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30-MINUTE LEISURE WALK’S EFFECTIVENESS ON THE

PRESSURE OF BLOOD AND PULSE ON HYPERTENSION

Hanny Irmaya

Department of Nursing, STIK Sint Carolus, Central Jakarta, DKI Jakarta, Indonesia

mamilotusdanrizo@gmail.com

PAPER INFO ABSTRACT

Received:

September 2022

Revised:

September 2022

Approved:

September 2022

Background: Today's lifestyle shift is really alarming. Many people alter

their lifestyles without considering the effects that may result or the long-

term effects of unhealthful lifestyle modifications. These lifestyle

modifications involve both food and exercise.

Aim: In the Puskesmas area in Pasar Minggu District, the goal of this study

is to ascertain the impact of a 30-minute leisurely stroll on changes in blood

pressure and pulse in hypertension patients.

Method: This study is quantitative and uses a quasi-experimental approach

to compare the performance of two groups. The 30-minute leisurely walking

intervention was tested before and after in this study to see how it affected

blood pressure and pulse in order to avoid hypertension. Blood pressure and

pulse in the control group were also cross-sectionally analyzed.

Findings: Blood pressure and pulse in the control group, or those who did

not participate in the activity, did not significantly differ from each other after

30 minutes of walking.

KEYWORDS

leisure walk, blood pressure, pulse, hypertension

INTRODUCTION

The change in lifestyle today is very concerning, many individuals change their lifestyle

without thinking about the impact that will occur or the long-lasting impact of unhealthy

lifestyle changes. The lifestyle changes include physical activity and food. The impact of this

lifestyle change is the beginning of the development of Non-Communicable Diseases. Non-

Communicable Diseases are chronic diseases, not transmitted from person to person (Marbun

et al., 2021). NCDs have a long duration and generally develop slowly. The four main types of

NCDs according to WHO are cardiovascular disease (coronary heart disease, stroke), cancer,

chronic respiratory diseases (asthma and chronic obstructive pulmonary disease), and diabetes

(WHO, 2015). In Indonesia the data for NCDs are asthma, COPD, cancer, DM,

hyperthyroidism, hypertension, coronary heart disease, heart failure, stroke, chronic kidney

failure, kidney stones, and joint/rheumatic diseases. The average cause of the development of

this disease is a change in a person's lifestyle (Kemenkes RI, 2012).

Hypertension is a condition when blood pressure in blood vessels increases chronically

(Astutik & Mariyam, 2021; Williams & Thompson, 2013). It can happen because the heart

works harder to pump blood to meet the body's oxygen and nutritional needs (Sulung & Poluan,

2018). Hypertension ranks 6

on the list of Non-Communicable Diseases in Indonesia

(Kemenkes RI, 2012).

The prevalence of hypertension in Indonesia obtained through measurements at the age of

≥18 years was 25.8 percent, the highest in Bangka Belitung (30.9%), followed by South

Kalimantan (30.8%), East Kalimantan (29.6%) and West Java (29.4%). The prevalence of

hypertension in Indonesia obtained through a questionnaire diagnosed by health workers was

30-Minute Leisure Walk’s Effectiveness on the Pressure of Blood and Pulse on Hypertension

1429 Interdisciplinary Social Studies, 1(12), Sep 2022

9.4 percent, who were diagnosed by health workers or were taking medications by 9.5 percent.

So, there are 0.1 percent who take the medicine themselves. Respondents who had normal

blood pressure but were taking hypertension medication were 0.7 percent. Hence, the

prevalence of hypertension in Indonesia is 26.5 percent (25.8% + 0.7 %) (Kemenkes RI, 2012).

Hypertension in Indonesia is not the first cause of death but the number of morbidity and

hospitalization rates, is still quite high, the number of deaths in hospitals due to hypertension

was 6.69% in 2010. Meanwhile, the number of hypertension patients hospitalized decreased

from 2009 by 2.42% to 1.91%. However, new cases in the outpatient unit of hypertension

occupied the first position, namely 3.13% in 2010, decreasing from 2009 of 3.66% (Kemenkes

RI, 2012).

The high prevalence of hypertension in Indonesia and in the world makes health workers

think of a management to reduce the incidence of hypertension. In the treatment of

antihypertensive can reduce the risk by 30% - 40%, reduce ischemic heart disease by 20% -

25% and cardiovascular-related diseases by 25%, but in addition to management

antihypertensive treatment for lifestyle changes such as physical activity is also carried out.

For someone who is not active in doing physical activity will have a 30% - 50% greater risk of

developing hypertension (Iellamo & Volterrani, 2010).

It is important for everyone to increase their interest and strength training to treat risk

factors and hypertension (Ambardini, 2015). The main recommendations and secondary

prevention of hypertension are with dynamic resistance training, for example aerobic, walking,

swimming and cycling (Ardiana, 2021). Training with a low resistance of 40-50% expressed

as moderate intensity with many repetitions can be recommended.

Being physically active is the most important to prevent or control high blood pressure

(Cristanto et al., 2021). It doesn't take much effort to become physically active because it takes

only 30 minutes with moderate physical activity on almost every day of the week examples of

kegiatan i.e. walking, cycling, sweeping leaves and gardening.

From the results of a study of 41 healthy women who were given the intervention to walk

and run for 15 to 20 minutes with a distance of 1600 meters for 5 months, it showed results

that a significant decrease in blood pressure and pulse was obtained before the implementation

of the intervention with after the implementation of the intervention. It is because both walking

and running cause activity from the sympathetic nerves that provide stimulation to the

acceleration center of the heart so that blood vessels that were vasocontriction can become wide

and increase blood flow so that the pressure can be lowered, namely systolic pressure of 10.4

mmHg and diastolic pressure of 6.8 mmHg (Munieskhar et al., 2014).

There are quite a lot of hypertension sufferers in Pasar Minggu District itself, Hypertension

itself is included in the 10 NCDs (Non-Communicable Diseases) in Pasar Minggu District, and

is ranked 2

after Upper Respiratory Tract Infections (ARI) with a total number of sufferers

per year 2014, namely13,483 or 8.74% (Data from Puskesmas Pasar Minggu District, 2014).

The role of nurses is to provide education to people with hypertension so that they can change

the expected lifestyle, in order to get an increase in heart work and improve the quality of life.

This study aims to determine the effect of a 30-minute leisure walk on changes in blood

pressure and pulse in hypertensive patients in the Puskesmas environment of Pasar Minggu

District.

30-Minute Leisure Walk’s Effectiveness on the Pressure of Blood and Pulse on Hypertension

1430 Interdisciplinary Social Studies, 1(12), Sep 2022

METHOD

This research is a quantitative study with a quasi-experimental design which is carried out

with two groups comparison, namely where a study is carried out with two groups; one group

was given treatment and another group as control was later observed. The purpose of this study

is to see whether there is an influence between independent variables on dependent variables

using intervention groups and control groups. The research was designed with pretest and post

test to determine the effect of the 30-minute leisurely walking intervention on blood pressure

and pulse to prevent hypertension, as well as analyze blood pressure and pulse in the control

group cross-sectionally. In this study, it used an effect test, a paired difference test and an

independent difference test between respondents who were given a 30-minute leisurely walk

treatment, as well as a control group on blood pressure and pulse in hypertensive patients.

The population in this study was primary hypertension sufferers who were in the Pasar

Minggu sub-district which consisted of 9 urban villages. The sample was calculated based on

the number of populations that have not been calculated before, that is, by using the formula:

N = 50 + 8X

Information:

N: Sample size X: Number of independent variables in the study

Based on this formula, the results are obtained:

N = 50 + 8 x 5 (Number of independent variables i.e. 30-minute leisure walk)

= 90 respondents

However, the possibility of reduced samples is anticipated so that the precision of the study

is maintained. The sample was divided into 2 groups, namely the intervention group and the

control group, namely with a comparison formula according to Pollitt (2001) which was 75%:

25%, namely 75 respondents as interventions and 25 respondents as control groups.

This research was conducted in the wilayah environment of the Puskesmas Pasar Minggu

District, South Jakarta. Puskesmas Pasar Minggu Subdistrict is a reference Puskesmas from 9

Puskesmas Subdistricts under the scope of Pasar Minggu District, which is the only Puskesmas

in the Pasar Minggu District area that has complete medical support equipment. The research

was conducted from April 2015 to August 2015.

The data analysis strategy used in this study is divided intoseveral stages, namely

preanalysis phase, preliminary phase assessment, preliminary action, principal analysis,

interpretive phase (Mak, 2018).

RESULTS AND DISCUSSION

Bivariate Analysis Results of Paired Different Tests and Independent Different Tests

The results of the analysis of different tests in pairs and different tests in pairs using paired

t-tests were carried out to determine the differences in blood pressure and pulse in the control

group simultaneously before and after the intervention (Before-After).

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1431 Interdisciplinary Social Studies, 1(12), Sep 2022

First Day Blood and Pulse Measurements of the Intervention Group with the Control Group

The results of the analysis of paired different tests and independent different tests can be

seen in table 1.

Table 1. Statistical Results of the First Day of Pretest Intervention with Post Test

TD hr 1 Post Test - TD hr 1

Pre Test

Pulse hr 1 Post Test - Pulse

hr 1 Pre Test

-.218

-1.000

Asymp. Sig. (2-tailed)

.827

.317

Source: Primary Data Analysis, 2015

From Table 1 it can be concluded that between the blood pressure of the first day of the

pre-test and the post test there was no significant result between blood pressure and pulse with

a p value for blood pressure 0.827 (>0.05) and a p pulse of 0.317 (>0.05).

From the results of RCT by several studies showed that after physical exercise there was

a decrease in blood pressure in systolic and diastolic, this study summarized 15 researchers, 5

of whom showed insignificant results between blood pressure before exercise and after

exercise, 10 other researchers showed that although there was a very small difference of 0.02

– 0.03 mm after post-workout but these results were very significant and had meaningful

implications for health. heart, but this depends on the type of physical exercise chosen.

Table 2. Statistical Results of the First Day of Intervention with Day One of Control

Blood Pressure

Pulse

Mann-Whitney U

333.000

513.000

Wilcoxon W

633.000

2166.000

-4.225

-3.899

Asymp. Sig. (2-tailed)

.000

Source: Primary Data Analysis, 2015

From table 2, it can be seen that there is a difference between the blood pressure of the

first day of the intervention group compared to the first day of the control group, namely the p

value = 0.000 (<0.05) and a significant difference between the pulse of the first day of the

intervention and the control with a value of p = 0.000 (<0.05).

Blood pressure will drop after one exercise session, from 12 study subjects in hypertensive

patients and patients with normotence, the results of blood pressure measurements showed

maximum exercise tests, hypertensive patients experienced a decrease in blood pressure ± 3.5

mmHg in systolic and ± 6.5 mmHg in diastolic pressure, while in respondents with normotence

decreased ± 3.1 mmHg in systolic pressure and ± 2.1 mmHg in diastolic pressure. It showed

differences in the control group who did not perform physical exercise, they had no change in

blood pressure either systolic or diastolic.

The results of another study on 9 normotensive women and 7 hypertensive women showed

that there was a decrease in cytolic blood pressure in hypertensive women, namely 63.1 mmHg

and diastolic pressure of 61.8 mmHg, in women with normotensive there was a systolic

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1432 Interdisciplinary Social Studies, 1(12), Sep 2022

decrease of 62.7 mmHg and a diastolic decrease of 61.6 mmHg. It was significant compared

to the control group i.e. women who did not practice physical exercise.

Blood Pressure and Pulse Measurements of the Last Day of the Intervention Group with the

Control Group

The results of the analysis of the paired different test and the independent difference test

on the measurement of blood pressure and pulse on the last day were intervened then compared

with the last day of the control group can be seen in tables 3 and 4.

Table 3. Results of the Last Day of Pre and Post Test Analysis

TD Pre – Post Test

Pulse Pre – Post test

-.258

-1.000

Asymp. Sig. (2-tailed)

.796

.317

Source: Primary Data Analysis, 2015

From Table 3, it was found that the results of the test analysis of the difference between

blood pressure on the last day of the intervention group before the intervention and after the

intervention there was no significance can be seen from the value of p = 0.796 (>0.05). Thus,

there was no significant pulse between before and after the intervention with a value of p =

0.317 (>0.05)

Table 4. Results of Intervention Analysis with Last Day Control

Pulse

Mann-Whitney U

640.000

648.000

Wilcoxon W

940.000

948.000

-.556

-1.138

Asymp. Sig. (2-tailed)

.578

.255

Source: Primary Data Analysis, 2015

From table 4, the results of the analysis were obtained, namely the difference in blood

pressure and pulse on the last day after the intervention on blood pressure measurement, namely

p = 0.578 (>0.05) and on measuring the pulse with a value of p = 0.255 (>0.05) there was no

significant result between blood pressure and pulse on the last day with the control group.

First Day Blood and Pulse Pressure Measurement with Last Day of Intervention

The results of the analysis of the test in pairs in the intervention group before the

intervention on the first day with after the intervention on the last day, can be seen in table 5.

Table 5. The First Day Analysis Compared to Last Day

Blood Pressure

Pulse

-5.369

-1.732

Asymp. Sig. (2-tailed)

.000

.083

Source: Primary Data Analysis, 2015

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From table 5, the results showed that there was a significant difference between the first

day before the intervention and the last day after the intervention on blood pressure with a p

value = 0.000 (<0.05) but there was no significant difference in the pulse group between the

first day and the last day of the intervention group with a p value = 0.083 (>0.05).

From the results of the analysis test with paired different tests in the intervention group

with data before and after the intervention, significant results were obtained, namely the value

of p = 0.000 meaning that this showed the effectiveness of a 30-minute leisure walk in the

intervention group.

This is in accordance with the study conducted by Sohn et al. (2007) after a 30-minute

walking intervention showed the results that systolic blood pressure decreased by 9.0%

compared to the control group and decreased by 7.42% in diastolic pressure compared to the

control group, this researcher argued that walking was the safest to do by patients with

hypertension because patients with hypertension had other problems, such as being overweight

and other symptoms of hypertension. The effect of doing physical activity on hypertension is

slight or small but very significant, a person with hypertension can lower blood pressure by

about 3/2 mmHg in those who have normotence and 7/6 mmHg in those who have

hypertension.

The American College of Sport Medicine (ACSM, 2010) mentioned that in cross sectional

studies in China and Japan that walked to work, it was stated that by walking, the systolic and

diastolic pressure would decrease by 3.0/2.4 mmHg at rest time and lower the pressure by

3.3/3.5 mmHg during the day. This study also mentioned that in addition to a decrease in blood

pressure, this exercise can also lose weight, body fat and waist circumference.

From the results of the study, it was stated that no significant results between the pulse

frequency before the intervention and after the intervention can be seen with a p value = 0.083.

However, if you look at the numbers from the primary data taken, there are differences or there

is a decrease in numbers or an increase that leads to better, but it is still considered normal.

In a study conducted at Harvest University, it was stated that 27% of people with

hypertension had a pulse of >80 times / minute, 15% had a pulse frequency of >85x / minute,

for a certain number of patients using a pulse was considered the right way to see hypertension,

but the pulse rate was more associated with an increase in cardiovascular or other coronary

artery diseases, this study said pulse measurements were taken only to see patient compliance

against treatment compared to in the direction that affects blood pressure (Reule & Drawz, 2012).

In another study, it was stated that, after the intervention of walking or running, the pulse

will only be seen significantly after 5 years of research, while systolic and diastolic blood

pressure decreases at the time after the exercise is done (Munieskhar et al., 2014).

Blood Pressure and Pulse in the Control Group

There was no difference between the blood pressure and pulse of the first day of control

and the last day of control, the control group continued to carry out daily activities as usual by

not doing additional physical exercise activities as in the intervention group.

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Table 6. Blood Pressure and Pulse Analysis in the Control Group Before and After the Study

was Carried Out

Blood Pressure

Pulse

-.707

-2.449

Asymp. Sig. (2-tailed)

.480

.014

Source: Primary Data Analysis, 2015

From the statistical results of the test of differences in the control group before the study

began with after the research was completed, it was seen that there was no significant difference

between blood pressure and pulse.

Differences in Blood Pressure and Pulse Before and After Intervention Week I and Week

The results of the analysis using Wicoxon between the first week of the intervention and

the second week of the intervention can be seen in the following table.

Table 7. Wicoxon Test Results on Differences in Blood Pressure and Pulse Before and After

Intervention Viewed from Sunday in Group Unintervened

Week I

Blood

Pressure

Week I

Pulse

Week II

Blood

Pressure

Week II

Pulse

-3.298

-1.000

-1.980

-1.732

Asymp. Sig. (2-tailed)

.001

.317

.048

.083

Source: Primary Data, 2015

Based on table 7, it can be concluded that:

1) The results of the independent test between blood pressures in week I had a significant

value of 0.001 (<0.005) these results indicated that there was a significant change in

blood pressure in the first week of the respondents' intervention;

2) The results of the independent test between the pulse before and the pulse after the

first week had a value of 0.317 (>0.005) this result was not significant which means

that there was no significant change in the pulse in the first week of the intervention;

3) The results of the independent test between the blood pressure of week I and Week II

have a value of 0.048 (>0.005) which means that it is not significant, this shows that

the blood pressure in week I with week II when compared will get the same results;

and

4) The results of the independent test between the pulse in week I and Week II had a

value of 0.083 (>0.005). It showed that there was no significant difference between

the pulse of week I and the pulse of week II.

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1435 Interdisciplinary Social Studies, 1(12), Sep 2022

Multivariate Analysis Results

Multivariate Analysis in this study used Multiple Linear Regression, which in this analysis

was to see the effect of variable X (30 Minutes Leisure Walk) on variable Y (Age, Gender,

BMI, Blood Pressure, and Pulse).

Table 8. Multiple Linear Regression Test Results between Variables X and Y

Dependent Variables

Test Results

R Square

P-Value

Systolic

0.062

0.939

Diastolic

0.088

0.020

Pulse

0.602

0.000

Source: Regression Analysis, 2015

From the results of the multiple linear regression tests that have been carried out, it was

found that the interventions carried out did not provide a significant difference in Systolic

Pressure with a value of p = 0.939 (p>0.05), but the intervention gave a significant difference

in diastolic pressure p = 0.020 (p<0.05) and at the pulse, namely with a value of p = 0.000

(p<0.05).

Walking gives the volume of the contents of the sekuncup and the volume of the ventricles

so that it can cause an increase in NO and dilatation of the arterioles, walking will decrease

cardiac output so that it will lower systolic and diastolic pressure, in this study the systolic

pressure decreased but the decrease was not significant, but significantly the decrease was in

diastolic and pulse pressure.

However, the slightest decrease in blood pressure contributes to reducing the risk of heart

disease and stroke. A decrease in blood pressure by 2 mmHg will reduce the risk of heart

disease by 4% and stroke by 6%, from this study it is stated that both systolic and diastolic

blood pressure will only be seen to decrease significantly in weeks 2, 3, and 4 after fast walking

and walking exercises provide better effectiveness against reducing systolic, diastolic and pulse

blood pressure compared to diet in people with hypertension.

Walking quickly is one of the physical exercises recommended by cardiologists in

America and Europe, it has a good impact on lifestyle changes in people with Hypertension,

walking quickly gives a decrease effect on systolic and diastolic blood pressure in hypertensive

patients.

From the results of the Pseudo R Square test where this is done to see the amount of

contribution given to independent variables (Intervention, Age of Sex, BMI and Smoking

History), from these results it can be said that the value of R Square Systolic of 0.062 or 6%

the remaining 94% is influenced by other factors. The R value for diastolic is 0.088 or 8.8%

the remaining 91.2% is influenced by other factors. Meanwhile, intervention on the pulse has

an influence of 0.602 or 60% and 40% is influenced by other factors.

CONCLUSION

The characteristics of the majority of respondents were aged 36-45 years 26 (50%), female

31 (57.80%), Body Mass Index (BMI) 28 (54%), and history of passive smoking 26 (50%).

30-Minute Leisure Walk’s Effectiveness on the Pressure of Blood and Pulse on Hypertension

1436 Interdisciplinary Social Studies, 1(12), Sep 2022

The majority of respondents experienced a decrease in blood pressure before the intervention

with after the intervention with a p value = 0.000 but there was no difference in the pulse

measurement before the intervention and after the intervention with a p value = 0.083. There

was no meaningful difference between blood pressure and pulse in the control group, namely

the group that did not do the activity walked 30 minutes.

This study was conducted with several limitations, including a short study time so that the

results of the difference in blood pressure in respondents with little hypertension, but this slight

difference was very influential in patients with hypertension. From the results of the study, the

difference in blood pressure will be seen markedly when respondents are given interventions

in week III and week IV as well as at pulse pressure will give more significant results if seen

in weeks III and to IV.

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