294 Published by DiscoverSys | Bali Med J 2019; 8(1): 294-298 | doi: 10.15562/bmj.v8i1.1287 ORIGINAL ARTICLE ABSTRACT Open access: www.balimedicaljournal.org and ojs.unud.ac.id/index.php/bmj The combination eﬀect of brisk walking and relaxation toward hs-crp and anxiety levels in subject with central obesity in Singaraja, Bali Ketut Indra Purnomo 1,2* , Muchsin Doewes 2 , Suroto 2 , Bhisma Murti 2 Background: Inﬂammation and anxiety have reciprocal relationships because low grade chronic inﬂammation characterized by elevated hs-CRP in central obesity has been proved to induce anxiety. Likewise, anxiety could also induce central obesity and inﬂammation of peripheral tissue. Brisk walking and relaxation have been proved to have anti-inﬂammatory eﬀects. However, the eﬀects of their application in central obesity population have not been observed. Objective: The aim of the study is to determine the combination eﬀect of brick walking and relaxation on hs-CRP and anxiety level. Method: This research is an experimental research with randomized controlled trial design. According to sample size formula, this study required 80 with central obesity which would be selected using purposive sampling. The sample was divided into 4 groups by randomization procedure intocontrol group, brisk walking group, relaxation group and combination of brisk walking and relaxation group. Each group was given thrice a week treatment for six weeks. Data were analyzed by using SPSS 22. Results: A total of 80 samples with central obesity were enrolled with mean age 47.66 ± 7.47 years old and WHtR 0.57 ± 0.04. There is no signiﬁcant eﬀect of brisk walking, relaxation, and their combination to hs-CRP level (p = 0.696). On the other hand, all of the interventions were signiﬁcantly reduce the anxiety level. However, the combination of brisk walking and relaxation had the most signiﬁcant eﬀect in decreasing anxiety level even when compared to either brisk walking or relaxation group (p <0.05). Conclusion: Both brisk walking and relaxation signiﬁcantly reduce the level of anxiety but their combination had the most signiﬁcant eﬀect. However, no intervention had proved to alter the level of hs- CRP. Keywords: Brisk walking, relaxation, combination of brisk walking and relaxation exercises, hs-CRP, anxiety level. Cite this Article: Purnomo, I.P., Doewes, M., Suroto., Murti, B. 2019. The combination eﬀect of brisk walking and relaxation toward hs-crp and anxiety levels in subject with central obesity in Singaraja, Bali. Bali Medical Journal 8(1): 294-298. DOI:10.15562/bmj.v8i1.1287 1 Faculty of Sport and Health, Ganesha Educational University, Singaraja, Bali, Indonesia 2 Doctoral Program, Faculty of Medicine, Sebelas Maret University, Surakarta *Corresponding to: Ketut Indra Purnomo. Faculty of Sport and Health, Ganesha University, Singaraja. ketut.indra@undiksha.ac.id Bali Medical Journal (Bali Med J) 2019, Volume 8, Number 1: 294-298 P-ISSN.2089-1180, E-ISSN: 2302-2914 Received: 2018-08-13 Accepted: 2019-01-26 Published: 2019-04-01 294 BACKGROUND Central obesity is a widespread health problem which oﬅen associated with cardiovascular disease, diabetes mellitus, cancer, osteoarthritis, and psychological disorders. 1 e mechanism involved in central obesity is the induction of low grade chronic inﬂammation characterized by increased pro-inﬂammatory cytokines and acute phase proteins such as high sensitive C-Reactive Protein (hs-CRP). 2,3 Central obesity status oﬅen determined bu measurement of waist-to-height ratio (WHtR). e psychoneuroimmunology ﬁeld explain the relationship between the immune system and the nervous system in psychiatric disorders. 4,5 Pro-inﬂammatory cytokines, such as interleukin (IL) -1β, IL-6, tumor necrosis factor (TNF) -α including CRP, could transverse the blood brain barrier and activate microglia which result in neuroinﬂammation. 6,7,8 e activated microglia release neurotoxic substances, such as pro- inﬂammatory cytokines (IL-6, TNF-α, IFN-γ, IL- 1β), reactive oxygen species (ROS), reactive nitrogen species (RNS) that could aﬀect the neuronal function. 9 Acute psychological stress activates the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic-adrenomedullary (SAM) system. e activation of HPA and SAM axis will increase the activation and expression of NF-кB. 10 Chronic psychological stress will ultimately lead to HPA fatigue, glucocorticoid resistance, the activation of inﬂammation related transcription pathway, and negative feedback which would further lead to increased pro-inﬂammatory cytokines. is processed underlie the reciprocal relationship between inﬂammation and psychological disorders. 11 Brisk walking is a moderate intensity of aerobic exercise that has been proved to have anti- inﬂammatory eﬀects. 12,13 Relaxation could oppose the stress response and alleviate the physiological and psychological alteration induced by stress. 14 However, the physiological eﬀects of brisk walking