization than general physiotherapy and deep muscle strengthening lumbar exercise.

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Original Article

Selection of a High Risk Group and the Effectiveness of an Exercise Program on Musculoskeletal Symptoms in Small and Medium Sized Enterprises: Bo Kyoung Kim, Chung Yill Park, Hyeon Woo Yim, Jung Wan Koo, Kang Sook Lee; Korean Journal of Occupational and Environmental Medicine 2005;17(1):10-25. Published online March 31, 2005; DOI: https://doi.org/10.35371/kjoem.2005.17.1.10

Abstract PDF

OBJECTIVES
This study was conducted to provide data for the establishment of a practical and the effective exercise program for managing the musculoskeletal symptoms of workers who are employed in small and medium sized enterprises.
METHODS
The risk factors related to musculoskeletal disease management were chosen according to the relevant literatures, and were based on advise from experts on the Delphi method. Questionnaires on selected risk factors (with a 5-point Likert scale) were given to 785 subjects who worked in small and medium sized enterprises. The subjects were then classified in the risk group when they had the symptoms and recorded at least 3 points. From those subjects in the risk group, those who had both work-related factors and general characteristics factors (with an average of at least 3 points) were further classified as the high risk group. We performed a 12-week musculoskeletal exercise program for the low and high risk groups to analyze their changes in symptoms and complaints in order to estimate the effectiveness of the exercise program.
RESULTS
Out of 785 subjects, 454(57.8%) were in the risk group of musculoskeletal diseases and 121(15.4%) were in the high risk group. According to multiple logistic regression analysis of the factors for the musculoskeletal symptoms in the low risk group, the significant risk factors were sex and personal disease related with musculoskeletal disease, while the risk factors in the high risk group were age, sex, and personal disease related with musculoskeletal disease. After the 12-week exercise program was performed by the low risk group, the number of musculoskeletal symptom complaints in the control group did not significantly changed, whereas for the intervention group, the number of musculoskeletal symptom complaints significantly declined for all parts of the body. After the 12-week exercise program performed by the high risk group, the number of musculoskeletal symptom complaints in the control group was significantly enhanced for the arm and elbow parts. In the intervention group, the complaint rate for musculoskeletal symptoms significantly declined only for the low back.
CONCLUSION
The musculoskeletal symptoms were significantly improved by the exercise program in the low risk group, but not in the high risk group. It is suggested that control measures on administrative and/or work related factors, in addition to the exercise program should be considered simultaneously for the control of musculoskeletal symptoms in groups at high risk of musculoskeletal disease.

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The association between long working hours and work-related musculoskeletal symptoms of Korean wage workers: data from the fourth Korean working conditions survey (a cross-sectional study)
Jae-Gwang Lee, Guang Hwi Kim, Sung Won Jung, Sang Woo Kim, June-Hee Lee, Kyung-Jae Lee
Annals of Occupational and Environmental Medicine.2018;[Epub] CrossRef
Barriers to Performing Stretching Exercises Among Korean‐Chinese Female Migrant Workers in Korea
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Analysis of the Factors Regarding Work-related Musculoskeletal Disease by Company Size
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Original Article

Effects of Thoracic Spinal Exercise Program in VDT Workers: Pain Relief and Increased Flexibility: Young Ae Yang, Young Hee Kim, Yong Kwon Kim, Jin Gang Hur, Jae Cheol Song, Yoon Shin Kim; Korean Journal of Occupational and Environmental Medicine 2004;16(3):250-261. Published online September 30, 2004; DOI: https://doi.org/10.35371/kjoem.2004.16.3.250

Abstract PDF

OBJECTIVES
The purpose of this study of the Thoracic Spinal Exercise Program was to evaluate its effects on VDT workers. These effects were found to include a decrease thoracic kyphosis, increase thoracic spine mobility and decrease in the VAS (visual analog scale). These measures provide a means of assessing the muscle endurance and muscle strength of the subjects.
METHODS
This study was conducted during the period from July 1 to August 31, 2003, and involved 58 VDT workers belonging to a company located in Seoul who were working seated in front of a computer for most of the day. After applying the thoracic exercise program, we examined the changes in the of thoracic kyphosis angle, spinal length (C7-S3), TFED (thoracic flexibility in the extension direction), MEBH (maximal elevation with both hands in the overhead direction) and CE (chest expansion).
RESULTS
Obtained f om this study are as follows. 1. A significant reduction in the VAS was observed in the exercise group (pre-exercise 5.90 +/- 0.88 points, post-exercise 4.23+/- 0.82 points), as compared with the control group (pre-exercise 6.00+/-0.90 points, post-exercise 5.93+/-0.81 points). 2. A significant reduction in thoracic kyphosis (pre-exercise 36.97+/-7.49, post-exercise 31.83 +/-5.90) and a significant increase in thoracic flexibility in the extension direction (pre-exercise 7 . 4 7+/-2.30, post-exercise 11.77+/-3.65) were observed in the exercise group. The thoracic kyphosis angle showed a significant reduction in the exercise group, as compared to the control group. The thoracic flexibility in the extension direction showed a significant increase in the exercise group, as compared to the control group. 3. There was a significant increase in the spinal length in the exercise group (pre-exercise 494 +/-27.66 mm, post-exercise 518.60+/-27.95 mm).
CONCLUSIONS
The Thoracic Spinal Exercise Program results in an increase in thoracic spine mobility and a decrease in pain. In practical terms, the effects of the exercise program are good health and posture.

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