JRSSEM 2023, Vol. 02, No. 6, 930 – 937

E-ISSN: 2807 - 6311, P-ISSN: 2807 - 6494

DOI : 10.36418/jrssem.v2i06.353 https://jrssem.publikasiindonesia.id/index.php/jrssem

PHYSIOTHERAPY MANAGEMENT TO PREVENT COVID-19

BY IMPROVED PHYSICAL ACTIVITY IN ELDERLY

Andung Maheswara Rakasiwi

Ade Irma Nahdliyyah

1,2

Pekalongan University, Health Faculty, Diploma 3 physiotherapy, Indonesia

e-mail: maheswaraandung@gmail.com, adeirmanahdliyyah@gmail.com

*Correspondence: maheswaraandung@gmail.com

Submitted

: 20

December 2022

Revised

: 10

January 2023

Accepted

: 17

January 2023

Abstract: Coronavirus 2019 (Covid 19) is an acute respiratory syn-drome caused by the corona-2

virus (SARS-CoV-2). Meanwhile, elderly is a condition characterized by a decline in the tissue's self-

repairing func-tion. This decline causes various diseases and health problems, hence, efforts are

needed to improve their physical condition and health after retirement. Therefore, this study aims

to reduce the impact of Covid-19 on the elderly as well as to provide an overview of the physical

problems associated with the virus and its prevention measures. This is an experimental study with

a pre-experimental research design in the form of a one-group pre-post-test design. The results

showed a probability with a p-value of <0.05, which indicates that physiotherapy management in

the elderly during Covid-19 increased their physical activity, thereby eliminating the risk of

exposure to the virus. The statistical analysis results showed that there was a sig-nificant difference

between the pre-test and post-test on physiotherapy management. Furthermore, physical activity

had a p-value of 0.015, which indicates that the level of physical activities carried out did not

change, but it served as a motivation. The fear of contracting the virus had a p-value of 0.007, which

shows that information on physical activity provided by physiotherapists had no effect on their fea.

Keywords: Covid-19; Elderly Physical Activity; PASE Scale.

Andung Maheswara Rakasiwi

Ade Irma Nahdliyyah

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INTRODUCTION

Coronavirus was identified from

several cases in Wuhan City, China, and in

mid-March, it was declared a pandemic by

WHO after infecting more than 150,000

people and causing more than 5,000

deaths in 123 countries around the world.

Consequently, all healthcare workers

including physiotherapists / physical

therapists have an important role in

managing the effects of the virus. This

study gathers relevant information that can

help rehabilitation professionals to

understand the virus and related diseases

as well as their role in management and

prevention. The disease is caused by the

Severe Acute Respiratory Syndrome

Corona-2 Virus (SARS-CoV-2), a single-

stranded ribonucleic acid (RNA)

encapsulated coronavirus. It is majorly

transmitted through relatively large

particles deposited in the air as well as

direct contact with a patient. At present,

there is still no specific antiviral treatment

for the infection, apart from supportive

therapy, such as respiratory care for

affected patients, especially in more severe

cases.

Approximately 15% of people with

COVID-19 also develop moderate to severe

diseases, and they often require

hospitalization and oxygen support.

Furthermore, 5% of the cases require

admission to the Intensive Care Unit as well

as supportive therapies, such as intubation

and ventilation.

The most common

complication in severe cases of the

infection is acute pneumonia, while others

include acute respiratory disorder

syndrome (ARDS), sepsis, and septic shock.

Meanwhile, multiple organ failures, such as

acute kidney and cardiac injuries are more

prevalent among the older age group > 70

years as well as patients with co-morbid

health problems, such as cardiovascular

disease, diabetes, lung disease, and

immunosuppression.

In the elderly, the disease is

characterized by respiratory muscle

atrophy, decreased long recoil elasticity,

increased size, pulmonary compliance as

well as tracheal and central airway stiffness.

They can also experience enlargement of

the alveolar duct, which causes an increase

in the transmural pressure gradient during

inspiration. Furthermore, the pressure

gradient helps to produce normal lung

expansion, improve gas exchange, and

prevent disruption of the oxygen delivery

process in the network.

The state of being

elderly is not a disease but an advanced

stage of life process that is characterized by

a decrease in the body's ability to adapt to

environmental stress. Generally, signs of

aging begin to appear from the age of 45

years, while health challenges start arising

around the age of 60 years. This process is

often accompanied by a decrease in life

quality which leads to several health

problems. One of the challenges associated

with the condition is imbalance, which

causes falling.

MATERIALS AND METHODS

This study aims to determine the

effectiveness of physiotherapy

management on the prevention of COVID-

19 in the elderly. Furthermore, this is an

932 | Physiotherapy Management To Prevent Covid-19 By Improved Physical Activity In Elderly

experimental study with a pre-experimental

design in the form of a one-group pretest-

posttest design, which compares the

physical activity level before and after

treatment. The sample population contains

a total of 23 elderly people aged between

50-70 years.

Study Design:

This is an experimental study that

uses a pre-experimental design in the form

of a one-group pretest-posttest design

Study Location

This study was conducted in the

elderly community.

RESULTS AND DISCUSSION

The table below shows the samples’ age and gender.

Table 1. Number of Elderly Responden

Gender

Fre-

quency

Percent

Valid

Percent

Cumulative

Percent

Valid

4.2

Male

58.3

62.5

Female

37.5

100.0

Total

100.0

From the table, 23 elderly people were used as the research subjects, with a total of 14

males and 9 females.

Table 2. Physical activity relationship between the elderly before and after the intervention

Premanagementp

hysiotherapy

Post

Management

physiotherapy

Physical activity

before

management

physiotherapy

Physical

activity after

management

physiotherapy

Before

getting

information,

fear of

contracting

the corona

virus

Before

getting

information,

fear of

contracting

the corona

virus

Chi-Square

5.261

15.217

8.435

12.565

7.348

Asymp.

Sig.

.022

.000

.015

.000

.007

Based on the table above with chi-

square, the physiotherapy management

probability for Covid-19 had a p-value of

0.000, p-value <0.05, which indicates that

there was a significant difference between

the pre-test and post-test. Meanwhile, the

elderly physical activity had a p-value of

0.015, which shows that the level of physical

Andung Maheswara Rakasiwi

Ade Irma Nahdliyyah

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activities carried out during the pandemic

did not change but it can serve as a

motivation. The information on the fear of

contracting the virus had a p-value of 0.007,

which indicates that the information on

physical activity provided by the

physiotherapists did not change their fear

of being exposed to Covid-19.

Discussion

Physiotherapy management in the elderly

The cardiovascular activity of every

physical activity is good, but the better its

intensity and quantity, the greater the

health benefits. Furthermore, regular

physical activity is associated with a

reduced risk of several diseases, including

cancers and dementia. Patients with long-

term disease conditions can benefit

substantially from physical activity, which

helps to prevent and manage several

chronic conditions and diseases. The British

Geriatrics Society has established its

protective function in older adults, and they

also stated that protecting parents from

Covid-19 must not compromise their

health and well-being. Staying indoors

more often has a negative effect on old

people as they are more likely to become

deconditioned, and lose their muscle

strength due to a lack of activity. Similarly,

increased inactivity among self-isolating

elderly leads to an increased risk of falling

and related injuries. Low levels of physical

activity also cause reduced strength, which

leads to loss of independence and the need

for future care. Consequently, the Public

Health UK, Sheffield Hallam University

(SHU), the National Center for Sport and

Exercise Medicine (NCSEM), and Sport UK

have developed an ‘Active at Home’

booklet to provide practical guidance on

home-based activities that can help to

maintain their strength and balance. The

Public Health England NFPCG also

provided expert advice on preventing falls,

fractures and promoting healthy aging. In

response to Covid-19, NFPCG members

have supported the development of several

new resources to address the current issues

surrounding falls and fractures (Akira &

Takeda, 2004; Gleeson, 2007; Nieman &

Wentz, 2019).

Coronavirus has infected many

people around the world, and in Indonesia,

more than 80,000 people have tested

positive for the disease. Strengthening the

body's immune system is a way of

preventing the spread of the virus, and it

can also protect the body from other

diseases (Gleeson, 2007). Meanwhile, pre-

Covid-19 data shows that there have been

various efforts across the UK to keep the

nation active, even among inequalities such

as women, adults above 55 years, disabled

as well as people with long-term

conditions. A recent Sport England survey

showed that 2 out of 3 (62%) adults

confirmed the importance of being active

and a similar proportion namely 69% and

65% believe that it helps to maintain their

physical and mental health respectively.

The survey also showed that physical

activity levels had decreased, where 31% of

adults did more activity, but 41% did less

with 30%-38% in children. Therefore,

efforts are needed to maintain the medical

advancement achieved in the last ten years

as well as to manage and recover from the

effects of the pandemic. The survey showed

that adults need to minimize the time spent

on motion, and all citizens also need to

934 | Physiotherapy Management To Prevent Covid-19 By Improved Physical Activity In Elderly

abstain from long-term inactivity.(Nieman

& Wentz, 2019; ShahAli et al., 2020; Thomas

et al., 2020) Strengthening and balancing

activities are an important part of

maintaining a healthy body for all age

groups. Furthermore, they help to build

healthy bones during childhood, maintain

strength in adulthood, and prevent the

decline in muscle mass and bone density

during old age. There are a variety of ways

to participate in these activities, such as

lifting heavy objects, taking yoga or pilates

classes, playing ball games, or badminton.

However, some of these activities are more

difficult to maintain indoors, but there are

resources and guidance that can be

followed.(Akira & Takeda, 2004; Gleeson,

2007; Nieman & Wentz, 2019).

The novel coronavirus 2019 (2019-

nCoV) causes respiratory system disorders,

acute pneumonia or lung infection as well

as kidney failure, and WHO officially named

it Covid-19 (Coronavirus disease 2019). At

present, there is no vaccine for the disease

(Pudjiastuti & Utomo, 2003; SANTOSO et

al., 2014; Thomas et al., 2020; Utomo &

Takarini, 2009)

, consequently, the

Indonesian Ministry of Health has urged all

citizens to always live a hygienic life and

maintain their immune system. The human

body has an immune system that fights

disease-causing viruses and bacteria, but

various factors impair their function, such

as aging, malnutrition, diseases, and some

drugs. Therefore, this function needs to be

maintained to increase the effectiveness of

the system. The consumption of foods rich

in antioxidants, such as vegetables and fruit

help the body to fight free radicals and

maintain the immune system. Increased

level of free radicals in the body leads to a

decrease in the immune system function,

which increases the risk of Covid-19

infection. It is also advisable to increase the

consumption of lean meats, nuts, and seeds

because they enhance the body’s immunity.

Subsequently, onions and ginger can be

consumed because they help the body

fight against infection and reduce

inflammation. (Gleeson, 2007; Morey et al.,

2015).

Regular exercise increases the body's

endurance and reduces the risk of

inflammation, hence, it is important to

exercise the body for at least 30 minutes

every day. It is also important to manage

stress because it increases the production

of cortisol, thereby decreasing the body’s

immunity. Furthermore, stress can be

controlled with various activities including

getting enough sleep every day, hanging

out with friends, sightseeing, meditation,

and engaging in fun-filled activities. Rest is

very essential as the lack of sleep has a

negative effect on health, such as a

decrease in body resistance against

diseases. Moreover, several studies have

showed that adults need approximately 7–

8 hours of sleep every day, while children

need 10 hours or more (Özkeskin et al.,

2020; ShahAli et al., 2020; Thomas et al.,

2020).

Physiotherapy management is a

highly recommended therapy for the

elderly because it strengthens their

immune system and reduces the spread of

Covid-19 to the lungs. Furthermore, it

involves performing various physical

activities which helps to improve the body’s

fitness and help with breathing.

Some of the recommended activities

include:

Andung Maheswara Rakasiwi

Ade Irma Nahdliyyah

| 935

1. Exercise at leisure: Activities that

make the body inactive, such as

watching TV and reading need to be

avoided because they decrease the

body’s fitness.

2. Outdoor activities: Outdoor

activities, such as walking, light

exercise, and stretching can be

carried out to improve physical

fitness, but attention needs to be

paid to Covid-19 protocols.

3. Engaging in recreational sports:

This can be performed by

combining sports activities with

recreation, such as playing light

games, jogging, swimming, and

cycling. Furthermore, they can be

carried out with children or family

because it provides physical and

cognitive relaxation, which help to

activate the immune system and

facilitate the production of more

hormones.

4. Moderate exercise: This includes

sports activities such as tennis,

badminton, and other activities that

require good energy and physical

strength. Family members can

accompany the elderly while

carrying out the activities and

attention needs to be paid to their

abilities.

5. Muscle strength training: These

exercises increase muscle strength

and the type of activity carried out

depends on individual’s capability.

For example, lifting a barbell with a

weight of 1/2 kg, push-ups in

certain positions increases the

arms’ strength as well as the body’s

endurance.

6. Household activities involves the

movement of many joints, and they

enhance the fitness of muscles,

ligaments, joints as well as

respiratory and cardiovascular

organs. Furthermore, performing

more functional activities maintains

the movement/motion range of

joints and prevents hypokinetic

diseases (lack of movement).

7. Elderly gym activities can be carried

out together with the community.

Gymnastics requires guides and

instructors to increase its

effectiveness as well as to prevent

injuries. Moving the joints or body

to a certain degree helps the elderly

stay fit and healthy.

8. Breathing exercises that can

improve the body’s fitness need to

be carried out along with physical

exercises to maintain the

respiratory function of patients with

long-term respiratory

distress.(Fletcher et al., 2001;

Goveas & Shear, 2020; Parmar &

Modh, 2013)

CONCLUSIONS

This study aims to determine the

effectiveness of physiotherapy

management carried out for the elderly

during the Covid-19 pandemic as well as to

assess the physical activities that improved

fitness levels and their effect on the body’s

immunity. The physical activities carried out

before the intervention was limited to daily

work activities at home, while sport

activities that can improve the body’s

fitness were rarely performed due to a tight

936 | Physiotherapy Management To Prevent Covid-19 By Improved Physical Activity In Elderly

work schedule. There-fore, physiotherapy

management is needed to support or

monitor the level of activity carried out.

Family members, medical personnels, and

the community also need to support

elderly people with declining physical and

functional conditions to improve their

physical fitness. These efforts increases

their immunity and reduces the risk of

exposure to Covid-19 caused inactivity

during the pandemic.

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