Effects of Three-Week Stair Climbing Exercise for Weight Control: A Case Series Study

Full text

Case Report
The Korean Journal of Sports Medicine 2016;34(2):185-189
https://doi.org/10.5763/kjsm.2016.34.2.185
pISSN 1226-3729 eISSN 2288-6028
제34권 제2호 2016 185
체중조절을 위한 3주간 계단 오르기의 효과
법무부 청주외국인보호소 부속의원1, 서울대학교 의과대학 의학과2, 서울특별시 보라매병원 가정의학과3
최주헌1
ㆍ
강경모2
ㆍ
김종성3
ㆍ
오범조3
Effects of Three-Week Stair Climbing Exercise for Weight Control:
A Case Series Study
Juheon Choi
1
, Kyungmo Kang
2
, Jong Seung Kim
3
, Bumjo O h
3
1
Cheongju Immigration Detention Center Clinic, Ministry of Justice, Cheongju,
2
Department of Medicine, Seoul National University College of Medicine, Seoul,
3
Department of Family Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
This study is designed to check whether everyday-life stair climbing, which is a low-cost and readily accessible form
of exercise, is effective for reducing overweight of sedentary people in various health indicators. We selected four
overweight people and measured body weight, body fat percentage, muscle quantity, pulmonary function,
lower-extremity strength and volume of thigh muscle and fat. After 3-week exercise of climbing stairs in more than
5 minutes twice a day, same procedures were taken. Body weight was reduced by 3.35 kg on average (standard
deviation [SD], 0.79), and body fat mass by 2.53 kg (SD, 1.36). Lower extremity strength improved about 5%, and
slight loss of thigh fat (right 3.2%; left 13.4%) was observed. However, pulmonary function and muscle quantity did
not grow significantly. Although only four people may not be representative as targets, but it is suggested that stair
climbing has sufficient utility as an easily accessible exercise.
Keywords:
Exercise, Overweight, Sedentary lifestyle, Lower extremity, Pulmonary function tests
Received: July 6, 2016 Revised: October 6, 2016
Accepted: October 13, 2016
Correspondence: Bumjo Oh
Department of Family Medicine, SMG-SNU Boramae Medical
Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Korea
Tel: +82-2-870-2682, Fax: +82-2-831-0714
E-mail: bo39@snu.ac.kr
Copyright ©2016 The Korean Society of Sports Medicine
CC
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.
Introduction
Obesity is a condition that substantially raises their risk of
morbidity from hypertension, dyslipidemia, type 2 diabetes,
coronary heart disease, etc
1)
. The majority of obese persons who
develop atherosclerotic cardiovascular disease typically have a
clustering of risk factors for metabolic syndrome
2)
. In 2010,
overweight and obesity were estimated to cause 3
–
4 million deaths
worldwide
3)
. In Korea, like other developed countries, the number
of obesity population has been gradually increasing, which led
to the prevalence of 31% in adult population (35%
–
36% in male,
25%
–
27% in female) since 2007
4)
.
It is well known that reducing body fat is essential for treating

J Choi, et al. Effects of Three-Week Stair Climbing Exercise for Weight Control: A Case Series Study
186 대한스포츠의학회지
Table 1. Physical characteristics of the subjects
Variable A B C D
Age (yr) 36 37 33 58
Sex Female Male Female Female
PAR-Q - - - -
Height (cm) 154 174 167 149
Weight (kg) 72.3 88.9 73.9 67.0
Body mass index (kg/m
2
) 30.5 29.4 26.5 30.6
Body fat mass (%) 31.6 26.5 28.6 26.6
Muscle quantity (kg) 22.2 35.2 24.6 21.8
Pulmonary function tests
FVC (L) 3.03 4.94 4.79 3.15
FEV
1
(L) 2.53 3.90 3.99 2.54
Volume of muscle and fat (by CT)
Thigh muscle (Rt, mm
2
) 11,158.42 16,890.19 9,815.86 10,003.57
Thigh muscle (Lt, mm
2
) 10,850.97 17,492.72 10,171.19 9,955.67
Thigh fat (Rt, mm
2
) 13,900.71 10,294.79 12,375.07 8,669.50
Thigh fat (Lt, mm
2
) 13,857.45 9,450.47 12,737.36 8,774.56
Lower-extremity strength by Biodex
Peak torque (60/sec, Rt, extension) 73.400 197.900 85.100 65.400
Peak torque (60/sec, Rt, flexion) 40.600 77.000 37.900 41.900
Peak torque (60/sec, Lt, extension) 56.200 206.800 51.100 57.400
Peak torque (60/sec, Lt, flexion) 45.300 75.900 19.200 41.500
Peak torque (180/sec, Rt, extension) 52.600 129.700 70.400 50.000
Peak torque (180/sec, Rt, flexion) 19.200 59.000 36.100 29.400
Peak torque (180/sec, Lt, extension) 41.000 139.900 64.200 45.500
Peak torque (180/sec, Lt, flexion) 23.000 52.500 32.700 34.300
PAR-Q: Physical Activity Readiness Questionnaire, FVC: forced vital capacity, FEV
1
: forced expiratory volume in 1 second,
CT: computed tomography, Rt: right thigh, Lt: left thigh.
obesity, which is achieved by continuous daily diet and exercise.
There have been many studies about the effective ways to exercise
for relieving obesity. Some of them claim that aerobic exercise
such as walking and cycling is proper for obesity, while other
claims strength exercise can help reducing body fat
5-7)
.
Stair climbing is a low-cost, inconspicuous, and readily
accessible form of exercise which is associated with a reduced
mortality in populations
8)
. Despite these features, stair climbing
as an exercise modality for resolving or reducing obesity has
not been considered so far, while it is already useful tools for
rehabilitating and enhancing lower limb power
9,10)
. This study
has been designed to check whether sequent, everyday-life stair
climbing can be effective for the sedentary people in various
health indicators.
Case Report
We selected four overweight people, who volunteered and have
no other underlying condition, and informed consent was obtained
from all of the subjects and the rights of the subjects were protected.
The characteristics of the subjects are shown (Table 1).
We used Physical Activity Readiness Questionnaire to rule
out unsuitable participants. We measured their body weight, body
fat percentage, and muscle quantity via InBody. And we tested
their pulmonary function by PFT, lower-extremity strength by
Isokinetics (De Queen, AR, USA), volume of thigh muscle and
fat by thigh computed tomography (CT). And after the 3-week
exercise of stair climbing in more than 5 minutes twice a day,
same procedures were taken. Participants were supposed to climb
stairs of their apartments and workplaces without rest, and the
interval between climbing or the method of going back down
was arbitrary. There was no exercise instructor especially assigned.

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제34권 제2호 2016 187
Table 2. Changes of subjects (average)
Variable Before (A) After (B) Difference (SD) Rate of change*
Weight (kg) 75.52 72.18 −3.35 (0.79) −4.44
Body fat mass (%) 28.32 25.80 −2.52 (1.36) −8.91
Muscle quantity (kg) 25.95 25.70 −0.25 (0.57) −0.96
Pulmonary functio n tests
FVC (L) 3.98 3.87 −0.11 (0.43) −2.64
FEV
1
(L) 3.24 3.19 −0.05 (0.21) −1.54
Volume of muscle and fat (by CT)
Thigh muscle (Rt, mm
2
) 11,967.01 11,941.32 −25.69 (159.5) −0.21
Thigh muscle (Lt, mm
2
) 12,117.63 11,925.29 −192.34 (244.2) −1.59
Thigh fat (Rt, mm
2
) 11,310.01 10,944.63 −365.38 (788.1) −3.23
Thigh fat (Lt, mm
2
) 11,204.96 9,698.05 −1,506.91 (982.6) −13.45
Lower-extremity strength by Biodex
Peak torque (60/sec, Rt, extension) 105.45 110.60 5.15 (17.54) 4.88
Peak torque (60/sec, Rt, flexion) 49.35 58.58 9.22 (8.66) 18.69
Peak torque (60/sec, Lt, extension) 92.88 97.78 4.90 (25.00) 5.28
Peak torque (60/sec, Lt, flexion) 45.48 52.38 6.90 (10.67) 15.17
Peak torque (180/sec, Rt, extension) 75.68 77.25 1.58 (12.97) 2.08
Peak torque (180/sec, Rt, flexion) 35.93 44.03 8.10 (9.01) 22.55
Peak torque (180/sec, Lt, extension) 72.65 74.10 1.45 (15.57) 2.00
Peak torque (180/sec, Lt, flexion) 35.63 40.60 4.98 (8.37) 13.96
SD: standard deviation, FVC: forced vital capacity, FEV
1
: forced expiratory volume in 1 second, CT: computed tomo
g
ra
p
h
y
,
Rt: right thigh, Lt: left thigh.
*Change rate=(B−A)/A×100.
The Seoul National University-Boramae Hospital Institutional
Review Board approved this study.
1. Assessing obesity
We measured their body weight, and body fat percentage, and
muscle quantity was assessed with eight-polar bioelectrical
impedance (InBody 3.0, Biospace, Seoul, Korea).
2. Assessing pulmonary function
Pulmonary Function Test was performed using standard
laboratory techniques according to guidelines by the American
Thoracic Society. The vital capacity and its subdivisions were
measured from a slow exhalation with a rolling seal spirometer
(Sensormedics 2800, SensorMedics Co., Yorba Linda, CA, USA).
Forced vital capacity (FVC) and forced expiratory volume in
1 second (FEV
1
) were obtained from forced expiration into the
spirometer.
3. Assessing lower limb muscle strength
We measured the peak torque of extensor and flexor at knee
joint via Biodex (Shirley, NY, USA) measuring right and left
respectively in load speed 60 degree/sec and 180 degree/sec with
extension and flexion five times and 10 times respectively.
4. Asse ssing thigh muscle and fat quantity
CT was used to measure cross-sectional area of mid-thigh bone,
muscle, and fat tissue and to characterize muscle attenuation.
With the subject supine, a 10-mm cross-sectional scan of both
legs was obtained, located at the midpoint between the anterior
iliac crest and the patella. In image analysis, area of bone, adipose
tissue, and skeletal muscle were measured by selecting the
following regions of interest, defined by the following attenuation
values:
≥
200 Hounsfield units (HU) for bone,
–
20 to
–
190 HU
for adipose tissue, and 0
–
100 HU for muscle; mean muscle
attenuation was determined from all pixels within this range.
5. Results
After 3-week exercise, the changes of subjects are shown (Table
2). The body weight of the four participants was reduced by
3.35 kg on average (SD, 0.79), and body fat mass by 2.53 kg

J Choi, et al. Effects of Three-Week Stair Climbing Exercise for Weight Control: A Case Series Study
188 대한스포츠의학회지
(SD, 1.36). The slight loss of thigh fat (right thigh, 3.2%; left
thigh, 13.4%) was confirmed by thigh CT, and strength of lower
extremities was improved about 5%. However, the thigh muscle
did not change significantly and FVC and FEV
1
were reduced
by 2.6% and 1.5%, respectively. Although it seems that pulmonary
functions of participants have decreased on average, the decrease
results from that of one of four participants (subject C), which
may be due to insufficient compliance in the test. And participants
reported their pulmonary function to be improved subjectively,
and no side effect or harm were reported due to the exercise.
Discussion
It has been already implied that stair climbing have close
relationship with muscle strength or pulmonary function, the key
factors of controlling overweight and obesity. There have been
many studies about stair climbing as a test of muscle capacity
or pulmonary function
8)
. We, however, focused on the aspects
of stair climbing as a modality improving physical function in
itself. We performed a study before, in which we selected one
male and one female subjects in their forties, measured their
blood pressure, heart rate and oxygen saturation, let them climb
up the 108 stairs in a subway station having no turn in 1 minute,
and took same measurement. As a result, blood pressure of the
male subject did not change significantly from 129/88 mm Hg
to 122/71 mm Hg, whereas heartrate increased from 80/min to
106/min, and blood pressure of the female subject changed from
105/67 mm Hg to 115/78 mm Hg, heartrate from 69/min to 90/min.
So, we could observe 60%
–
90% of maximum heartrate for the
age, and infer that continuing stair climbing could be a proper
form of aerobic exercise. After that, this study has been designed
to check further effect of stair climbing in various health indicators,
and it has the significance in inspecting direct relationships of
those indicators.
But it might be jumping to the conclusion that climbing stairs
has ‘proved’ to be effective for the weight loss only based on
this study because of some limitations. Our study has intrinsic
limitation in the fact that it is merely ‘case study.’ Only four
people as a target may not be representative. As a matter of
fact, this sample size cannot have statistical significance even
with non-parametric test like Wilcoxon signed-rank test (p
＞
0.12),
and in order to assure statistical significance we require at least
a sample size of 6 or more in Wilcoxon signed-rank test. In
addition, the nutrition of subjects was not so strictly controlled
that the possibility may not be ruled out that changes of indicator
were affected by the diet. In fact, no significant growth of thigh
muscle can be regarded as the effect of exercise alone not followed
by adequate protein ingestion. In further study, homogenous group
or the larger number of subjects will be needed for inspecting
more sophisticated relationship. And still stricter diet control has
to be introduced.
In our study, participants consist of the office worker, the
housewives, one of whom became overweight after the childbirth,
and all of them have sedentary life style in common. They have
little extra physical activity except irregular leisure time of 1
–
2
times a month. But continuous climbing stairs for 3 weeks in
daily life offers them benefits like losing body weight, strengthening
of lower extremity and losing of thigh fat without separated physical
activity. Despite all the limitations of this study, it can be suggested
that stair climbing can be an effective way to lose weight for
the people who have sedentary life style.
Conflict of Interest
No potential conflict of interest relevant to this article was
reported.
References
1. NHLBI Obesity Education Initiative Expert Panel on the
Identification, Evaluation, and Treatment of Obesity in Adults
(US). Clinical guidelines on the identification, evaluation, and
treatment of overweight and obesity in adults. Bethesda:
National Heart, Lung, and Blood Institute; 1998.
2. Grundy SM. Obesity, metabolic syndrome, and cardiovascular
disease. J Clin Endocrinol Metab 2004;89:2595-600.
3. Ng M, Fleming T, Robinson M, et al. Global, regional, and
national prevalence of overweight and obesity in children and
adults during 1980-2013: a systematic analysis for the Global
Burden of Disease study 2013. Lancet 2014;384:766-81.
4. Park YR, Cho YG, Kang JH, et al. Comparison of obesity
and overweight prevalence among Korean adults according to
Community Health Survey and Korea National Health and
Nutrition Examination Survey. Korean J Obes 2014;23:64-8.

최주헌 외. 체중조절을 위한 3주간 계단 오르기의 효과
제34권 제2호 2016 189
5. Al Saif A, Alsenany S. Aerobic and anaerobic exercise
training in obese adults. J Phys Ther Sci 2015;27:1697-700.
6. Gardner AW, Skinner JS, Vaughan NR, Bryant CX, Smith
LK. Comparison of treadmill walking and stair climbing over
a range of exercise intensities in peripheral vascular occlusive
disease. Angiology 1993;44:353-60.
7. Wycherley TP, Noakes M, Clifton PM, Cleanthous X, Keogh
JB, Brinkworth GD. A high-protein diet with resistance
exercise training improves weight loss and body composition
in overweight and obese patients with type 2 diabetes. Diabetes
Care 2010;33:969-76.
8. Boreham CA, Wallace WF, Nevill A. Training effects of
accumulated daily stair-climbing exercise in previously seden-
tary young women. Prev Med 2000;30:277-81.
9. Natalio MA, Faria CD, Teixeira-Salmela LF, Michaelsen SM.
Content validation of a clinical assessment instrument for
stair ascent and descent in individuals with hemiparesis. Braz
J Phys Ther 2014;18:353-63.
10. Thoma LM, Flanigan DC, Chaudhari AM, Siston RA, Best
TM, Schmitt LC. Quadriceps femoris strength and sagittal-
plane knee biomechanics during stair ascent in individuals
with articular cartilage defects in the knee. J Sport Rehabil
2014;23:259-69.