The Effect of Virtual Reality Exergame on Physical Activity and Fitness in The Elderly
Phase: NA
Conditions: Healthy Elderly
Sponsor: Hasanuddin University

STUDY PROTOCOL
THE EFFECT OF VIRTUAL REALITY EXERGAME ON
PHYSICAL ACTIVITY AND FITNESS IN THE ELDERLY
--------------------------------------------------------------------------------------------------
ANDI AMIRAH SHALEHA JUNAEDI
Email
: junaediaas21c@student.unhas.ac.id
Phone
: (+62)812 4149 3400
Adress
: Perumahan Phinisi Nusantara residence (RSI
Faisal XVII street), Makassar, South Sulawesi, Indonesia,
90222
Last revised 29 February 2024
1

CHAPTER I
BACKGROUND
As individuals age, there is a decline in biological, physiological, and functional
capacities (Russo et al., 2012; Kushkestani, Parvani, and Moghadassi, 2020).
Functional declines such as muscle strength, endurance, flexibility, balance, mobility,
and speed (Verbrugge, Latham, and Clarke, 2017) lead to an inability to perform daily
activities such as walking, sitting, and standing (Conrad, Cermak, and Drake, 1983).
This, in turn, impacts the quality of life of older adults. A recent approach to evaluating
quality of life, in addition to Life Expectancy, is Healthy Adjusted Life Expectancy
(HALE). The average HALE in Indonesia is 62.25 years, meaning 8.85 years are lost
due to chronic diseases and disabilities (Ministry of Health of the Republic of
Indonesia, 2020).
One strategy for managing chronic diseases and disabilities sustainably is
through prevention via physical activity, such as exercise/sports (Braith and Stewart,
2006; Yeom, Jung, and Choi, 2011). The World Health Organization's (WHO) exercise
recommendations include aerobic exercise, strength training, flexibility, and balance
exercises to reduce the risk of falls (Chodzko-Zajko et al., 2009). Aerobic exercise
stimulates the heart, lungs, all muscle groups, and results in beneficial changes to the
body and mind (Brown et al., 2009).
Scientific evidence shows that the success of physical exercise depends on
adherence to exercise, and among older adults, adherence and motivation tend to
be low. This is due to external factors such as mobility difficulties, distance, or lack of
adaptation to the environment of exercise centers (Brown et al., 2009). Therefore, it is
crucial to consider interventions that improve exercise success among older adults,
particularly due to issues of adherence and motivation. One such intervention is
through exergames (Fragala et al., 2019).
Exergames are physical exercises combined with active play or sports (i.e.,
active video games or sports-based games), serving not only as entertainment but

also as a strategy to improve the fitness of older adults (Fragala et al., 2019).
Exergames also incorporate elements of immersive virtual reality (VR). Virtual reality
(VR) is an active video game that controls body movements within a safe environment,
involving physical activity and interaction. One VR exergame, the Nintendo Switch
RingFit Adventure (RFA), is a novel exergame that integrates resistance training,
aerobic exercise, and balance. VR exergames can address the limitations of repetitive
and monotonous physical exercise by offering an engaging and multisensory game
environment where interaction occurs through full-body movements (Tuan et al.,
2022).
According to a systematic review, VR exergame interventions can improve
physical function, reduce symptoms of depression and anxiety, and enhance health-
related quality of life (Rosenberg et al., 2010; Villafaina et al., 2020). However,
research using the Nintendo Switch RingFit Adventure (RFA) rarely focuses on
fitness levels and physical activity in older adults. Therefore, the researcher is
interested in investigating the effectiveness of virtual reality exergames on fitness
levels and physical activity in older adults.

ᵅ2
CHAPTER II
RESEARCH METHODS
2.1 Research design
This study is an experimental study with a randomized controlled trial – double
blind research design. The researchers and data processor (statisticians) conducting
this experimental study are blinded, meaning it's unaware of the distribution of
samples in the intervention and control groups.
2.2 Place and time of research
The research will be conducted from February 2024 to June 2024 by taking a
population of elderly people in Makassar City.
2.3 Population and sample
a. 
Population
Population is the whole object of research. The target population in this study
were all elderly people in Makassar City. The affordable population is the elderly at
Olive Elderly Community in Makassar City who meet the inclusion criteria.
b. 
Sample
The sample is a portion taken from the entire subject under study and is
considered representative of the entire population. The sample of this study was 40
subjects who were randomly selected and divided into 2 groups.
2.4 Sample Size
The sample size formula for the two mean difference hypothesis test for
numerical variables is as follows :
ᵅ = (ᵄᵄ + ᵄᵄ)2.2 . (ᵆ)2

+ ᵄ
0
ᵅ
Za : Z value for type 1 error
Z : Z value for type 2 error
s2 : variance of the difference of 2 mean pairs
d2 : mean estimate before intervention
Based on previous research, the value of s2 = 3,6 and value d = 3,7 (Wu et
al., 2023). Value Z = 1,96 with a confidence interval of 95% and value Z = 0,84 with
80% power so that,
n =
2x3,6 1.96+0,842
(3,7)2
n = 7
To anticipate the occurrence of dropouts in subjects, corrections were made by :
N = n/(1-f)
Description =
N = correction sample size
n = initial sample size
f = estimated dropout proportion of 20%
so
N = 7/(1-20%)
N = 7/(1-0,2)
N = 7/0,8
N = 8,75  9
This research also has categorical variables, so the sample size formula for
randomized controlled trial hypothesis testing of dichotomous variables with clinical
superiority design is as follows (Zhong, 2009) :
n = 2 × (
ᵄ1−∝
− ᵯ 
1−ᵯ)
2 
× ᵅ × (1 − ᵅ)
n = size per group

1,96 + 0,84
2,5 − 2
p = group response rate (0,5)
ᵄ1−∝= degree of confidence 95% (1,96)
ᵄ1−ᵯ= power 80% (1.84)
d = difference in effect between two groups
0 = clinically acceptable values
Based on previous research, the value of d = 2,5 (Yang et al., 2020) and value
ᵯ0 = 2 (Wright et al., 2011), so
2
n = 2 × (
) × 0,5 × (0,5)
n : 15,68  16
To anticipate the occurrence of dropouts in subjects, corrections were made by :
N = n/(1-f)
Description =
N = correction sample size
n = initial sample size
f = estimated dropout proportion of 20%
so
N = 16/(1-20%)
N = 16/(1-0,2)
N = 16/0,8
N = 20
Based on the sample formula used, each group had a minimum of 20 subjects
with a total of 40 subjects divided into 2 groups to reduce bias. The first group is the
Ring Fit Adventure virtual reality exergame training group as the intervention group
and the second group is the elderly aerobic exercise group from KEMENKES as the
control group. The sampling technique used was cluster randomized controlled trial.
2.5 Inclusion, Exclusion, and Drop Out Criteria
Inclusion criteria :

1. Participation in the research
2. Aged > 60 years old
3. Able to watch television with or without glasses from a distance of 2 meters
(visus 20/20 - 20/80)
4. No cognitive impairment (MOCA-Ina score: 26-30)
Exclusion criteria :
1. Congestive heart failure disease
2. Uncontrolled hypertension
3. Fracture or history of surgery in the last 6 months 4.
4. Currently on the waiting list for orthopedic surgery
5. Myocardial infarction or stroke in the last 6 months
6. Wheelchair dependent
7. Severe hearing and vision impairment
8. Other neuromusculoskeletal disorders that interfere with the ability to perform
exercises (pain with VAS >4)
Drop out criteria
Patients were excluded from the study if :
1. Participant died
2. Participant attended the exercise <3 times for 2 consecutive weeks
3. Participant refused to continue training sessions
4. Participant felt any of the symptoms of intervention side effects/cybersickness
2x consecutive training sessions
5. Participant experienced exacerbated hemodynamic and 
neurological
impairment during training 
2.6 Data Collection
This study used 40 subjects taken from the elderly population. The subjects were
selected based on the inclusion and exclusion criteria. After that, the research subjects

will be grouped into virtual reality exergame group as the intervension group and
aerobic exercise group as the control group using randomization method.
1. 
Pre-Intervension
Firstly, participants who fit the inclusion criteria were educated and consented
to the study. Next, participants were interviewed about their identity, place and date of
birth, age, address, marital status and occupation, history of physical activity and
exercise in the last 3 months, history of illness and routine medication use, history of
surgery, ability to watch TV within 2 meters with or without glasses and dependence
on a wheelchair. After that, a physical examination will be conducted which includes
vital signs and an examination of the participant's nutritional status which includes
weight, height, and body mass index.
In addition, participants will be subjected to several examinations to assess the
variables in this study in the form of :
•
International Physical Activity Questioner (IPAQ) – Short Form Indonesian
Version
Participants will be given an International Physical Activity Questionnaire
(IPAQ) - Short Form Indonesian version questionnaire assessed to measure
participants' daily physical activity carried out independently by participants before
and after the intervention for 6 weeks.
•
30 second-sit-to-stand test
The 30-second sit-to-stand test is conducted to assess lower extremity
muscle endurance. This test uses a chair that has a backrest, no armrests, a hard
chair seat, and adjustable chair leg length. During the examination procedure, the
participant will be instructed to sit in the center of the chair and the height of the
chair will be adjusted to the height of the participant's fibula bone (or 17 inches).
Then, participants will be instructed to cross their arms over their chest, ensuring
that both feet touch the floor in a neutral position with the hips and knees in a 90-
degree flexion position. The participant will be seated in an upright position and
instructed to start the sit-to-stand cycle upon the “start” signal. Cycles will be
counted from sitting to upright standing and back to sitting. Outcome measures

will be based on the number of sit-to-stand cycles within 30 seconds that will be
used.
•
Hand muscle strength
This examination uses a handgrip dynamometer brand CAMRY ISO 9001
model EH101 with a static method. Participants were asked to firmly grasp the
tool according to the participant's ability in the dominant and non-dominant hands.
During the measurement, participants were asked to stand, bend their elbows 90
degrees, and grip the handgrip dynamometer using the dominant/non-dominant
hand three times as hard as possible while holding their breath for 5 seconds, and
rest 15 seconds for a break in each measurement to prevent fatigue. The highest
measurement (in kilograms) of the dominant/non-dominant hand will be recorded.
•
Flexibility
This examination uses the chair-sit-and-reach test. Participants were asked
to sit on the edge of a chair with their feet on the floor at a distance of 6-12 inches
to the body line and stretch the other leg forward with the knee in extension, the
heel resting on the floor with a neutral ankle position of 90 degrees. Then
participants were instructed to inhale and then exhale while reaching for the toes
by bending the hips, with the knee remaining in extension, and the grip was held
for 2 seconds. Scores were recorded using a ruler parallel to the Tibia bone, the
center of the toe representing a score of “zero”. A shorter reach of the toes was
recorded as a minus score, and a longer reach of the toes was recorded as a plus
score.
•
Body composition
This examination will use a bioimpedance analysis (BIA) tool to measure
body fat mass and fat-free mass, which includes muscle and bone. First, turn on
the BIA device, then enter your age, weight, height, and gender. After that, stand
on the device and press the start measurement button and wait a few moments
to see the results.

Furthermore, participants will be subjected to additional examinations in this research
in the form of :
•
MOCA-Ina
Participants will be evaluated for cognitive function using the Montreal
Cognitive Assessment (MOCA) - Indonesian version before the intervention.
•
Borg Scale
Participants will be screened to measure the level of physical activity
intensity using the Borg scale before the intervention.
Secondly, the participant underwent a pre-exercise protocol which consisted of
screening for risk factors and contraindications, a 6-minute walk test, introduction to
the explanation of equipment use, and recommended clothing to be used during
exercise. This pre-exercise protocol will be done only once at the beginning before the
intervention. Education in the form of an introduction to the virtual reality exergame
tool - Nintendo Switch Ring Fit Adventure in the intervention group and an elderly
aerobic exercise video in the control group.
2. 
Intervention
Participants will first warm up for 5-10 minutes. After that, the intervention group
participated in the virtual reality exergame training using the Nintendo Switch Ring Fit
Adventure in a quiet, obstacle-free room with different durations for each session. If
any participant felt symptoms of cybersickness (fatigue, headache, nausea, difficulty
focusing, sweating, or dizziness), the training was stopped and the participant was
given initial treatment according to the symptoms experienced. If the symptoms
disappear after the initial treatment is given, participants are allowed to continue the
exercise. However, if the symptoms persist for 30 minutes after the initial treatment is
given, the participants will be taken to the nearest health service by the researcher.
Exercise in the intervention group is given for 6 weeks and will be done 3x
exercise/week.
Meanwhile, the control group will perform conventional exercises using aerobic
exercise procedures that will be supervised by a physiotherapist. The physiotherapist

will supervise the exercises performed by the participants in the control group.
Exercise in the control group is given for 6 weeks and will be done 3x exercise/week.
Hemodynamic monitoring was carried out before and after the intervention, in
addition, the intensity of the exercise was monitored based on Heart Rate Reserved
40%-60% and RPE scale 12-13.
3. 
Post Intervention
After the training session ends at week 6, data will be collected again the next
day in the form of physical examination data, physical activity assessment physical
activity assessment (IPAQ), hand muscle strength assessment (handgrip
dynamometer), limb endurance assessment (30 second sit to stand test), flexibility
assessment (chair sit and reach test), and body composition assessment (BIA).
Both groups will be given progressive overload as shown in table 4.1 according
to research conducted by Wu et al in 2023, which is modified by the researcher in the
form of monitoring the intensity level before and after training each session based on
heart rate reserved using a switch tool on the Ring Fit or RPE scale 12-13.
Table 2. 1 Exercise duration in research (Wu et al., 2023).
Description
Duration (minute)
a. Warming up
Dynamic stretching (neck, arms, hands, hips, legs, and ankles)
10
according to KEMENKES aerobic exercise video
b. Exercise
Intervention
VR Exergame (Frequency = 3 day/week; Intensity [Heart
Rate Reserved = 40%-60% and RPE scale 12-13]; aerobic
type)
· Phase 1 (Week 1) : Exercise with the beginnia game program
10
(2 sets of 2 minutes each), then moenster den (2 sets of 3
minutes each set).

Description
· Phase 2 (Week 2) : Exercise with the beginnia game program
(2 sets of 2 minutes each), then trotter's groove (2 sets of 3
minutes each set).
· Phase 3 (Week 3) : Exercise with the beginnia game program
(1 set with a game duration of 2 minutes each set), then
moenster den (2 sets with a game duration of 3 minutes each
set), then sportan highway (1 set with a game duration of 7
minutes each set).
· Phase 4 (Week 4) : Exercise with the beginnia game program
(1 set with a game duration of 2 minutes each set), then
moenster den (1 set with a game duration of 3 minutes each
set), then starting block bridge (2 sets with a game duration of 4
minutes each set), then sportan highway (1 set with a game
duration of 7 minutes each set).
· Phase 5 (Week 5) : Exercise with the beginnia game program
(1 set with a game duration of 2 minutes per set), then dragon
stadium 2 (1 set with a game duration of 2 minutes per set),
then moenster den (2 sets with a game duration of 3 minutes
per set), then starting block bridge (2 sets with a game
duration of 4 minutes per set), then sportan highway (1 set
with a game duration of 7 minutes per set).
· Phase 6 (Week 6) : Exercise with the dragon stadium 2 game
program (1 set with a game duration of 2 minutes each set),
then moenster den (2 sets with a game duration of 3 minutes
each set), then starting block bridge (2 sets with a game
duration of 4 minutes each set), then sportan highway (2 sets
with a game duration of 7 minutes each set).
Duration (minute)
10
15
20
25
30
Control
Aerobic exercise (Frequency = 3 day/ week; Intensity [Heart
Rate Reserved = 40%-60% and RPE scale 12-13]; aerobic
type)

Description
· Phase 1 (Week 1) : Aerobic exercise with a duration of 10
minutes
· Phase 2 (Week 2) : Aerobic exercise with a duration of 10
minutes
· Phase 3 (Week 3): Aerobic exercise for 10 minutes, then
strength exercise for 5 minutes.
· Phase 4 (Week 4): Aerobic exercise for 10 minutes, then
strength exercise for 10 minutes.
· Phase 5 (Week 5): Aerobic exercise for 15 minutes, then
strength exercise for 10 minutes.
· Phase 6 (Week 6): Aerobic exercise for 15 minutes, then
strength exercise for 15 minutes.
Duration (minute)
10
10
15
20
25
30
c. Cooling down
Static Stretching (neck, arms, hands, hips, legs, and ankles)
according to KEMENKES aerobic exercise video
10

2.7 Data Collection
The data collected is primary data obtained in accordance with the inclusion
criteria. Samples who are willing to become research subjects will be interviewed,
physical examinations, examinations to assess variables including physical activity
using the Indonesian version of the International Physical Activity Questionnaire
(IPAQ) Short Form and physical fitness in the form of body composition, hand muscle
strength, limb muscle endurance, and flexibility.
The interview questionnaire in this study will contain a list of participant identities
including name, age, marital status, address, education history, employment history,
activity and exercise history in the last 3 months, self-reported vision ability.
2.8
Research Instrument
In supporting the research process, support is needed in the form of :
1. Research ethics permission letter
2. Sheet explaining the respondent's actions and consent
3. Screening sheet and MOCA-Ina
4. Test form sheet (International Physical Activity Questionnaire (IPAQ)
questionnaire, body composition, handgrip dynamometer, 30 second sit to stand,
chair sit and reach test)
5. Intervention adverse effect sheet
6. Nintendo Switch + Ring Fit game equipment
7. Projector + LCD or television
8. KEMENKES aerobic exercise video at the link:
https://www.youtube.com/watch?v=YiA_n0q18LA&t=1888s
9. Bioelectrical impedance analysis (BIA) brand Tanita BC 730
10.
Electronic hand dynamometer brand CAMRY ISO 9001 model EH101
11.
Stopwatch
12.
Spygmomanometer brand OMRON and stethoscope brand litman
13.
Meter measuring tape
14.
Pen
15.
Chair with backrest without armrest
14

16.
Computer and data analysis software SPSS version 23
17.
Digital camera (research documentation tool)
18.
Oxygen transfer, nasal cannula, and oxygen saturation/oximeter brand
General Care
19.
Wheelchair
20.
Mattress
21.
Gurney

2.9 Research flow
Population
Elderly (>60 years old) at Olive Elderly Community
Sample
The sampling technique is a cluster randomized controlled trial that meets
the research criteria until the specified time period
Informed consent and research approval
Intrvention group : 20 orang
Control group : 20 orang
Baseline data collection: research questionnaire, physical examination,
physical activity assessment (IPAQ), hand muscle strength assessment
(handgrip dynamometer), limb endurance assessment (30 second sit to stand
test), flexibility assessment (chair sit and reach test), body composition
assessment (BIA), and other additional data. Informed consent and research
approval
Intervention :
1.
Before the day: pre-exercise testing and introduction to exergames and
aerobic videos
2.
The day : pre-exercise hemodynamics and neurology, warm-up (5-10
minutes), intervention (exergame/aerobic exercise) with intensity adjusted
to RPE 12-13, cool-down (5-10 minutes), post-exercise hemodynamics
and neurology, and adverse events.
s
Final data collection (H+1 phase 6): physical examination, physical activity assessment
(IPAQ), hand muscle strength assessment (handgrip dynamometer), limb endurance
assessment (30 second sit to stand test), flexibility assessment (chair sit and reach test),
and body composition assessment (BIA).
Data collection, processing, and analysis
Presentation of
results
Publication
Picture 2. 1 Research Flow

2.10 Statistical Analysis Plan
·
The data obtained will be subjected to descriptive analysis to explain the
characteristics of the participants.
·
This study will be analyzed by chi square or mc nemar (categorical dependent
variables) and t test (numerical dependent variables).
·
Data on the effects of VR exergames compared to aerobic exercise training will
be assessed using independent t test (normally distributed data) and
nonparametric man whitney test (non-normally distributed data).
·
On the numerical dependent variable, normality and homogeneity tests
(Kolmogrov-Smirnov) will be conducted. Data is said to be normally distributed if
the p value is >0.05.
·     Interpretation of the results will be comprehensively discussed between
researchers and a team of experts in each field to draw appropriate conclusions.
·
The relationship between each parameter will be assessed using Pearson
correlation test (normally distributed data with numerical dependent variable) or
Spearman
test
(categorical-ordinal
variable)
or
contigency
coefficient
(categorical-nominal variable) to determine how much correlation between the
variables.
·
The assessment of effectiveness between virtual reality exergame (Intervention)
and aerobic exercise (control) will be analyzed by logistic regression.
·
Data will be processed and analyzed using SPSS version 23.
2.11 Ethics
Before the research :
a. Researchers took care of ethical licensing at the ethics commission of the Faculty
of Medicine, Hasanuddin University.
b. Apply for permission to the Chairperson of the Elderly Community.
During the research :

a. All research procedures were only carried out if participants were willing to
become research subjects.
b. Virtual reality exergame was taught and supervised by a doctor specializing in
physical medicine and rehabilitation.
c. Aerobic exercise was taught and supervised by a general practitioner.
d. If the research subjects felt tired or had other medical complaints during the
exercise, the exercise would be stopped and focused on managing the symptoms
of the research subjects (appendix 7).
After the research :
a. Keeping the personal identity of the research subjects from the public.
b. All examination results conducted in the study will be delivered to each research
subject.

CHAPTER III
INFORMED CONSENT
KEMENTERIAN PENDIDIKAN, KEBUDAYAAN, RISET DAN TEKNOLOGI
UNIVERSITAS HASANUDDIN FAKULTAS KEDOKTERAN
KOMITE ETIK PENELITIAN UNIVERSITAS HASANUDDIN
RSPTN UNIVERSITAS HASANUDDIN
RSUP Dr. WAHIDIN SUDIROHUSODO MAKASSAR
Sekretariat : Lantai 2 Gedung Laboratorium Terpadu
JL.PERINTIS KEMERDEKAAN KAMPUS TAMALANREA KM.10 MAKASSAR 90245.
Contact Person: dr. Agussalim Bukhari.,MMed,PhD, SpGK TELP. 081241850858, 0411 5780103, Fax : 0411-581431
SUPPLEMENTARY 1
* informed consent in Indonesian language and approved by human subjects protection
review board of hasanuddin university
FORMULIR PERSETUJUAN SETELAH PENJELASAN (PSP)
(INFORMED CONSENT)
Assalamu’alaikum warahmatullahi wabarakatuh
Salam sejahtera Bapak/Ibu. Saya dr. Andi Amirah Shaleha Junaedi yang
akan melakukan penelitian tentang EFEKTIVITAS VIRTUAL REALITY
EXERGAME TERHADAP AKTIVITAS FISIK DAN KEBUGARAN FISIK
PADA LANJUT USIA, kami bermaksud mengikutsertakan anda sebagai subyek pada
penelitian ini.
Penelitian ini bertujuan untuk mengetahui perbandingan efektivitas virtual
reality exergame menggunakan permainan Nintendo Switch Ring Fit Adventure dan
senam aerobik KEMENKES terhadap aktivitas fisik dan kebugaran fisik pada lanjut
usia, khususnya di Makassar. Penelitian ini diharapkan dapat memberikan pengetahuan
tentang efektivitas virtual reality exergame dan latihan senam aerobik KEMENKES
untuk meningkatan aktivitas fisik dan kebugaran fisik sehingga meningkatkan kualitas
hidup pada populasi lansia.

Adapun kriteria partisipan yang akan diikutsertakan dalam penelitian ini adalah
pria atau wanita berusia > 60 tahun, mampu menonton televisi dengan atau tanpa
kacamata dari jarak 2 meter, mampu memahami perintah dengan baik, dan tidak
memiliki penyakit berat atau rasa nyeri yang dapat mengganggu kemampuan dalam
melakukan latihan. Adapun kelompok penelitian akan dibagi menjadi dua kelompok
yaitu kelompok perlakuan berupa latihan aerobik berbasis virtual reality exergame dan
kelompok kontrol berupa latihan senam aerobik KEMENKES. Partisipan akan diacak
ke dalam kelompok penelitian, sehingga partisipan akan masuk kelompok perlakuan
atau kontrol.
Penelitian ini tidak memaksa keikutsertaan Bapak/Ibu, bersifat sukarela, dan
Bapak/Ibu dapat mengundurkan diri kapan saja tanpa mengurangi hak mendapatkan
pelayanan kesehatan. Adapun apabila partisipan menyetujui untuk ikut pada penelitian,
maka Bapak/Ibu diharapkan mengikuti prosedur penelitian ini sampai selesai.
Adapun prosedur yang akan dilaksanakan pada penelitian ini yaitu Pertama
berupa wawancara (identitas, tempat dan tanggal lahir, umur, alamat, status
pernikahan dan pekerjaan, riwayat aktivitas fisik dan berolahraga dalam 3 bulan
terakhir, riwayat penyakit dan penggunaan obat rutin, riwayat tindakan operasi,
kemampuan menonton tv dalam jarak 2 meter dengan atau tanpa kacamata serta
ketergantungan terhadap kursi roda); pemeriksaan fisik (meliputi tanda-tanda vital
berupa tekanan darah, nadi, laju pernafasan, suhu, dan saturasi oksigen dan
pemeriksaan status nutrisi partisipan yang meliputi berat badan, tinggi badan, dan
indeks massa tubuh. Pemeriksaan ini akan dilakukan pada awal sebelum dan setelah
latihan baik kelompok perlakuan maupun kontrol selama 6 minggu); pemeriksaan
tambahan dan pengisian kuesioner (aktivitas fisik keseharian partisipan
menggunakan kuesioner International Physical Activity Questioner (IPAQ) – Short
Form Versi Indonesia; ketahanan otot tungkai bawah melalui 30 second-sit-to-stand
test. Pengukuran dilakukan berdasarkan jumlah siklus duduk berdiri dalam waktu 30
detik; kekuatan otot tangan menggunakan spring-type dynamometer dengan
menggenggam secara kuat alat tersebut sesuai kemampuan partisipan pada tangan

dominan maupun non-dominan sebanyak tiga kali; fleksibilitas atau luas gerak sendi
melalui pemeriksaan chair-sit-and-reach test. Partisipan diminta untuk menggapai jari
kaki menggunakan tangan dengan posisi duduk di tepi kursi dan kaki lurus kedepan;
dan komposisi tubuh menggunakan alat bioimpedance analysis (BIA) berupa massa
lemak tubuh (body fat) dan massa bebas lemak (fat-free mass) yang mencakup otot dan
tulang. Pemeriksaan ini akan melengkapi lembar khusus untuk pemeriksaan komposisi
tubuh). Pemeriksaan tambahan ini dilakukan sebelum dan setelah latihan baik
kelompok perlakuan maupun kontrol selama 6 minggu.
Selanjutnya, partisipan akan dilakukan pemeriksaan tambahan lainnya pada
penelitian ini berupa : MOCA-Ina (pemeriksaan fungsi kognitif menggunakan
Montreal Cognitive Assessment (MOCA) - versi Indonesia diawal sebelum dilakukan
latihan baik kelompok perlakuan maupun kontrol; Borg Scale (pemeriksaan untuk
mengukur tingkat intensitas aktivitas fisik menggunakan skala Borg sebelum dan
setelah setiap dilakukan latihan baik kelompok perlakuan maupun kontrol); dan USG
diafragma dan otot quadriceps mengukur ketebalan otot diafragma dan otot
quadriceps menggunakan alat USG sebelum dan setelah dilakukan intervensi.
Kedua, berupa protokol pre-exercise/pre-latihan. Partisipan melakukan protokol
pre-exercise yang terdiri dari skirining faktor risiko dan kontraindikasi dan uji latih
jalan 6 menit pada hari pertama. Selanjutnya pada hari kedua pengenalan mengenai
penjelasan penggunaan alat dan pakaian yang disarankan digunakan saat latihan.
Protokol pre-exercise ini akan dilakukan hanya satu kali di awal sebelum intervensi.
Penjelasan pengenalan alat virtual reality exergame – Nintendo Switch Ring Fit
Adventure pada kelompok perlakuan dan video latihan senam aerobik lansia pada
kelompok kontrol.
Ketiga, pada hari latihan. Partisipan menggunakan baju kaos dan celana olahraga
yang nyaman dan tidak ketat, juga sepatu olahraga yang nyaman dan tidak licin.
Sebelum dilakukan latihan, partisipan pada kelompok perlakuan dan kelompok kontrol
akan melakukan pemanasan terlebih dahulu selama 10 menit dengan mengikuti
instruktur/video. Begitupun setelah melakukan latihan, partisipan pada kelompok

intervensi dan kelompok kontrol akan melakukan pendinginan selama 10 menit
mengikuti instruktur/video.
Setelah itu, kelompok perlakuan berpartisipasi dalam latihan VR exergame
menggunakan Nintendo Switch dengan permainan Ring Fit Adventure dengan durasi
yang berbeda tiap sesinya di ruangan yang tenang pada bidang yang datar tanpa ada
tangga, tidak licin dan tidak ada rintangan. Selama Latihan berlangsung peneliti akan
memantau gejala efek samping intervensi yang mungkin dialami partisipan. Jika ada
partisipan merasakan gejala efek samping intervensi berupa cybersickness (fatigue,
sakit kepala, mual, susah fokus, berkeringat, atau pusing) maka latihan akan dihentikan
dan partisipan akan diberikan penanganan awal sesuai gejala yang dialami. Jika gejala
hilang setelah penanganan awal diberikan, partisipan diperbolehkan untuk melanjutkan
latihan. Namun bila gejala bertahan selama 30 menit setelah penanganan awal
diberikan, maka partisipan akan dibawa ke pelayanan kesehatan terdekat oleh peneliti.
Latihan pada kelompok intervensi diberikan selama 6 minggu akan dilakukan 3x
latihan/minggu.
Pada kelompok kontrol akan melakukan latihan konvensional menggunakan
prosedur senam aerobik yang akan diawasi oleh seorang dokter. Dokter akan
mengawasi latihan yang dilakukan oleh partisipan pada kelompok kontrol. Latihan
pada kelompok kontrol diberikan selama 6 minggu akan dilakukan 3x latihan/minggu.
Pemantauan kepatuhan latihan termasuk keluhan sebelum, selama, dan setelah
latihan, serta pemantauan tingkat intensitas sebelum dan setelah latihan setiap sesi
berdasarkan heart rate reserved/detak jantung dan RPE akan dicatat dalam logbook.
Pemantauan ini dilakukan pada kedua kelompok perlakuan dan kontrol.
Keempat, setelah sesi latihan berakhir pada minggu ke-6 akan dilakukan
pengambilan data kembali seperti yang dilakukan saat sebelum latihan baik kelompok
perlakuan maupun kontrol pada keesokan harinya.
Kami menyadari bahwa dengan mengikuti penelitian ini maka partisipan akan
mengorbankan waktu dan tenaga, sehingga kami akan memberikan kompensasi untuk
hal tersebut dengan memberikan konsumsi pada setiap sesi setelah latihan. Selama

melakukan latihan ini, anda mungkin akan merasakan lelah sebagai efek samping
namun kami akan memberikan waktu yang cukup untuk periode istirahat. Latihan ini
memerlukan pemantauan oleh peneliti dan dapat menyebabkan efek samping latihan,
sehingga peneliti akan bertanggung jawab penuh untuk hal tersebut. Estimasi waktu
yang dibutuhkan setiap pertemuan (sesi latihan) akan meningkat setiap minggu yaitu
40 – 60 menit. Sedangkan estimasi waktu secara keseluruhan untuk semua rangkaian
penelitian mulai dari wawancara, pemeriksaan fisik dan pemeriksaan tambahan, hingga
latihan adalah 20 jam.
Biaya penelitian ini akan ditanggung oleh dokter yang melakukan penelitian
dan tidak dibebankan pada anda. Kami menjamin kerahasiaan semua data pada
penelitian ini. Semua hasil pemeriksaan yang terkait dengan penelitian ini akan
disampaikan kepada anda secara terbuka.
Kami sangat mengharapkan partisipasi anda, dengan bersedia untuk ikut dalam
penelitian ini secara sukarela. Bila anda bersedia, kami berharap anda dapat
memberikan persetujuan dalam bentuk lisan dan tertulis.
Bila anda merasa masih ada yang belum jelas atau belum dimengerti dengan
baik, anda dapat menanyakan atau minta penjelasan pada saya. Terima kasih.
Penanggung Jawab Penelitian
Nama
Alamat
No. Telepon
: Andi Amirah Shaleha Junaedi
: Perumahan Phinisi Nusantara Residence Blok B No. 5
: 081241493400
Penanggung Jawab Medis
Nama
: dr. Melda Warliani, Sp.KFR,K.R.(K)
Alamat
: Jl. Sungai Saddang I No.28 Makassar
No. HP
: 0818625715

KEMENTERIAN PENDIDIKAN, KEBUDAYAAN, RISET DAN TEKNOLOGI
UNIVERSITAS HASANUDDIN FAKULTAS KEDOKTERAN
KOMITE ETIK PENELITIAN UNIVERSITAS HASANUDDIN
RSPTN UNIVERSITAS HASANUDDIN
RSUP Dr. WAHIDIN SUDIROHUSODO MAKASSAR
Sekretariat : Lantai 2 Gedung Laboratorium Terpadu
JL.PERINTIS KEMERDEKAAN KAMPUS TAMALANREA KM.10 MAKASSAR 90245.
Contact Person: dr. Agussalim Bukhari.,MMed,PhD, SpGK TELP. 081241850858, 0411 5780103, Fax : 0411-581431
SUPPLEMENTARY 2
* informed consent in Indonesian language and approved by human subjects protection
review board of hasanuddin university
FORMULIR PERSETUJUAN SETELAH PENJELASAN
Saya yang bertandatangan di bawah ini:
Nama
:
Umur
:
Pekerjaan
:
Pendidikan Terakhir :
Alamat
:
No. HP
:
setelah mendengar/membaca dan mengerti penjelasan yang diberikan mengenai tujuan,
manfaat, dan apa yang akan dilakukan pada penelitian ini, menyatakan setuju untuk
ikut dalam penelitian ini secara sukarela tanpa paksaan.
Saya tahu bahwa keikutsertaan saya ini bersifat sukarela tanpa paksaan,
sehingga saya bisa menolak ikut atau mengundurkan diri dari penelitian ini. Saya
berhak bertanya atau meminta penjelasan pada peneliti bila masih ada hal yang belum
jelas atau masih ada hal yang ingin saya ketahui tentang penelitian ini.
Saya juga mengerti bahwa semua biaya yang dikeluarkan sehubungan dengan
penelitian ini, akan ditanggung oleh peneliti. Saya percaya bahwa keamanan dan
kerahasiaan data penelitian akan terjamin dan saya dengan ini menyetujui semua data
saya yang dihasilkan pada penelitian ini untuk disajikan dalam bentuk lisan maupun
tulisan.
Dengan membubuhkan tandatangan saya di bawah ini, saya menegaskan
keikutsertaan saya secara sukarela dalam studi penelitian ini.
NAMA
Partisipan…………….
Saksi...…………….
TANDA TANGAN
………… ………….
…………………….
TANGGAL
……………..
……………..

(Tanda Tangan Saksi diperlukan hanya jika Partisipan tidak dapat memberikan
consent/persetujuan sehingga menggunakan wali yang sah secara hukum, yaitu untuk
partisipan berikut :
1. Berusia di bawah 18 tahun
2. Usia lanjut
3. Gangguan mental
4. Pasien tidak sadar
5. Dan lain-lain kondisi yang tidak memungkinkan memberikan persetujuan
Penanggung Jawab Penelitian :
Nama : Andi Amirah Shaleha Junaedi
Alamat : Perumahan Phinisi Nusantara
Residence Blok B No.5
Penanggung Jawab Medis :
dr. Melda Warliani, Sp.KFR,K.R.(K)
Jl. Sungai Saddang I No.28 Makassar
Tlp
: 081241493400.
0818625715