Effect of Ergonomic Gymnastic on Blood Pressure and Lipid Profile Hypertension Patient at Sumber Agung Village, Jatirejo District, Mojokerto City, Indonesia

Background : Hypertension is the most common disease found in the community. It does not only degrade the quality of life, but it can be life-threatening. Hypertension is known as heterogeneous group of disease because it can affect anyone from different age groups and various economic classes. There are two therapies for hypertension ie pharmacology and nonpharmacology. One of non-pharmacology therapy is doing ergonomic gymnastics. The purpose of this study is to see the effect of ergonomic gymnastics on blood pressure in people with hypertension in Sumber Agung Village, Jatirejo Sub-district, Mojokerto Regency. Method : This research method used one group pre test - post test design with control group. Sampling technique used was simple random sampling, from 80-person population of hypertension patient in Sumber Agung Village Jatirejo Sub-district Mojokerto Regency and become sample number 20 respondents in treatment group, and 20 respondents in control group according to criteria. Data collection using interval scale blood presure and total cholesterol. Analysis using statistical test Paired T test and Independent T-test SPSS 17. Result : From the analysis we got result p value 0,00 <0,05 it indacted that means of blood presure and lipid profile before ergonomic gymnastic and after ergonomic gymnastic shown significat value, it means that ergonomic gymnastic was very effective for blood pressure and lipid profile (total cholesterol). Discussion : Ergonomic gymnastics is one of effective therapy, easy to do and useful. Because ergonomic gymnastics can make the body become relaxed and blood vessels become vasodilated so that the blood flow and oxygen supply becomes smooth and it get impact in lipid profile . keywords : Aergonomic Gymnastic, Blood Pressure, Lipid Profile, Hipertension.


BACKGROUND
Hypertension is the most common disease found in the community, and in recent years there has been an increased prevalence of hypertension. Hypertension is known as a heterogeneous group of disease (Indrayani, 2009). The shifting pattern of people's lives that increasingly consume foods containing fat causes the occurrence of atherosclerosis to increase (Ardiansyah, 2012). Lack of physical activity also increases the risk of atherosclerosis.
Hypertension is defined as systolic blood pressure ≥140 mmHg and diastolic blood pressure ≥90 mmHg. High blood pressure is associated with an increased risk of stroke, myocardial infarction, heart failure, renal failure. Systolic blood pressure above 115 mmHg is the most important determinant of the risk of death worldwide, responsible for 7.6 million cardiovascular deaths annually. From 1960 to 1991, blood pressure decreased in the United States, and After the first ten years of this interval, the rate of cardiovascular death decreased. However, from 1990 to 2002 blood pressure increased due to a healthy dietary pattern decreased during this period and the prevalence of obesity continued to increase (Sacks & Campos, 2010).
Clients with hypertension should perform physical activities such as exercise and be included as a hypertension management program (Beveers, 2008). One of them is gymnastics / ergonomic exercise. This ergonomic gymnastics can be applied anytime and anywhere. This exercise can help reduce the symptoms of hypertension, such as a headache, the strain of the eyes, neck, back and waist, shoulders, and pain in the wrist. One of the goals of ergonomic exercise is the achievement of "pain-free movement" through the liberation of nerve irritation and improvement of nerve flexibility, preventing static loading, normalization of nerve microcirculation, postural correction, joint mobilization, soft tissue. Also, ergonomic exercise can increase oxygen supply throughout the body so that blood pressure can be controlled (Madyo W., 2010).
Prevalence of hypertension according to WHO (2011), it is estimated that 40% of developing countries have hypertensive patients, while in developed countries 35% and Southeast Asia estimated 36% of the population suffers from hypertension (Widiyani, 2013 Kedungwuni sub-district of Pekalongan district, showed that with 20 samples there is a difference in effectiveness between healthy heart gymnastics with ergonomic gymnastics to decrease systolic and diastolic blood pressure in elderly hypertension. The mean value of systolic blood pressure reduction with ergonomic gymnastics of 8.73 mmHg and heart-healthy gymnast is 23.60 mmHg, and the mean value of diastolic blood pressure drop with ergonomic gymnast is 4,80 mmHg, and heart-healthy gymnast is 13,66 mmHg.
Meanwhile, based on the preliminary study on April 6, 2017, in Sumber Agung village which is the working area of UPT Puskesmas Jatirejo. Obtained data, hypertension patients who do pharmacology treatment as much as 41 patients during January with total visits 369 and in February as much as 33 patients total visit 307 patients. Patients always do pharmacological treatment, but sometimes patients visit if only have complaints and treatment is not done continuously and continues, other than that the patient who came is not aware of ergonomic gymnastics methods.
Many healing efforts either pharmacological or non-pharmacological therapy. Pharmacological treatments, for example, use drugs such as thiazide diuretics, beta blockers, calcium channel inhibitors, ACE inhibitors, alpha blockers, centrally acting drugs, angiotensin receptor antagonists. While nonpharmacological treatments such as, changing diet and lifestyle, limit the consumption of salt, weight control, not consuming alcohol, stress counseling, potassium supplements, and perform regular exercise. Choosing sports such as leisurely walks, swimming, treadmills, light exercises that can make a little sweat and do not exert a weary effect on the body but the application remains optimal (Beevers, 2002). In addition to exercise the Mediterranean diet or dietary diets of the DASH model is very well associated with the MHO model diet and the MONW phenotype, it is proved that potential dietary interventions prevent cardiometabolic disease in several different age groups (Park et al., 2016).

Madyo
Wratsongko MM, ergonomic gymnastics creator, from Indonesian Ergonomic Gym and Health Care, this gymnastics is useful to prevent and cure various diseases. To obtain satisfactory results, it would be better if the exercises are done continuously, at least 2-3 times a week ± 20 minutes if all movements are done perfectly. The benefits obtained by doing ergonomic exercises such as movement, activate the function of organs, generate biolistrik in the body and launch enough oxygen circulation in the body so that the body will feel fresh and energy increases, healing various diseases that attack the spine, help cure sinusitis and asthma, increase endurance, control high blood pressure, increase bone elasticity, help cure migraine disease, vertigo, dizziness, nausea, help overcome bowel problems, strengthen waist muscles, kidneys, etc. (Sagiran, 2012) . Based on the description above obtained the formulation of the problem is "Is there an influence of ergonomic gymnastics to blood pressure and lipid profile in patients with hypertension in Sumber Agung Village Kec. Jatirejo Kab. Mojokerto? "

A. General Purpose
Identify the influence of ergonomic gymnastics on blood pressure and lipid profile in hypertensive patients.
B. Specific Purpose 1. To Identify blood pressure before and after ergonomic gymnastics in hypertensive patients in Sumber Agung Village Jatirejo District. 2. To Identify lipid profiles before and after ergonomic exercise in hypertensive patients in Sumber Agung Village Jatirejo District. 3. To analyze the difference of ergonomic gymnastics effect on blood pressure in treatment group and control group of hypertension patient in Sumber Agung Village, Jatirejo District. 4. To analyze the difference of ergonomic gymnastics effect on the lipid profile in the treatment group and control group of hypertension patients in Sumber Agung Village, Jatirejo District.

RESEARCH METHOD
The research design used was pre-post experimental design, said pre-experimental design. In this study the population of all hypertensive patients in the village of Sumber Agung Jatirejo District Mojokerto regency as many as 40 respondents.

Analysis using statistical test Paired T-test and
Independent T-test. Based on table 1 respondents by age in the treatment group most of the respondents based on the age of the elderly group of 11 respondents (55%). While in the control group most of the respondents based on the age of the early elderly group as many as nine respondents (45%). Respondents by sex in the treatment group were mostly male respondents were 15 respondents (75%). While in the control group most of the respondents were male as 17 respondents (85%). Respondents based on smoking habit in the treatment group most of the respondents had the habit of smoking as much as 14 respondents (70%). While in the control group most have a smoking habit as much as 16 respondents (80%). Respondents based on genetic factors in treatment group most of the respondents had a history of 16 respondents (80%). While in the control group most of the respondents have a history of descent that is as many as 14 respondents (70%). Respondents based on high salt diet habits in treatment group most of the respondents did not diet high salt as much as 12 respondents (60%). While in the control group most respondents high salt diet 12 respondents (60%).    Table 5 Analysis of lipid profile changes before and after performing ergonomic exercise in the treatment group and control group of hypertension Based on Table 5.9 it is known that the results of different test data analysis using Independent T-test with SPSS 17 obtained results p-value 0.00 <0.05 which means H0 rejected, so there is ergonomic gymnastics effect on lipid profile of hypertensive patients.

Analysis of changes in blood pressure before and after doing ergonomic exercise in people with hypertension
Based on The first factor that can affect the incidence of hypertension is age. The normal value of blood pressure varies throughout life and will continue to vary from one beat to another. The normal standard for teens and adults is 120/80 mmHg. The incidence of hypertension increases at age 35 and above. This is because the arteries are harder and less flexible to the blood. This increases systolic pressure. Diastolic pressure also increases as blood vessel walls are no longer flexibly retracted at a decrease in blood pressure.
The second factor is gender; clinically there is no significant difference between men and women. However, after menopause women tend to have high blood pressure than men (Perry & Potter, 2005). Men in the general population have the highest diastolic rate in their blood pressure compared to women.
Although men have the highest incidence hypertension in men and women can cause stroke, left ventricular enlargement, and kidney dysfunction. The reason for the difference in blood pressure by sex is unknown but is being investigated by several laboratories. Estrogen has been believed but has not been proven to lower blood pressure in young women. From the blood pressure fluctuation data during life brings support to the hypothesis. However, the incidence is related to changes in blood pressure from all life to the smallest level of endogenous cells.
The third factor is heredity, based on the results of the study as many as 13 respondents (65%), have a history of hypertension, genetically hypertensive disease has a significant relationship with the genes trigger hypertension contained in the human chromosome. Although hypertension genes have not been accurately identified genetic factors in humans may affect the reninangiotensin-aldosterone system (Ridwan M., 2009). This states that if the parents experience hypertension, then the child is likely to have hypertension due to genetic traits inherited to offspring.
The fourth factor was smokers, some respondents in the treatment group or control group had a smoking habit. As many as 14 respondents (70%) in the treatment group and as many as 16 respondents (80%) in the control group. This suggests that nicotine in your tobacco is the cause of increased blood pressure soon after the first suction. Like other chemicals, in nicotine cigarette smoke will be absorbed by the tiny blood vessels in the lungs, then circulated throughout the body through the bloodstream. Within seconds the nicotine has reached the brain. The brain will react to nicotine into the brain by signaling the adrenal gland to release epinephrine (adrenaline). This powerful hormone will react to constrict the blood vessels, as the blood vessels of the brain narrow it will force the heart to work heavier because of higher pressure. If the pumping of the heart is strong enough, and the narrowing of blood vessels in the brain due to epinephrine reactions is also quite strong, it will happen blood vessels of the brain to break; this will cause stoke. Smoking will harm the blood vessel walls and accelerate the formation of atherosclerosis (hardening of the arteries). So, although it does not increase blood pressure directly, smoking is the very bad effect on everyone especially those who already have high blood disease (hypertension). From various studies that have been done, smoking behavior is known to give the impact of the metabolic shift in the form of growth hormone release and add fatty acid, glycerol and lactate, resulting in decreased HDL (high density lipid) cholesterol, increase LDL (low-density lipid) cholesterol and triglyceride, also acts as a trigger for increased insulin resistance as well as hypersulinemia which further leads to heart defects, blood vessels, and hypertension and increases the risk of coronary heart disease or cardiac death (Sani, 1994(Sani, , in sianturi, 2004. The next factor is high salt diits, Excess salt intake can increase arterial vascular constriction, so this can increase blood pressure. Salt consumption is allowed if less than 5 grams, about one teaspoon (Beevers, 2005). If you consume more than 5.8 grams of salt per day, this can increase your blood pressure. If we can reduce 1.8 grams per day alone, it can lower systolic blood pressure by 4 mmHg and diastolic 2mmHg (Ridwan M., 2009). Consumption of excessive salt and takes place daily will have a direct impact on the body because what we consume must be processed by the digestive system is absorbed and flowed throughout the body by blood vessels. If high salt levels in the body will result in narrowing of blood vessels and this is what makes the workload of jatung will increase and there is high blood pressure or hypertension. The association between the Dietary Approach to stop hypertension (DASH) -the diet diet and the development of metabolic syndrome (MetS) in 424 children and adolescents. CI OR and 95% developed MetS at the highest, compared with the lowest, quartile DASH score was 0.36 (0.14-0.94). (Larsson, Wallin, & Wolk, 2016) After the treatment was given, all respondents in the treatment group experienced a decrease in blood pressure. Based on the results of the study and presented in Table 5.6 it can be seen that after intervention the mean value is 128.4 / 77.15 mmHg, while the median value is 127.5 / 80 mmHg, and the mode value is 120/80 mmHg. Based on existing theory there are various factors that influence blood pressure, as described above? And measures to lower blood pressure are pharmacology and nonpharmacology. One of these nonpharmacological treatments is to exercise like ergonomic exercise. This ergonomic gymnastics can smooth the blood circulation, oxygen supply throughout the body and can achieve maximum relaxation so that it can affect blood pressure (Madyo W., 2010). This ergonomic gymnastics consists of 5 basic movements namely chest movement, submissive gratitude, sitting mighty, and sitting burning and lying down resigned. Each movement contains tremendous benefits in maintaining fitness, can launch blood flow because all the blood vessels will experience vasodilatation.
Therefore after doing ergonomic gymnastics appropriately and done routinely every respondent will have good body resistance and prime hence can influence blood pressure. Not only quality and quantity in doing ergonomic gymnastics, after given treatment, need to improve healthy lifestyle in order to keep control of his blood pressure, from which blood pressure can decrease.
From the above discussion, based on the characteristics of sex, hereditary history, and salt intake strongly support the occurrence of hypertension, to change the lifestyle to be more qualified as consuming the food we need will be better than consuming the food we want. This is done so that we can control blood pressure and no further complications occur. This is in accordance with the research of Prime, RM (2014) about the effectiveness of ergonomic gymnastics with low impact aerobic gymnastics on blood pressure level in elderly hypertension that is the result of research indicate there is a difference of influence of ergonomic gymnastics and low impact aerobic to blood pressure level of sistole and diastole at elderly hypertension , and the most effective effect is ergonomic gymnastics on the pressure of systole and low impact aerobic gymnastics on diastole pressure. It is recommended for elderly to be more active to follow ergonomic gymnastics or low impact aerobic so that blood pressure can be stable. Table 5 it is known that lipid profiles in the treatment group before being given ergonomic gymnastics interventions, most of the respondents have a mean value of 227.25 mg / dl. The mode value is 223 mg / dl. Median value 229 mg / dl. In the control group, most respondents had mean values of 212.25 mg / dl. The mode value is 236 mg / dl. Median value 224 mg / dl. Table 5 it is known that lipid profiles in the treatment group after ergonomic gymnastics interventions given, most respondents have mean value 194 mg / dl. The mode value is 200 mg / dl. Median value 200 mg / dl. With an average difference of 33.25 mg / dl. In the control group, most respondents had mean values of 210.55 mg / dl. The mode value is 236 mg / dl. The median value was 223.5 mg / dl. With an average difference of 1.7 mg / dl. Many factors that can cause research results one of them is the lifestyle of research samples that can not be controlled by researchers, including daily physical activity and eating patterns of the sample. Increased levels of HDL cholesterol are directly proportional to the intensity and frequency of exercise in a matter of weeks. elevated levels of HDL cholesterol and regular physical exercise In contrast to previous research conducted by Rattu and Rampengan in Manado, HDL cholesterol levels increased significantly after exercise. This study maintains a diet low in saturated fat during exercise. Solid saturated intake affects the blood lipid profile that plays a role in the decline in HDL cholesterol levels. Exercise accompanied by dietary changes has been shown to improve the profile of lipoproteins, including HDL cholesterol.

Based on
Age factor of the respondent itself where total cholesterol in elderly is higher than cholesterol at a young age. According to research conducted by Faisal baraas (1999) and Listiana, Purbosari (2006) explained that at an aging age, total cholesterol is higher levels. This suggests that age can affect a person's total cholesterol level. Older age total cholesterol is relatively higher than total cholesterol at a young age; this is because the older an individual LDL receptor activity may be less. These receptor cells act as cholesterol circulatory hemostasis in the blood and are present in the liver, gonadal glands and adrenal glands. If this receptor cell is disturbed, then the cholesterol will increase in the blood circulation. In addition, in the elderly are often found abnormalities of narrowing of the blood vessels of the heart, this is closely related to changes that occur in the walls of blood vessels, such as arteries that are likely to shrink gradually over long periods. The amount of fat that exists in old age is more likely to drain than young age. At an older age, physical activity tends to decrease or lack of exercise, whereas to maintain normal cholesterol levels in women requires at least 1500-1700 calories of fat burned a day, while in men it takes up to 2000-2500 calories of fat burned a day. With physical activity and less exercise possible in old age, cholesterol is not able to experience the process of metabolism and combustion is perfect, in this case, the cholesterol that is accumulating in the blood vessels. The amount of fat in young adult men generally ranges from 15-20% of total body weight and 20-25% in women. Usually, the amount of fat in the body tends to increase with increasing age.
Other factors that support no effect of this elderly gymnastics are possible lifestyle by the subjects among other foods that are consumed by subjects that can not be controlled by researchers and subjects daily activities. Other habits such as smoking accompanied by drinking coffee, this habit is also made by the subject of research. This habit is very common in men who get older even though it started since youth but the effects of all that new look at the increasingly twilight age. Cigarettes can lower levels of HDL cholesterol around 4.5-6% as a result of higher LDL cholesterol levels, and this affects the total cholesterol levels are relatively higher too. In women who enter menopause, cholesterol levels in the blood tend to increase this is because the hormone estrogen is not formed. This estrogen hormone is thought to have a protective effect on atherosclerosis that can bind cholesterol in the blood. Uncontrolled diets are also another contributing factor; this is because at an aging age the food they consume is poorly maintained, so it is possible that the cholesterol present in the food has a very high level.

Analysis of changes in blood pressure
before and after doing ergonomic gymnastics in the treatment group and control group of people with Hypertension in Sumber Agung Village, Jatirejo Sub-district, Mojokerto Regency Based on the statistical test showed that in the treatment group more showed a decrease in blood pressure than the treatment group. It is proved by the result of Independent T-test with SPSS 17 got result p-value 0,00 <0,05 for systolic blood pressure and diastolic, meaning there is a significant difference to systolic and diastolic blood pressure change in hypertension patient. Thus it can be concluded that ergonomic gymnastics is effective in lowering blood pressure for the elderly. It is recommended that ergonomic gymnastics is applied as an alternative to lowering hypertensive elderly blood pressure and can be one of the nursing orders. In accordance with previous research by Novia Putri Ningsih 2015 on "Influence of Ergonomic Gymnastics Against Blood Pressure of Elderly Hypertension at Elderly Posyandu Father-Mother of Andalas Puskesmas Working Area" stated that ergonomic gymnastics effective in lowering blood pressure for elderly.
While in the control group, did not show significant changes in blood pressure decrease. This is influenced factor because in the process of collecting data control group is not given assistance in the implementation of ergonomic gymnastics. So it can not be ascertained whether the control group performed all stages of SOP in ergonomic gymnastics. Because researchers only provide ergonomic gymnastics explanations and mentoring only once in the research process.

Analysis of lipid profile change before and after doing ergonomic gymnastics on treatment group and control group of hypertension patient in Sumber Agung
Village Jatirejo Sub-District Mojokerto Regency Based on statistical test showed that in the treatment group more showed a decrease in lipid profile compared with treatment group. This is evidenced by the results of Independent T-test with SPSS 17 obtained results p-value 0.00 <0.05 which means there is a significant difference in lipid profile changes in patients with hypertension. While in the control group, did not show significant changes in the decrease in lipid profile. This is influenced factor because in the process of collecting data control group is not given assistance in the implementation of ergonomic gymnastics. So it can not be ascertained whether the control group performed all stages of SOP in ergonomic gymnastics. Because researchers only provide ergonomic gymnastics explanations and mentoring only once in the research process.

CONCLUSION
Most of the treatment group respondents experienced a decrease in blood pressure, while in the control group most did not experience a drop in blood pressure. Most of the treatment group respondents experienced a decrease in lipid profile, while in the control group most did not experience a decrease in lipid profile.

SUGGESTION
1. Respondents are expected to be more often and regularly doing ergonomic gymnastics because ergonomic gymnastics has beneficial effects on the body by improving blood circulation. Ergonomic gymnastics easy to do and does not cause negative impacts to the body than it is expected also hypertensive patients try to use other nonpharmacological therapy that can lower blood pressure. 2. Health workers are expected to make ergonomic gymnastics as an alternative independent nursing action that can be used by nurses or other health workers, especially to lower blood pressure in people with hypertension.