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"Latar Belakang : Remodelling otot jantung terkait latihan fisik merupakan mekanisme adaptasi fisiologis tubuh terhadap beban jantung yang meningkat. Tipe/karakteristik, intensitas, dan durasi latihan menentukan besarnya beban jantung dan berpengaruh terhadap pola dan tingkat remodelling otot jantung. Didapatkan pola remodelling yang berbeda antara tentara dengan atlet atau orang biasa. Pada tentara, intensitas latihan fisik yang diterima lebih berat dibandingkan atlet maupun orang biasa, dengan durasi kumulatif yang lebih lama, serta beban volume dan pressure overload yang diterima lebih besar. Selain itu, tentara juga menghadapi stresor psikis yang tinggi, serta waktu istirahat/recovery pasca latihan yang berbeda dibandingkan dengan atlet maupun orang biasa.Tujuan : Untuk melihat pengaruh latihan fisik Para Komando dengan terjadinya remodelling ventrikel kiri baik fisiologis maupun patologis pada populasi Pasukan Khusus TNI Angkatan Udara dibandingkan latihan fisik regulerMetode : Studi ini merupakan studi observasional potong lintang. Remodelling otot jantung pasukan khusus TNI Angkatan Udara yang menjalani latihan fisik Para Komando dibandingkan dengan anggota militer yang menjalanin latihan fisik reguler. Parameter remodelling otot jantung yang dinilai antara lain Left Ventricular Mass Index (LVMI), fungsi ventrikel kiri (Left Ventricular Ejection Fraction/LVEF Biplane dan Global Longitudinal Strain/GLS), dan Myocardial Work (Global Constructive Work, Global Waste Work, Global Work Index, Global Work Efficiency).Hasil : Terdapat 43 orang pasukan khusus yang menjalani latihan fisik Para Komando dan 43 orang anggota militer yang menjalani latihan fisik reguler. Kelompok pasukan khusus yang menjalani latihan fisik Para Komando memiliki usia yang lebih tua dibandingkan dengan anggota militer yang menjalani latihan fisik reguler, 27 (23-30) vs 20 (20-26) tahun p < 0.001. Setelah dilakukan analisis multivariat dengan memperhitungkan faktor usia, pada kelompok latihan fisik para komando dibandingkan dengan latihan fisik reguler didapatkan hasil LVMI 79,67 ± 18,5 vs 79,64 ± 13,1 g/m2, p = 0.993; LV GLS -21 (-16 s.d -25) vs -19 (-15 s.d -22)%, p = 0.003; LV GWI 1843,8 ± 239,7 vs 1800,5 ± 258,6 mmHg%, p = 0.464; LV GCW 2140,4 ± 257,4 vs 2111,1 ± 273,8 mmHg%, p = 0.619; LV GWW 41 (12-152) vs 52 (18-117) mmHg%, p = 0.009; LV GWE 97 (94-99) vs 97 (93-99)%, p = 0.002.

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.Background: Cardiac muscle remodelling related to physical exercise is a physiological adaptation mechanism as a respons to cardiac load. Type, characteristic, intensity, and duration of exercise determine the magnitude of the cardiac load and affect the pattern and rate of remodelling of the heart muscle. Different remodelling patterns were found between soldiers and athletes or ordinary people. In soldiers, the intensity of physical exercise is heavier than that the athletes or ordinary people, with a longer cumulative duration, greater volume and pressure load. In addition, soldiers also faced with high psychological stressors, as well as different recovery times after training compared with athletes and ordinary people

Objective: To observe the effect of the Commandos' physical training on the occurrence of physiological or pathological left ventricular remodelling in Airforce Elite Soldiers compared to regular physical exercise.

Methods: This study is a cross sectional observational study. Cardiac remodelling of elite soldiers who underwent Commandos’ physical training compared to regular troops who underwent regular training. The heart muscle remodelling parameters being assessed include Left ventricular Mass Index (LVMI), Left Ventricular Ejection Fraction/LVEF Biplane, Global Longitudinal Strain/GLS, and Myocardial Work (Global Constructive Work, Global Waste Work, Global Work Index, Global Work Efficiency).

Results: There were 43 elite soldiers who underwent Commandos’ physical training and 43 regular troops who underwent regular training. The elite soldiers group had an older age compared with regular troops, 27 (23-30) vs 20 (20-26) years p < 0.001. After doing a multivariate analysis taking into account the age factor, in the group of Commandos' physical training compared to regular physical exercise, the LVMI results are 79,67 ± 18,5 vs 79,64 ± 13,1 g/m2, p = 0.993; LV GLS -21 (-16 s.d -25) vs -19 (-15 s.d -22)%, p = 0.003; LV GWI 1843,8 ± 239,7 vs 1800,5 ± 258,6 mmHg%, p = 0.464; LV GCW 2140,4 ± 257,4 vs 2111,1 ± 273,8 mmHg%, p = 0.619; LV GWW 41 (12-152) vs 52 (18-117) mmHg%, p = 0.009; LV GWE 97 (94-99) vs 97 (93-99)%, p = 0.002.

Conclusions: The Commandos' physical training is associated with better echocardiographyc result compared to regular physical exercise, indicated by higher LVEF, LV GLS, GWE, and lower GWW value"

"Perilaku kurang aktif pada pasien DM tipe 2 dapat meningkatkan risiko penyakit kardiovaskular. Salah satu faktor yang menentukan perilaku aktif, yaitu persepsi latihan fisik. Penelitian kualitatif dengan wawancara mengenai persepsi latihan fisik dan perilaku latihan fisik dilakukan di Puskesmas Kecamatan Menteng pada pasien DM tipe 2 yang mengikuti senam. Terdapat 9 informan, sebagian besar usia produktif, perempuan, pendidikan rendah, ibu rumah tangga, riwayat menderita DM > 5 tahun, kadar HbA1 ≥ 6,5%, > 1 tahun bergabung dalam komunitas senam, 3 informan memiliki komplikasi. Sebagian besar informan merasakan sangat bermanfaat terhadap persepsi manfaat latihan fisik. Namun, ada beberapa informan merasakan latihan fisik kurang bermanfaat memperbaiki kolesterol, tidur kurang nyenyak, penurunan kekuatan otot dan penurunan kelenturan. Sebagian besar informan tidak merasakan persepsi hambatan latihan fisik. Sebagian besar informan berperilaku aktif. Frekuensi dan durasi latihan fisik sangat dipengaruhi persepsi manfaat dan hambatan latihan fisik. Strategi edukasi sangat diperlukan agar perilaku hidup aktif dapat dipertahankan untuk mengontrol kadar glukosa darah, mengendalikan komplikasi dan mencegah disabilitas. Sedentary behaviour in type 2 diabetes patients can increase the risk of cardiovascular disease. Exercise perception is a factor that determines regular exercise behaviour. Qualitative research with interview about exercise perception and exercise behaviour in type 2 diabetes patients participated in aerobic exercise at Puskesmas Kecamatan Menteng.

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There were 9 informants, majority had productive age, female, low education, housewives, history of type 2 DM more than 5 years, HbA 1 c level ≥ 6.5%, more than 1 year joined the community. 3 informants had complications. Most of the informants felt very beneficial for the perception of exercise benefits. However, there were some informants who felt exercise less useful in improved cholesterol level, worst sleep, decreased muscle strength and decreased flexibility. Most of the informants did not feel exercise barriers and  performed aerobic exercise regularly. The frequency and duration of aerobic exercise were very influenced by exercise benefits and barriers perception. The education strategies were very needed to maintenance active lifestyle, blood glucose control, reduce complications and prevent disability."

"Penyakit hipertensi termasuk masalah besar dan serius, di samping karena prevalensinya yang tinggi dan cenderung meningkat. Latihan fisik yang dapat menjadi alternatif terapi untuk menurunkan tekanan darah adalah latihan fisik ergonomis. Penelitian ini bertujuan untuk mengetahui pengaruh latihan fisik ergonomis terhadap penurunan tekanan darah lansia hipertensi dengan metode quasi eksperimen dan desain pre dan post test group design with control group melibatkan sampel 108 lansia. Analisis menggunakan uji wilcoxon dan mann withney. Hasil penelitian didapatkan penurunan tekanan darah setelah dilakukan latihan fisik ergonomis, yaitu rata-rata penurunan sistolik 12,3 mmHg dan rata-rata penurunan diastolik 6,09 mmHg. Perawat komunitas mengaplikasikan latihan fisik ergonomis kepada masyarakat terutama lansia hipertensi untuk menurunkan tekanan darah.

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Hypertension has become a major and serious health problem in society for its high prevalence and is likely to increase in cases. Moreover, an alternate therapy of physical exercise that can be used to lower blood pressure is ergonomic exercise. This study is aimed to determine the effect of ergonomic exercise for lowering ederly hypertensive blood pressure using quasi-experimental method as well as pre and post test group design with control group involving 108 elderlies as its sample. The analysis used wilcoxon and mann withney.

The results of the study shows a decrease in blood pressure after the ergonomic exercise, with an average of 12.3 mmHg systolic decrease and an average of 6.09 mm Hg diastolic decrease. This ergonomic exercise is usually used by community nurses, especially to lower the blood pressure of hypertensive ederly."

"Latar belakang Kanker kepala leher adalah kanker yang paling sering ketujuh di dunia dengan 890.000 kasus baru dan 450.000 kematian tiap tahunnya. Diperkirakan prevalensi karsinoma nasofaring di Indonesia adalah 6,2/100.000 dengan 12.000 kasus baru tiap tahunnya. Terapi definitif untuk kanker kepala leher adalah operasi dengan kemoradiasi sebagai terapi adjuvan sedangkan untuk kanker nasofaring kemoradiasi adalah terapi definitif untuk stadium lokal lanjut, yang paling sering terdiagnosis di Indonesia. Toksisitas kemoradiasi berkaitan dengan malnutrisi dan massa dan kekuatan otot yang rendah. Dengan melakukan intervensi nutrisi dan latihan fisik aerobik dan resistensi, diharapkan angka toksisitas kemoradiasi berkurang. Di Indonesia latihan fisik aerobik resistensi pada kanker kepala leher belum menjadi panduan tatalaksana nasional. Untuk itu diperlukan evaluasi keamanan dan kepatuhan latihan fisik aerobik dan resistensi pada kanker kepala leher dengan malnutrisi yang menjalani kemoradiasi.Tujuan Mengetahui proporsi malnutrisi pada kanker kepala leher yang akan menjalani kemoradiasi dan mengetahui keamanan dan kepatuhan latihan fisik aerobik dan resistensi untuk dapat dilakukan selama kemoradiasi pada kanker kepala leher degan malnutrisi.Metode. Penelitian pendahuluan menggunakan desain potong lintang dengan kriteria inklusi pasien kanker kepala leher dan karsinoma nasofaring stadium III-IV yang akan menjalani kemoradiasi, dengan pengambilan sampel secara konsekutif. Subjek akan dievaluasi penapisan malnutrisi dengan Malnutrition screening tool (MST) dan evaluasi data klinis dan laboratorium lainnya. Penelitan utama dengan desain intervensi single arm pre-post study bersama terapi standar nutrisi dengan kriteria inklusi subjek dari penelitian pendahuluan dengan skor MST lebih besar sama dengan 2, usia dewasa 18-59 tahun, status performan ECOG 0-1 dan tanda vital baik. Intervensi yang diberikan berupa latihan fisik aerobik dan resistensi yang terdiri dari uji latih dan latihan selama kemoradiasi. Pengamatan selama kemoradiasi akan dievaluasi kepatuhan dan keamanan serta evaluasi kekuatan genggam tangan, skor MST, skor kualitas hidup dan toksisitas kemoradiasi.Hasil Sebanyak 36 subjek eligible. Proporsi subjek kanker kepala leher sebelum menjalani kemoradiasi dengan malnutrisi adalah 25 (69,5%) dan berisiko malnutrisi 7 (19,4%). Dari 15 subjek yang eligible untuk latihan fisik aerobik dan resistensi, sebanyak 10 subjek telah menjalani latihan. Dari 13 sesi latihan yang dikerjakan, seluruhnya dapat dilakukan hingga akhir dan tanpa efek samping terkait latihan. Latihan ini hanya terlaksana 13 (31,7%) sesi latihan. Alasannya karena masalah medis dan jadwal untuk dapat terlaksana latihan aerobik dan resistensi. Dengan latihan fisik aerobik dan resistensi terjadi penurunan skor MST 1,7+0,05 p 0,04, kenaikan kekuatan genggam tangan 0,6+0,45 kg p 0,36 dan berat badan 1,93+0,3 kg p 0,521 di akhir minggu kedua. Terdapat perbaikan skor kualitas hidup untuk domain skala gejala mulut kering, pemakaian sonde makan, dukungan nutrisi namun tidak berbeda bermakna secara statistik.Simpulan Proporsi malnutrisi pada kanker kepala leher sebelum kemoradiasi 69,5%. Latihan fisik aerobik dan resistensi aman untuk dapat dilakukan selama kemoradiasi namun belum mampu laksana karena kepatuhannya 31,7%. Latihan fisik aerobik dan resistensi belum dapat dievaluasi apakah menyebabkan perbaikan malnutrisi, kekuatan otot, dan skor kualitas hidup.

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Background Head and neck cancer is the 7th most common cancer in world with 890,000 new cases and 450,000 mortality every year. Approximately the prevalence of nasopharyngeal cancer in Indonesia is 6.2/100,000 with 12,000 new cases every year. Definitive treatment for head neck cancer is surgery continue with chemoradiation as adjuvant therapy, whereas chemoradiation in nasopharyngeal cancer is definitive treatment for locally advance settings which the most common diagnosed in Indonesia. Chemoradiation toxicity related to malnutrition and low muscle mass and strength. Nutritional and aerobic and resistance training can decrease the incidence of chemoradiation toxicity. In Indonesia, these training in head neck cancer have not yet included in national management guideline. Thus, there is a need to evaluate the safety and compliance of aerobic and resistance training in head neck cancer with malnutrition who underwent chemoradiation.

To know the proportion of malnutrition in head neck cancer who underwent chemoradiation and to know the safety and compliance of aerobic and resistance training to be able to be done during chemoradiation in head neck cancer with malnutrition.

Method The cross-sectional study of preliminary study included consecutively head neck cancer and nasopharyngeal cancer stage III-IV who will underwent chemoradiation. The subject will be evaluated for malnutrition screening with malnutrition screening tool (MST) together with other clinical and laboratory baseline data related to malnutrition. The main study was using intervention single arm pre and post study design together with nutritional standard therapy, which included subject from the preliminary study with MST score 2 or higher, adult 17-59 years old, performance status ECOG 0-1 and good vital sign. Subjects will be given aerobic and resistance training as an intervention arm during chemoradiation. Evaluation of safety and compliance together with hand grip strength, MST score, quality of life score using EORTC-QLQ C30 and HN35 and chemoradiation toxicity using National cancer institute common toxicity criteria version 4.0 will be done periodically to included subject.

Result A total of 36 eligible subjects were included. The proportion of malnutrition and disease at risk malnutrition in head neck cancer before underwent chemoradiation was 25 (69.5%) and 7 (19.4%) respectively. Ten of 15 eligible subjective have done aerobic and resistance training. From 13 training session, all of them were done until the end without any complication. There were only 13 (31.7%) training can be done by the subjects during chemoradiation. There were medical and schedule problems explaining why the training have not been able to be done as schedule. Aerobic and resistance training were associated with decreased MST score 1.7+0.05 p value 0.04, increased hand grip strength 0.6+0.45 kg p value 0.36 and body weight 1.93+0.3 kg p value 0.521 at the end of second week. There was an improvement of quality-of-life score for domain symptoms scale dry mouth, tube feeding and nutritional support, however there was not statistically significant.

Conclusion The proportion of malnutrition in head neck cancer before chemoradiation was 69.5%. Aerobic and resistance training safe to be done during chemoradiation. The compliance or feasibility of aerobic and resistance training during chemoradiation was only 31.7%. Aerobic and resistance training was not able to evaluate weather associated with improvement of malnutrition, muscle strength, and quality of life."