Correlation between Hyperkyphosis and Balance of Elderly Who Join

Osteoporosis Gymnastics at Royal Taruma Hospital, West Jakarta

Fransisca Crisanti Wijaya

Muthiah Munawwarah

and Trisia Lusiana Amir

Esa Unggul University, Arjuna Utara Street, West Jakarta, Indonesia

Department of Physiotherapy, Esa Unggul University, West Jakarta, Indonesia

Keywords: Hyper Kyphosis, Balance, Osteoporosis Gymnastics.

Abstract: Objective: Determine the correlation between hyperkyphosis and balance of elderly who join osteoporosis

gymnastic at Royal Taruma Hospital. Samples: This study consisted of 25 elderly who participated in

osteoporosis gymnastic at Royal Taruma Hospital, which was selected based on purposive sampling. The

samples aged ranges from 55-80 years with a gymnastic frequency >4 weeks. The sample examined the

thoracic hyperkyphosis curve with flexicurve-ruler and balance with Berg Balance Scale. Method: This study

was a cross-sectional with observational study and was a correlation study. Results: Average and standard

deviation of the hyperkyhposis curve in elderly who participated in osteoporosis gymnastic was 50.63±5.42

while the balance was 49.96±2.55. Pearson test obtained the value of p=0.183 (p> 0.05), meaning that there

is no correlation between the degree of the hyperkhyphosis curve and balance in elderly who participated in

osteoporosis gymnastic at Royal Taruma Hospital. Whereas the value of r (correlation strength) = -0.276, it’s

mean that there is a negative correlation between hyperkyphosis and balance of the elderly. Conclusion:

There is no correlation between hyperkyphosis and balance of elderly who join osteoporosis gymnastic,

however, there is a negative correlation between hyperkyphosis and balance, so the higher hyperkyphosis

curve, the lower balance of elderly.

1 INTRODUCTION

Elderly is the final stage in the development cycle of

human life and is characterized by the failure of an

equilibrium for maintain health and physiological

stress conditions. Elderly also associated with a

decrease in the ability to live and sensitivity

individually. (Hawari, 2001).

As we get older, our body systems also decrease.

The decrease occurred in all systems of the body such

as sematosensori, visual, vestibular an d

musculoskleletal. The decrease in the

musculoskeletal system is the most commonly

experienced by the elderly, characterized by

decreased muscle mass and increased fat mass

(sarcopenia), as well as the decrease to loss of bone

mass (osteopenia and osteoporosis). The decreased of

bone mass may increase the degree of kyphosis in

thorakal.

One of the physical changes that almost all elderly

experience is changes in body posture (bones,

muscles and joints) which physiologically cause

changes in spinal curvature. The changes in postural

alignment of the body that often can cause thoracal

hyper kyphosis, experienced by 20-40% of elderly in

worldwide. (Fernandes et al, 2018).

Thoracal hyper kyphosis is a term that refers to an

abnormal curvature of thoracal. Normally thoracal

angle is 10-20 degrees. As we get older, the thoracic

angle increases, around 44-48 degrees. Most

researchers who have investigated hyper kyphosis,

assume that the main cause of hyper kyphosis are

fractures, arthritis and osteoporosis (Kado, 2009).

Thoracal hyper kyphosis can affect daily

activities. Adverse effects arising from these

conditions are difficult to bend, climb, walk, down to

the basic daily activities like bathing. The increased

of thoracic kyphosis angle, can directly cause

impaired balance and increased risk of falling in the

elderly. The posture changes cause a decrease in the

ability to maintain postural balance in elderly due to

decreased muscle strength and bone mass.

When the elderly experiencing thoracal hyper

kyphosis, there is a changes in the center of gravity

(center of gravity) or the body's center of mass (center

of mass), which became one of the factors that affect

Wijaya, F., Munawwarah, M. and Amir, T.

Correlation between Hyperkyphosis and Balance of Elderly Who Join Osteoporosis Gymnastics at Royal Taruma Hospital, West Jakarta.

DOI: 10.5220/0009588802050209

In Proceedings of the 1st International Conference on Health (ICOH 2019), pages 205-209

ISBN: 978-989-758-454-1

205

the balance. The center of gravity is the main point on

the body that will evenly distribute body mass. COG

humans at normal (upright) located just above the

waist between the front and back of the vertebra of

the sacrum to two. When the center of gravity moves

(from normal), then the distribution of body mass

changes. Body burden becomes more leaning forward

so it is difficult to maintain the balance of the body.

One of treatment that can be given to the elderly

who have thoracal hyper kyphosis and balance

disorders is with Physiotherapy. According to PMK

no. 65, 2015 Physiotherapy is a form of health care

which is form of health service aimed at individuals

and/or groups to develop, maintain and restore

motion and bodily functions throughout the life span

using manual, increased motion, modalities (physical,

electrotherapeutic and mechanical) functional

training, communication. Therefore physiotherapy as

health workers should have the ability and skills to

optimize the potential of motion associated with

developing, prevent, improve, and restore motion and

function of a person's body.

In the case of hyper kyphosis, Sports

Physiotherapy plays an important role in posture

correction. the goal of sports physiotherapy is to

improve skeletal stability, substantial

remineralization, relieve pain, and prevent the risk of

falls. (Lange et al, 2005) In addition to preventing the

risk of falling, exersice conducted by the elderly also

can improve muscle strength, coordination and

balance. According to Cosman (2013), the more

movement and exercise, the muscles will help the

bones to form new bone mass. Old bones and

fractured bones will be reshaped. This means that

rarely exercising can inhibit the process of osteoblasts

or new bone formation, thus accelerating bone loss.

One of the exercises that can be done to improve

posture and balance Osteoporosis Gymnastics.

Osteoporosis Gymnastics is a bone health exercise

that serves to increase bone density and prevent bone

loss early. This exercise focuses on muscle strength

without an increase in bone strength (improve balance

and flexibility in the elderly) are performed safely,

without movement of high impact and movement of

spinal flexion, not on the mat slippery, not with

abdduksi and adduction motion of the foot to the load,

and done step by step (foot, isotonic abdominal, back

extension).

2 SAMPLES

The samples in this study consisted of 25 elderly

people who follow osteoporosis gymnastics in Royal

Taruma Hospital, West Jakarta with age ≥55 years.

The study lasted 5 days with samples obtained

through the administration of questionnaires, and the

samples are given an explanation of the purpose and

intent of the study and fill out the informed consent.

Then the researchers take measurements:

hyperkyphois curve with flexicurve ruler and balance

with the Berg Balance Scale (BBS).

The sampling criteria (inclusive criteria): (1)

consists of elderly who follow gymnastics

Osteoporosis in Royal Taruma Hospital, West

Jakarta, (2) aged ≥55 years, (3) kyphosis curves >40

degrees and, (4) the subject is still actively

participating in training exercises conducted by

Hospital at least 4 weeks, while the rejection criteria

(exclusive criteria): (1) consists of elderly who have

acute or chronic illness, (2) use a walker, (3) subject

uncooperative and unable to follow the study.

3 METHODS

The study was conducted with a quantitative

approach that was included in the research analysis.

Quantitative research is research that emphasize the

analysis of numerical data is processed using

statistical tests.

The type of the research is observational research/

surveys. This is a descriptive study with the type of

correlation studies to determine the correlation

between variables using a cross sectional study design

in the same time, by describing the results of the

thoracic kyphosis curve measurement with the flexi

curve ruler and the measurement results of the

balance with the Berg Balance Scale (BBS).

The measurement is used to determine the

correlation of hyper kyphosis and balance in elderly

who follow Osteoporosis gymnastic in Royal Taruma

Hospital, West Jakarta. In this study, it is expected

there is a lack of compatibility between the methods

used by the objectives to be achieved by the

researchers.

4 RESULT

Based on research carried out on 25 samples, the

sample’s characteristics of the study consisted of

gender, age, blood pressure, pulse rate, respiration

rate, body mass index. Characteristics of the sample

by gender is composed of men and women, where the

elderly who follow Osteoporosis gymnastic in Royal

Taruma Hospital, West Jakarta are mostly women

ICOH 2019 - 1st International Conference on Health

206

with a number of 22 people (88%), while men were 3

people (12%) with the most elderly age who follow

osteoporosis gymnastics is 66-70 years (9 elderly).

The average blood pressure of elderly people who

follow osteoporosis gymnastics is 132/85 mmHg.

The highest pulse rate in the elderly, ranges from 91-

100 times per minute, while the lowest is around 51-

60 times per minute, where the average pulse rate is

around 61-70 times per minute, which consists of 13

people. The respiration rate of the elderly who follow

osteoporosis gymnastics ranges from 16-35 times per

minute, where the highest respiration rate ranges from

21-25 times per minute, which consists of 12 people.

Based on weight and height obtained the value of the

lowest BMI in elderly who follow gymnastics

osteoporosis range 16-20 kg/m

and the highest score

is 31-35 kg/m

, in which the highest value is 21-25

kg/m

, which is 12 people.

The mean and standard deviation of the

hyper kyphosis curve in the elderly who following the

osteoporosis gymnastic is 50.63±5.42 while mean

and standard deviation of balance is 49.96±2.55.

Table 1: Normality Test Results Hyper kyphosis Curve and

Balance.

Variables p-value

Information

Hyper kyphosis

Curve

0.195 Normal

Balance 0.126 Normal

Because the number of samples used in research

is less than 30, the researchers conducted a normality

test using the Saphiro Wilk Test, where data

distribution can be said to be normal if the p value>

0.05 and the data is said to be not normally distributed

if the p value <0.05.

After the normality test, it can be concluded that

the data are normally distributed in the

Hypercyphosis and Balance Curves, where the hyper

kyphosis curve (p=0.195) is normally distributed and

the balance (p=0.126) is also normally distributed

which can be seen in Table 1.

Correlation between hiper kyphosis and balance

in the elderly who follow osteoporosis gymnastics

statistically tested with Pearson Product Moment

Correlation. This is because the data were normally

distributed, provided the results of testing the

hypothesis Ho is rejected when p <0.05 and Ho

received when the value of p> 0.05. The results of

hypothesis testing found that p> 0.05. This can be

seen in Table 2.

Table 2: Correlation Hiperkifosis and Balance in the

Elderly with Pearson Test.

Balance

Hiperkifosis

r = -0.276

p = 0.183

n = 25

Based on the results Hiperkifosis Correlation Test

and Balance in the Elderly with Pearson Test p value

= 0183 (p> 0.05) means insignificant. While the value

of r (correlation strength) = - 0276, that is to say there

is a negative correlation between the curves and

balance hiperkifosis elderly who follow gymnastics

osteoporosis in Taruma Royal Hospital, West Jakarta

5 DISCUSSION

The results of hypothesis testing with Pearson

Product Moment Correlation test found that p> 0.05

(0.183). This shows that there is no correlation

between the degree of the hyperkyphosis curve and

balance in the elderly who follow osteoporosis

gymnastics in Royal Taruma Hospital, West Jakarta.

Hiper kyphosis will change the balance of the whole

body in both lower limbs and affects mobility inhibits

spinal vertebrae each of the joints to move at

maximum ROM (Briggs et al., 2007).

But that is not found in the elderly who have hiper

kyphosis and follow osteoporosis gymnastic in Royal

Taruma Hospital, West Jakarta. Almost all elderly

who follow gymnastics and experience

hyperkyphosis do not notice any decrease in balance

as measured by the Berg Balance Scale (BBS). That

is, hyper kyphosis is not a major factor in the

decreased in balance in the elderly.

Hyper kyphosis can be affected by many things,

such as a decrease in bone mass and decreased muscle

strength. In this study, the sample used is the elderly

who follow osteoporosis gymnastics routinely. So

that despite experiencing hyper kyphosis due to

decreased bone mass, muscle strength can be one of

the good factors in the balance value in the elderly

who follow osteoporosis gymnastic at the Royal

Taruma Hospital, because these exercises are

principally aimed at increasing muscle strength. It can

be said that the exercises were able to improve

balance in the elderly, because in a short interview

conducted by the researchers, almost all elderly

impaired balance (often falling) before doing

osteoporosis gymnastic routinely.

The statement was supported in the journal study

conducted by Lange, et al., Entitled "Exercise and

Correlation between Hyperkyphosis and Balance of Elderly Who Join Osteoporosis Gymnastics at Royal Taruma Hospital, West Jakarta

207

Physiotherapeutic Strategies for Preventing and

Treating Osteoporosis" in 2005, which states that

physical exercise (sports) has several benefits for the

elderly among other things, to stabilize circulation

and improve the ability of the elderly to avoid the risk

of tripping or falling, reducing the risk of fracture as

well. However, the intrinsic factor fall risk (blood

pressure, pulse, and cerebral ischemia) as well as

related to environmental factors must also be reduced.

For example, exercise (cardio-exercise therapy) can

improve the balance of which is quite large and

reduce the risk of falls by improving muscle strength

and coordination.

In addition, the frequency of exercise also affect

the value of the balance (BBS) was very good in the

elderly who follow gymnastics osteoporosis in

Taruma Royal Hospital, West Jakarta. All samples in

this study average gymnastics osteoporosis have

followed for more than 2 years. This is according to

research conducted by Lange, et al. (2005) that

ideally done during gymnastic exercise 2-3 times per

week. Powered by prior research on "Exercise

Frequency, Health Risk Factors, and Diseases of the

Elderly" (Kemmler and Stengel, 2013) that the

average frequency of exercise more than 18 months

can affect bone repair dam muscle mass in the elderly.

There is no correlation between hyper kyphosis

and balance in elderly who follow osteoporosis

gymnastic at the Royal Taruma Hospital can also be

caused due to the use of measuring instruments that

are not appropriate balance. Measuring instrument

used in this study is the Berg Balance Scale which is

basically a measurement tool shown in the elderly

with balance disorders such as stroke and Parkinson's,

while the samples are elderly people who follow

gymnastics osteoporosis is a healthy elderly without

specific health problems. According to Stephen

Downs in the journal “The Berg Balance Scale” in

2015 said that the Berg Balance Scale measuring tool

is not a good screening for someone with no particular

health problems that affect balance.

These test results show the value of the correlation

(r) -0.276. This means that there is a negative

correlation between hiperkifosis and balance, which

indicates that there is a relationship which is inversely

between hyper kyphosis and balance in the elderly

who follow osteoporosis gymnastics in Royal Taruma

Hospital. This is supported by the theory of Briggs et

al. in 2007 the higher the hyper kyphosis curve, the

lower the balance in the elderly. This is because the

body is leaning forward, making it difficult to

maintain balance.

6 CONCLUSION

Based on the results of research and discussion, the

conclusions that can be drawn are as follows:

There is no correlation between hyper kyphosis and

balance in the elderly who follow osteoporosis

gymnastics in Royal Taruma Hospital, West Jakarta.

REFERENCES

Abreu, D. C. 2010. The Association Between Osteoporosis

and Static Balance in Elderly Women. Osteoporos Int.

21:1487–1491.

American Heart Association. 2015. All About Heart Rate

(Pulse). Dallas: National Center.

Banaszkiewicz, Paul A dan Deiary F. Kader. 2014. Classic

Papers in Orthopaedics. UK: Newcastle Upon Tyne.

Barret, Eva, Karen McCreesh, dan Jeremy Lewis 2013.

Intrarater and Interrater Reliability of the Flexicurve

Index, Flexicurve Angle, and Manual Inclinometer for

the Measurement of Thoracic Kyphosis. Australia

Journal of Dermatology. DOI: 10.1155/2013/475870.

Bougie, D.J. dan Morgenthal, A.P. 2001. The Age Body.

United State Of America. Amerika: McGraw-Hill

Publisher.

Briggs AM, van Dieen JG, Wrigley TV, et al. Thoracic

Kyphosis effect Spinal Loads and Trunk Muscle Force.

Phys. Ther. 2007; 85:595-607.

Bruno, Alexander G. 2012. The Effect of Thoracic

Kyphosis and Sagittal Plane Alignment on Vertebral

Compressive Loading. Journal of Bone and Mineral

Research. 27(10): 2144–2151.

Corbin, Charles B dkk. 2000. Definitions: Health, Fitness,

and Physical Activity. President's Council on Physical

Fitness and Sports.

Cosman. 2009. Osteoporosis Panduan Lengkap Agar

Tulang Anda Tetap Sehat. Yogyakarta: BFrist.

Depkes RI. 2009. Profil Kesehatan Indonesia 2009. Jakarta.

Available at http://www.depkes.go.id/ [Acceseed 20 Jan.

2019].

D. L. Waters dkk. 2010. Osteoporosis and gait and balance

disturbances in older sarcopenic obese New Zealanders.

Osteoporos Int. 21:351–357.

Downs, Stephen. 2015. The Berg Balance Scale. Journal of

Physiotherapy. 61 (2015):46.

Dunsky, Ayelet, Aviva Zeev, dan Yael Netz. 2017. Balance

Performance Is Task Specific in Older Adults. DOI:

10.1155/2017/6987017.

Fernandes, Viviane Lemos Silva; Ribeiro, Darlan Martins

et al. Postural changes versus balance control and

falls in community-living older adults: a systematic

review. Fisioter. Mov. 2018. ISSN 1980-5918.

http://dx.doi.org/10.1590/1980-5918.031.ao25.

Gibson, John. 2002. Fisiologi dan Anatomi Modern untuk

Perawat. Jakarta: EGC.

ICOH 2019 - 1st International Conference on Health

208

Hawari, Dadang. 2001. Manajemen Stres, Cemas, dan

Depresi. Jakarta: Fakultas Kedokteran Universitas

Indonesia

Hines, Tonya. 2018. Anatomy of the Spine. Ohio: Mayfield

Clinic.

Ira, Suryani. 2013. Senam Osteoporosis.

Irfan. (2016). Keseimbangan pada Manusia. Available at:

https://ifi.or.id/artikel02.html# [Acceseed 25 Jan. 2019].

Jahari, Abas Basuni dan Prihatini Dan Sri. 2014. Risiko

Osteoporosis di Indonesia. Bogor: Puslitbang Gizi dan

Makanan Depkes RI.

Jang, Hyun-jeong, Myung-jun Kim, dan Suhn-yeop Kim.

2016. Effect of thorax correction exercises on flexed

posture and chest function in older women with age-

related hyperkyphosis. The Society of Physical Therapy

Science. 27: 1161–1164.

Kado, Deborah M. 2014. The Rehabilitation of

Hyperkyphotic Posture in the Elderly. European Journal

Of Physical And Rehabilitation Medicine. 45(4): 583-

593.

Kado, Deborah M, Katherine Prenovost, dan Carolyn

Crandall. 2007. Hyperkyphosis in Older Persons.

Annals of Internal Medicine. Ann Intern Med. 47:330-

338

Katzman, Wendy B dkk. 2010. Age-Related

Hyperkyphosis: Its Causes, Consequences, and

Management. Journal Orthophedic Sports Physical

Therapy. 40(6): 352–360.

Kauffman, Timothy L dkk. 2014. A Comprehensive Guide

to Geriatric Rehabilitation. London: Elsevier Ltd.

Kemkes RI. 2017. Analisis Lansia di Indonesia. Jakarta:

Kementerian Kesehatan Republik Indonesia.

Kvell, Krisztián dkk. 2011. Molecular and Clinical Basics

of Gerontology. University of Pécs. Available at:

https://www.tankonyvtar.hu. [Acceseed 26 Jan 2019].

Lange, U dkk. 2005. Exercises and Physiotherapeutic

Strategies for Preventing and Treating Osteoporosis.

Europa: Medicophys. 41(2): 173-181.

Lin, Harrison W dan Neil Bhattacharyya. 2012. Balance

Disorders in the Elderly: Epidemiology and Functional

Impact. 122:1858–1861.

Loretz, Lorraine. 2005. Primary Care Tools for Clinicans:

A Compendium of Forms, Questionnaires, and Rating

Scale for Everyday Practices. Massachusetts: Elsevier

Health Sciences.

Maryam, R. Siti dkk. 2008. Mengenal Usia Lanjut dan

Perawatannya. Jakarta: Salemba Medika.

Mayfield. 2018. Anatomy of the Spine. Myfield Clinic.

McGinnis, Peter Merton. 2005. Biomechanics of Sport and

Exercise. Australia: Human Kinetics.

Middleditch, Alison dan Oliver, Jean. 2005. Functional

Anatomy of the Spine. London: Elsevier Health

Sciences.

Miko, Ibolya. 2018. Effect of a Balance-Training

Programme on Postural Balance, Aerobic Capacity and

Frequency of Falls in Women with Osteoporosis:

Journal Rehabilitation Medic. 50: 542–547.

National Early Warning Score. 2017. National Early

Warning Score 2 (NEWS2). London: Royal College of

Physicians.

Nugroho, Wahyudi. 2000. Keperawatan Gerontik Edisi

Kedua. Jakarta: EGC.

Page, Phill, et.al.. 2010. Assesment and Treatment of

Muscle Imbalance: The Janda Approach. Sheridan

Books, Printed in the United States of America, Hal 5.

Paterson, Jane. 2009. Teaching Pilates for Postural Faults,

Ilness and Injury. Elsavier’s Health Sciences Rights

Departement. Philadelphia. Hal 18-19.

Pearce, Evelyn Clare. 2009. Anatomi dan Fisiologi untuk

Paramedis. Jakarta: Gramedia.

Pollock, Alexandra S. 2000. What is balance?. Clinical

Rehabilitation. 14: 402–406.

Rubenstein, Laurence Z. 2006. Falls in Older People:

Epidemiology, Risk Factors and Strategies for

Prevention. Age and Ageing. 35(2): ii37–ii4.

Savitri, Astrid. 2016. Waspadalah Masuk Usia 40 ke Atas.

Jakarta: Pustaka Baru Press.

Setyoadi, Yulian Wiji Utami, dan Sheylla Septina. 2013.

Senam dapat Meningkatkan Keseimbangan Tubuh

Lansia di Yayasan Gerontologi Kecamatan Wajak

Kabupaten Malang. Jurnal Ilmu Keperawatan. 1(1): 35-

40.

Shariatzadeh, Hooman. 2017. The Effect of Dynamic

Hyperextension Brace on Osteoporosis and

Hyperkyphosis Reduction in Postmenopausal

Osteoporotic Women. Archives Of Bone And Joint

Surgery. 5(3): 181-185.

Simanjuntak, Farida M. 2013. Hubungan Pemanfaatan

Senam Osteoporosis dengan Kualitas Nyeri

Muskuloskeletal pada Lansia di Klinik Aurel Medika

DS. Dukuh Cisaem Subang Tahun 2013. Bekasi.

Supriyono, Eko. 2015. Aktifitas Fisik Keseimbangan Guna

Mengurangi Resiko Jatuh pada Lansia. Jurnal Olahraga

Prestasi. 11(2): 91-95.

Tisher, Kristen dkk. 2018. Functional Measures Show

Improvements After a Home Exercise Program

Following Supervised Balance Training in Older Adults

with Elevated Fall Risk. Physiotherapy Theory and

Practice. DOI: 10.1080/09593985.2018.1444116.

Umamah, Farida dan Faisal Rahman. 2016. Hubungan

Senam Osteoporosis dengan Kejadian Osteoporosis

pada Peserta Senam di Rumah Sakit Islam Surabaya.

Jurnal Ilmiah Kesehatan. 9(2): 114-120.

Watson, Mary Ann. 2008. The Human Balance System—A

Complex Coordination of Central and Peripheral

Systems. Vestibular Disorders Association.

Vasc Health Risk Manag. 2007. Summary of the 2007

European Society of Hypertension (ESH) and European

Society of Cardiology (ESC) Guidelines for the

Management of Arterial Hypertension. 3(6): 783.

W Kemmler dan S. Von Stangel. 2013. Exercise frequency,

health risk factors, and diseases of the elderly. Arch

Phys Med Rehabil. DOI: 10.1016/j.apmr.2013.05.013.

WHO. 2011. Global Health and Aging. US: National

Institute on Aging and National Institutes of Health.

Yanagawa, Teri L dkk. 2000. Assessment of Thoracic

Kyphosis Using the Flexicurve for Individuals with

Osteoporosis. Hong Kong Physiotherapy Journal. 18(2):

53-57.

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