Body Mass Index, Physical Activity, and Physical Balance among Community-Dwelling Older Adults in A Rural Balinese Village: A Cross-Sectional Study

Putu Wira Kusuma Putra; Ni Komang Matalia Gandari; Meriana Barreto Amaral

doi:10.58545/jrcnp.v4i2.935

Authors

Putu Wira Kusuma Putra Nursing Program, STIKES Bina Usada Bali, Indonesia https://orcid.org/0009-0001-4459-0335
Ni Komang Matalia Gandari Nursing Program, STIKES Bina Usada Bali, Indonesia https://orcid.org/0000-0002-0460-5520
Meriana Barreto Amaral Faculdade de Medicina e Ciências de Saúde, Escola Superior de Parteira, Universidade Nacional Timor Lorosae, Dili, Timor Leste https://orcid.org/0009-0007-0097-2386

DOI:

https://doi.org/10.58545/jrcnp.v4i2.935

Abstract

Background: Population aging in Indonesia has been accompanied by a rising burden of falls among older adults, and rural villages carry much of this burden while having the least access to geriatric rehabilitation services. Impaired physical balance is a modifiable precursor of falling, yet nutritional status and habitual activity have rarely been examined together in rural Balinese communities. Purpose: To examine the relationship of body mass index and physical activity with physical balance among community-dwelling older adults in Gulingan Village, Mengwi Sub-district, Badung Regency, Bali, Indonesia. Methods: An analytical cross-sectional study was conducted between February and March 2026 among 248 older adults aged 60 years and over, recruited by purposive sampling from the village register of integrated health posts for older people. Nutritional status was expressed as body mass index calculated from measured weight and height, and classified with Asia-Pacific cut-off points. Habitual activity was measured with the Physical Activity Scale for the Elderly, and physical balance with the Timed Up and Go test. Associations were tested with the Spearman rank correlation. Results: Mean age was 71.60 years (standard deviation 7.46) and 134 respondents (54.0%) were women. Obesity class 1 was the most frequent nutritional category (85 respondents; 34.3%); 166 respondents (66.9%) had a low level of habitual activity; and 126 respondents (50.8%) were classified as high risk of falling. A higher body mass index category was associated with poorer physical balance (r = 0.848; p < 0.001), and a lower level of physical activity was likewise associated with poorer physical balance (r = 0.725; p < 0.001). Conclusions: Nutritional status and habitual activity were both strongly associated with physical balance in this rural older population, and both are modifiable. Nurses working in village settings should combine routine measurement of weight, height, and activity level with performance-based balance screening and cadre-delivered balance training within existing integrated health posts for older people.

Keywords:

Accidental Falls, older people, Body Mass Index, Exercise, Postural balance

Downloads

Download data is not yet available.

References

Badan Pusat Statistik. (2023). Statistik penduduk lanjut usia 2023. https://www.bps.go.id/id/publication/2023/12/29/5d308763ac29278dd5860fad/statistik-penduduk-lanjut-usia-2023.html

Barry, E., Galvin, R., Keogh, C., Horgan, F., & Fahey, T. (2014). Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: A systematic review and meta-analysis. BMC Geriatrics, 14, 14. https://doi.org/10.1186/1471-2318-14-14

Batsis, J. A., & Villareal, D. T. (2018). Sarcopenic obesity in older adults: Aetiology, epidemiology and treatment strategies. Nature Reviews Endocrinology, 14(9), 513–537. https://doi.org/10.1038/s41574-018-0062-9

Bull, F. C., Al-Ansari, S. S., Biddle, S., Borodulin, K., Buman, M. P., Cardon, G., Carty, C., Chaput, J.-P., Chastin, S., Chou, R., Dempsey, P. C., DiPietro, L., Ekelund, U., Firth, J., Friedenreich, C. M., Garcia, L., Gichu, M., Jago, R., Katzmarzyk, P. T., ... Willumsen, J. F. (2020). World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine, 54(24), 1451–1462. https://doi.org/10.1136/bjsports-2020-102955

Cruz-Jentoft, A. J., Bahat, G., Bauer, J., Boirie, Y., Bruyère, O., Cederholm, T., Cooper, C., Landi, F., Rolland, Y., Sayer, A. A., Schneider, S. M., Sieber, C. C., Topinkova, E., Vandewoude, M., Visser, M., & Zamboni, M. (2019). Sarcopenia: Revised European consensus on definition and diagnosis. Age and Ageing, 48(1), 16–31. https://doi.org/10.1093/ageing/afy169

Dharmawan, P., Jaya, I. P. P., & Suadnyana, I. A. A. (2022). Hubungan indeks masa tubuh (IMT) terhadap keseimbangan dinamis pada lansia di PWRI Kota Denpasar. PREPOTIF: Jurnal Kesehatan Masyarakat, 6(3), 1662–1668. https://doi.org/10.31004/prepotif.v6i3.5616

Dyer, S. M., Suen, J., Kwok, W. S., Dawson, R., McLennan, C., Cameron, I. D., Hill, K. D., & Sherrington, C. (2023). Exercise for falls prevention in aged care: Systematic review and trial endpoint meta-analyses. Age and Ageing, 52(12), afad217. https://doi.org/10.1093/ageing/afad217

Fadila, N., Wijaya, A., & Roni, F. (2024). Hubungan aktivitas fisik dengan indeks massa tubuh pada lanjut usia di Desa Kalikejambon, Kabupaten Jombang. Jurnal Persatuan Perawat Nasional Indonesia, 9(2), 125–133. https://doi.org/10.32419/jppni.v9i2.528

Faidah, N., Kuswardhani, T., & Artawan Eka Putra, I. W. G. (2020). Pengaruh latihan keseimbangan terhadap keseimba-ngan tubuh dan risiko jatuh lansia. Jurnal Kesehatan, 11(2), 100. https://doi.org/10.35730/jk.v11i2.428

Gandham, A., Mesinovic, J., Jansons, P., Zengin, A., Bonham, M. P., Ebeling, P. R., & Scott, D. (2021). Falls, fractures, and areal bone mineral density in older adults with sarcopenic obesity: A systematic review and meta-analysis. Obesity Reviews, 22(5), e13187. https://doi.org/10.1111/obr.13187

Ganz, D. A., & Latham, N. K. (2020). Prevention of falls in community-dwelling older adults. New England Journal of Medicine, 382(8), 734–743. https://doi.org/10.1056/NEJMcp1903252

Gupta, S., & Singla, D. (2024). Aging and balance control: Analyzing the increased attentional demands – A comprehensive review. Biomedical Journal of Scientific & Technical Research, 57(3), 49243–49247. https://doi.org/10.26717/BJSTR.2024.57.008999

Ismail, N., Hairi, F., Choo, W. Y., Hairi, N. N., Peramalah, D., & Bulgiba, A. (2015). The Physical Activity Scale for the Elderly (PASE): Validity and reliability among community-dwelling older adults in Malaysia. Asia Pacific Journal of Public Health, 27(8), 62S–72S. https://doi.org/10.1177/1010539515590179

Kementerian Kesehatan Republik Indonesia. (2023). Survei Kesehatan Indonesia 2023: Laporan nasional. Badan Kebijakan Pembangunan Kesehatan.

Luo, Y., Wang, Y., Tang, S., Xu, L., Zhao, X., Han, M., Liu, Y., Xu, Y., & Han, B. (2024). Prevalence of sarcopenic obesity in the older non-hospitalized population: A systematic review and meta-analysis. BMC Geriatrics, 24(1), 357. https://doi.org/10.1186/s12877-024-04952-z

Montero-Odasso, M., van der Velde, N., Martin, F. C., Petrovic, M., Tan, M. P., Ryg, J., Aguilar-Navarro, S., Alexander, N. B., Becker, C., Blain, H., Bourke, R., Cameron, I. D., Camicioli, R., Clemson, L., Close, J., Delbaere, K., Duan, L., Duque, G., Dyer, S. M., ... Masud, T. (2022). World guidelines for falls prevention and management for older adults: A global initiative. Age and Ageing, 51(9), afac205. https://doi.org/10.1093/ageing/afac205

Neri, S. G. R., Oliveira, J. S., Dario, A. B., Lima, R. M., & Tiedemann, A. (2020). Does obesity increase the risk and severity of falls in people aged 60 years and older? A systematic review and meta-analysis of observational studies. The Journals of Gerontology: Series A, 75(5), 952–960. https://doi.org/10.1093/gerona/glz272

Niswatin, D., Cahyawati, W. A. S. N., & Rosida, L. (2021). Literatur review: Hubungan indeks massa tubuh (IMT) dengan massa otot pada lansia. Homeostasis, 4(1), 171–180. https://doi.org/10.20527/ht.v4i1.3378

Nugraha, S., Prasetyo, S., Susilowati, I. H., & Rahardjo, T. B. W. (2021). Urban-rural dimension of falls and associated risk factors among community-dwelling older adults in West Java, Indonesia. Journal of Aging Research, 2021, 8638170. https://doi.org/10.1155/2021/8638170

Oktriani, S., Kusmaedi, N., Ray, H. R. D., & Setiawan, A. (2020). Perbedaan jenis kelamin, usia, dan body mass index (BMI) hubungannya dengan kebugaran jasmani lanjut usia. Jurnal Terapan Ilmu Keolahragaan, 5(1), 28–40. https://doi.org/10.17509/jtikor.v5i1.24895

Podsiadlo, D., & Richardson, S. (1991). The timed "Up & Go": A test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society, 39(2), 142–148. https://doi.org/10.1111/j.1532-5415.1991.tb01616.x

Putra, G. A. G. B., Parwata, I. M. Y., & Vitalistyawati, L. P. A. (2023). Hubungan indeks massa tubuh terhadap keseimbangan lansia di Desa Batubulan. Jurnal Kesehatan, Sains, dan Teknologi, 2(3), 29–34. https://doi.org/10.36002/js.v2i3.2691

Putra, P. A. R., Astrawan, I. P., & Suadnyana, I. A. A. (2023). Kualitas tidur dan IMT dengan keseimbangan postural pada lansia Banjar Tainsiat Kota Denpasar Bali. JIK: Jurnal Ilmu Kesehatan, 7(1), 16–23. https://doi.org/10.33757/jik.v7i1.592

Salari, N., Darvishi, N., Ahmadipanah, M., Shohaimi, S., & Mohammadi, M. (2022). Global prevalence of falls in the older adults: A comprehensive systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research, 17(1), 334. https://doi.org/10.1186/s13018-022-03222-1

Shalahuddin, I., Maulana, I., Eriyani, T., & Nurrahmawati, D. (2022). Latihan fisik untuk menurunkan resiko jatuh pada lansia: Literatur review. Jurnal Keperawatan Jiwa, 10(4), 739–754. https://jurnal.unimus.ac.id/index.php/JKJ/article/view/10005

Sherrington, C., Fairhall, N. J., Wallbank, G. K., Tiedemann, A., Michaleff, Z. A., Howard, K., Clemson, L., Hopewell, S., & Lamb, S. E. (2019). Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, 2019(1), CD01242 4. https://doi.org/10.1002/14651858.CD012424.pub2

Washburn, R. A., Smith, K. W., Jette, A. M., & Janney, C. A. (1993). The Physical Activity Scale for the Elderly (PASE): Development and evaluation. Journal of Clinical Epidemiology, 46(2), 153–162. https://doi.org/10.1016/0895-4356(93)90053-4

Wiedenmann, T., Held, S., Rappelt, L., Grauduszus, M., Spickermann, S., & Donath, L. (2023). Exercise based reduction of falls in community-dwelling older adults: A network meta-analysis. European Review of Aging and Physical Activity, 20(1), 1–10. https://doi.org/10.1186/s11556-023-00311-w

World Health Organization. (2021). Falls. https://www.who.int/news-room/fact-sheets/detail/falls

World Health Organization. (2022). Ageing and health. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health

Xia, Q., Zhou, P., Li, X., Li, X., Zhang, L., Fan, X., Zhao, Z., Jiang, Y., Zhu, J., Wu, H., & Zhang, M. (2023). Factors associated with balance impairments in the community-dwelling elderly in urban China. BMC Geriatrics, 23(1), 545. https://doi.org/10.1186/s12877-023-04219-z

Xiong, W., Wang, D., Ren, W., Liu, X., Wen, R., & Luo, Y. (2024). The global prevalence of and risk factors for fear of falling among older adults: A systematic review and meta-analysis. BMC Geriatrics, 24(1), 321. https://doi.org/10.1186/s12877-024-04882-w

Yang, H., Jiang, Y., Liang, D., Yang, C., Qin, K., Xie, Y., Zhang, L., Tang, P., Cui, X., & Lyu, H. (2025). Sarcopenia-related traits and risk of falls in older adults: Results from meta-analysis of cohort studies and Mendelian randomization analyses. Aging Clinical and Experimental Research, 37(1), 96. https://doi.org/10.1007/s40520-025-02997-7

Yu, H., Zhong, J., Li, M., & Chen, S. (2025). Effects of exercise intervention on falls and balance function in older adults: A systematic review and meta-analysis. PeerJ, 13, e20190. https://doi.org/10.7717/peerj.20190

Zhu, T.-R., Xu, H.-Q., Wei, J.-P., Quan, H.-L., Han, X.-J., Li, T.-X., & Shi, J.-P. (2025). Effectiveness of exercise prescription variables to reduce fall risk among older adults: A meta-analysis. European Review of Aging and Physical Activity, 22(1), 1–22. https://doi.org/10.1186/s11556-025-00374-x