The Influence Of Calisthenics Rheumatism To Increased Quality Of Life Of

Elderly Sufferers Of Osteoarthritis Of The Knee

Sulthoni T.H

ABSTRAK
People with osteoarthritis experience various symptoms of disease disorders that
have a negative impact on quality of life. Improving quality of life is important as one of
the goals of therapy in chronic diseases. This study generally aims to determine the quality
of life scores and evaluate what factors influence the quality of life of patients with
osteoarthritis of the knee. The survey results from the World Health Organization (WHO)
report that the number of elderly people is a group of people aged 60 years or more.
Globally in 2015 the proportion of the population aged over 60 years is 13.7% of the
world's total population. Musculoskeletal problems such as disorders of the joints and
bones that affect mobility and activity are vital for the health of the elderly. Some
abnormalities due to joint changes that occur in the elderly include; osteoarthritis,
rheumatoid arthritis and gout, but which are often affected by joints that bear weight such
as the pelvis, knee and spinal joints of the lower lumbar portion. Rheumatic gymnastics
is exercise that focuses on maintaining the maximum range of motion of the joint. Another
goal of rheumatic exercise is to improve movement ability, function, strength and
endurance of muscles, aerobic capacity, balance, biomedicine, joints and a sense of joint
position. Objective: to determine the effect of rheumatic exercise on improving the quality
of life of the elderly in performing ADL (Activity Daily Living) independently
Keywords
Knee Osteoarthritis, Rheumatic Gymnastics, Quality of Life, Elderly

1. Background
The elderly undergoing the aging process marked by physiological changes
that occur in some organs and systems. Changes that occur to cause a decrease in
bodily functions to do the activity (Efendi, 2009). Musculoskeletal problems such as
disorders of the joints and bones become a problem that often occurs in the elderly
as it affects mobility and activity that is vital to the health of the elderly. Some
abnormalities in the joints due to changes that occur in the elderly, among others;
osteoarthritis, rheumatoid arthritis and gout can cause pain in the joints. OA
(Osteoarthritis) can attack all joints, but are often exposed to IE joints that bear the
brunt of the weight like hips, knees, spine and joints lumbar section below. Location
of OA that is often found at the location of the knee (Arissa, 2013).
Data from the World Health Organization (2011) shows the number of people
with Osteoarthritis in the world as many as 151 million people. In the Southeast Asia
the incidence of Osteoarthritis reaches 24 million people (Arden, N & Nevitt, M C,
2006). As for the rheumatic region of Indonesia, it reached 23.6% to 31.3%. This
figure shows that the incidence of rheumatism is high. An increase in the number of
 elderly people who experience osteoarthritis also occurs in East Java, based on
Indonesian statistics (2016), in East Java the number of elderly in 3 2015 was 173,606
people, with good health status 64,818 people, quite 72,705 people and poor health
status good 36,083 people. In Malang Regency and Malang City, the prevalence of
osteoarthritis was found to be 10% and 13.5% (DHO; East Java, 2011). Osteoarthritis
can affect all joints, the most common prediction is in joints that bear heavy loads
such as the pelvis, knees and spinal joints of the lower lumbar portion. The location
of Osteoarthritis that is often found is at the location of the knee (Arissa, 2013). The
location of the discovery of the Osteoarthritis incident is similar to the report of the
Riskesdas data stating that the most occurrence of Osteoarthritis is in the knee joint
which reached 89.91% (Riskesdas, 2013).
The exercise given to people with knee osteoarthritis can be physical exercise.
Physical exercise aims to maintain joint movement and has a major influence on
decreasing the scale of joint pain (Stevenson, 2012). One of the simple and easy
physical exercises to do is rheumatic exercise (Nurhidayah, 2012). Rheumatic
gymnastics is a gymnastic that focuses on maintaining the maximum range of motion
of the joint. The goal of rheumatism is to reduce joint pain and maintain the physical
health of rheumatoid sufferers. Other benefits of rheumatic gymnastics are that the
bones become more flexible, the muscles remain tight, blood circulation improves,
keeping blood fat levels normal, not susceptible to injury, and the body's reaction
speed for the better (Heri, 2014).
2. Rheumatic Gymnastics
Rheumatic gymnastics is exercise that focuses on maintaining the maximum
range of motion of the joint. Other goals of rheumatic exercise are to improve the
ability of movement, function, strength and endurance of muscles, aerobic capacity,
balance, biomedicine, joints and a sense of joint position. By doing rheumatoid
exercise, the quality of life of the elderly is expected so that the elderly can do ADL
(Activity Daily Living) to the fullest and not a burden to others6. According to
research conducted by Andriyanti (2009) at the PSTW Noble Buddy Unit, Kasongan
Bantul, Yogyakarta, showed a connection between rheumatism exercise and the
independence of doing basic activities in daily life, the elderly could move
independently. Mandiri in caring for themselves and can carry out daily life activities
(AKS). AKS / ADL can be eating, drinking, bathing, walking, sleeping, sitting, BAK,
BAB, and moving limbs (Maryam, 2012).
Rheumatic gymnastics that have an effect on improving the quality of life of
the elderly basically has 6 principles which have a positive impact, among others, the
first principle in breathing exercises that underlies the reduction of pain by relaxation
techniques lies in the autonomic nervous system physiology which is part of the
peripheral nervous system that maintains environmental homeostasis individual
internal. When the release of chemical mediators such as bradykinin, prostaglandins
and substances, will stimulate the sympathetic nerves causing vasoconstriction which
ultimately increases muscle tone which results in various effects such as muscle
 spasm which ultimately suppress blood vessels, reduce blood flow and increase
muscle metabolism which causes impulse delivery pain from the spinal cord to the
brain and perceived as pain. The second principle is a warm-up exercise, before
practicing by heating for 5-10 minutes. This heating can be done by walking or
cycling casually, or by light stretching. Stretching serves to prepare the muscles and
joints of the body before the actual exercise activity, by increasing the body
temperature by approximately one degree Celsius. An increase in body temperature
followed by an increase in heart rate causes faster blood flow throughout the body so
that the supply of oxygen to the muscles becomes more abundant. The third principle
is exercise joints, the ability of a joint and muscle, and the rope around it to move
freely and comfortably in the maximum movement space expected. Optimal
flexibility allows a group or one joint to move efficiently to carry out movements in
the joints, elasticity of the muscles of the tendons and ligaments and exercises to train
several joint points such as the neck joint, shoulder joint, hip joint, wrist and finger
joints. The fourth principle is the exercise of muscle strength, the Rheumatic
Gymnastic Movement aims to train the muscles, and can be done as many as 3-5 sets,
with a grace period of 1-2 minutes. So that the joint muscles are not stiff and can
move freely without any interference. The fifth principle is cardio exercise, this
exercise is done for heart health and increase stamina. This exercise can take the form
of brisk walking, running, swimming, aerobics, and cycling. Do exercises for 30-45
minutes by heating for 5-10 minutes. can stimulate the work of the pulmonary heart
and blood circulation. Increasing the endurance of the pulmonary heart can be used
as a single indicator to determine a person's physical fitness level. According to
Wilmore (1994) the effect of aerobic exercise on resting heart rate can decrease by
30 to 40 beats per minute. The sixth principle is Stretching, Rheumatic Gymnastic
Movement is done to increase the flexibility of joints and muscles. To be more
relaxed, you can use soft musical accompaniment. Stretching also has the role of
relaxing stressed muscles, increasing performance during core exercise. If not
stretching the joint movement will be limited so that when doing certain movements
that suddenly and require agility such as running or jumping, then the factor of injury
to the joint or muscle will become even greater.
3. Osteoarthritis Of The Knee
Osteoartitis (OA) is a degenerative joint disease where the joints are painful
and stiff, the overall structure of the joints experiences pathological changes. It
usually occurs in the knees, thighs and spine. Marked by cartilage damage hyalin
joints, increased thickness and sclerosis of bone plates, osteophytic growth at the
edges of joints, stretching joint capsules, inflammation, and weakening of the
muscles connecting joints (Felson D.T, 2008).
a. Clinical signs and symptoms
Osteoarthritis has symptoms that usually make it difficult for the life of the
sufferer. The following are complaints that can be found in OA patients:
1) Joint Pain
 This complaint is the patient's main complaint. Pain usually increases
with movement and decreases slightly with rest. There are certain movements
that can sometimes cause pain that exceeds other movements. This change can
be found even though OA is still relatively early (radiologically). Generally the
heavy burden increases with the increasing severity of the disease in patients
with OA, joint sufferers can only be shaken and become contractures. Motion
barriers can be concentric (all direction of movement) or eccentric (just one
direction of movement) (Soeroso, 2009). Cartilage does not contain nerve
fibers and loss of cartilage in the joints will not cause pain. So it can be assumed
that the pain that arises in OA comes from outside the cartilage (Felson, 2008).
In research using MRI, it was found that the source of the pain that arises is
thought to originate from inflammation of the joints (synovitis), joint effusion,
and bone marrow edema (Felson, 2008).
2) Barriers to joint motion
A person will feel pain that is very severe in line with increasing weight
a burden that he supports, so that patients will experience a disturbance or
obstacle to move their joints (Soeroso, 2009).
3) Morning Stiff
Patients will experience stiffness when their joints are not used to move
like sitting in a chair or car for quite a long time, even after waking up in the
morning sufferers can experience stiffness in their joints (Soeroso, 2009).
4) Crepitation
This symptom is common in patients with knee OA, which is a feeling
of cracking in the affected joint. In the beginning it was only a feeling of
something broken or broken by the patient or the doctor who examined it.
Along with the development of the disease, crepitus can be heard up to a certain
distance (Soeroso, 2009).
5) Asymmetrical joint swelling
Swelling of the joints can arise due to the occurrence of effusion in the
joints which is usually not much (<100 cc) or because of the presence of
osteophytes, so that the shape of the joint surface changes (Soeroso, 2009).
6) Signs of Inflammation
Redness in the joints is a sign of inflammation in the joints (tenderness,
disordered movement and warm feeling that is evenly distributed) can be found
in OA due to the presence of synovitis. Usually these signs are not prominent
and arise in the development of a more advanced disease. This symptom is
often found in knee OA (Soeroso, 2009).
7) Gait Changes
This symptom is a symptom that troubles the patient and is a big threat
to the independence of OA patients, patients will find it difficult to move even
may only be able to crawl for patients with severe OA, especially in elderly
patients. This will reduce the quality of life of patients. Conditions like this are
 always associated with pain because it becomes the foundation of weight,
especially in knee OA (Soeroso, 2009).
4. Quality of Life
The quality of life assessment based on the AIMS 2 SF questionnaire includes
the numbers 0 to 10. The closer the number 0, the quality of life is considered to be
getting better, and vice versa, the closer the number 10 the quality of life is considered
to be getting worse. Based on the quality of life scores of the SF AIMS 2, it can be
concluded that the quality of life of osteoarthritis patients at Dr. RSUP Sardjito has a
total quality of life score of 4.187. This number shows the quality of life quality of
patients with osteoarthritis in RSUP Dr. Sardjito Yogyakarta tends to be good. The
factors that can influence the quality of life for osteoarthritis patients include:
a. Age
In this study, the effect of age on the quality of life of osteoarthitis patients
can be seen in table IV. This study shows that age affects the quality of life of
patients with osteoarthritis. From table 2, it can be seen that the results of the
significance of the total quality of life for each age group are 0,000 (p <0.05). This
shows a significant difference in the quality of life scores between the two age
groups.
Table 1. Life Quality Score of Osteoarthritis Patients in Dr. RSUP
Sardjito Yogyakarta
Domain Quality of life score based on AIMS 2 SF

Physical 4,197
Symtomps 4,710
Affect/Suasana hati 4,157
Social 4,225
Work 3,345
Total Quality of Life 4,187*
Ket : 0 is the best quality of life score
10 is the worst quality score

Table 2. Life Quality of People with Osteoarthritis by Age

Age
Quality of Life Based
<60 th >60 th P
AIMS
(n=26) (n=44)
Physical 4,723 3,886* 0,020*
Symtomps 4,223 4,995 0,068
Affect/Suasana hati 4,38 4,022 0,294
Social 5,168 3,667* 0,006*
Work 3,365 0,596* 0,000*
Total Quality of Life 4,374 3,433* 0,000*
b. Gender
From this study it is known that gender does not affect the quality of life,
although there is a tendency for the value of male quality of life to be better than
the quality of life of women. Based on table 3 it can be seen that the significance of
the total value of quality of life in the male and female sex groups is 0.928 (p>0.05).
This shows that there is no significant difference between the male and female
groups.
Table 3. Quality of Life of Patients with Osteoarthritis Based on
Gender
Gender
Quality of Life Based
Male Female P
AIMS
(n=27) (n=43)
Physical 4,111 4,251 0,701
Symtomps 4,535 4,821 0,498
Affect/Suasana hati 3,870 4,337 0,171
Social 4,333 4,156 0,750
Work 1,990 1,395 0,342

Total Quality of Life 3,7682 3,792 0,928

c. Job Status
In this study, it is known that occupational status affects the quality of life
of patients with osteoarthritis. Based on table IV, it is known that the significance
of the quality of life in the working and non-working groups is 0,000 (p <0.05).
This shows that there are significant differences between working groups and not
working.
d. Comorbidities
In this study, the influence of comorbidities on the quality of life of patients
with osteoarthritis can be seen in table 4. Based on table 4 it is known that the
significance of the quality of life in the group of comorbidities was 0.843 (p> 0.05).
This shows that there is no significant difference in the quality of life scores
between groups of comorbidities, so it can be concluded that the presence of
concomitant diseases does not affect the quality of life for people with
osteoarthritis.
 Table 4. Quality of Life of Osteoarthritis Patients Based on Co-
morbid Diseases

Commordibities
Quality of Life Without Only >2
P
Based AIMS Commordibities Commordibities Commordibitie
(n=16) (n=15) (n=39)
Physical 3,901 4,536 4,188 0,490
Symtomps 4,581 5,272 4,548 0,359
Affect/Suasana 3,968 4,266 4,192 0,817
hati 4,343 3,708 4,375 0,605
Social 1,875 2,5 1,185 0,212
Work
Total Quality of 3,734063 4,056 3,697 0,843
Life

5. Elderly
Elderly (Elderly) is a phase of decreased intellectual and physical abilities,
which begins with the presence of several physiological changes that occur in several
organs and systems of the body. This will cause various diseases that are not
contagious or due to aging (degenerative) (Psychologymania, 2012). The aging
process is the process by which a person naturally enters old age which experiences
setbacks, for example physical deterioration characterized by sagging skin, white hair,
toothless teeth, less clear hearing, worse vision, slow motion and disproportionate
body ( Nugroho, 2012).
6. Conclusion
Osteoartitis (OA) is a degenerative joint disease where the joints are painful and
stiff, the overall structure of the joints experiences pathological changes. It usually
occurs in the knees, thighs and spine. Marked by damage to cartilage (cartilage) hyalin
joints, increased thickness and sclerosis of the bone plate, growth of osteophytes at the
edges of joints, stretching of joint capsules, inflammation, and weakening of the
muscles that connect joints. Joint pain suffered by the elderly can affect the quality of
life of the elderly. The other factors that affect the quality of life in the elderly are age,
gender, work status, and comorbidities. Rheumatic gymnastics is a therapy that is
highly recommended to improve the quality of life in elderly people with knee OA.
There are movements that can increase the muscles to facilitate blood flow so that the
pain decreases and the patient can freely move so that the quality of life of the elderly
with knee OA increases.
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