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Effect of Walking Exercise Method on Blood Pressure

in the Elderly (Age 55-60 Years) Patients with Hypertension
in the village of Aralle, District of Aralle
Mamasa County

Lisda Alvita1, Nur Isriani Najamuddin2, Abdurauf 3

Department of Nursing STIKes Bina Generasi Polewali Mandar123

Artikel info
Abstract. Hypertension is a condition of a person experiencing
Article history: increased blood pressure blood is above normal and chronic.
Received; 01 October 2019 Hypertension in Indonesia is a problem health with the highest
Revised: 10 December 2019 prevalence of 25.8%, the prevalence of ProvinceWest Sumatra by
Accepted: 20 January 2020 22.6%. Data from Mamasa district, there are 19,559 cases of
hypertension with details for men as many as 6,891 and women as
many as 6,891 (Mamasa Health Office, 2019). Treatment of
Coresponden author: hypertension is done by pharmacological and non-
................................................. pharmacological treatment. One of the non-pharmacological
E-mail: treatments for hypertension is physical activity, namely the
……………………………. walking exercise method. This research is an Experimental Design
with a Control Group Pre-Posttest approach. The study was
DOI: carried out from April to May 2021. The sampling method was
………………………………………….. carried out by purposive sampling, totaling 40 people. The sample
was divided into 2 groups, namely 20 treatment samples and 20
control samples. Primary data includes initial and final blood
pressure of respondents, while secondary data includes general
data of respondents. The data were analyzed using the Paired T
Test statistical test. These results indicate an average decrease in
systolic and diastolic blood pressure in the treatment group of
13.40 mmHg and 13.60 mmHg, respectively. The results of the
Paired T Test with a p value of 0.000 indicate that there is an
effect of the walking exercise method on blood pressure in the
elderly (aged 55-60 years) with hypertension in Aralle Village,
Aralle District, Mamasa Regency. Suggestions from this study are
the walking exercise method can be used as an alternative non-
pharmacological treatment to help lower blood pressure.

Keyword: Walking Exercise Method, Hypertension, Blood

Pressure, Elderly Age 55-60 Years

This is an Open Access article distributed under the terms of the Creative
Commons Attribution 4.0 International License CC BY -4.0

International Journal of Nursing and Health Services (IJNHS), Volume 3, Issue 2, April 20th, 2020 611
INTRODUCTION

Indonesia is entering an era of increasing number of elderly population. In 2013, the

number of elderly people increased by 9.58% with a life expectancy of 67.4 years. In 2020,
this figure will be 11.20% with an average life expectancy of 70.1 years (Zaen, 2020).
The increasing population of the elderly cannot be separated from the health
problems that occur in the elderly, the decline in organ function triggers the occurrence of
various degenerative diseases. This degenerative disease in the elderly, if not handled
properly, will increase the financial burden of the state which is not small and will reduce the
quality of life of the elderly because it increases morbidity and can even cause death
(Kemenkes RI, 2018).
Hypertension is one of the most common degenerative diseases experienced by the
elderly. Hypertension is a disorder of the circulatory system that often occurs in the elderly,
which is characterized by increased contraction of blood vessels, then increases the work of
the heart to work more optimally to pump blood through arteries that are too narrow. If this
situation continues, it will cause blood vessels and heart to be damaged (Farrar 2015).
Data from WHO (2015) shows that one in five adults worldwide experience an
increase in blood pressure. The incidence of hypertension has doubled in the last 5 years in
all social strata. It is estimated that between 20% and 40% of the American Territory adult
population suffers from hypertension. The prevalence of hypertension in Indonesia increased
by 8.3% in 2017 from 25.8% to 34.1% with a mortality rate of about eight million people
every year (Kemenkes RI 2018). The Institute for Health Metrics and Evaluation (IHME) in
2017 stated that of a total of 1.7 million deaths in Indonesia, the risk factor that caused death
was blood pressure (hypertension) of 23.7%. Meanwhile, according to Riskesdas 2018, the
prevalence of hypertension based on the results of measurements in the population aged 18
years was 34.1%, the highest was in South Kalimantan (44.1%), while the lowest was in
Papua (22.2%). The estimated number of hypertension cases in Indonesia is 63,309,620
people, while the death rate in Indonesia due to hypertension is 427,218 deaths (Kemenkes
RI 2018).
Based on data from the West Sulawesi Health Office, the prevalence of hypertension
in West Sulawesi in 2018 was 64,710 people (West Sulawesi Health Office 2018). While in
Mamasa district, there were 19,559 cases of hypertension with details of 6,891 men and
6,891 women (Mamasa Health Office, 2019).
The increase in the incidence of hypertension in theory cannot be separated from
lifestyle changes and low levels of healthy living behaviors such as poor diet, insufficient rest
time, lack of exercise, smoking, drinking alcoholic beverages and stress that can lead to
hypertension (Anwari, et. al 2018). Most people with hypertension overcome the problem of
hypertension by taking outpatient treatment, giving blood pressure-lowering drugs or
antihypertensives. But some people can not overcome the problem of hypertension that he
experienced. If hypertension is not treated, it can cause blood vessels to break down, harden
and tighten. This condition blocks blood flow to the heart, and causes chest pain and
shortness of breath. Obstruction of blood flow can also trigger an irregular heartbeat, even a
heart attack (Yitno, et.al 2017).
Therefore it is important to make efforts to overcome the problem of hypertension. In
addition to taking medicines to treat hypertension, sufferers can try various traditional
medicines such as garlic. As with previous research, conducted by Fredi Pampang Karua
(2019) on "The Effect of Giving Garlic on Blood Pressure of Elderly Patients with
Hypertension in the Work Area of the Sesenapadang Health Center, Mamasa Regency" the
results showed that there was an influence in giving garlic to elderly people with
hypertension. . Then research by Muh. Afdal (2019) regarding "The Effect of Giving Celery

International Journal of Nursing and Health Services (IJNHS), Volume 3, Issue 2, April 20th, 2020 612
Leaves to Blood Pressure in Elderly Patients in the Work Area of the Mambi Community
Health Center, Mamasa Regency" from the study, it was found that celery leaves can lower
blood pressure.
In addition to the use of traditional medicine, people with hypertension can also
lower blood pressure with physical activity. Physical activity is any bodily movement that
increases energy and energy expenditure. The physical activities in daily life that can be done
by the elderly include sweeping, mopping, washing clothes, gardening, cleaning the
bathroom, and adding water. From Nur Afni Karim's research on "The Relationship of
Physical Activity with Hypertension Degrees in Outpatients in the Work Area of the
Tagulandang Health Center, Sitaro Regency" it was found that there was a significant
relationship between physical activity and the degree of hypertension in outpatients in the
work area of the Tagulandang Public Health Center, Sitaro Regency. Regular physical
activity can cause changes, for example, the heart will get stronger in its smooth muscles so
that the capacity is large and the construction or pulse is strong and regular, besides that the
elasticity of blood vessels will increase due to relaxation and vasodilation so that fat deposits
will decrease and increase blood pressure. contraction of the muscle walls of the blood
vessels. Physical activity can also be done in the form of sports (Karim, et. al 2018).
Walking exercise is a form of moderate physical exercise, with the technique of
walking regularly for at least 3 times a week with a minimum duration of 20-30 minutes for
each exercise (Zaen 2020). research conducted by Siti Robi'atus Sholiha (2019) with the title
"The Combination of Walking Exercise and Hydrotherapy Affects Blood Glucose Levels in
Patients with Type II Diabetes Mellitus" the result is that there is an effect of a combination
of walking exercise and hydrotherapy on blood glucose levels in patients with type II
diabetes mellitus with p = 0.000. By walking, contractions occur between skeletal muscles
which trigger an increase in the ability of insulin to activate glucose transport to the muscles
resulting in muscle metabolism through an insulin independent pathway so that the plasma
glucose level decreases and causes the synthesis of hexokinase which is useful for glucose
absorption then glucose is carried to cells and there is lowers blood sugar levels and produces
energy. (Sholiha, 2019). With this study that walking exercise has an effect on lowering
blood glucose levels, prospective researchers are interested in researching whether the
method of walking exercise or walking normally can also affect blood pressure.
The results of a preliminary study carried out on February 25, 2021 at the Aralle
Health Center, obtained data from the Administration of the Aralle Health Center, in 2020
there were 1,607 hypertension patient visits, of this number, the elderly (aged 55-60 years)
were 1,076 people with details 295 men and 781 women. Aralle Health Center is one of the
health centers in Mamasa Regency, overseeing 11 villages and 1 sub-district. The distribution
of patients with hypertension in each village, namely, Uhailanu village 95 people, Baruru
village 43 people, Pamoseang village 68 people, Uhaidao village 99 people, ralleanak village
103 people, north ralleanak village 41 people, South Aralle village 92 people, Panetean
village 133 people , 72 people in Kalakbe village, 104 people in Hahangan village, 63 people
in North Aralle village and 165 people in Aralle Village.
From the description above, with the large incidence of elderly people suffering from
hypertension, and by non-pharmacological treatment of hypertension, such as using herbal
medicines and exercising, prospective researchers are interested in conducting a study
entitled "The Effect of the Walking Exercise Method on Blood Pressure in the Elderly (Age
55). -60) Patients with hypertension in Aralle Village, Aralle District, Mamasa Regency''.

International Journal of Nursing and Health Services (IJNHS), Volume 3, Issue 3, June 20th, 2020 613
OBJECTIVE

The objectives of this study are: to determine blood pressure before the walking
exercise method is performed on the elderly (aged 55-60 years) with hypertension in the
Aralle village, Aralle district, Mamasa district, to determine blood pressure after the walking
exercise method in the elderly with hypertension in the village. Aralle, Aralle District,
Mamasa Regency and to analyze the effect of the walking exercise method on blood pressure
in the elderly (aged 55-60 years) with hypertension in the Aralle village, Aralle district,
Mamasa district.
METHOD

The type of research used is Experimental Design with a Control Group Pre-Posttest
Design approach. This design model seeks to reveal the effectiveness of the control group in
addition to the experimental group. With the selection of the two groups were not chosen
randomly. In both groups, it started with a pre-test, and after the treatment was given a post-
test was held (Pamungkas, 2017). This research was conducted in the Aralle village, Aralle
district, Mamasa district, in April-May 2021. The population in this study were hypertensive
patients in the Aralle village, Aralle district, Mamasa district, as many as 165 people. The
sampling technique used is a non-probability sampling method, namely purposive sampling,
where the sample in this study amounted to 40 people.
Researchers obtained data on hypertension sufferers in Aralle Village at Aralle
Health Center, Mamasa Regency. The researcher obtained the respondent's identity by
conducting a home visit asking the respondent's consent to participate in the research activity.
Then the researcher divided the respondents into 2 groups, namely the treatment group
(intervention of the walking exercise method) where the researcher asked for agreement with
the respondents not to use pharmacological therapy during the walking exercise intervention
and the control group (without the intervention of the walking exercise method) but continued
to use pharmacological therapy. Then the researchers collected respondents to do the walking
exercise method. Before doing the walking exercise method, the researcher measured the
respondent's blood pressure and after doing the walking exercise method, the researcher again
measured the respondent's blood pressure. The data from the research were then processed by
Univariate and Bivariate using a computer program.
The bivariate analysis used in this study was an independent t test (paired t test).
Independent T-test is a parametric statistical test to determine whether there are differences in
the mean of the two groups that are related. Researchers will compare the data before and
after treatment (Pamungkas 2016).

International Journal of Nursing and Health Services (IJNHS), Volume 3, Issue 2, April 20th, 2020 614
RESULTS
Research result
Characteristics of Respondents
Table 1.
Distribution of Respondents
Eksperimental Group Control Group
Characteristics of Respondents
N % N %
Gender
Man 9 45 8 40
Women 11 55 12 60
Amount 20 100 20 100
Age
55 years old 2 10 4 20
56 years old 2 10 1 5
57 years old 1 5 2 10
58 years old 2 10 4 20
59 years old 4 20 3 15
60 years old 9 45 6 30
Amount 20 100 15 100
Education
SD 10 50 9 45
SMP 7 35 2 10
SMA 3 15 5 25
PT - 4 20
Amount 20 100 20 100
Work
Farmer 4 20 5 25
Breeder 1 5 3 15
Civil Servant 1 5 3 15
Entrepreneur 3 15 2 10
Does not work 11 55 7 35
Amount 20 100 20 100
Note : primery data 2021
Table 1 shows the characteristics of respondents based on gender, respondents in the
eksperimental group (intervention of the walking exercise method) female sex as many as 11
people (55%) and male sex as many as 9 people (45%). And for the control group respondents
(without the intervention of the walking exercise method) the female sex was 12 people
(60%) and the male sex was 8 people (40%).
Characteristics of respondents based on age, respondents in the eksperimental group
(intervention with walking exercise method), the number of respondents aged 55 years was 2
(10%), at age 56 years was 2 (10%), at age 57 years was 1 (5%), at the age of 58 years as
many as 2 (10%), at the age of 59 years as many as 4 (20%) and 60 years as many as 9 (45%).
As for the control group respondents (without the intervention of the walking exercise
method), the number of respondents aged 55 years was 4 (20%), at the age of 56 years as
many as 1 (5%), at the age of 57 years as many as 2 (10%), at the age of 56 years. 58 years as
many as 4 (20%), at the age of 59 years as many as 3 (15%), and at the age of 60 years as
many as 6 (30%).
Characteristics of respondents based on education, respondents in the eksperimental
group (intervention with the walking exercise method), education graduated from elementary
school as many as 10 respondents (50%), graduated from junior high school as many as 7
respondents (35%), high school as many as 3 respondents (15%), while for the control group
(without the intervention of the walking exercise method) of the 20 respondents there were 9
respondents (45%), 2 respondents graduated from elementary school (10%), 5 respondents
graduated from high school (25) and 4 people graduated from PT (20%) .

International Journal of Nursing and Health Services (IJNHS), Volume 3, Issue 3, June 20th, 2020 615
 Characteristics of respondents based on occupation, respondents in the eksperimental
group (intervention with the walking exercise method), respondents who did not work as
many as 11 respondents (55%), working as farmers as many as 4 respondents (20%),
entrepreneurs 3 respondents (15%), farmers 1 respondent (5 %) and civil servants 1
respondent (5%). While the control group respondents (without the intervention of the
walking exercise method), most of the respondents did not work as many as 7 respondents
(35%), farmers 5 respondents (25%), farmers 3 respondents (15%), entrepreneurs 2
respondents (10%), and PNS as many as 3 respondents (15%) .

Univariate Analysis
Acceptance of the Walking Exercise Method
Respondents in this study were divided into two groups, namely 20 respondents in the
eksperimental group (intervention of the walking exercise method) where for 2 weeks,
respondents did walking exercise for 6 meetings, with the agreement not to use
pharmacological therapy. Based on the results of this study, out of 20 respondents using the
walking exercise method, only 15 respondents did the walking exercise method for 6
meetings and the other 5 did not follow the walking exercise method until the end. And in the
inclusion criteria it was determined that the sample criteria in this study were one of them
"willing to be a respondent and follow the research procedure from the beginning to the end".
So 5 respondents who did not follow the walking exercise method for 6 meetings were
considered to have resigned. So the respondents for the treatment group were 15 respondents.
In the process of this study, before and after each walking exercise, the respondent's blood
pressure was measured.
Then 20 control respondents (without the intervention of the walking exercise method)
where respondents with hypertension were not given the intervention of the walking exercise
method, but still used pharmacological therapy. This study was conducted for 2 weeks, and
the pharmacological therapy used was captopril 12.5 mg. Catopril 12.5 mg is used as
prescribed by a doctor for 2 weeks. Captopril is given 2 times a day (morning and evening)
and on an empty stomach that is half an hour before meals or 2 hours after eating. This is
because the absorption of captopril will be reduced by 30%-40% when given together with
food. In the process of this study, before being given the drug, the blood pressure was first
measured and then the blood pressure was measured again after 2 hours of taking the drug
(Nugroho, 2014). From the beginning to the end of the study the respondents were monitored
by the researcher.
Characteristics of Blood Pressure in the Eksperimental Group
Table 2
Blood Pressure Characteristics Before (pre) and After (post) Walking Exercise Method
Name Blood Pressure
Pre Post Descrease
Sistole Diastole Sistole Diastole Sistole diastole
Ny. D 152 100 139 83 13 17
Ny.Y 157 100 140 88 17 12
Tn. B 145 98 137 88 11 10
Tn.D 149 100 139 87 10 13
Tn.Y 155 99 140 80 15 19
Ny.Hi 158 104 147 99 11 5
Tn.A 150 97 145 85 5 12
Ny.He 149 97 132 82 17 15
Ny.M 148 100 135 88 13 12
Ny.P 150 100 148 97 2 3
Tn.Ar 159 110 140 87 15 23
Tn.N 155 102 142 89 13 13
Ny.T 158 100 129 81 29 19
Ny.G 142 100 132 86 11 14
Tn. L 156 101 140 84 16 17
mean 152,20 100,53 139,00 86,93 13,20 13,60
Median 152,00 100,00 139,50 86,67 13,00 13,00
Min. 142 97 129 80 2 3
Max 159 110 148 99 29 23
SD 5,14 3,15 5,42 5,28 6,03 5,20

International Journal of Nursing and Health Services (IJNHS), Volume 3, Issue 2, April 20th, 2020 616
 Based on table 2 shows that from the study there was a change in the respondent's
blood pressure after the walking exercise method was carried out. It can be seen that the
respondent's blood pressure value before the intervention was carried out showed that the
median value of systolic blood pressure was 152.20 mmHg with the lowest value of 142
mmHg and the highest value of 159 mmHg. The respondent's blood pressure value after the
intervention/treatment was found that the average value of systolic blood pressure was 139.00
mmHg, with the lowest value of 129 mmHg and the highest value of 148 mmHg. Diastolic
blood pressure before the intervention was found that the average value of diastolic blood
pressure was 100.00 mmHg with the lowest value of 97 mmHg and the highest value of 110
mmHg. Diastolic blood pressure after the intervention was found that the average value of
diastolic blood pressure was 86.93 mmHg with the lowest value of 80 mmHg and the highest
value of 99 mmHg. Overall, there was a decrease in blood pressure with an average decrease
in systolic blood pressure of 13.20 mmHg and diastolic blood pressure of 13.60 mmHg.

Characteristics of Blood Pressure in the Control Group

Table 3 Characteristics of Blood Pressure Control Group
Blood Pressure
Name Pre Post Descrease
Sistole Diastole Sistole Diastole Sistole diastole
Tn.A 168 100 130 86 38 14
Ny.H 175 109 141 80 34 29
Ny.M 163 90 120 84 43 6
Tn.R 160 100 122 80 38 20
Ny.Ag 159 90 120 80 39 10
Tn.J 190 120 150 99 40 21
Ny.L 180 100 142 85 38 15
Tn.M 160 99 131 80 29 19
Ny.Y 170 110 120 81 50 29
Tn.Mk 190 120 133 89 57 31
Tn.Mt 155 100 120 80 35 20
Ny.Na 162 100 150 92 12 8
Ny.Nu 173 106 132 98 41 8
Ny.He 182 120 150 100 32 20
Ny.Ar 170 100 129 81 41 19
Ny.Hu 166 99 126 85 40 14
Tn.E 175 112 141 89 34 23
Tn.D 181 110 132 88 49 22
Ny.E 163 100 125 86 38 14
Ny.P 177 112 137 85 40 27
Mean 170,95 104,85 132,55 86,40 38,40 18,48
Median 170,00 103,75 131,33 85,30 38,50 19,50
Min. 155 90 120 80 12 6
Max 190 120 150 100 57 31
SD 10,21 10,33 5,42 5,28 6,03 6,49

Based on table 3, it shows that from the study there was a change in the respondent's
blood pressure in the control group the average value of systolic blood pressure was 170.95
mmHg with the lowest value being 155 mmHg and the highest value being 190 mmHg. The
average value of initial diastolic blood pressure was 104.85 mmHg with the lowest value of
90 mmHg and the highest value of 120 mmHg. While the average value of end systolic blood
pressure without intervention was 132.55 mmHg with the lowest value of 120 and the highest
value of 150 mmHg. Then the average value of diastolic blood pressure is 86.40 mmHg with
the lowest value of 80 mmHg and the highest value of 100 mmHg. Overall, there was a
decrease in blood pressure with an average decrease in systolic blood pressure of 38.40
mmHg and diastolic blood pressure of 18.48 mmHg.

Bivariate Analysis
Bivariate analysis was conducted to determine the effect of the walking exercise
method on blood pressure in the elderly (55-60 years) with hypertension in Aralle Village,
Aralle District, Mamasa Regency. The statistical test carried out was the Paired Sample T
Test, computerized at the level of confidence using p-value <0.005 at a confidence interval of
95

International Journal of Nursing and Health Services (IJNHS), Volume 3, Issue 3, June 20th, 2020 617
 Table 4
The Effect of the Walking Exercise Method on Blood Pressure in the Elderly (55-60 Years) with
Hypertension in Aralle Village, Aralle District, Mamasa Regency
Group Tekanan Darah Average decline Significance connection

Pre Systolic Blood Pressure - Post Systolic

Blood Pressure
13,20 0,000 related/meaning
Ekeperimental
Pre Diastolic Blood Pressure - Post
13,60 0,000 related/meaning
Diastolic Blood Pressure

Pre Systolic Blood Pressure - Post Systolic 38,40 0,000 related/meaning

Control Blood Pressure

Pre Diastolic Blood Pressure - Post

18,45 0,000 related/meaning
Diastolic Blood Pressure

Note : Paired Sampel T Test

Table 4 shows that the average decrease in systolic blood pressure in the treatment
group (walking exercise method) was 13.20 mmHg with a significance of 0.000 while for
diastolic blood pressure a decrease of 13.60 mmHg with a significance of 0.000 was obtained.
For the control group the decrease was higher than the treatment group where the decrease for
systolic blood pressure was 38.40 mmHg with a significance of 0.000 and diastolic blood
pressure of 18.45 mmHg with a significance of 0.000.

DISCUSSION
Based on the results of data analysis and adapted to the research objectives and the
research concept framework, the discussion is stated as follows:
Analysis of Average Systolic and Diastolic Blood Pressure Before Walking Exercise
Method
The study, which was conducted for two weeks, showed that for the treatment group
(intervention with the walking exercise method) systolic blood pressure before the walking
exercise was performed as many as 15 respondents were included in the category of stage 1
hypertension (140-159 mmHg). The mean initial diastolic blood pressure (pre) was 152.20
mmHg, the lowest value was 142 mmHg and the highest value was 159 mmHg. Diastolic
blood pressure before the intervention with the walking exercise method was 13 respondents
in the pre-hypertension category 2 (100-110 mmHg) and 9 others in the stage 1 hypertension
category (90-99 mmHg). The mean initial diastolic blood pressure (pre) was 100 mmHg, the
lowest value was 97 mmHg and the highest value was 110 mmHg.
As for the control group (without the intervention of the walking exercise method),
the initial systolic blood pressure of 20 respondents, 2 respondents were in the category 1
hypertension (140-159 mmHg), 13 respondents were in the 2nd stage hypertension category
(160-179 mmHg), and 5 respondents in the category of hypertension stage 3 (> 180 mmHg).
The mean initial systolic blood pressure (pre) was 170.95 mmHg, the lowest value was 155
mmHg and the highest value was 190 mmHg. And the initial diastolic blood pressure of 20
respondents, 4 respondents in the category of stage 1 hypertension (90-99 mmHg), 9
respondents in the category of stage 2 hypertension (100-109 mmHg), and 7 respondents in
the category of stage 3 hypertension (>110 mmHg). The average initial diastolic blood
pressure was 104.85 mmHg with the lowest value being 90 mmHg and the highest value
being 120 mmHg.

Analysis of the average systolic and diastolic blood pressure after the walking exercise
method
The results of the 2-week study showed that there were changes in systolic and end-
diastolic blood pressure in the treatment group and the control group. In the treatment group

International Journal of Nursing and Health Services (IJNHS), Volume 3, Issue 2, April 20th, 2020 618
(intervention with the walking exercise method). After the walking exercise, 7 respondents
were in the prehypertension category (130-139mmHg) and 8 others were in the stage 1
hypertension category (140-159 mmHg). The mean end systolic blood pressure (post) was
139.00 mmHg, with the lowest value being 129 mmHg and the highest score being 148
mmHg. And the diastolic pressure value of all respondents after treatment (intervention with
the walking exercise method) was in the prehypertension category (85-89 mmHg). The
average final diastolic blood pressure after treatment (intervention with the walking exercise
method) was 86.93 mmHg with the lowest value of 80 mmHg and the highest value of 99
mmHg.
While the final systolic blood pressure in the control group of 20 respondents, 6
respondents were in the category 1 hypertension (140-159 mmHg), 6 respondents were in the
prehypertension category (130-139 mmHg), and 8 respondents were in the normal
hypertension category (>130 mmHg). ). The average end systolic blood pressure (post) was
132.55 mmHg with the lowest value being 120 and the highest value being 150 mmHg. And
the final diastolic blood pressure was 11 respondents in the normal hypertension category
(<85 mmHg), 5 respondents in the prehypertension category (85-89 mmHg), and 4
respondents in the stage 1 hypertension category (90-99 mmHg). The average end-diastolic
blood pressure was 86.40 mmHg with the lowest value of 80 mmHg and the highest value of
100 mmHg.

Analysis of the Effect of the Walking Exercise Method on Blood Pressure

Based on the results of the study in the treatment group, the systolic and diastolic
blood pressures before and after the walking exercise changed.
Factors that cause a higher decrease in blood pressure in the control group
respondents, due to using pharmacological therapy. The results of this study are comparable
to Irawati's research (2018) which examined "Comparison of Celery (Apium Graveolens) and
Catopril Reduction in Blood Pressure Reduction in Primary Hypertensive Patients in the
Bajoe Health Center, Bone Regency" the results obtained were that there was a significant
decrease in blood pressure before and after after administration of captopril and celery. Where
in the study, the researchers divided 2 groups, namely the intervention group with captopril
drug administration, the control group where respondents were only given celery (Apium
Graveolens), the result was that the group given captopril decreased blood pressure, namely
the average initial systolic blood pressure of 161.7 mmHg after being given captopril 12.5 mg
there was a decrease with an average systolic blood pressure of 140.6 mmHg with an average
decrease of 21.6 mmHg. While the average diastolic blood pressure before administration of
Celery (Apium Graveolens) was 110 mmHg, after administration of captopril decreased, the
average diastolic pressure was 90.3 mmHg with an average decrease of 20 mmHg.
Catopril is one of the antihypertensives with the mechanism of action of inhibiting
ACE (angiotensin converting enzyme). Treatment of hypertension using captopril requires no
small amount of money because its use is for long-term therapy, even for life, so that it has
the potential to cause side effects by the drug. The side effects of captropil that have been
identified include dry cough, kidney failure, angioneurotic edema and hypotension (Nugroho,
2014). Side effects vary due to drug use and duration of treatment. Therefore, many studies
are looking for alternatives to treat hypertension, for example from natural ingredients and
physical activity that have low side effects and are even safe for long-term treatment because
they are natural, especially in the elderly, because the function of body organs begins to
decline (Irawati, 2018) .
One alternative treatment for hypertension is physical activity, one of which is the
walking exercise method. Walking Exercise is a movement / activity of the body by means of
regular walking rhythmically with the arms swinging in accordance with the rhythm of one's

International Journal of Nursing and Health Services (IJNHS), Volume 3, Issue 3, June 20th, 2020 619
walk which is carried out in a planned manner. Exercise walking (walking exercise) for 20-30
minutes 3 times a week. Give a break for 3 minutes every 10 minutes after the exercise is
done. Instruct the respondent to maintain a body position and adjust the pace of his steps
(approximately 0.89 m/s or 2 mph) to feel more comfortable during the activity (Oktaviani,
2018).
From the results of the study, the Effect of the Walking Exercise Method on Blood
Pressure in the Elderly (Age 55-60 Years) in Hypertension Patients in Aralle Village, Aralle
District, Mamasa Regency, obtained statistical test results using the Paired T Test with the
help of SPSS 20.0, the p value was obtained. 0.000 (<0.05), meaning Ho is rejected and Ha is
accepted, meaning that there is a significant effect or difference between blood pressure
before and after the walking exercise. So, it can be concluded that there is an effect of the
walking exercise method on blood pressure in the elderly (aged 55-60 years) with
hypertension in Aralle Village, Aralle District, Mamasa Regency in 2021.
Walking exercise has an impact on reducing the risk of mortality and morbidity in
hypertensive patients through the mechanism of burning calories, maintaining body weight,
helping the body relax and increasing beta endorphins which can reduce stress and the safety
level of implementing the walking exercise method at all age levels of people with
hypertension (Kowalski, 2018) .
Sports training for the elderly aims to improve physical health and fitness. Physical
fitness in the elderly is fitness related to health, namely heart fitness, lung blood circulation,
muscle strength and joint flexibility. To obtain good physical fitness, you must train all the
basic components of physical fitness which consist of heart resistance, blood circulation and
respiration, muscle endurance, muscle stiffness and body flexibility (Said Junaidi, 2018).
There have been many previous studies that support the statement that physical
activity affects blood pressure in hypertension such as research conducted by Sonhaji, et al.
(2017), from the results of this study, it is known that in hypertensive patients when doing
walking exercises regularly for a week with a frequency of 3 times within 30 minutes of each
exercise will reduce blood pressure significantly.
According to the researchers' observations, the walking method can be used by people
with hypertension, especially the elderly, as an alternative to lowering blood pressure, which
is safe for the long term. This walking exercise method does not require too much cost and
has no harmful side effects (Kowalski, 2018). Blood pressure changes after walking exercise
if done correctly, according to procedures and carried out regularly and regularly, each
respondent will have excellent body resistance so that it can affect changes in blood pressure.
In addition, it is also necessary to improve a healthy lifestyle in order to still be able to control
blood pressure.
The duration of administration also has an influence in lowering blood pressure. In
previous studies, the walking exercise method was only carried out for 1 week, and in this
study it was carried out for 2 weeks. In a previous study conducted by Sonhaji, et al. (2017),
the decrease in systolic blood pressure was 7.5 mmHg and diastolic blood pressure was 7.7
mmHg. Meanwhile, in this study, the decrease in systolic blood pressure was 13.20 mmHg
and diastolic blood pressure was 13.60 mmHg. According to the researcher's observations, if
the walking exercise method can be carried out 4-5 times a week, or can be carried out
regularly every day, maybe the results will be much better or the decline will be much higher
than this study.

CONCLUSION

Based on the results of research conducted on the Effect of the Walking Exercise
Method on Blood Pressure in the Elderly (Age 55-60 Years) in Hypertension Patients in

International Journal of Nursing and Health Services (IJNHS), Volume 3, Issue 2, April 20th, 2020 620
Aralle Village, Aralle District, Mamasa Regency in 2021, it can be concluded that the walking
exercise method affects blood pressure in the elderly (age 55-60 years old) with hypertension
in Aralle Village, Aralle District, Mamasa Regency, with a p value of 0.000 (<0.05).
The results of this study, other researchers can compare the therapy in this study with
other therapies or combine it with other therapies for the same respondent so that the results
are likely to be even better, or researchers can do the walking method 4-5 times per week on a
regular basis, so the possibility of lowering blood pressure will be higher.

STRENGTH AND LIMITATION

In previous studies, the walking exercise method was only carried out for 1 week, and
in this study it was carried out for 2 weeks. In a previous study conducted by Sonhaji, et al.
(2017), the decrease in systolic blood pressure was 7.5 mmHg and diastolic blood pressure
was 7.7 mmHg. While in this study, the decrease in systolic blood pressure was 13.20 mmHg
and diastolic blood pressure was 13.60 mmHg. This is the strength of this research.
This research has been attempted and carried out in accordance with scientific
procedures, however, it still has limitations, namely: There is still a lack of dietary control on
the respondents during the study. In this study, there should be 20 treatment respondents and
20 control respondents. The other 5 were considered disqualified because they could not
participate in the study until the end. So that it affects the results of the study in the treatment
group and the control group. In this study, the treatment group should continue to use
pharmacological therapy so that it can be compared with the control group whose blood
pressure value is much higher than the blood pressure value of the treatment group. In this
study, in measuring respondents' blood pressure, researchers used digital blood pressure,
researchers should also measure respondents' blood pressure with manual tension, so that the
results can be more accurate.

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