Impact of "SI Kumbang" Gymnastic Exercise on Physical Performance and Immunity in the Elderly
Phase: NA
Conditions: Healthy
Sponsor: Umi Sjarqiah

UNIVERSITAS INDONESIA 
 
 
 
 
 
 
 
 
1 
Study Protocol with Statistical Analysis Plan  
 
Impact of “SI Kumbang” Gymnastics Exercise on Physical Performance and 
Immunity in the Elderly 
 
Version: 
November 19th 2025 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

UNIVERSITAS INDONESIA 
 
 
 
 
 
 
 
 
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Impact of “SI Kumbang” Gymnastics Exercise on Physical Performance and 
Immunity in the Elderly 
Umi Sjarqiah 1, Nury Nusdwinuringtyas 2, Nani Cahyani Sudarsono3, Evy Yunihastuti 4, Ikhwan 
Rinaldi 5, Aulia Rizka 6, Maria Regina Rachmawati7, Ruliando Hasea Purba8, Siti Chandra 
Widjanantie9, Muhammad Syauqi Ridhallah 10, Muhammad Jalaluddin Rumi 11 
 
1 Doctoral Program in Medical Sciences, Faculty of Medicine University of Indonesia (Indonesia)  
2 Department of Rehabilitation Medicine PELNI Hospital Jakarta (Indonesia) 
3 Department of Community Medicine and Center for Sport and Exercise Studies Indonesia 
Medical Education and Research Institute (IMERI)(Indonesia) 
4 Faculty of Medicine University of Indonesia and Department of Internal Medicine, Allergy and 
Immunology Division , Cipto Mangun Kusumo Hospital (RSCM) (Indonesia) 
5 Faculty of Medicine University of Indonesia and Department of Internal Medicine Hematology 
and Oncology Medic Division, Cipto Mangun Kusumo Hospital (RSCM) (Indonesia) 
6 Faculty of Medicine University of Indonesia and Department of Internal Medicine Geriatric 
Division, Cipto Mangun Kusumo Hospital (RSCM) (Indonesia) 
7 Department of Rehabilitation Medicine, Gunadarma University of Jakarta (Indonesia) 
8 Department of Rehabilitation Medicine State University of Jakarta (Indonesia) 
9 Department of Rehabilitation Medicine, Persahabatan Hospital, Jakarta, (Indonesia) 
10 Faculty of Medicine, Sebelas Maret University (Indonesia) 
11 Pondok Kopi Jakarta Islamic Hospital (Indonesia) 
Corresponding author: 
umi.sj274@gmail.com 
 
Abstract 
Background: The most common issue associated with aging is frailty, which has a 
significant impact on the physical performance and immunity of older adults. 
Exercise is the primary modality in medical rehabilitation. The Indonesian Strong 
and Balanced Healthy Exercise (SI Kumbang) gymnastic exercise is a newly 
designed exercise model developed by researchers, which is a type of low-impact 
aerobic exercise with moderate intensity. SI Kumbang exercises are performed 
three times a week for 30 minutes over a period of 12 weeks. The main basis of 
these exercises is foot movements that follow a rhythm, with the feet rotating in 
sequence in the four cardinal directions. 
Objective: This study aimed to evaluate and compare the impact of SI Kumbang 
gymnastic exercises and Bugar Lansia gymnastic exercise programs on physical 
performance dan immunity in elderly. 
Methods: A randomized single-blind clinical trial involved 66 elderly participants 
aged 60–70 years, divided into SI Kumbang  (n=33) and Bugar Lansia  (n=33) 
groups. Each group exercised three times weekly for 12 weeks. Outcomes measured 
for physical performance were cardiorespiration endurance using Six-Minute Walk 
Distance (6MWD), strength muscle using handgrip JAMAR, balance using Short 
Physical Performance Battery (SPPB), physical activity using Physical Activity 
Scale for the Elderly (PASE). Outcomes measured for immunity were 
inflammasome using Caspase-1 and IL-18. Data were analyzed using SPSS 29.0 
tests with significance set at p<0.05.  
Results: Physical performance in elderly showed, SI Kumbang group had 
significantly impact in cardiorespiration endurance (6MWD) (p=0.005) and 
physical activity (PASE) (p=0.001). However, there was no significant impact on 
strength muscle (handgrip JAMAR), and balance (SPBB). Immunity in elderly 

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showed, both group there were no significant in inflammasome Caspase-1 
(p=0,055) and IL-18 (p=0,255). 
Conclusion: In conclusion, SI Kumbang gymnastic exercise group has 
more significant impact in terms of physical performance, particularly in 
enhancing cardiorespiration endurance and physical activity rather than Bugar 
Lansia gymnastic exercise group. And there is no difference in physical 
performance aspects such as muscle strength, balance, and immunity aspects as 
Caspase-1 and IL-18 in the elderly. 
 
Keywords: elderly, physical performance, immunity, SI Kumbang exercise 
gymnastics. 
 
 
INTRODUCTION 
The number of people in the world who are 60 years of age or older is 
currently increasing, making up nearly 7% of the community.  In both industrialized 
and emerging nations, the number of elderly people is increasing quickly.  In 2020, 
727 million people worldwide were 65 years of age or older.1 The number of elderly 
people in Indonesia has increased significantly over the past 50 years. During this 
period, the proportion of elderly people in Indonesia has doubled compared to the 
previous period. In 2021, the proportion of elderly people reached 10.82%, or 
approximately 29.3 million people. This figure indicates that Indonesia has entered 
a phase of an aging population structure, marked by the proportion of people aged 
60 and over in Indonesia exceeding 10% of the total population. In fact, according 
to projections from the Central Statistics Agency (BPS), by 2045, the number of 
elderly people in Indonesia is estimated to reach almost one-fifth of the total 
population and is expected to continue to increase.2 
The most common issue associated with aging is frailty, which has a 
significant impact on the physical performance and immunity of older adults. 
Furthermore, skeletal muscle mass and strength decline with age, thereby 
diminishing physical autonomy. This decrease raises the chance of illness, 
disability, and functional limitations—all of which are referred to as frailty—which 
have an adverse effect on one's physical, mental, and social well-being.5 Reduced 
muscle strength, endurance, and physiological function are common characteristics 
of physically frail older persons, which raises their risk of poor health outcomes, 
functional decline, hospitalization, and death.3 
 

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A key component of medical rehabilitation is exercise, which serves as the 
foundation for efficient treatment to stop pre-frail from becoming frail. Exercise 
training can enhance walking speed and physical performance in pre-frail older 
subjects, according to systematic reviews and meta-analyses. The advantages of 
many types of exercise, both at home and in groups, have been investigated for 
senior citizens.
6,7 
Aerobic exercise is one type of exercise that can help stop muscle loss. The 
heart and lungs must work harder during aerobic exercise to meet the increased 
demand for oxygen. Dance-style rhythmic movements use the aerobic energy 
system to work major muscles while adhering to the chosen music. This creates 
rhythmic patterns, duration, and continuity that are intended to enhance and sustain 
bodily performance. Exercises that utilize dance movements is aerobic exercise 
performed through low-impact dance moves. If performed consistently for 30 to 60 
minutes, the leg movements simply consist of variants of walking on the spot rather 
than many hops, making it safe for beginners and people of all ages and preventing 
knee and back injuries.8  
Numerous physical exercise regimens have been created to address the 
deterioration of functional capacity in the elderly. Among these are the SI Kumbang 
and Bugar Lansia gymnastic exercises, which are planned workouts intended to 
enhance general physical function, strength, and mobility. There is, however, little 
data comparing the efficacy of these two therapies. Bugar Lansia gymnastic 
exercise is one form of exercise that is appropriate for senior citizens in Indonesia. 
Seniors can benefit from Bugar Lansia, a mild, simple, and non-strenuous type of 
exercise. Bugar Lansia is a set of organized, consistent physical exercises that 
preserve and enhance mobility, which enhances quality of life.9 Bugar Lansia is a 
moderate-intensity exercise known to have a positive effect on improving 
functional movement in the elderly through assessments.10  
Additionally, Indonesia offers a wide range of well-liked modern dances 
that are appropriate for moderately strenuous exercise. One such dance is the Poco-
Poco dance, which evolved into the gymnastics exercise of SI Kumbang. This local 
culture-based gymnastics is quite simple to execute and offers several health 
advantages, including increased blood vessel elasticity, circulation, oxygen intake, 

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balance, coordination, and muscle strength. SI Kumbang gymnastics exercise is 
ideal for senior citizens due to its distinctive low-impact motions and music, which 
can enhance physical fitness.
15,19 Elderly quality of life is often improved by 
moderate-intensity gymnastics training, which also delays the beginning of various 
diseases. In addition, this activity can help maintain optimal cardiorespiration 
endurance, muscle strength, balance, physical activity and immunity.  11 In order to 
ascertain whether intervention offers more advantages for geriatric health, 
immunity and physical performance in elderly groups, this study compares the 
effects of SI Kumbang gymnastics exercise and Bugar Lansia gymnastics exercise 
on physical performance and immunity in the elderly. 
 
METHODS 
This study was designed as a randomized clinical trial with allocation 
concealment and single blinding to assess how the "SI Kumbang" gymnastic 
exercise and the "Bugar Lansia" gymnastic exercise model affected physical 
performance and immunity in elderly. In cooperation with the Rehabilitation 
Medicine Polyclinics, the 12-week intervention took place at the Ahmad Dahlan 
Indoor Hall of RS Islam Jakarta Pondok Kopi, East Jakarta, between April until 
September 2025. According to the FI-40 score, the target demographic was made 
up of senior citizens who were categorized as robust and pre-frail. Patients who 
visited the Rehabilitation Medicine Polyclinics at RS Islam Jakarta Pondok Kopi 
during the study period were included in the accessible population.  
Female participants between the ages of 60 and 70 who met the following 
inclusion criteria were categorized as pre-frail (FI-40 score > 0.08 < 0.25) or robust 
(FI-40 score ≤ 0.08) and had a body mass index (BMI) between 18.5 and 24.9. 
Participants had to have managed diabetes mellitus (GDS ≤ 120 mg/dL) and blood 
pressure (≤130/80 mmHg) without taking any drugs that affected heart rate. Only 
those who were willing to participate, able to adhere to the study procedures, and 
had not been enrolled in any organized exercise program in the previous three 
months were included. Chronic heart or lung conditions, chronic conditions that 
cannot be reversed (e.g., cancer or chronic renal disease), diabetes complications in 
the extremities, motor impairment (MMT < 5), knee pain, lower limb deformities 

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(genu varus/valgus), and hand deformities were among the exclusion criteria. 
Dropouts were defined as those who did not finish the study, missed more than six 
workouts, or had negative outcomes linked to the intervention. 
A sample size of 33 people per group was determined. The study supervisor 
oversaw the use of a basic randomization program to carry out the random 
allocation. The Sequentially Numbered, Opaque, Sealed Envelope (SNOSE) 
technique was used to guarantee allocation concealment. Outcome assessors were 
subjected to single blinding; they were not told about group allocations and were 
not allowed to look for relevant information. The “SI Kumbang” and "Bugar 
Lansia" gymnastics exercise regimens were part of the intervention groups. For 12 
weeks in a row, both therapies included three 30-minute sessions per week. 
Participants received adaption sessions to acquaint themselves with the workout 
regimens throughout the first week. The Borg Scale was utilized to track intensity. 
The Six-Minute Walk Distance (6MWD) for cardiorespiratory endurance, 
and handgrip strength muscle measured using a handgrip JAMAR.  The Physical 
Activity using Physical Activity Scale for the Elderly (PASE) questionnaire, the 
balance using Short Physical Performance Battery (SPPB) were among the outcome 
measures and the immunity aspect using inflammasome marker Caspase-1 and IL-
18.  The research team reviewed patient logbooks at the beginning of each week to 
track adverse effects such weariness, shortness of breath, pain, or dizziness. At RS 
Islam Jakarta Pondok Kopi, every suspected adverse event was swiftly assessed, 
and any required medical attention was given. Every adverse event was reported to 
the ethics committee of the institution.  
Data analysis was performed using SPSS 29.0 tests with significance set at 
p<0.05. Descriptive summaries of the sample characteristics were provided. Prior 
to analysis, the normality of the data was checked. Dependent t-tests were used to 
compare pre intervention and post intervention score in the SI Kumbang and Bugar 
Lansia groups for normally distributed outcomes (6MWD, handgrip, SPPB, PASE, 
Caspase-1, IL-18); the Wilcoxon test was used to assess non-normal data. 
Independent t test or Mann-Whitney U test is used for compared the effectiveness 
of the two interventions (∆ score). A p-value of less than 0.05 was deemed 
significant.  

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RESULT 
 
A total of 66 elderly participants in the study, divided into the "SI Kumbang" 
and "Bugar Lansia” gymnastic exercise group. Table 1 summarizes the baseline 
characteristics of the subjects. Both groups have similar characteristics. 
Table 1. Baseline Characteristics 
Characteristics 
Si Kumbang  
Bugar Lansia  
(n=33) 
(n=33) 
Age (years), mean (SD) 
65,25 (3,25) 
65,14 (2,99) 
Body Mass Index, mean (SD) 
Normal 
Overweight 
23,5 (22,7) 
31 (86,1) 
5 (13,9) 
22,95 (21,6 – 24,2) 
31 (86,1) 
5 (13,9) 
Gender, n (%) 
 
 
Female 
36 (100,0) 
36 (100,0) 
Living History, n (%) 
 
 
Alone 
8 (22,2) 
5 (13,9) 
Husband 
25 (69,4) 
30 (83,3) 
Childs 
2 (5,6) 
1 (2,8) 
Siblings 
1 (2,8) 
0 (0) 
Educational Background, n (%) 
 
 
 
No Education 
1 (2,8) 
2 (5,6) 
 
Primary 
2 (5,6) 
5 (13,9) 
 
Secondary 
5 (13,9) 
3 (8,3) 
 
High School 
16 (44,4) 
14 (41,7) 
 
University 
12 (33,3) 
11 (30,6) 
 
Comorbid 
 
 
 
Diabetes Mellitus 
8 (22,2) 
3 (8,3) 
 
Hypertension 
10 (37,8) 
11 (30,6) 
 
Use of Diabetes Mellitus 
Medication 
8 (23,2) 
3 (5,6) 
 
Use of Hypertension 
Medication 
10 (37,8) 
11 (30,6) 
 
SD (standard deviation) 
Baseline characteristics of clinical outcomes of physical performance and 
immunity in elderly prior to intervention. Both groups are similar except for IL-18, 
which will be adjusted using ANCOVA analysis. 
 
 

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Table 2. Baseline Characteristics of Physical Performance and Immunity in Elderly 
before Intervention 
Variabel 
Si Kumbang  
Bugar Lansia  
(n=33) 
(n=33) 
The Six-Minute Walk Test 
(6MWT) (meters), median (IR) 
344,75 (293,75 - 
376,5) 
353 (311,25 – 
375,75) 
Handgrip strength (kg), mean 
(SD) 
16,11 (3,30) 
16 (3,39) 
Skor The Short Physical 
Performance Battery (SPPB), 
median (RIK) 
9 (9 – 11) 
9 (8,25 – 10,75) 
Skor The Physical Activity 
Scale for the Elderly (PASE), 
mean (SD) 
19,31 (2,73) 
20,67 (3,97) 
CASPASE-1, mean (SD) 
52251,52 (26750,02) 
56129 (25767,23) 
IL-18, median (IR) 
186,77 (136,37 – 
295,03) 
279,56 (190,67 – 
438,45) 
IR (interquartile range); SD (standard deviation) 
 
 
The impact of the SI Kumbang group and Bugar Lansia group gymnastic 
exercise interventions on physical performance and immunity are displayed in 
Table 3. SI Kumbang group had significantly impact in cardiorespiration endurance 
(6MWD) (p=0.005) and physical activity (PASE) (p = 0.001). However, there was 
no significant impact on strength muscle (handgrip JAMAR) (p=0,136), and 
balance (SPBB) (p=0,194). Immunity in elderly showed, both group there were no 
significant in inflammasome Caspase-1 (p=0,055) and IL-18 (p=0,327). For IL-18, 
adjustment was performed using the ANCOVA test (p=0.255). 
 
Table 3. Impact Of “SI Kumbang” Exercise and “Bugar Lansia” on Physical 
Performance and In Elderly Analysis 
Variables 
“SI Kumbang” 
group (n=33)  
“Bugar Lansia” 
group (n=33) 
p 
Adjusted 
∆  
∆  
 
The Six-
Minute Walk 
Distance 
(6MWD) 
(meter) 
81 (57,25 – 
119,5) d 
54 (25 – 76,5) d 
 
0,005 d 
 

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Handgrip 
strength (kg) 
1,14 (2,69) c 
 
2,06 (2,27) c 
 
0,136 c 
 
The Short 
Physical 
Performance 
Battery 
(SPPB) 
3 (1 - 3) b 
 
2 (0 - 3) b 
 
0,194 d 
 
The Physical 
Activity 
Scale for the 
Elderly 
(PASE) 
5,39 (4,38) c 
 
1,16 (5,26) c 
 
0,001 c 
 
Caspase-1 
-38945,33 
(27628,63) c 
-24957,94 
(30423,15) c 
0,055 c 
 
IL-18 
-0,03 (-44,28 – 
30,84) 
10,41 (-26,9 – 
47,32) 
0,327 d 
0.255 e 
a Normally distributed variables presented as mean ± Std. Deviation; b Non-
normally distributed variables presented as Median (range); c Independent t test; d 
Mann-Whitney U test; eAdjusted with ANCOVA analysis 
 
DISCUSSION 
This study is the first to test the new SI Kumbang gymnastics exercise. 
Randomization has been performed, and the baseline demographic and clinical 
characteristics of the two groups are not different, except for IL-18, which shows a 
difference and is adjusted using ANCOVA. 
From the clinical baseline data, the clinical picture of 6MWD, balance, and 
physical activity is less than normal. This illustrates the condition of elderly people 
who are generally inactive or sedentary in Indonesian society, that these three 
physical performances have indeed declined in elderly people entering the age of 
60-70 years. In general, they will experience a decline in physical condition and 
health, especially in healthy elderly people who are inactive in sports, sedentary, or 
with various chronic diseases.26 
Other studies analyzed the relationship between sedentary time and physical 
endurance in elderly. They compared 83 older adults aged 60-87 years. Physical 
activity (light, moderate, or vigorous) and sedentary time were assessed using 
ActiGraph® GT1M Accelerometers (Fort Walton Beach, FL, USA). The Senior 

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Fitness Test assesses five physical fitness components (aerobic endurance, 
muscular strength, agility/dynamic balance, flexibility, and BMI), and includes six 
tests: 6-min walk distance (meters); chair stand test (repetitions/30 s); arm curl test 
(repetitions/30 s); 2.44 m up and go test (seconds); chair sit and reach test 
(centimeters); and back scratch test (centimeters).  Regarding physical endurance, 
when compared to the inactive group, the active group achieved higher average 
results on aerobic endurance (6 min walk distance), upper and lower limb strength 
(arm curl and chair stand test, respectively), agility/dynamic balance. Elderly 
people are more likely to experience frailty, which many of us mistakenly believe 
to be a natural aspect of aging.  It might be challenging to diagnose frailty in daily 
life and to differentiate between frailty syndromes and the normalcy associated with 
age vulnerabilities.27 
According to this study, elderly physical performance significantly 
improved because of both SI Kumbang and Bugar Lansia gymnastic exercise. Both 
groups showed substantial within-group improvements in the 6MWD, the same 
direction with a study by Casanova et al, which showed higher 6MWD values in 
the group that regularly performed aerobic exercise, with a 6MWD range of 380–
782 meters. The impact of age on 6MWD became substantial at ≥60 years of age.28 
Significant variations in 6MWD can be explained by the gender, age, height, 
and weight of respondents. Degenerative diseases also increase with age, and even 
“apparently healthy” elderly people who are eager to participate in physical training 
sessions exhibit a wide range of health statuses. 
Furthermore, a meta-analysis by Azimkhani et al. shows that endurance, 
aerobic, 
and 
combination 
exercise 
programs 
significantly 
improve 
cardiorespiratory endurance in older adults; the level of improvement depends on 
the intensity, duration, and adherence to the exercise program.29 Given the 
advanced age of the participants and the relatively short duration of the study 
intervention, these significant differences may be attributed to adequate exposure 
to training for improving cardiorespiratory endurance over 12 weeks, resulting in 
detectable physiological changes. Harber et al. emphasize that while improvement 
often requires sustained commitment to exercise therapy, accurate assessment of 
cardiorespiratory endurance, such as continuously increasing distance covered, 

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provides important insights into overall health and mortality risk.30 
This study shows that there is no significant difference between the muscle 
strength of the SI Kumbang exercise group and the Bugar Lansia exercise group as 
measured by handgrip strength. Handgrip strength is a valid and simple measure of 
our total body muscle strength. Grgic et al. support this by finding that an aerobic 
exercise regimen can increase muscle strength depending on the intensity of the 
exercise, duration, and type of exercise movements and exercise load required for 
significant hypertrophy and muscle strength changes.31 In the SI Kumbang exercise, 
a 0.5 kg barbell weight was given to the hands, which did not significantly affect 
muscle strength improvement compared to the Bugar Lansia exercise, which did 
not use barbell weights in the hands. Therefore, further studies are needed on the 
weight of the barbell and the type of movements that involve the core muscles or 
large muscles more to optimize muscle strength improvement.  
The results of the balance difference analysis with SPPB scores show that 
there is no significant difference between the two exercise groups. SPPB is valid, 
reliable, responsive, and measures physical function in the elderly population. A 
change of 0.5 points on the SPPB is considered small but significant, while a change 
of 1 point is considered substantial. Lu et al. highlight the significance of aerobic 
exercise in maintaining or improving physical function by emphasizing the 
predictive validity of the SPPB and physical performance measures in identifying 
older adults at higher risk of falling over time. Both exercise programs showed an 
improvement in balance after exercise, and the two programs showed similar 
results.32 Ansai et al. provided aerobic exercise to elderly individuals for 16 weeks 
and found no significant difference between exercise and balance and the risk of 
falling because the elderly require a combination of multi-component muscle 
movements. 33 
Physical activity in this study was significant for the SI Kumbang exercise 
group. In the elderly population, PASE scores were closely related to their 
functional abilities and overall health status. Higher PASE scores are often 
associated with better mobility, increased muscle strength, and a reduced risk of 
chronic diseases. According to Ayvat et al., PASE is a sensitive tool for identifying 
physical inactivity in the elderly population and successfully distinguishes between 

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active and inactive elderly individuals.34 The significant difference in PASE scores 
between the SI Kumbang exercise group and the control group in this study likely 
reflects the interaction between environmental, social, and daily behavioral factors 
that influence increased physical activity among the elderly outside of exercise 
activities. The increase in the average PASE score in the SI Kumbang exercise 
group shows a promising trend that could lead to a significant increase in physical 
activity levels and better functional health outcomes. 
The decrease in Caspase-1 levels in both groups indicates that the exercise 
intervention successfully reduced inflammatory activity in older adults associated 
with inflammasomes. These results are in line with a systematic review by 
Bautmans et al., which found that various types of exercise, especially those 
combining resistance and aerobic components, can reduce Caspase-1 and other 
proinflammatory cytokines such as IL-1β, IL-6, and IL-18, thereby altering the 
inflammatory profile of older adults. The downregulation of inflammasome 
signaling pathways is demonstrated by the reduction in Caspase-1, a crucial enzyme 
that activates cytokines from the IL-18 family.35 Although there were no differences 
in changes between the two exercise groups. 
Following exercise intervention, IL-18 levels did not decrease because the 
analysis of the process pathway showed that caspase-1 activation requires various 
processes to produce a decrease in IL-18, that activated caspase-1 will cleave the 
same tetrapeptide site in pro-IL-18. The crystal structure of the caspase-1 and pro-
IL-18 complex reveals a two-site (binary) substrate recognition mechanism, a 
catalytic pocket that binds the tetrapeptide, and a unique exosome that critically 
recognizes GSDMD10 and binds to a specific structure formed jointly by the 
propeptide sequence and the post-cleavage site in pro-IL-18. This binary 
recognition is also used by caspase-1 to process pro-IL-18; structural deviations 
around the exosite underlie its inability to target rationally designed pro-IL-18. The 
structure of pro-IL-18 displays an autoinhibitory interaction between the propeptide 
and the post-cleavage site region, preventing recognition by the IL-18Rα receptor.35  
Caspase-1 cleavage induces substantial conformational changes in IL-18 to 
generate two critical receptor binding sites and establishes IL-18 as a 
lipopolysaccharide-activated caspase-1 target. This finding represents a paradigm 

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shift in the understanding of noncanonical inflammasome-mediated defense and the 
function of IL-18 in immunity and disease. Thus, many important roles in the 
process of IL-18 reduction, which targets IL-18, are likely caused by gaps caused 
by the involvement of cytokines and other proteins in the signaling pathways of 
various inflammatory diseases other than IL-18. In this study, there were patients 
undergoing treatment for diabetes mellitus who may have influenced the increase 
in IL-18 in the two exercise groups. Chronic muscle injury in diabetes mellitus and 
the elderly can also cause an increase in IL-18. Although it was stated that 9 weeks 
of exercise could reduce IL-18 levels, the 12-week exercise intervention in this 
study was not able to reduce IL-18 levels. Another factor that could explain the lack 
of significant differences was that subjects were not prohibited from traveling 
outside the city and were not isolated during the exercise intervention.35  
CONCLUSION 
Both SI Kumbang and Bugar Lansia gymnastic exercises improved physical 
performance in older adults, as shown by significant gains in cardiorespiration 
endurance and physical activity in elderly. And there is no difference in physical 
performance aspects such as muscle strength, balance, and immunity aspects as 
Caspase-1 and IL-18 in the elderly. 
These study results indicate that although both exercise modalities are 
effective in enhancing physical performance in elderly, SI Kumbang appears to 
provide superior benefits, particularly in improving cardiorespiration endurance 
and physical activity in elderly.  
 
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 Authors Details 
Umi Sjarqiah  
Nury Nusdwinuringtyas  
Nani Cahyani Sudarsono 
Evy Yunihastuti  
Ikhwan Rinaldi  
Aulia Rizka  
Maria Regina Rachmawati 
Ruliando Hasea Purba 
Siti Chandra Widjanantie 
Muhammad Syauqi Ridhallah 
Muhammad Jalaluddin Rumi 
umi.sj274@gmail.com  
nury_nus@yahoo.com  
nani.cahyani@ui.ac.id  
evy.yunihastuti@gmail.com  
ikhwanrinaldi@gmail.com  
dr.auliarizka@yahoo.co.id  
rachmawati@staff.gunadarma.ac.id 
ruliando@unj.ac.id  
sitichandraw@gmail.com  
ridhallah30@gmail.com  
mjrumi.work@gmail.com 
Author & Translator 
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