Effectiveness of Poco–Poco Exercise on Elderly’s Cholesterol Levels:

A Preliminary Study

Imelda Derang

, Ance M. Siallagan

and Nia Nova Sitanggang

Saint Elisabeth Medan Nursing College, Medan, Indonesia

Keywords: Elderly, Exercise, Poco-Poco, Cholesterol Level.

Abstract: Elderly is a condition where people will lose the ability of tissues to improve themselves and lose their

immune power against infections that result in decreased function of muscle tissue such as the heart. The

highest cause of cardiovascular disease is high cholesterol levels in the blood. One solution to deal with

cholesterol problems in the elderly is by doing exercise. Poco-Poco is an aerobic exercise where the

continuity of movement involves muscle groups that contract and can lower blood fat levels, so the danger

of deposition of fat in blood vessel walls can be reduced. This preliminary study aimed to identify the effect

of poco-poco exercise on cholesterol levels in the elderly. This research used pre-experimental method with

one group pretest and posttest design to 15 elderly people in Medan. Instruments used for data retrieval are

guideline and glucometer. Data analysis used was Wilcoxon test with p value 0,001 (α< 0, 05). This

research indicates that there is significant effect of poco-poco exercise on cholesterol levels in elderly.

Further research can apply the poco-poco exercise at least two times a week for long time period in elderly

as one of alternative way in lowering cholesterol.

1 INTRODUCTION

Elderly is a condition where humans will lose their

immunity to infection, which results in a decrease in the

function of muscle tissue to the function of body organs

such as the heart, liver, brain and kidneys. One of the

effects of a decline in heart organ function is the

deposition of atherosclerotic substances that can cause

changes in blood vessel elasticity (Mayasari, 2016). The

prevalence of disease experienced by elderly between

musculoskeletal (61.4%) and cardiovascular diseases

(51.1%) was experienced by more elderly men

compared to elderly women (Tjokoprawiro, 2015). One

of the highest causes of cardiovascular disease is high

abnormal cholesterol levels (Arisman, 2014).

The Government of Healthy Living Movement

Program is a choice in realizing a better community

health status. The goal is to raise awareness in the

community in preventing disease by exercising

regularly, eating nutritious foods, and regular health

checks to control blood pressure, blood sugar levels, and

cholesterol levels in the body. This program will save

more costs when compared to treating. Exercise is any

body movement carried out by the frame so as to

produce energy. In the elderly body movements and

physical activity decreased. Aging normally occurs in a

person's body composition including decreased body

mass, basal metabolism, protein reserves, and water

reserves. Reduced muscle strength due to loss of muscle

mass, level of activity and exercise patterns can affect

muscle strength which will result in slowing

performance of daily activities.

This poco-poco exercise has advantages compared

to other exercises and can be classified as aerobic

exercise because of continuity and involves many

groups of muscles that contract. Looking at the burden

or intensity of training that is quite large owned by poco-

poco exercises, it can be said that this exercises can be

equated with line dance from Bali in terms of the effect

it has on some physiological parameters of the body

(Saputra, 2015). Poco-poco gymnastics has several

advantages. First, movement rhythm is easy to

remember. If we rarely exercise, poco-poco is a good

choice because it does not drain our body too much.

Second, movement of poco-poco is not difficult

because it consists of complex movements with

moderate difficulty. Third, this exercise increase the

elasticity of blood vessels, so that it can reduce the

possibility of rupture of vessels if blood pressure rises

and blood circulation will be more perfect to take,

circulate, and use oxygen. Fourth, poco-poco exercise

can reduce levels of fat in the blood, such as cholesterol

Derang, I., Siallagan, A. and Sitanggang, N.

Effectiveness of Poco–Poco Exercise on Elderly’s Cholesterol Levels: A Preliminary Study.

DOI: 10.5220/0008395200002442

In Proceedings of the Aceh International Nursing Conference (AINC 2018), pages 109-118

ISBN: 978-989-758-413-8

109

and triglyceride, so the danger of deposition of fat in the

walls of blood vessels can be reduced. Last, this

exercise make us more love the country. One of our

patriotic forms of nation and state is poco-poco dancing.

Besides being healthy, we also appreciate the work

of our own nation. Observations show that judging from

the loading on the heart, poco-poco exercises have

advantages compared to other gymnastics and can be

classified as aerobic exercise because they can train

muscle strength and blood circulation to be more perfect

in taking, circulating, and using oxygen. Seeing the

considerable burden or intensity of exercise that is

owned by poco-poco gymnastics, it can be said that this

exercise can be compared with Line dance from Bali in

terms of its effects on several physiological parameters

of the body.

Arif (2015) stated that there were four weeks of

poco-poco exercise effect on HDL levels in elderly

people in Manado. Decrease in blood cholesterol levels

in the elderly group given physical activity therapy in

Suwarsi's (2017) study in Yogyakarta stated that the

provision of physical activity therapy can reduce blood

cholesterol levels in the elderly. On this basis,

researchers conducted preliminary study to prove the

effect of poco-poco exercise with a decrease in

cholesterol levels in the elderly with

hypercholesterolemia in Medan.

2 METHODS

This preliminary study used pre-experimental design, to

find a causal relationship with the existence of research

involvement in manipulating the independent variables

(Nursalam, 2014). Researchers used the design of one

group pre-post test design (Polit and Beck, 2010). The

number of respondents in this study were 15 and the

inclusion criteria were, age >60 years, cholesterol levels

> 200 mg/dl, no musculoskeletal disorders and other

chronic diseases, not receiving any cholesterol therapy.

The instrument used was video exercise: poco-poco, a

standard guide adopted from the Nusantara Community

2016 (see appendix), a new glucometer set with the Easy

Touch brand and an observation sheet.

After obtaining ethical clearance from the Santa

Elisabeth Medan Nursing College Health Ethics

Committee, the researchers determined the respondents.

Prospective respondents first explained about the

purpose and intervention of the research and the benefits

for them. Then the prospective respondents who agreed

to sign the informed consent sheet and were willing to

follow the poco-poco exercise intervention for one

month.

The researcher also coaching with health workers at

the research location in equating the perception of the

procedure exercise: poco-poco. The researcher explains

the work procedure before giving the exercise: poco-

poco. Respondents are encouraged to fast for 9 hours

before measuring cholesterol levels. After the pre-

intervention cholesterol level was measured, the

respondents followed exercise: poco-poco with

researchers and staff including 35 minutes of warming

up, core and cooling down. This exercise is carried out 2

times a week during March 2018. On the last day before

training, respondents were again advised to fast before

measurement of blood cholesterol levels post

intervention.

3 FINDINGS

Respondents who participated in the study consisted

of elderly people aged 60-69 years, women,

Protestant and married, Batak Toba tribes, and had

the last high school education. Data shows that all

respondents had high cholesterol levels> 200 mg/ dl

before being given exercise: poco-poco. After the

intervention data was obtained that as many as 8

respondents experienced a decrease in normal

cholesterol levels (53.3%) as in table 1 below.

Table 1: Cholesterol level before and after intervention poco-poco exercise in the elderly.

Cholesterol Level

(mg/dl)

Pre-intervention

Post- Intervention

f (n)

Mean

f(n)

Mean

Normal (<200)

53,3

213.20

19.432

Borderline (200-240)

237.93

15.476

46,7

High (>240)

Table 2: The results of Wilcoxon sign rank test effect of exercise: poco-poco on cholesterol levels in the elderly.

Respondents

Mean

Median

Min-Max

CI 95%

P value

Pre-intervention

237.93

230.00

15.476

220-262

229.36-

246.50

0.001

Post-intervention

213.20

198.00

19.432

195- 240

202.44-

223.96

AINC 2018 - Aceh International Nursing Conference

110

Table 1 shows data that as many as 15 respondents

who have high cholesterol levels are worth 100%

before being given exercise: poco-poco. Cholesterol

blood was measured by using glucometer during the

first meeting with the respondents. Then they was

doing exercise: poco-poco during one month. After

that, researchers measured cholesterol of blood again

post exercise. We found as many as 8 respondents

experienced normal cholesterol levels after being

given exercise: poco-poco (53.3%).

After all data has been collected from all

respondents, an analysis is performed using

computer statistical program tools. The results of the

normality test showed that the data were not

normally distributed so the researchers used the

Wilcoxon sign rank test as in table 2.

Table 2 shows that 15 respondents obtained the

mean cholesterol level of respondents before

exercise: poco-poco was 237.93, with a standard

deviation of 15.476. While the average cholesterol

level after exercise: poco-poco is 213.20, with a

standard deviation of 19.432. Thus there are

differences in mean cholesterol levels in respondents

before and after exercise: poco-poco intervention.

The results of the Wilcoxon Sign Rank Test

statistical test show that the value of p = 0.001 where

(α <0.05), which means that giving exercise: poco-

poco affects cholesterol levels in the elderly.

4 DISCUSSION

Before giving the exercise, poco-poco intervention,

researchers measured cholesterol levels using a

glucometer with results of borderline cholesterol

levels (200-240 mg / dl) and excessive (> 240 mg /

dl). Increased cholesterol levels can be affected by a

decrease in physical activity caused by a decrease in

the musculoskeletal system in carrying out daily

activities with increasing age, limb muscle strength

below is reduced by 40% between the ages of 30-80

years. This disorder causes interference in the form

of swelling, pain, joint stiffness, limited joint

motion, road disturbances, and limited activities

(Padila, 2013). Another cause that triggers an

increase in cholesterol levels in the blood, is diet,

activity and age. Increased fat consumption by 100

mg / day can increase total cholesterol by 2-3 mg/dl

(Suwarsi, 2017).

Older age is also one of the factors that can cause

an increase in cholesterol. Aging age is usually

followed by a decrease in physical activity which

results in decreased numbers of basal metabolites

and increased fat tissue, due to the activity of several

types of hormones (such as insulin, growth hormone,

and androgens). A decrease of hormone causes a

decrease in lean fat while an increase in other

hormone activity increases fat mass. The older a

person, the less the ability or activity of the ldl

receptor, causing low density lipid blood to increase

and accelerate the occurrence of clogged arteries.

Elderly women have cholesterol 2-6 times

greater than men. This is because in elderly women

had a decrease post menopause estrogen. At post

menopause, women experience a decrease in

estrogen and thus have a high risk of heart disease

(Miller, 2017). Increased cholesterol levels in the

elderly in Medan can be caused by various factors,

one of which is age, gender and ethnicity. Elderly

people aged> 60 years are prone to increased

cholesterol and are experienced by all sexes, namely

men and women. Besides that cultural tribes such as

the Bataknese can also affect the elderly

experiencing increased cholesterol where they

prefers to consume foods such as meat which

contains high cholesterol.

After giving exercise poco-poco for four weeks,

the elderly who had high cholesterol levels, obtained

8 elderly (53.3%) included in the normal cholesterol

category and 7 elderly (46.7%) had blood

cholesterol in the borderline category. There are

many factors that cause an increase in cholesterol in

the blood, one of which is a lack of physical activity.

A physical activity result in energy expenditure that

is proportional to muscle work and is associated

with health benefits. The more physical activity

carried out every day, the greater the daily energy

expenditure resulting in a reduction in weight and

fat, this can reduce the amount of cholesterol,

resulting in changes in cholesterol transfer in the

blood (Utami, 2013).

Exercise poco-poco which is carried out

regularly is an initial effort to control and overcome

the increase in blood cholesterol levels in the

elderly. Exercise poco-poco is carried out and taught

twice a week for 4 weeks with duration of 35

minutes for the respondent, and then the cholesterol

level is measured again. This exercise is very easy

for the elderly to do with the movements of the

exercise poco-poco is not difficult and easy to

remember because it consists of complex

movements with moderate difficulty.

In addition, it can be done in groups that allow

for social interaction. The movement used in this

gymnastics is quite accommodating, the song

rhythm is good, and the movements are easy for

everyone, even the old people to follow because they

include movements in every sport such as

Effectiveness of Poco–Poco Exercise on Elderly’s Cholesterol Levels: A Preliminary Study

111

badminton, volleyball and footballs. This poco-poco

exercise can also be done in various places with a

flat and hard surface. Poco-poco is useful in

increasing the elasticity of blood vessels, so as to

reduce the possibility of rupture of vessels if blood

pressure rises and muscles and blood circulation will

be more perfect to take, circulate, and use oxygen

and can reduce blood fat levels, for example

cholesterol and triglyceride, so the danger of

deposition of fat in the walls of blood vessels can be

reduced (Ria, 2016).

Arif (2015) stated that exercise: poco-poco was

effective in increasing HDL cholesterol levels which

could affect the decrease in total cholesterol levels in

the blood after being done twice a weeks for four

weeks. Poco-poco has been able to reduce

cholesterol levels in the elderly. This is evidenced by

a decrease in cholesterol levels in the elderly who

previously had borderline cholesterol levels to an

optimal level. A healthy diet, low in fat and rich in

fiber will be very beneficial in maintaining healthy

cholesterol levels. No more than 25 and 35% of the

total daily calories must come from fat; saturated fat

should be calculated at less than 7 percent of this

amount. To reduce LDL cholesterol and increase

HDL, it is recommended to eat foods high in fiber.

High HDL levels will flow in the blood throughout

the body and bring LDL to the liver to be removed

so there is a decrease in LDL levels that can affect

total cholesterol levels in the blood (Soleha, 2012).

The decrease in cholesterol levels in the elderly

is caused by several factors, namely the seriousness

of the elderly in following exercise: poco-poco and

the frequency of exercise carried out by the elderly.

Exercise frequency, which is carried out

continuously, and the seriousness of the elderly in

exercising characterized by the sweat coming out so

that there was a maximum burning of energy, which

can reduce cholesterol levels.

The results of the Wilcoxon statistical test

showed that the results of p = 0.001 <α 0.05, which

means there is a significant effect between Exercise:

Poco-Poco on cholesterol levels in the elderly.

Statistically shows the effect of exercise: poco-poco

on cholesterol levels in the elderly with OR = 21.52,

which means a decrease in cholesterol 21.52 times

compared to respondents who did not exercise:

poco-poco. Regular physical activity can increase

HDL and reduce cholesterol, LDL, triglycerides

(Miller, 2017). Lipid profile in the blood is affected

by several enzyme activities in fat tissue and muscle

will increase with increasing activity. Therefore, if a

person lacks physical activity, the activity of the

lipoprotein lipase enzyme will not increase so that it

will not reduce LDL levels and blood cholesterol

levels (Sugeha, 2013).

Increased activity of lipoprotein lipase causes

HDL in the body to transport excess cholesterol

from the body (Ali, 2013). Saputri (2014) stated that

there was an effect of aerobic exercise on total

cholesterol levels in the blood. Non-pharmacological

counter measures against high total cholesterol by

doing aerobic exercise. Aerobic exercise given to

respondents was done in three stages, namely,

heating, core movement, and cooling. Warming is

done by jogging in place, folding hands, and head

facing right and left, down alternately with eight

counts. The light core movement with modern dance

involves the upper extremities and lower extremities.

While cooling by breathing slowly, exhale and

followed by hand and stomach movements. Sugeha

(2013) also said that with elderly exercises could

increase HDL levels and reduce LDL levels.

Preliminary study that was conducted in Medan

shows a decrease in cholesterol levels in the elderly

which is better than previously carried out exercise:

poco-poco. Cholesterol reduction in the elderly is

caused by the frequency of exercises that is done

twice a week and the seriousness of the respondent

in exercising to the maximum.

5 CONCLUSION

Research conducted in Medan shows a decrease in

cholesterol levels in the elderly which is better than

previously carried out exercise intervention: poco-

poco. The results of the Wilcoxon statistical test

showed that the results of p = 0.001 <α 0.05, which

means there is a significant effect between

Exercise: Poco-Poco on cholesterol levels in the

elderly. It was suggested that health workers

especially in community have to continue poco-

poco exercise twice a week for long time period to

maintain cholesterol levels of the elderly and

minimize the occurrence of hypercholesterolemia

complication. Further research is needed to

measure significancy of this exercise reduce

cholesterol blood levels with bigger samples.

ACKNOWLEDGEMENT

This research was partially supported by Saint

Elisabeth College Medan. We thank our colleagues

from several clinic who provided insight and

expertise that greatly assisted the research, although

they may not agree with all of the

AINC 2018 - Aceh International Nursing Conference

112

interpretations/conclusions of this paper. We would

also like to show our gratitude to all respondents for

sharing their pearls of wisdom with us during the

course of this research. We are also immensely

grateful to conference reviewer committee for their

comments on an earlier version of the manuscript.

REFERENCES

Ali, M.A., 2013. Pengaruh latihan aerobik terhadap

peningkatan kadar high density lipoprotein pada atlet

aerobic gymnastic. Journal Meida Ilmu Keolahragaan

Indonesia. Vol.3.No.2

Arif AW, et.al., 2015. Pengaruh senam poco-poco

terhadap kadar kolesterol low density lipoprotein

darah. Jurnal e Biomedik (eBM). Vol. 3, No.2

Retrieved from https://ejournal.unsrat.ac.id

Arisman., 2014. Obesitas, diabetes mellitus, dislipidemia.

EGC, Jakarta.

Arora., 2010. Lima langkah memahami lolesterol. BIP,

Jakarta.

Aspiani, R., 2014. Buku ajar asuhan keperawatan

gerontik. Trans Info Media, Jakarta.

Dahlan., 2009. Statistik untuk kedokteran dan kesehatan.

Salemba Medika, Jakarta

Freeman.. 2010. Kolesterol rendah jantung sehat. BIP,

Jakarta.

Grove, S ., 2015. Understanding nursing research

building an evidence based practice. Elsevier, USA,

6th Edition.

Komsiatiningsih., 2015. Pengaruh program rutin exercise

aerobik dan pemberian latihan relaksasi otot progresif

terhadap latensi dan durasi tidur pada lansia di upt

magetan. [Undergraduate research report].

Unpublished. Retrieved from

http://repository.unair.ac.id

Komunitas Nusantara., 2016. Standar operasional

prosedur poco-poco. Jakarta: Ministry of Youth and

Sport

Mamitoho, et.al., 2016. Pengaruh senam lansia terhadap

kadar kolesterol total pada lansia di bplu senja cerah

Manado. Jurnal e Biomedik (eBM). Vol. 4, No.1.

Retrieved from

https://media.neliti.com/media/publications/62134-ID-

pengaruh-senam-lansia-terhadap-kadar-kol.pdf

Mayasari., 2016. Pola asupan kolesterol mingguan dan

kadar kolesterol pada lansia posyandu waras di desa

Krajan kecamatan Gatak kabupaten Sukoharjo.

[Undergaduate research report]. Unplubished.

Retrieved from

http://eprints.ums.ac.id/47330/1/NASKAH%20PUBLI

KASI.pdf

Nursalam., 2014. Metodologi penelitian ilmu keperawatan

pendekatan praktis edisi 4. Salemba Medika, Jakarta

Padila., 2013. Keperawatan gerontik. Nuha Medika,

Yogyakarta

Polit and Beck., 2010. Nursing research appraising

evidence for nursing practice, Lippincott, New York,

7th edition.

Prasetyorini., 2015. Pengaruh latihan senam diabetes

melitus terhadap risiko terjadinya ulkus diabetik pada

pasien diabetes melitus tipe 2 di desa Rambi Puji

Kecamatan Rambipuji Kabupaten Jember.

[Undergraduare research report]. Unplubished.

Retrieved from http://repository.unej.ac.id

Rachmat C, et.al., 2015. Pengaruh senam poco-poco

terhadap kadar trigliserida darah. Jurnal e Biomedik

(eBM). Vol. 3, No.1. Retrieved from

https://media.neliti.com/media/publications/60968-ID-

none.pdf

Saputri, L., 2014. Pengaruh senam aerobic low impact

terhadap kadar kolesterol total dalam darah pada

penderita hiperkolesterolemia wanita usia subur di

desa Jatirunggo kecamatan Pringapus kabupaten

Semarang. [Undergraduare research report]. Retrieved

from https://anzdoc.com/lis-saputri-program-studi-

keperawatan-stikes-ngudi-waluyo-un.html

Sari, F P., 2013. Effect of decreasing total cholesterol level

as a response to aerobic exercise at aerobic and fitness

center sonia Bandar Lampung. Medical Journal of

Lampung University. Vol. 3, No. 2. Retrieved from

http://juke.kedokteran.unila.ac.id

Soleha, M., 2012. Kadar kolesterol tinggi dan faktor faktor

yang berpengaruh terhadap kadar kolesterol darah.

Jurnal Biotek Medisiana Indonesia. Vol. 1, No.2.

Retrieved from http://ejournal.litbang.depkes.go.id

Sugeha S, et.al., 2013. Pengaruh senam bugar lansia

terhadap kadar hdl dan ldl di BPLU Manado. Jurnal e

Biomedik (eBM). Vol. 1, No.2. Retrieved from

https://ejournal.unsrat.ac.id/index.php/ebiomedik/articl

e/view/5477

Suwarsi., 2017. Penurunan kadar kolesterol darah pada

kelompok lansia yang diberikan terapi aktifitas fisik di

desa Wedomartani Sleman. Jurnal Keperawatan

Respati Yogyakarta. Vol. 4, No. 3. Retrieved from

http://nursingjurnal.respati.ac.id/index.php/JKRY/artic

le/viewFile/128/pdf

Tjokroprawiro., 2015. Buku ajar ilmu penyakit dalam edisi

2. Airlangga University Press, Surabaya.

Effectiveness of Poco–Poco Exercise on Elderly’s Cholesterol Levels: A Preliminary Study

113

APPENDIX

Poco-poco Exercise Guideline

Material

DVD set of Poco-poco Nusantara 2016

Tape

Speaker

Microphone

Vital sign set

Assessment

Vital sign measurement

Assess health history

Observe indication and contraindication for exercise

Warming up

Figure 1: Walk in place while while swing your hands back and forth alternately with a count of 2X8

Figure 2: Step up 4 times then clap once, then step back 4 times back then applause once (do it with

2X8 count)

Figure 3: Step 1 time forward and lift both hands with the palm position in front (Do it with a count of

2X8

Stretching

Figure 4: Step 1 backward and lower your hands with your palm in front (Do it with a count of 2X8)

AINC 2018 - Aceh International Nursing Conference

114

Exercise

Figure 5: Walk in place while swinging your hands back and forth alternately

Figure 6: Step 2 times to the right and 2 times to the left while holding your finger and bending your

elbow

Figure 7: Step 1 step back, the right hand is lifted parallel to the neck, the left hand is raised straight

then the second hands swung forward and backward (do 4X8 in all directions).

Figure 8: Step 2 times right and 2 times left with the body position slightly bent and both hands

stretched down

Effectiveness of Poco–Poco Exercise on Elderly’s Cholesterol Levels: A Preliminary Study

115

Figure 9: Step 2 times to the right while swinging your right hand forward and twice to the left while

swinging your left hand forward

Figure 10: Right leg backs up one step and position the right side of the body with the position of both

hands swinging backwards (with the position of the hand preparing to punch

Figure 11: Walk in place while swinging your hands forward and back and forth with a count of 4X8

Figure 12: Step 1 time right with your right hand swung from behind to the front parallel to

right hip (like demonstrating badminton games

Figure 13: Right foot backs 1 step behind the left hand swung 1x in a circle, steps 2 times forward with

the position of the head flexed and both hands straight and swing forward. Do as much as 4X8 (in all

AINC 2018 - Aceh International Nursing Conference

116

directions of the wind.

Figure 14: Step 2 times to the right and left with the position of the left hand raised down parallel to the

abdomen then the right hand is held down along the stomach (demonstrating hitting the basketball)

Figure 15: Walk in place while swinging your hands forward and back and forth with a count of 4X8

Figure 16: Step 2X to the right, the right hand is aligned parallel to the right shoulder (palm above) and

the left hand holds the left ear, and vice versa

Figure 17: Right foot backs 1 step, hands are lowered parallel to the abdomen. Then step 1x right, your

body slightly bent and both hands straightened down until it reaches below the knee

Effectiveness of Poco–Poco Exercise on Elderly’s Cholesterol Levels: A Preliminary Study

117

Cooling Down

Figure 18: Walk in place while swinging your hands back and forth alternately with a count of 2X8

Figure 19: Step 4 times then clap once. Next step 4 times back then clap once.

Evaluation

Vital sign measurement

Documentation

AINC 2018 - Aceh International Nursing Conference

118