Available via license: CC BY 4.0
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Corresponding author:
Warsono
warsono@unimus.ac.id
South East Asia Nursing Research, Vol 2 No 2, June 2020
ISSN:2685-032X
DOI: https://doi.org/10.26714/seanr.2.2.2020.10-14
Original Research
Effectiveness of Slow Deep Breathing Exercise on Decreasing Stress Levels
for Patients with Diabetes Mellitus
Warsono1
1 Universitas Muhammadiyah Semarang, Indonesia
Article Info
Abstract
Article History:
Accepted May 7th, 2020
Keywords:
Slow deep breathing;
Diabetes Mellitus; Stress
Level
The prevalence of diabetes mellitus patients increases in Semarang province
every year. Whereas, it reached 120 numbers of patients in Kedungmundu
public health center by 2020. One of the psychological problems
encountered by patients with diabetes is a high risk of stress levels. The
condition of stress, anxiety, and fear influence the production of adrenaline
hormones which aggravate the capability of patients to perform daily living
activities. Slow deep breathing exercise is a nonpharmacologic method to
reduce stress levels on diabetes mellitus patients. This study aimed to
investigate the effect of slow deep breathing exercises on decreasing stress
levels for patients with diabetes mellitus. This study used a quasi-
experiment pretest-posttest with a control group design was conducted at
Kedungmundu public health center, Semarang. All of 32 samples were
recruited in this study. Wilcoxon test analysis calculated a value of p=0.000
< ɑ 0,005. The statistical analysis found significantly different results
between the pretest and posttest in the experimental group. Slow deep
breathing exercise is effective to decrease the stress levels for patients with
diabetes mellitus. Slow deep breathing exercise is strongly suggested for
patients with diabetes mellitus as self-intervention to reduce stress levels.
INTRODUCTION
Diabetes mellitus (DM) is a disease of
metabolic disorder that occurs when the
pancreas can not produce insulin with a
marked presence of impaired metabolism
of carbohydrates, proteins, and fats caused
due to the increase in insulin levels in
relative terms. Damage to the pancreas is
due right of the swelling in the pancreas
which is usually caused by digestive
enzymes become active inside the pancreas,
so that attack and destroy pancreatic tissue
and causes diarrhea and even weight loss.1,2
The level of prevalence globally patient DM
in the year 2016 amounted to 11.3% of the
total population of the world and
experiencing an increase in the year 2017
into 677 million cases. Indonesia is a
country that occupies the order of the 6th
with patients DM number of 12.5 million
people after China, India, United States,
Brazil, Russia, and Mexico. Prevalence of
DM by the data results in 3 showed the
prevalence of the disease is not contagious
experience hike when compared with
Riskesdas (2013) among others DM occurs
an increase of 6.9% in the year 2013
South East Asia Nursing Research, Vol 2 No 2, June 2020/ page 10-14 11
Warsono / Effectiveness of Slow Deep Breathing Exercise on Decreasing Stress Levels for Patients with Diabetes
Mellitus
increased into 8.5% in the year 2018 with
the number of cases reaching 46,174.
Stress is the body's reaction that occurs
when a person is faced with a threat,
pressure, or a change. Stress is also caused
by environmental, economic, and unhealthy
living factors, which are one of the triggers
for diabetes mellitus. In times of stress, the
pituitary gland in the brain decreases the
production of the hormone serotonin.
Serotonin is a mood-regulating hormone
that affects the pancreas gland to secrete
insulin. When stressed, the production of
the hormone serotonin is produced in small
amounts, insulin automatically decreases
and can reduce its ability to neutralize
blood sugar. because blood lacks insulin
production, blood glucose will remain in the
bloodstream without being able to enter the
cell wall, so there is an increase in blood
sugar. 4,5
Treatment diabetes or diabetes mellitus in
general only be given treatment in the form
of drug pharmacological such as metformin,
and insulin therapy while non-
pharmacological administration was not
considered in nursing when one nurse
handling to note that non-pharmacological
therapy. Nonpharmacological therapy has
not been widely applied by nurses in a
hospital such as therapy in handling stress
on diabetes mellitus. The method of slow
deep breathing is one of the nursing actions
that can reduce the stress that occurs a
decrease in anxiety and automatically can
lower blood sugar levels. Relaxation can
influence the hypothalamus to regulate and
decrease sympathetic nervous system
activity. Stress can not only increase blood
sugar levels physiologically. Patients in a
state of stress can also change their good
habit patterns, especially in terms of eating,
exercise, and medication. 6
The research entitled SDB (slow deep
breathing) on anxiety levels and blood
sugar levels in people with diabetes
mellitus. Slow deep breathing research 2
times a week for 4 weeks, the results of the
level of anxiety obtained by the p-value of
the intervention group were (0.000) <0.005
and the results of the control group test
obtained the p-value (0.0830> 0.05, while
on examination Blood glucose obtained by
the p-value of the intervention group was
decreased and the results of the control
group test showed that the p-value was
increased but not significant.7
Research by 6 entitled the effect of
relaxation on reducing blood sugar levels in
patients with Type 2 diabetes mellitus at
Tasikmalaya Hospital. According to the
research results, the reduction in blood
sugar levels was very significant in the
intervention group after relaxing for seven
days, and doing it twice a day. The highest
decrease was on the seventh day (p =
0.000). Different sexes did not differ the
mean reduction in KGD in the two groups (p
= 0.730). And it can be concluded that
relaxation can reduce blood sugar levels in
type 2 DM patients.
From patient data for the last 3 months,
January-March 2019, it was found that
there were 120 people with diabetes
mellitus, both male and female, where
respondents were still taking drugs such as
metformin. Researchers aim to provide
non-pharmacological therapy, namely slow
deep breathing (SDB) therapy.
METHODS
This study used a quasi-experimental
research design. The study design using
pre-post-test control group design by using
the instrument Hamilton Anxiety Rating
Scale (HARS), which is done by providing a
pre-test before treatment is given and do
the re-measurement (post-test) after the
treatment given to the intervention group
while the control group did not give any
therapy. Therapy or intervention is carried
out after 7 hours to avoid the effect of the
work of the drug that is consumed by the
respondent. The sampling in this study by
using a sampling probability technique
random sampling with criteria inclusion of
South East Asia Nursing Research, Vol 2 No 2, June 2020/ page 10-14 12
Warsono / Effectiveness of Slow Deep Breathing Exercise on Decreasing Stress Levels for Patients with Diabetes
Mellitus
patients with diabetes mellitus for ± 1 year,
a patient who experiences anxiety with a
score of 95-141 moderate stress, p ria and
women ages 30-50 35-55 years, suffering
can communicate well and b willing to be a
respondent. The population in the study
were all people with diabetes mellitus at
Kedungmundu Public Health Center
Semarang, and data were obtained for the
last 3 months from January to March 2019
with a total population of 120 people with
diabetes mellitus at Kedungmundu Public
Health Center Semarang area. The sample
used in this study was 32 respondents
consisting of an experimental group of 16
respondents and a control group without
treatment of 16 respondents, this study was
conducted on 22 September - 6 October
2019. Univariate and bivariate analysis data
using the Wilcoxon test.
RESULTS
Characteristics and general description of
respondents age, gender, last education of
respondents, occupation of respondents,
and stress level of respondents, which are
presented in the central tendency in the
form of frequency values. The number of
respondents was 32 people (n = 32).
The results of the study have shown that the
mean age of the respondents is in the late
adulthood category. The mean age of the
respondents was 43.19 years, with the
youngest being 30 years old and the oldest
being 55 years old.
Based on the Levene's statistics test, it is
known that the stress experienced by
respondents before the intervention has the
same baseline (p = 0.104).
The effectiveness of the Slow Deep
Breathing Exercise is known by comparing
the stress values before and after the action.
The results of the study have shown that
there is a significant difference between the
average stress values before and after the
intervention. whereas in the control group
there were no similar results. So it can be
concluded that slow deep breathing
exercise intervention can reduce stress in
diabetes mellitus patients.
Table 1
Characteristic
of respondents at Kedungmundu Public Health
Center, Semarang (n=32)
Indicators
f
(%)
Gender
Male
15
46.9
Women
17
53.1
Occupation
Does not work
15
46.9
PNS / POLRI / TNI
6
18.8
Entrepreneur
11
34.4
Education
Elementary school
8
25.0
Junior High
9
28.1
High school
10
31.1
Bachelor
5
15.6
Level of stress
Mild stress
9
28.1
Moderate stress
2 3
71.9
Table 2
Differences in stress before and after the
intervention
Indicators
Intervention
group
Control
group
Stress score before
intervention
71.88
(±7,182)
126.69
(±3,772)
Stress score before
intervention
69.06
(±7,280)
129.50
(±4,719)
0,0001*
0,425*
* Wilcoxon test
DISCUSSION
In the adult age range related to behavior
and lifestyle, a person tends to not pay
attention to their food intake so that it can
affect blood sugar levels and stress levels
because the food content is not following
diabetes mellitus suffered.8–10
Women have a higher risk of
suffering neuropathic complications
related to parity and pregnancy, large body
mass index, and menstrual cycle
syndrome as well as during menopause
which results in inhibition of the transport
of gnocchi into cells, leading to diabetes
mellitus.11
South East Asia Nursing Research, Vol 2 No 2, June 2020/ page 10-14 13
Warsono / Effectiveness of Slow Deep Breathing Exercise on Decreasing Stress Levels for Patients with Diabetes
Mellitus
The level of education is very influential in
changes in attitudes and behavior in healthy
living. Patients who have a low level of
education will find it difficult to accept and
understand the health messages conveyed
so that it affects the patient's ability to
respond to a problem he faces. Conversely,
sufferers who have higher education will
have broader knowledge also allow the
patient to control himself in overcoming the
problems at hand, have high self-
confidence, experience, and have the right
estimate, how to deal with events, and
easily understand what recommended by
health workers in providing therapy.12
The level of employment of respondents as
the motherhouse ladder includes sweeping,
washing dishes, cooking including the
activity of the physical light that has a risk
of 4.36 times is great for people with
diabetes mellitus in comparison with those
that have activity moderate and severe.13,14
Levels of stress experienced by the
response can be controlled by the treatment
of slow deep breathing for therapy that is
one of the independent nursing
interventions that can be used to overcome
the psychological symptoms of patients. It is
important to teach patients to remember
the conditions they face are uncertain, for
example experiencing psychological
symptoms. This relaxation can be useful for
improving health conditions and inhibiting
stress and anxiety. Because of the very
strong connection between the body and
the mind, it not only has a calming effect on
the body but is also beneficial in giving calm
to the mind. Until now, deep breathing
relaxation is still one of the most widely
used therapies because it is easy and does
not require tools when performed. It only
requires full concentration, a comfortable
position, and can use imagination.6,15,16
The results of these data indicate that the
provision of slow deep breathing therapy
reduces stress levels so that this study is
proven.
CONCLUSION
Slow deep breathing exercise intervention
can reduce the stress of diabetes mellitus
patients. nurses can use this therapy to
reduce stress in diabetes mellitus patients,
to reduce the impact caused by stress.
ACKNOWLEDGMENTS
We would like to express our appreciation
to all patients who participated in this
research.
CONFLICTS OF INTEREST
Neither of the authors has any conflicts of
interest that would bias the findings
presented here.
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