Relationship of Body Mass Index and Haemoglobin with Cardiorespiration Endurane in Female College Students

Cardiorespiratory endurance is the maximum capacity of using oxygen which can be influenced by Hb and BMI levels, so it does not get tired easily after doing activities. Students tend to have unbalanced Hb and BMI. This study aims to determine the relationship of BMI and hemoglobin levels with cardiorespiratory endurance in female college students. A literature review searched three database (Google Scholar, Pro Quest, and National Journal) that use crosssectional or quasi-experimental designs published after 2010. The prism checklist is used as a guide to assess the feasibility of studies. The research findings were carried out by tabulating data and narrative analysis. Found 8 journals that met the inclusion criteria based on two broad that affected cardiorespiratory endurance, BMI (n=3), Hb (n=5). Most of these studies use cross-sectional or quasi-experimental designs. The average number of respondents of the study was more than 50 people for the study of the relationship of hemoglobin and body mass index with cardiorespiratory endurance in female college students. The research examined in this article shows that BMI and Hb are associated with cardiorespiratory endurance in female college students. This can be used as nurses to provide education about the importance of maintaining a balance of BMI and hemoglobin levels in increasing cardiorespiratory endurance so that they can perform physical activity maximally.


INTRODUCTION
Human activity always requires physical or physical support so that it can become a basic factor for human activity 1 . One of the physical fitness related to health is cardiorespiratory resistance 2 .
Cardiorespiratory resistance is the maximum ability for oxygen utilization in the body. A person who has good cardiorespiratory endurance, does not get tired quickly after doing activities 3 .
Cardiorespiratory endurance can be seen from the measurement of body mass index and blood composition, especially hemoglobin levels 4 .
The latest research conducted by Putri at the Faculty of Medicine, Andalas University, from 38 students studied, found that 24 students (63.2%) were at a very poor fitness level, 6 students (15.8%) were at a low fitness level, and each 4 students (10.5%) at a sufficient and good fitness level and not a single student has a very good level of physical fitness. This shows that more than 50% of students have a very low level of physical fitness 5  . Research from Astuti, revealed that the cardiorespiratory endurance was higher at 47.59 ml / kg / minute on normal hb, and only 37.84 ml / kg / minute at low db. During the blood donation event at STIKES Hang Tuah Surabaya, it was known that 71.7% of the 46 female students who did not pass the blood donation test were due to Hb levels that were less than normal 4 . Cardiorespiratory endurance can determine the level of physical fitness because oxygen processing is a metabolic ability that the body has 2 . Cardiorespiratory resistance can be affected by BMI 7 . Body mass index can be seen by weight and height. Someone who is overweight will often feel out of breath, heavy body, often feel hot, pain in the waist, hips, thighs and knees. This is a warning that a person must be aware and must make adequate and appropriate eating arrangements and physical exercise to stay healthy and fit 8 . Cardiorespiratory resistance can also be affected by hemoglobin because it requires oxygen, which in the oxygen-producing body which acts as a transport medium that delivers oxygen throughout the body is hemoglobin 9 . Hairy argues that hemoglobin levels can increase if you do regular exercise 10 .
For students, physical fitness is needed to support activities during lectures 11 . Students in each faculty have different demands, especially nursing students who have to take practical and theoretical lectures. Nursing students as prospective health workers in the future are expected to be role models in their environment and be able to promote physical activity to each patient.

METHOD
The method used in this Literature review begins with selecting a topic, then determining keywords for journal searches using English and Indonesian through databases, namely Google Scholar,  13 . This study shows that body mass is the most influencing parameter in cardiorespiratory endurance. Women who are obese have lower cardiorespiratory fitness, decreased muscle strength of the lower extremities with normal peer body weight 14 . Obesity in a person can make changes in the body, such as the presence of adipose / fat tissue around the ribs, abdomen, and visceral cavities that fill the abdominal wall resulting in increased intra-abdominal pressure resulting in inadequate inspiratory process so that vital lung capacity decreases 15 . Thick chest wall by fat folds in an advanced state will greatly inhibit chest wall breathing movements, and can even cause intermittent airway obstruction and the visceral cavity that fills the abdominal wall resulting in increased intra-abdominal pressure resulting in an inadequate inspiratory process so that the vital capacity of the lung decreases 16 .

Hemoglobin levels
This researcher is in line with research by Fannisa Mahastuti, and Zen Rahfiludin that the better the hemoglobin level, the better the level of physical fitness. Researchers also added that if the better the energy adequacy level, the better a person's hemoglobin level. if the better iron sufficiency, the better a person's hemoglobin level 17 . The research was also supported by Philo U Saunders, Laura A Garvican-Lewis, Walter F Schmidt, Christopher J Gore entitled Relationship between changes in hemoglobin mass and maximal oxygen uptake after hypoxic exposure revealed that there was a relationship between hemoglobin levels and VO2max 18 .
In a study on hemoglobin status, smoking habits and cardiorespiratory endurance (vo2 max) in basketball student activity unit athletes by Anggraeni and Wirjatmadi, it was suggested that athletes who were not anemic and non-smoking had good cardiorespiratory endurance. Basketball athletes are advised to maintain a balanced Hb level and avoid smoking in order to have good cardiorespiratory endurance. Researchers added that normal hemoglobin levels in the body are very beneficial for athletes because they match their function. Hemoglobin can bind to oxygen which will then be carried to tissues or organs in the body that need it to do work. Researchers added that normal hemoglobin levels in the body are very beneficial for athletes because they match their function 19 .

Gender
In the research of Rini Wuri Astuti entitled Hematocrit and Hemoglobin Levels with Maximum Oxygen Consumption (Vo2max) in adolescent athletes, it was revealed that gender had an effect on the relationship between hemoglobin and VO2max levels 4 . Oxygen consumption can be affected by body composition. The most common measurement of body composition is the percentage of fat. In this study, there was no measurement of fat percentage, where a person is advised to have a body fat percentage of between 8-18% to maintain cardiorespiratory. Generally, men have lower fat than women 20 .

CONCLUSIONS AND SUGGESTIONS
Cardiorespiratory endurance will run well if accompanied by adequate body composition (BMI and Hb levels). A person who has a high BMI tends to have a low VO2 max. Body weight can affect speed, endurance and muscle strength. Fatigue is caused by a decrease in the maximum amount of oxygen uptake (VO2 max). A decrease in hemoglobin levels for female students can result in a lack of oxygen being circulated to the body and brain. This is influenced by the number of red blood cells and the status of hemoglobin in them. Good hemoglobin has enough oxygen for the body's metabolic system. Therefore, if oxygen transport decreases, the cardiorespiratory capacity will also decrease.
Maintaining good body mass index status and hemoglobin levels is important for female students to get maximum cardiorespiratory endurance, get optimal appearance and support daily activities so as to improve health. The health team, such as nurses, are expected to be able to implement and provide health education about the importance of training cardiorespiratory endurance. Additional research needs to be done with similar themes but with different research methods and instruments.