Physical Activity, Sleep Quality and Physical Fitness of the Elderly
Who Live in Nursing Homes
Elida Ulfiana, Dyah Priyantini and Rista Fauziningtyas
Fakultas Keperawatan, Universitas Airlangga, Kampus C Mulyorejo, Surabaya, Indonesia
Keywords: Physical Activity, Sleep Quality, Physical Fitness, Elderly.
Abstract: The aging process can cause a reduction in physiological function. Being older means a 30-50% decrease in
physical fitness for the elderly. Factors related to elderly fitness are associated with the Giant Geriatric
Syndrome including physical activity and sleep quality. This research is intended to explain the relationship
of physical activity and sleep quality with the level of physical fitness of the elderly who live in nursing
homes. This research used a descriptive correlational design with a cross-sectional approach. The population
was the elderly with a Barthel score > 60. Sample size was 102 respondents with total sampling. The
variables were physical activity, sleep quality and physical fitness. The instrument used was a 24 hours
activity recall questionnaire, Pittsburg Sleep Quality Index. Physical fitness was measured using a six
minutes walking test, five times sit to stand test, chair sit and reach test and body mass index. Data analysis
used chi square α 0,05. The results showed that there was a significant correlation between physical
activity and sleep quality and physical fitness (p=0,001). Physical activity in the category of moderate to
hard activity and good sleep quality can improve physical fitness in the elderly because the physical fitness
results from metabolism that occurs in the sleep cycle. It can be concluded that physical activity and sleep
quality had the effect of maintaining physical fitness.
1 BACKGROUND
The aging process causes changes in the
physiological condition of the body and affects
physical fitness. Physical fitness is the body’s ability
to perform daily activities without causing excessive
fatigue, and still have the energy reserves to rest or
do the work suddenly (Francesco Landi, Riccardo
Calvani, Anna Picca, Matteo Tosato & Emanuela
D’Angelo, Elisabetta Serafini, Roberto Bernabei,
2018; Junaidi, 2011). The elderly are said to
demonstrate fitness if they have strong muscles so
that the risk of falls can be reduced, the
cardiopulmonary ability is good and be marked with
VO2. Max height and pulse breakdown, body
flexibility is good, body composition is ideal, they
are able to perform physical activity independently,
the body’s endurance is good and they have
adequate sleep (Afriwardi, 2008; Nugraheni, 2013).
The elderly aged > 60 years old who are still fit will
improve their physiological capabilities and can
retard the degenerative process. However, the fact is
that in the community the age increase can reduce
the body’s physical fitness by 30%-50% (Akmal,
2012).
The factors causing impaired fitness in the
elderly include a problem related to the Giant
Geriatric Syndrome, namely immobility, inanition
(malnutrition), instability (imbalance),
immunodeficiency (decreased endurance), and
insomnia (sleep disorder) (Darmojo, 2015). The
previous study on the physical fitness of the elderly
by Zelvya (2014) showed that nutrition, health status
and also exercise have a strong relationship with the
physical fitness of the elderly who live in nursing
homes. The study related to other factors such as
physical activity and the need to sleep, but to
achieve a good quality of life the elderly need three
components, namely activities, food, and rest.
The eldery population in Indonesia ranked fifth
in the world in 2015, which increased 15.5% from
2014 and is estimated to reach 35 million in 2035
(Ministry of Health of the Republic of Indonesia,
2016). An increasing elderly population will impact
on the health status of the country. Based on
physical fitness indicators proposed by Afriwardi
(2008) and Nugraheni (2013) it is shown that the
388
Ulfiana, E., Priyantini, D. and Fauziningtyas, R.
Physical Activity, Sleep Quality and Physical Fitness of the Elderly Who Lived in Nursing Home.
DOI: 10.5220/0008325703880393
In Proceedings of the 9th International Nursing Conference (INC 2018), pages 388-393
ISBN: 978-989-758-336-0
Copyright
c
2018 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
physical fitness of the elderly in Indonesia is still
lacking, as evidenced by morbidity still being high.
Elderly morbidity in 2012 was 24.77% in urban and
28.62% in rural areas. This is supported by the
percentage of elderly who have health complaints
during the years 2012 – 2015, the everage reached
47.17% of the total elderly in Indonesia (Ministry of
Health of the Republic of Indonesia, 2016). The
morbidity among the elderly in East Java reached
26.93% with a top rank in Surabaya city reaching
35,99% in 2015 (Health Office of Surabaya). The
condition of the less fit made 11.90% of elderly in a
state of complete dependence (total care). The
American Community Survey also supports that
28% of the elderly aged > 65 years have limitation
in activities so they need full assistance (total care)
(Administration of Aging, 2013).
The results of a preliminary study carried out in
one of Surabaya’s nursing homes in April 2017
showed the morbidity of the elderly reaching 85%.
This condition is also accompanied by heavy
dependency of the elderly (40.38%) and total
dependency of elderly 19.23% (Barthel index 60).
The total of elderly (59.61%) in nursing homes is
not included in the independent category, so it is
difficult to perform activities that improve fitness.
The results of preliminary data obtained from
measurements of fitness that are accumulated based
on the scale of Guttman (Zelvya, 2014), show 20
elderly who lived in nursing homes, 8 elderly in a fit
condition and 12 elderly in un-fit condition. 20
elderly as a whole say they could not sleep soundly
and perform fewer daily activities, so they only sit
and lie down.
The physical fitness will have an impact on the
physiological condition of the elderly. The poor
physical fitness speeds up the degenerative process,
increasing morbidity, increasing fall incidents, and
decreasing life expectancy, with many not reaching
the age of 70 (Junaidi, 2011).
Growing old can not be avoided, but growing old
healthily is a need of everyone. Healthy ageing is the
concept that has a purpose of making the elderly
period healthy. Healthy ageing is influenced by the
endogenous aging factor from the body and the
exogenous aging factor from environment and life
style. The elderly who achieve a healthy ageing
condition will have an old age of higher quality and
free from pathological conditions (Darmojo, 2015).
Healthy ageing will help the elderly become more
able to perform activities, so they become more
healthy, fit, and able to prevent the occurrence of
disease. Based on the existing phenomenon,
researchers consider it necessary to conduct research
on other variables that represent the factor
influencing elderly fitness. In accordance with the
Giant Geriatric Syndrome other factors that need to
be considered are the condition of limited movement
(immobility) and sleep disorders (insomnia), so the
researchers are interested in conducting research on
the relationship of physical activity and sleep quality
with physical fitness of the elderly who live in
nursing homes.
2 METHODS
The design used in this research is correlation
descriptive with a cross-sectional approach. The
overall population of elderly in UPTD Griya Wredha
Jambangan Surabaya, Social Welfare Institution of
Hargo Dedali Elderly and Anugrah’s Nursing Home,
Surabaya is as many as 175 people. The target
population based on elderly characteristics with
Barthel index > 60 is 108 people. The affordable
population who can be reached by researchers is
limited in time to 2017 and place so there are 102
people. This population is in accordance with the
criteria having verbal communication, no psychiatric
disorder, MMSE score (Mini Mental Status
Examination) 17 and no heart disease, stroke, and
malignancy. The sample size in this study is 102
elderly obtained with a total sampling technique.
The independent variables in this study are
physical activity and sleep quality, dependent
variable is elderly physical fitness. The instruments
were questionnaires, one 24-hours in activity recall
to measure physical activity and a Pittsburgh Sleep
Quality Index (PSQI) questionnaire to measure sleep
quality of the elderly. The physical fitness variable
of the elderly was measured using six minutes walk
distance test, five times sit to stand test, chair sit and
reach test and bpdy mass index (IMT).
Analysis of data used in this tsudy is Chi Square
(x2) test.
3 RESULTS
A total of 35 respondents (34,3%) had mild physical
activity, 56 respondents (54,9%) had good sleep
quality, and 53 respondents (52%) in fitness
condition (Table 1).
25 respondents (24.6%) did mild physical
activity at the level unfit. While 32 respondents
(31.4%) did moderate physical activity at the level
of fitness (Table 2). The elderly in the category of
Physical Activity, Sleep Quality and Physical Fitness of the Elderly Who Lived in Nursing Home
389
moderate and hard physical activity had higher
physical fitness compared to the elderly in category
of very mild and mild physical fitness. The result of
the analysis of the chi square test showed p = 0.000,
so there is a significant relationship between
physical activity with physical fitness of the elderly
who live in nursing homes.
The elderly with poor sleep quality had more un-
fitness, while the elderly with good sleep had more
fitness. The analysis result of the chi square test
showed p = 0.000 meaning there was a relationship
between sleep quality and physical fitness of the
elderly who live in nursing homes.
4 DISCUSSION
4.1 The Relationship of Physical
Activities and Physical Fitness
Physical activity and physical fitness among those
living in nursing homes had a significant
relationship. Physical activity in the very mild and
mild categories show the elderly to be unfit, and
otherwise physical activity in the moderate and hard
categories made the elderly fit. The regular physical
activity related to FITT (frequency, intensity, type,
and time) will make the body more healthy and fit.
Physical activity has an impact on physical health by
increasing cardivascular endurance. Cardiovascular
endurance in a well condition will keep the function
of the cardiac muscle, respiratory, and vascular
systems intact. Physical activity also strengthens the
body’s muscles, maintains balance, and body
flexibility of the elderly and maintans body
composition (Francesco Landi, Riccardo Calvani,
Anna Picca, Matteo Tosato & Emanuela D’Angelo,
Elisabetta Serafini, Roberto Bernabei, 2018; Junaidi,
2011).
The fit elderly had a level of activity above that
of the un-fit. The un-fit elderly tend to prefer to
sleep and sit, while the fit elderly will try to perform
independent activities such as household chores
(washing clothes, dishes, cooking, sweeping,
cleaning room), making crafts and performing light
activities (watching TV, listening to the radio,
chatting, leisurely strolling, activities in the hall).
This was in line with a study by Junaidi (2011) which states that people who have a good value VO2
Table 2: Cross Tabulation Physical Activity and Physical Fitness of the Elderly Variables in Nursing Home.
Physical Activity
Physical Fitness
Total
Un-Fitness Fitness
N % N % N %
Ver
y
Mild 25 24.6 3 2.9 28 27.5
Mild 21 20.6 14 13.7 35 34.3
Moderate 3 2.9 32 31.4 35 34.3
Hard 0 0 4 3.9 4 3.9
Total 49 48,1 53 51.9 102 100
Chi S
q
uare test
p
= 0.000
Table 3: Cross Tabulation Sleep Quality and Physical Fitness of the Elderly Variables in Nursing Home.
Sleep Quality
Physical Fitness
Total
Un-Fitness Fitness
N % N % N %
Poo
r
43 42.2 3 2.9 46 45.1
Good 6 5.9 50 49 56 54.9
Total 49 48,1 53 51.9 102 100
Chi Square test
p
= 0.000
Table 1: The data of Physical Activity, Sleep Quality
and Physical Fitness of the Elderly in Nursing Homes.
n %
Ph
y
sical Activit
y
Ver
y
Mild 28 27.5
Mild 35 34.3
Moderate 35 34.3
Hard 4 3.9
Sleep Quality
Good 56 54.9
Poo
r
46 45.1
Ph
y
sical Fitness
Fitness 53 52
Un- fitness 49 48
INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research
390
Max (a distance > 320 metres) are able to perform
more physical activity. However, based on the
obtained data some fit elderly could not achive a
distance > 320 metres. The factors causing the
elderly to stop the walking test after 6 minutes
included dizziness, joint pain, and using walking
aids. The elderly who did moderate-hard physical
activity were more active and had more interaction
than the elderly who did less physical activity,
because their physical fitness condition was also
different. This is in accordance with the study by
Akmal (2012) which states that elderly with physical
activity moderate-hard are more likely to participate
in activities such as gymnastics routines. The result
of the study was also consistant with the research by
Alrushud, Rushton AB, Kanavaki AM et al. (2017)
on elderly with obesity, which states that physical
activity has a significant result in weight loss, so that
the body composition remains ideal.
In accordance with the concept of healthy ageing
for the elderly good physical activity will achieve a
state of healthy ageing, which is achieved through
active ageing, in various fields – cultural, economic
determinant, social, spiritual and health. The active
elderly will increase their quality of life, active
participants enjoy well-being and are able to
optimize the healthy body (Darmojo, 2015) Physical
activity has an impact on physical fitness as
evidenced by the significant relationship, in
accordance with the concept of healthy ageing.
According to the reseacher achieving a healthy old
age should be stimulated by factors that influence it,
but the whole of the factors must be optimal in order
to achieve the purpose. All of these factors meant
belonging to endogenous aging and external factors.
Physical activity acts as an external factor and will
make the eldery more active. At the level of physical
activity moderate and heavy the elderly become
more active in moving than the elderly with physical
activity very mild and mild. The increasing
movement of the elderly’s gestures will stimulate the
muscles and they do not atrophy. The habit of
regular activity during old age will maintain the
body systems, ranging from cardiovascular system,
respiration, and neuromuscular.. If all the body
systems are still functioning properly, the body will
remain in a healthy condition and fit.
4.2 Relationship of Sleep Quality and
Physical Fitness
Sleep quality and physical fitness in the elderly
have a significant relationship. This is in accordance
with the results of a study showing that good quality
sleep maintained 50 elderly (49%) in a fit condition,
while for the elderly with poor quality sleep only 3
elderly (2.9%) were in a fit condition. This showed
that good sleep quality has a greater impact on the
elderly’s physical fitness.This is in accordance with
the indicators of elderly physical fitness by
Nugraheni (2013), which were that physical fitness
was good if having good sleep quality and adequate
rest of at least 6-7 hours per day.
Sleep is one of the basic needs for maintaining
health and functioning of the body’s cells (Miller,
2012). According to Mubarak, Indrawati and
Susanto (2015) during sleep regeneration of
damaged cells occurs, with immune enhancement,
repairation of the brain’s neurons and recovery of
the body’s energy that has been used during a full
day. This was consistent with the results of a study
showing that respondents having good quality sleep
also had good fitness. The good sleep quality
increased the cell regeneration activity, resulting in
better fitness when waking the next day.
When an individual sleeps well the body’s
metabolism for repairing damaged cells also occurs
releasing hormones from the pons and brainstem
(Bulbar Syncronizing Regional) (Anita D. Christie,
Seery & Jane A. Kent, 2016). The hormones
released are serotonin, melatonin, endorphin dan
enkephalin. Serotonin hormone functions to regulate
body temperature, appetite, sleep quality, memory,
mood, and circulatory function. Melatonin is
associated with circadian rhythm. Endorphin results
in euphoria, repressing pain so helping in cell
regeneration, and Enkephalin inhibits pain impulse
through a prostaglandin inhibitor (Khasanah &
Hidayati, 2012). When an individual has good
quality sleep, then the stages of the sleep cycle will
be fulfilled both NREM and REM. The hormone
secretion of sleep if occurring properly will impact
to regenerate cells during sleep. The body feels fresh
the next morning if experiencing good sleep quality.
Conversely, poor quality sleep will mean the
elderly’s physical condition is not fresh the next
morning, they will be drowsy interfering with daily
activities. Based on the results of interviews and
recall questionnaire PSQI, the poor sleep quality of
the elderly is caused by unfavorable environment
conditions, frequent wakening, insomnia and not
being able to go back to sleep after wakening in the
night. This is in accordance with the theory that the
elderly’s sleep pattern will change, namely
shortening NREM III and REM, so the elderly will
be easy awakened. If the elderly fail to gain good
sleep quality, hormone secretion will be inhibited
Physical Activity, Sleep Quality and Physical Fitness of the Elderly Who Lived in Nursing Home
391
and the regeneration process will be occur. This
makes the body un-fit the next day.
In accordance with the concept of healthy
ageing, one factor that allows the elderly to achieve
healthy aging is that of endogenous aging, namely
sleep pattern. Elderly sleep patterns consist of
several cycles of NREM and REM. The good sleep
cycle will also allow good sleep quality. During
quality sleep metabolism of cell regeneration will
occur increasing the body’s energy, the damaged
cells will regenerate and hormone secretion will
occur from the bulbar synchronizing region helping
the metabolic process of the body. Cell metabolism
and energy recovery that impact on the elderly’s
bodily health can actualize the healthy ageing
condition (Darmojo, 2015).
The healthy ageing concept can be demonstrated
by the author through two respondents, one has good
sleep quality and is fit (respondent 30H) and the
other one has poor sleep quality and is unfit
(respondent 32H). During interviews respondent
30H had given a greeting first, looked cheerful, did a
lot of activities and did not seem sleepy. Respondent
30H did not have any sleep disorder, so he/she was
subjectively assessing sleep very well. While
respondent 32H looked more lazy, un-cheerful, there
were bags under the eyes, irritability, and
drowsiness. During the interview, the respondent
said that it was difficult to sleep every night because
he was remembering his granddaughter, he often
awakened at night due to frequent dreaming and
wanting to go to the bathroom. Based on these two
examples, it can be proved that there is a significant
relationship between sleep quality and physical
fitness of the elderly. The elderly with good sleep
quality will be more fit, and otherwise the elderly
with poor sleep quality will not be fit. The un-fitness
of the body is due to the process of repairing body
cells while sleeping being impaired causing
difficulty in maintaining physical activity. While
sleeping, the body will work to repair the body’s
energy metabolism, the energy that has been used
during a full long day will be recovered again, the
fatigue will be improved, so that the elderly feel
fresh when waking the next day. The maintaining of
physical activity that stimulates the elderly body
muscles will maintain the ability to still perform
independent activity, so the elderly will become
more healthy and fit.
5 CONCLUSIONS
The physical activity of the elderly who lived in
nursing homes is mostly mild and moderate. The
physical activity and physical fitness of the elderly
have a significant relationship. If physical activity is
in the category level of very mild and mild, the
elderly will be in an unfit condition. But if the
physical activity is moderate and hard, the elderly
are in a fit condition. Sleep quality of the elderly in
nursing homes is mostly shows good. Good sleep
quality will have an impact on repairing the body
systems and restoring the elderly energy. Sleep
quality and physical fitness of the elderly who live in
nursing homes had a significat relationship. The
elderly with good sleep quality will become fit and
the elderly with the poor sleep quality will become
unfit.
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