E:\IBUK\NERS DESEMBER 2021\10-- 328 Jurnal Ners dan Kebidanan, Volume 8, Issue 3, December 2021, page 328–333 Control Blood Sugar Levels by Brisk Walking Method Sriwahyuni1, Junaidin2, Jamila Kasim3, Noviyati Hamundu4, Sri Darmawan5 1Nurse Study Program, STIKes Nani Hasanuddin Makassar, Indonesia 2Nursing Study Program, STIKes Amanah Makassar, Indonesia 3Nursing Diplomatiga Study Program, STIKesNani Hasanuddin Makassar, Indonesia 4S1 Nursing Study Program, STIKes Nani Hasanuddin Makassar, Indonesia 5Nursing Diplomatiga Study Program, STIKes Nani Hasanuddin Makassar, Indonesia JURNAL NERS DAN KEBIDANAN (JOURNAL OF NERS AND MIDWIFERY) http://jnk.phb.ac.id/index.php/jnk JNK History Article: Received, 24/06/2021 Accepted, 27/07/2021 Published, 05/08/2021 Keywords: Brisk Walking, Blood Sugar Levels Article Information Abstract Diabetes mellitus (DM) is a chronic disease, and specific treatments are needed in order to control blood glucose. In addition to pharmacological therapy, non-pharmacology therapy also takes an important role to control blood glucose levels and should be done regularly. Brisk walking is one example of physical activity which included in non-pharmacology therapy and can improve body expenditure. This activity can help DM patient to control their blood glucose level within the normal range. The physical ac- tivity of Brisk Walking, which is one type of exercise that can maintain blood sugar levels within the normal range, especially in people with Diabetes Mellitus. This study aimed to determine the effect of Brisk Walking on the blood glucose level of DM patients at Tamalenrea Health Center Makassar City. This study adopted a quasy experiment and a one-group pre-post test design. A total of 16 respondents were selected purposively based on the determined criteria. Data analysis of the difference of blood sugar level be- tween the treatment and control was carried out by using the Spearman correlation test with SPSS version of 21. The difference was significant with the value of p < 0.05. The results showed that the physical activity of Brisk Walking could control blood sugar levels. Statistical analysis showed that the average blood sugar content was significantly lower in patients practic- ing Brisk Walking (blood sugar level <200 mg/dl)(176.06%) than the control (blood sugar level > 200 mg/dl) (218.81%). So it can be concluded that by doing physical activity Brisk Walking can control blood glucose levels. © 2021 Journal of Ners and Midwifery 328 Correspondence Address: STIKes Nani Hasanuddin Makassar – East Java, Indonesia P-ISSN : 2355-052X Email: sriwahyunicallista@gmail.com E-ISSN : 2548-3811 DOI: 10.26699/jnk.v8i3.ART.p328–333 This is an Open Access article under the CC BY-SA license (http://creativecommons.org/licenses/by-sa/4.0/) https://doi.org/10.26699/jnk.v8i3.ART.p328-333 https://crossmark.crossref.org/dialog/?doi=10.26699/jnk.v8i3.ART.p328-333&domain=pdf&date_stamp=2021-12-26 329Sriwahyuni, Junaidin, Kasim, Hamundu, Darmawan, Control Blood Sugar Levels by Brisk Walking Method INTRODUCTION Diabetes mellitus (DM) includes in the ten non- communicable diseases that occupy the top rank of most cases and are the diseases with the largest financing burden in Indonesia (Wahyuningrum et al 2020). According to the World Health Organization (WHO) in 2015, 415 million adults suffer from dia- betes, a 4-fold increase from 108 million in 2015. 1980s. By 2040 it is estimated that the number will be 642 million. Nearly 80% of people with diabetes live in low- and middle-income countries and are the 6th leading cause of death by 2030 (World Health Organization 2016). WHO predicts an increase in the number of people with diabetes mellitus in In- donesia from 8.4 million in 2000 to around 21.3 mil- lion in 2030, this shows an increase in the number of people with diabetes mellitus by 2-3 times in 2034. Diabetes mellitus (DM) is a metabolic disease char- acterized by high blood sugar levels (hyperglyce- mia) that occurs due to insulin disorders and insulin work disorders or a combination of both. (Azitha, Aprilia, & Ilhami, 2018). Diabetes is a chronic dis- ease where blood therapy is needed to be able to check glucose levels properly, in addition to phar- macological therapy that is needed in addition to therapy to control glucose. Type 2 diabetes (DMT2) is the most common form of diabetes. T2DM treat- ment therapy consists of five main components, namely diet regulation, exercise, monitoring of meta- bolic status, pharmacological therapy, and pharma- cological therapy (Ali, 2011, Rudianto et al 2011). Most DMT2 patients have difficulty in self-man- agement regarding physical activity, eating health, drug use, blood glucose monitoring, and stress man- agement (Aghili et al 2016). According to the doctor’s perspective, most of the patients who re- ceiving insulin therapy failed to achieve therapy tar- gets caused by lifestyle factors, non-compliance, and about medical expenses not covered by insur- ance (out-of-pocket costs). Among the components of DM therapy, the adoption and maintenance of physical activity is an important focus for blood glu- cose management and overall health in individuals with diabetes and prediabetes. Recommendations and precautions vary depending on individual char- acteristics and health status. Physical activity in- cludes all movements that increase energy use, whereas exercise is planned, structured physical activity. Exercise improves blood glucose control in type 2 diabetes, reduces cardiovascular risk fac- tors, contributes to weight loss, and improves well- being (Chen et al 2015). Regular exercise can pre- vent or delay the development of type 2 diabetes (Schellenberg et al 2013). Regular exercise also has considerable health benefits for people with type 1 diabetes (eg, improved cardiovascular fitness, muscle strength, insulin sensitivity, etc.) (Yardley et al 2014). The challenges associated with blood glu- cose management vary with the type of diabetes, the type of activity, and the presence of diabetes- related complications (Colberg et al 2010). There- fore, recommendations for physical activity and exercise must be tailored to meet the specific needs of each individual. Physical activity is defined as any body movement produced by skeletal muscles that requires energy expenditure (Chen et al 2015). Physical activity is body movement that is pro- duced by muscles and produces energy. Physical activity that is done repeatedly can maintain physi- cal and mental health, as well as the quality of life to stay healthy (Sakung, et.al 2018). Lack of physi- cal activity is a big enough factor for a person to be overweight and weaken the work of vital organs such as the heart, liver, kidneys, and pancreas. Lack of physical activity ca n also cause diabetes. (Rahmatul Fitriani, 2016). Physical exercise or ex- ercise in people with diabetes has a very important role. The type of physical exercise recommended for people with diabetes mellitus is brisk walking, which is a type of aerobic exercise that aims to improve health and fitness, especially to improve the function and efficiency of the body’s metabo- lism so that it will help control blood sugar levels. Aerobic exercise involves repeated and continuous movement of large muscle groups (Physical Activ- ity Guidelines Advisory Committee, 2009). Activi- ties such as walking, cycling, jogging, and swim- ming rely primarily on aerobic energy-producing systems. Brisk walking or brisk walking is a type of exercise that can keep blood sugar levels within normal limits. Light exercise that can be done is walking for 30 minutes and brisk walking for 20 minutes (Suyono et al 2011). According to Houmard (2003) brisk walking is one of the sports that is done with a duration of 30-60 minutes, a frequency of 3- 5 times a week and if done regularly will increase insulin work, stimulate glycogen synthesis through increased insulin action and stimulate glucose trans- port by glucose transporters. GLUT4 (Fenny Rosa Indah, 2013). Brisk walking is a sport that is very easy to do, because it can be done anywhere, es- pecially outside the home and does not cost any- 330 Jurnal Ners dan Kebidanan, Volume 8, Issue 3, December 2021, page 328–333 thing (Listyarini & Fadilah, 2017). Based on data from the Tamalanrea Community Health Center Makassar City, it shows that the number of visits by people with diabetes mellitus in 2016 was 859 (8.59%) people, increased in 2017 to 897 people, increased again in 2018 to 977 (10%). people, while in January to June 2019 there were 246 people. The results of interviews with implementing nurses at the time of initial data collection showed that most people with diabetes mellitus only gave pharmaco- logical drugs to patients. Based on the explanation of the background above, the researcher is inter- ested in conducting a study with the title “The Ef- fect of Brisk Walking of Diabetes Mellitus Patients on Control of Blood Sugar Levels in the Working Area of the Tamalanrea Health Center Makassar City”. METHOD This study adopted a quantitative research us- ing the Quasy Experiment method with one group pre-post test design. The effectiveness of the treat- ment was assessed by comparing the pre-test and post-test scores. The sampling technique in this study used accidental sampling. The sample in this study was 20 people. This studywas conducted at the Puskesmas Tamalanrea Makassar City from Oc- tober 8th to November 8th, 2019. a. Inclusion Criteria 1) Patients with diabetes mellitus who seek treatment at the Puskesmas Tamalanrea Makassar City 2) Patients aged 30-65 years 3) The patient is conscious 4) Patients who are willing to be respondents 5) Does not depend on insulin injections 6) Patients who are willing to follow the brisk walking 3 times a week within 30 minutes as far as 2 miles b. Exclusion Criteria 1) Patients who do not regularly follow a schedule 2) Patients whose body condition does not allow for physical activity 3) People with gestational diabetes Data analysis of the difference between the treatment and control was carried out by using the Spearman correlation test with SPSS version of 21. The difference is significant if the value of p < 0.05. The results of Table 1 show that of the 16 re- spondents, 13 respondents (81.3%) have an age of 56-65 years. A total of 10 respondents (62.5%) were female. A total of 7 respondents (43.8%) who have a bachelor’s level education. as many as 16 respon- dents (100%) married status. A total of 8 respon- dents (50.0%) have had diabetes mellitus for a long time. RESULT 1. Univariate analysis Characteristics (n) (%) Age 45-55 years 3 18.8 56-65 years 13 81.3 Sex Man 6 37.5 Women 10 62.5 Education High school 6 37.5 D3 2 12.5 S1 7 43.8 Retired 1 6.3 Married Status Married 16 100 Long Suffering 1-5 Years 8 50.0 6-10 Years 6 37.5 11-15 Years 1 6.3 16-20 Years 1 6.3 Table 1 Frequency distribution based on demographic characteristics (n = 16) When blood sugar Mean Min-Max Brisk Walking Physical Activity Pre Test 218.81 101-314 Brisk Walking Post Test Physical Activity 176.06 124-251 Table 2 Characteristics of The Distribution of Blood Sugar Respondents During the Pre-test and Post-test Physical Activity of Brisk Walking In Table 2, the blood sugar during the pre-test, physical activity of Brisk walking, has an average value of 218.81 mg / dl, a minimum blood sugar level of 101 mg / dl is a maximum of 314 mg / dl and a post-test blood sugar level of physical activ- ity of Brisk walking has an average value of 176.06 mg. / dl minimum 124 mg / dl and maximal 251 mg / dl. 331Sriwahyuni, Junaidin, Kasim, Hamundu, Darmawan, Control Blood Sugar Levels by Brisk Walking Method Based on Table 3, the difference in the mean ± Std.Deviation in Brisk walking physical activity is 42.740 ± 67.589. The results of the Paired T Test obtained a t value of 2.530 and a p value = 0.023 <á = 0.05, so the alternative hypothesis (Ha) is ac- cepted and the null hypothesis (H0) is rejected. In- terpretation is the effect of physical activity of Brisk Walking with diabetes mellitus sufferers on con- trolling blood sugar levels while in the working area of Puskesmas Tamalanrea, Makassar City. DISCUSSION The results of the study conducted on 16 re- spondents obtained 11 respondents who have a good activity pattern, because 11 respondents routinely do physical activity brisk walking for 20-30 min- utes, and it is carried out 3-5 times a week with a time of 20-30 minutes and a distance of 2. mill. In this study there were 11 respondents with good physical activity with brisk walking and controlled blood sugar levels, where before the respondents did physical activity brisk walking there were 11 respondents whose blood sugar levels were> 200 mg / dl, and there were 5 respondents whose blood sugar levels < 200 mg / dl. However, when respon- dents do physical activity brisk walking 3-5 times a week with a time of 30 minutes and a distance of 2 miles is good and routine, their blood sugar levels fall bellow 200 mg/dl. When exercising, the body requires extra en- ergy which causes the muscles in the body to ab- sorb glucose which helps lower blood sugar levels in the body. It is known that age is closely related to an increase in blood sugar levels because insulin production begins to decrease, this is an increase in fat levels in the muscles so that it is more difficult for glucose to be used as energy for activities, but when someone does activities regularly and cor- rectly it will help muscle movement. so that it can accelerate blood circulation and by doing activities can reduce blood sugar levels. In this study, there were 5 respondents who had uncontrolled blood sugar levels, did not experi- ence a significant change between before and af- ter physical activity brisk walking with a time of 30 minutes and a distance of 2 miles. By doing good physical activities can reduce the amount of fat and increase tissue metabolism, such as increasing muscle strength, nerves and bones. Physical activity brisk walking can also re- duce blood pressure and bad cholesterol and in- crease good cholesterol. Meanwhile, there were 4 respondents who had a bad activity pattern where the respondents did not do physical activity properly and correctly with the specified time and distance because the respon- dent said they did not have enough time to do physi- cal activity brisk walking. Thus these 4 respondents were excluded from the studyresults because they did not match the inclusion criteria. This study is in accordance with the research conducted by (Listyarini & Fadilah, 2017). From the results of the research conducted, the following conclusions were obtained (1) There was an effect of brisk walking on reducing blood glucose levels in diabetes mellitus sufferers. (2) There is a differ- ence in the results of the study between the inter- vention and non-intervention groups. From the re- sults of this study, it showed that the average value after doing the brisk walking, the blood sugar levels of diabetes mellitus sufferers were able to decrease on average to 184.79 mg / dl, there was a decrease in blood sugar levels by an average of 19.26 mg / dl. although most of them experienced a decrease, there were also those who experienced an increase in blood sugar levels, this was because this was due to the lack of dietary supervision on the re- spondents. So the conclusion of the study is that there is an effect of brisk walking on reducing blood glucose levels in people with diabetes mellitus. Resea r ch r esult (Rehma ita , Muda tsir, 2018)showed a significant effect on reducing blood sugar levels in patients with type 2 diabetes melli- 2. Bivariate Analysis Statistical test between variables Mean Std. Deviation T Score  Brisk walking pre test of physical activity - Post test of physical activity of brisk walking 42,750 67,589 2,530 0.023 Table 3 The effect of physical activity of Brisk Walking with diabetes mellitus on controlling blood sugar levels 332 Jurnal Ners dan Kebidanan, Volume 8, Issue 3, December 2021, page 328–333 tus and walking. By doing good and proper physi- cal activity, regularly can stabilize blood sugar lev- els. Physical exercise has an important role in con- trolling blood sugar levels. Likewise with the research results (Yitno & Riawan Wahyu, 2017)stated that after doing a light walk for 30 minutes from 24 respondents. The re- sults of this study indicate the effect of 30 minutes of walking exercise on reducing blood sugar levels in people with diabetes mellitus. This is proven by walking for 30 minutes can reduce blood sugar lev- els in people with diabetes mellitus. Research conducted Fahrunnisa, E, R Setyowati (2019)shows that during the pre-test and post-test the average blood sugar level before a leisurely walk was 194.17 mg / dl. while the mean of blood glu- cose after a leisurely walk was 182.7 mg / dl. This is because during physical activity, brisk walking can cause glucose in the body to be used through the work of the insulin hormone due to the increased sensitivity of insulin receptors in muscles during exercise to produce energy. Regular exercise can reduce insulin resistance so that insulin can be used better by the body’s cells and can lower blood sugar levels. Likewise with (Fauzi, 2013)states that research conducted on moderate walking and high walking shows a decrease in blood sugar levels in diabetes mellitus patients (blood sugar when <250 mg / dl). It can be concluded that there is an effect of mod- erate and high intensity walking on reducing blood sugar levels in diabetes mellitus patients. Exercise, in this case walking with moderate intensity, is more recommended for people with diabetes mellitus. This can lower blood glucose because it can in- crease muscle glucose compared to the release of hepatic glucose. By doing walking, it is possible to prevent in- creased insulin resistance, glucose intolerance and obesity. This study is also supported by the research conducted (Nurayati & Adriani, 2017)which states that there is a relationship between physical activ- ity and fasting blood sugar levels in diabetics. 62.9% of respondents have low activity and as many as 58.0% of respondents have fasting blood sugar levels in the high category. The results of this study show that there is a relationship between physical activ- ity and fasting blood sugar levels in diabetes melli- tus sufferers, it is better if diabetes mellitus suffer- ers can apply physical activity. good and routine such as cycling or walking 3-4 days a week with 20 minutes every day and reducing sitting activity so that fasting blood sugar levels are controlled CONCLUSION There is an effect of physical activity of brisk walking with diabetes mellitus on controlling blood sugar levels in the working area of the Puskesmas Tamalanrea Makassar City with a statistical test, the value of p = 0.023