The Aquatic Game Model for Children of Asthma Patients

in 6-12 Years

Putri Deviani

, Panggung Sutapa

Department of Sport Science, Graduate School Program, Yogyakarta State University, Sleman, Yogyakarta, Indonesia

Keywords: Aquatic Game Models, Asthma, 6-12 Years Old.

Abstract: This study aims to produce an aquatic game model which is suitable for children aged 6-12 years with

asthma. This research model was research and development. The instruments in data collection used were

interview guides, questionnaires, and children's health questionnaires. The data were analyzed descriptively

and quantitatively on the model rating scale, sign test (t test) on effectiveness and descriptive qualitative

tests on the input of model assessment and interview results. The result gained from this study was an

aquatic game model for children with asthma aged 6-12 years, consisting of nine aquatic game models,

namely (1) walking, running, jumping, and jumping water, (2) magic circles, (3) waves wavy, (4) water

bubbles, (5) drowning, (6) pushing the ball, (7) pulling thrust friends, (8) you hide I find, (9) throwing balls.

The model developed was effective for children with asthma aged 6-12 years.

1 INTRODUCTION

Health always overcomes illness and illness that

causes disease does not choose who is attacked.

Children, adolescents, adults, and even very old

people can suffer an illness that we may not realize.

When people are sick, they will definitely divert all

activities, especially children who are still in the

growth period.

School-age children will have difficulties in the

future if they have many health problems. Children's

health at this time will greatly determine the quality

of children in the future. If the health problems are

not taken into account, they can develop into more

serious illness. Health problems in school-age

children often occur in developing countries

including Indonesia. School-age children need to get

regular treatment or medical checkup at school or at

home.

Some health problems that often occur in school-

age children are: diarrhea, tuberculosis, Dengue

Hemorrhagic Fever (DHF), whooping cough,

diphtheria, fever, tetanus, hepatitis, measles, worms,

chickenpox, meningitis, mumps, middle ear

infection and dengue asthma. Asthma is a disease

that is often experienced by school-age children. The

General Director of Disease Control and

Environmental Health (P2PL), MARS, DTM &

HDTCE explained that astma from childhood can

continue in adulthood. Asthma from children or

adults who have been infected is likely to be cured

(Pos Kota, Tuesday, December 20, 2011). Asthma is

still the top ten diseases that cause illness and death

in Indonesia. Asthma is also a major cause of

disability, deteriorating quality of health throughout

the world. Asthma treatment has been quite

effective, but asthma morbidity and mortality rates

remain high (Stanojevic, et.al., 2012).

Based on Pos Kota news, more than 6% of

children in Indonesia were diagnosed with asthma.

In 2009 in America, 8.2% was diagnosed with

asthma and it affected 24.6 million people (17.5

million adults and 7.1 million children with the age

range 0-17 years (Centers for Disease Control and

Prevention, 2009). In Indonesia, asthma also

increases by 75% today, even the sufferers are 40%

more than urban areas. From the data of World

Health Organization (WHO), the number of people

with asthma in the world is estimated to reach 300

million people. This figure is feared to continue to

increase in 2025 to 400 million people (Global

Initiative for Asthma, 2012).

In Indonesia, the prevalence of asthma is

uncertain, but the results of research on children

392

Deviani, P. and Sutapa, P.

The Aquatic Game Model for Children of Asthma Patients in 6-12 Years.

DOI: 10.5220/0009787003920398

In Proceedings of the 3rd Yogyakarta International Seminar on Health, Physical Education, and Sport Science in conjunction with the 2nd Conference on Interdisciplinary Approach in Sports

(YISHPESS and CoIS 2019), pages 392-398

ISBN: 978-989-758-457-2

aged 13-14 years using the ISAAC questionnaire

(International Study of Asthma and Allergies in

Children) in 1995 the prevalence of asthma was still

2.1%, while in 2003 it increased to 5.2%. The survey

results of asthma in school children in several cities

in Indonesia (Medan, Palembang, Jakarta, Bandung,

Semarang, Yogyakarta, Malang, and Denpasar)

showed that the prevalence of asthma in elementary

school children (6 to 12 years) ranged from 3.7% -6,

4%, while for junior high school children in Central

Jakarta 5.8% in 1995 and 2001 and 8.6% in East

Jakarta. Based on the description above, it is a public

health problem that needs serious attention.

Some sports recommended by the experts in

reducing or minimizing asthma in school-age

children are running and swimming. As stated by

Sumosardjuno (2012), activities such as running and

swimming improve fitness and reduce asthma

symptoms. Swimming has advantages.

Physiologically, this exercise trains the strength of

the respiratory muscles, and the water/ the

environment in a swimming pool helps keeping the

respiratory tract from interference with dust or dirt

carried by the air which will stimulate recurrence of

asthma.

Physical activities such as swimming for asthma

sufferers suggested by experts should be done at

moderate intensity. Swimming with moderate

intensity helps breathing exercises in asthmatics and

prevents recurrence during exercise. Asthma attacks

can occur in patients with physical conditions

triggered by being too tired or exhausted, so

swimming should be designed to make sufferers feel

happy and it aims to practice breathing.

A study conducted by The UK National Asthma

Management Study together with the Tayside

Asthma Management Initiative involving 12.203

respondents showed that the most common asthma

attacks occurred in children aged less than five years

(37%). Asthma in children is a problem for the child

itself and the family, because asthma in children

influences various specific aspects related to quality

of life, including the process of growth and

development, both in infancy, infancy, and

adolescence (Sidhartani, 2007). If an acute asthma

attack occurs, the child will experience shortness of

breath, experience disruption of daily activities,

including frequent absence from school, reduced

physical fitness, and recurring anxiety and can

reduce quality of life (Anurogo, 2009).

The results of the study of Robert, et.al., (2010)

state that the factors that can affect the quality of life

of children with asthma are lung function,

characteristics of asthma symptoms, and

psychosocial functions. Children with asthma are

mostly aware of their limitations in activities such as

running, playing, and learning, sometimes feeling

angry and frustrated in children due to their

limitations. The effects of asthma in children such as

disruption of daily activities, such as playing,

running, and children seem to avoid the usual

activities. Another impact seen in asthmatic a child

is rest and sleep disorders. Children are seen as

having difficulty sleeping and there are disturbances

in sleep patterns.

Preliminary observations related to swimming

exercise carried out by asthmatics, especially

elementary school age children were done in

swimming clubs or in private swimming lessons.

The researchers' initial observations were carried out

at one of the swimming clubs in Yogyakarta and the

elementary schools in Yogyakarta which held

learning and extra swimming. According to the

chidren' parents, the children who took part in

swimming exercises at the club felt less confident

and less able to take part in training even though

they were still the basis of swimming. Children felt

less confident because they considerred themselves

as the one being unable to carry out heavy activities.

The basic abilities possessed by asthmatic children

were also categorized as less than other friends who

do not suffer from asthma at the same age. Thus, it

made the children lazy to do the exercises. The

children in elementary schools having asthma tended

to be less active and were interested in sports and

aquatic learning. The sports carried out at the club

were to achieve achievements, so the exercise used

was carried out in accordance with the achievement

training program, while swimming with private

lessons made children bored because the training

given tends to be monotonous.

The researchers interviewed some parents of the

elementary school children who took their children

to take extra swimming activities. The parents said

that they did that because their children suffered

from asthma and their mobility was sometimes not

optimal because the children were not confident and

were afraid if their asthma recurs. The parents felt

that the health of asthma children was important

because the children’s parents who took part in

swimming suffered from asthma. Therefore, the

parents expected that their children's extra

swimming would make the children more confident

in doing movement activities. However, sometimes

when the learning was too heavy, the children

relapsed when he was home.

Preliminary observations with the swimming

instructors or swimming trainers about aquatic

The Aquatic Game Model for Children of Asthma Patients in 6-12 Years

393

activities for children with asthma showed that the

system of swimming exercise was usually to get

achievements. The children who participated in

swimming clubs would usually tend to be more

silent and they were not able to cope with the

training activities provided by the coach. Asthma

children who do the exercise would usually feel

burning sensation in their chest and find it difficult

to breathe when the exercise given was rather

excessive, so it took a long rest period. Sports

instructors or teachers who accompanied

extracurricular activities rarely used game

approaches in implementation and often did not

assess the learning process of children, especially

children with asthma who tended to have limited

mobility and lack of confidence. Asthma children

who were not so confident made the quality of

motion not optimal and it could interfere the

development and development of elementary school

age children.

Based on the above problems, it was necessary to

make a game model adapted to asthmatics,

especially children aged 6-12 years. Game model

was an effort to provide variations in the game that

could attract the interest of children to play games,

as a form of giving physical activity as a whole.

Giving overall physical activity could be done

through various sports activities done in leisure time,

or by habituation in daily life. This is in accordance

with that expressed by Branca & Valuena (2001)

that ”A good level of physical activity should be

promoted in children of all ages through organized

sport, leisure, and everyday habits.

The children with asthma do not have to swim in

doing activities in water, especially for beginners.

One of the water activities that can be done by

children with asthma is by playing in water. The

most important water game for people with asthma

is to try to keep the child moving in the water and to

practice breathing management when getting into

and leaving the water. A fun game will make the

child become unconscious when the exercise

maximizes basic motion quality and improves

fitness in order to minimize the occurrence of

asthma attacks and to increase endurance.

Aquatic games focussed on improving the

motion quality of elementary school-aged asthma

children and increasing their fitness and endurance.

Until now, there had not been developed a game

package in water (aquatic) specifically for

asthmatics of elementary school age children that

could minimize the asthma attacks. The purpose of

this study was to develop an aquatic game model

designed to reduce or minimize asthma in children

aged 6-12 years (elementary school) which was

expected to be one of the solutions that could be

done and useful, especially to answer the problem of

asthma.

2 RESEARCH METHODS

2.1 Types of Research

This type of research was research and development.

It is the type of research used to produce certain

products and test the effectiveness of those products

(Sugiyono, 2014).

2.2 Development Procedure

This procedure of research utilized the steps of Borg

& Gall (2007). The design of the development of the

Borg and Gall development model was later

modified more simply involving seven main steps:

(1) preliminary study, (2) design of the initial draft,

(3) validation of the initial and revised drafts, (4)

small-scale trials and revisions, (5) large-scale trials

and revisions, (6) final products, and (7)

effectiveness tests.

2.3 Target/ Research Subject

The targets/ subjects of this study were taken in a

small-scale trial at Muhammadiyah Elementary

School in Karangkajen Yogyakarta aged 6-12 years

suffering from asthma, as many as 4 children. Large-

scale trials were conducted in the same place as the

number of students of 8 children. The effectiveness

test was carried out on 10 children aged 6-12 years

with asthma at Muhammadiyah Elementary School

Karangkajen.

2.4 Instruments and Data Collection

Techniques

The instruments of data collection used by

researchers were: (1) interviews, (2) questionnaires.

The interview instrument was carried out when the

researcher collected initial information.

Questionnaire was used to state the feasibility of the

draft game.

2.5 Data Analysis Technique

The data used in this study were qualitative and

quantitative data. The effectiveness test was done by

YISHPESS and CoIS 2019 - The 3rd Yogyakarta International Seminar on Health, Physical Education, and Sport Science (YISHPESS

2019) in conjunction with The 2nd Conference on Interdisciplinary Approach in Sports (CoIS 2019)

394

quasi-experimental method, by comparing the

results of the pretest with the results of the posttest.

Data analysis was conducted by using nonparametric

statistical tests, the sign test. According to Hasan

(2008), it is called a sign test because the data

analyzed is expressed in the form of signs that are

positive signs and negative signs, positive and

negative signs will be known based on differences in

scores during pre-test and post-test. This sign test

can be used to find out the effects of a particular

action, the effects of those actions are expressed in

positive and negative signs.

3 RESEARCH RESULT

This study aims to develop an aquatic play model for

children suffering from asthma aged 6-12 years.

This was done as an effort to help swimming

practitioners and parents having asthma children in

introducing water. The researchers expected that the

products produced in the development of this game

model could be a safe alternative when parents

wanted to introduce water for their children with

asthma aged 6-12 years.

Validation was carried out by experts/ the

experts associated with this research. They were the

experts in the fields of aquatic, health, and sports

teachers. The results of expert evaluations of the

draft model are presented in Table 1 as follows.

Table 1: Data on the results of expert validation on the

model draft.

No Expert % Category

1 Expert 1 82.5 Very good

2 Expert 2 90 Very good

3 Teacher 87.5 Very good

Table 1 above shows that the expert 1 classified

the model in very good category, having 82.5%

percentage. The expert 2 categorized the model in

very good category, acquiring the percentage of

90%. Besides, the teacher categorized the model in

very good category, reaching the percentage of

87.5%. From the experts’ judgement, the assessment

obtained was in the very good category, the

suggestions and inputs from the initial draft were

revised in accordance with the results of validation.

This shows the expert's assessment of the model

made was worth testing.

From the implementation of small-scale trials,

the researcher obtained the data from two experts

and one teacher. These data are presented in Table 2

as follows.

Table 2: Data on assessment results for models in small-

scale trials.

No Expert % Category

1 Expert 1 82,5 Very good

2 Expert 2 87,5 Very good

3 Teacher 87,5 Very good

Table 2 above shows the assessment result from

the experts and the teacher, the expert 1 having a

percentage of 82.5% in the very good category,

expert 2 having a percentage of 87.5% in the very

good category, and the teacher a percentage of

87.5% in the very good category. From the

evaluation on the small-scale trial, it was found that

the assessment was in the very good category, this

shows that the evaluation of the model was feasible

to be tested on a large scale.

Large-scale trials involved the children from SD

Muhammadiyah Karangkajen. The children with

asthma were made as subjects, as many as 8

children.

Table 3: Data on assessment results for models in small-

scale trials.

No Expert % Category

1 Expert 1 87,5 Very good

2 Expert 2 90 Very good

3 Teacher 92,5 Very good

Table 3 above shows the assessment result from

the expers and the teacher, the expert 1 having a

percentage of 87.5% in the very good category,

expert 2 having a percentage of 90% in the very

good category, and the teacher having a percentage

of 92.5% in the very good category. From the

evaluation of large-scale trials, it was found that the

evaluation in the very good category showed that the

evaluation of the model was feasible. In general, the

material experts and the sports teacher rated it with

good category, by adding the instructions for

carrying out asthma medication in children engaged

in activities.

4 DISCUSSION

The ultimate goal of this development research is to

produce a product in the form of an aquatic game

guidebook for children with asthma aged 6-12 years.

The purpose of the guidebook is to explain more

specifically about the model, so that the teachers and

the students as practitioners in the field as well as

the readers will understand the purpose of the model

The Aquatic Game Model for Children of Asthma Patients in 6-12 Years

395

developed, the tools needed, the preparation of tools,

and how to implement them.

The development of an aquatic game model for

children with asthma aged 6-12 years started from

stage (1) preliminary study, (2) design of the initial

draft, (3) validation of the initial and revised drafts,

(4) small scale trials and revisions, (5 ) large-scale

trials and revisions, (6) final products, and (7)

effectiveness tests. The final product of this

development research was in an aquatic game guide

book for children with asthma aged 6-12 years. The

final product of the aquatic game model for children

with asthma aged 6-12 years consisted of nine

aquatic game models, namely (1) road, run, jump,

and jump water, (2) magic circle, (3) choppy waves,

(4) water bubbles, (5) drowning, (6) thrusting balls,

(7) pulling thrust friends, (8) you hide I find, (9)

throwing balls. The model was compiled using

simple, inexpensive, and safe facilities and

infrastructure so that it is easily available and not

harmful to children. Aquatic games for asthmatics

can be chosen which one to use and, in each

exercise, can be carried out 2-3 games with the time

of play accompanied by a maximum rest of 1 hour.

Health assessment carried out in this study uses

indicators to determine the usefulness of the game

for the health of asthma children. The Effectiveness

Test indicators consist of (1) Frequency of Asthma

Attacks, (2) Asthma intensity on a scale of 1-10, 1

mild to 10 weight, (3) Asthma Attack Duration in

minutes, (4) Frequency of Other Diseases related to

power body resistance, and (5) Heart Rate When

Recovery related to fitness is calculated using the

Recovery Heart Rate "RHR". The results of the

effectiveness test using the sign test are presented in

the table as follows.

Table 4: Sign test results.

No Indicato

Signifikansi

ecovery Heart Rate “RHR” 0,004

2 Fre

uenc

of Asthma Attacks 0,031

3 Asthma intensit

0,002

4 Asthma Attack Duration 0,016

5 Frequency of Other Diseases 0,016

Based on the results of the analysis in Table 4

above, it shows that the significance value is <0.05,

so there are significant differences.

Based on the results of the effectiveness test

above, it shows that the developed model is effective

for children with asthma aged 6-12. Effectiveness is

shown by increasing Recovery Heart Rate (RHR),

and decreasing the frequency of asthma attacks,

asthma intensity, duration of asthma attacks in the

form of duration of asthma attacks in hours,

frequency of other diseases associated with

endurance. This is reinforced by the results of

Handayani (2012) who stated that swimming

exercises and asthma exercises regularly can

increase the value of FEV1 in asthmatics; swimming

exercises and asthma exercises regularly can

increase cortisol hormone levels in asthmatics;

Increased FEV1 values and higher levels of cortisol

hormone in the pool exercise group compared to the

asthma exercise group. Added McArdle, Katch, &

Katch (1994) that swimming exercise requires more

energy compared to other exercises (running or

walking) because swimming exercises emphasize

the movement of the legs and arms and there is a

force that blocks the subject, namely water so that

pulmonary function in the muscles -The respiratory

muscles are also better.

The role of physical exercise in the

pathophysiology of asthma and disease control has

been the focus of attention for consideration. Better

ventilation capacity and relief of symptoms

associated with asthma are the benefits of physical

exercise for asthmatic patients. Physical exercise

causes improvements in physical fitness, reduces

shortness of breath, reduces consumption of inhaled

steroids in asthma patients, reducing physical

exercise can cause bronchospasm.

Some of the benefits of water therapy include: to

prevent flu / fever, improve fertility, cure fatigue,

improve immune function, increase body energy,

and help smooth blood circulation (Chaiton, 2002).

Hydro therapy or water therapy is a method of

treatment and healing by using water to get the

effects of therapists (Chaiton, 2002). In particular,

water has the quality to achieve a bodily response

that can heal the symptons and improve the body's

mechanism in the face of external threats. Benefits

of aquatic activity / swimming exercises include

reducing blood pressure, diabetes mellitus, heart

disease, arthritis, hypercholesterolemia, and obesity.

According to Albert M. Hutapea (in Tamyiz,

2008), in his book "Towards a Healthy Lifestyle"

revealed, a 16-year study of 17,000 alumni of

Harvard University showed that those who were not

actively exercising (who burned no more than 500

calories per week in activities exercise) is more

likely to have heart disease. The following is

explained some of the benefits of swimming

exercise as a therapy for internal medicine which

affects many people who are lazy to exercise

(Tamyiz, 2008). Tamyiz (2008) added that the

benefits of aquatic activity / swimming exercise are

to reduce children who suffer from asthma.

YISHPESS and CoIS 2019 - The 3rd Yogyakarta International Seminar on Health, Physical Education, and Sport Science (YISHPESS

2019) in conjunction with The 2nd Conference on Interdisciplinary Approach in Sports (CoIS 2019)

396

Educational efforts provided by educators should

be carried out in pleasant situations by using

strategies, methods, materials and media that are

interesting and easy for children to follow. Through

play children are invited to explore, discover and

utilize objects that are close to the child, so that

learning becomes meaningful. Games for children

are a creative process for exploring, can learn new

skills and can use symbols to describe their world.

When playing they build understanding related to

their experience.

The nature of the game is physical activity

carried out seriously, voluntarily and pleasantly.

Aquatic learning also involves physical activity

carried out seriously to achieve the learning

objectives. Through the playing approach the

learning objectives will be easily achieved because

students will carry out physical activities voluntarily,

happily, and in a pleasant atmosphere. Water games

are the introduction of students to water without

realizing it. In playing students will walk, run, jump

both forward and backward and sometimes fall into

the water. This game will be carried out by students

happily without realizing students have known the

nature of water, including: cold, water objects,

providing obstacles upward or forward that are quite

large. With this game the feeling of fear of water

will disappear and trust in oneself will arise, so that

it will be easy to accept the forms of the next lesson.

The nature of the game is physical activity

carried out seriously, voluntarily, and fun. As stated

by Sukintaka (1998, p.24) play is a physical activity

that is carried out voluntarily and is serious about

getting pleasure from these activities. Aquatic

learning also involves physical activities that are

carried out seriously to achieve the learning

objectives. Through the play approach the learning

objectives will be easily achieved because students

will carry out physical activities voluntarily, happily,

and in a pleasant atmosphere. The water game is the

student's unconscious recognition of water. In

playing students will walk, run, jump both back and

forth and sometimes fall into the water. This game

will be carried out by students happily without

realizing it students already know the nature of

water, including: cold, water objects, providing

obstacles up or forward which is quite large. With

this game the feeling of fear of water will disappear

and self-confidence arises, so that it will be easy to

accept the following forms of learning.

5 CONCLUSION

From the results of data analysis, conclusions can be

drawn: (1) Aquatic game models have been

developed for children with asthma aged 6-12 years

consisting of nine aquatic game models, namely (1)

walking, running, jumping, and jumping water, ( 2)

magic circle, (3) choppy waves, (4) water bubbles,

(5) drowning, (6) thrusting balls, (7) pulling thrust

friends, (8) you hide I find, (9) throwing balls . The

model is compiled using simple, inexpensive, and

safe facilities and infrastructure so that it is easily

available and not harmful to children. Aquatic

games for asthmatics can be chosen which one to

use and in each exercise can be carried out 2-3

games with the time of play accompanied by a

maximum rest of 1 hour. (2) The model developed is

effective for children with asthma aged 6-12 years.

Effectiveness was shown by increasing Recovery

Heart Rate (RHR), and decreasing the frequency of

asthma attacks, the intensity of asthma attacks, the

duration of asthma attacks, and the frequency of

other diseases that were significant (p <0.05).

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2019) in conjunction with The 2nd Conference on Interdisciplinary Approach in Sports (CoIS 2019)

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