2. Thesis Title
Yunus Elon

3. The Problem
Cardiovascular diseases (CVDs) are the
number one cause of death globally. It was
estimated that by 2030, about 25 million
people will die from CVDs, mainly from
heart disease and stroke. These are
projected to remain the single leading
causes of death
(WHO, 2011).

4. According to
WHO, (2011)
82% of CVDs
deaths take
place in low-
and middle-
income
countries and
occur almost
equally in
men and
women.

5. Indonesia categorized as middle-
income countries and according to the
latest WHO data published in April
2011, CVDs deaths in Indonesia
reached 243,048 or 17.05% of total
deaths.

6. Based on studies,
plants specifically
lime which is rich in
Vitamin C is effective
in protecting against
endothelial
dysfunction, high
blood pressure, and
the blood vessel
changes that precede
heart disease.

7. Results of Phytochemical analysis
reveals, lime contains pectin,
saponins, tannins, alkaloids,
steroids, synephrine, and
flavonoids
(Akthar, 2013; Tristiyanti, 2012).

8. These chemical substances are the
reason why some authors
(Tundis et al. 2012; Ojiezeh, Nwachukwu, & Udoh 2011;
Boshtam, et al. 2011; Yaghmaie, Parivar & Haftsavar 2011;
Goepp, 2008)
claimed that lime possess:

9. Flexible line
of defence
Normal line
of defence Line of
resistance
Basic
structure
Figure: Illustrating the Neuman’s line of defence and resistance
Theoretical Framework

10. Figure: Illustrating the Neuman’s line of defence and resistance
Theoretical Framework
_ _ _ _ _ _ _ _ _ _ _ _ _ _ FLD
_____________________ NLD
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ LR
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Activates Line of Resistance:
↑ Cholesterol →Risk for CVD
ILLNESS
Stressors

11. Figure: Illustrating the Neuman’s line of defence and resistance
Theoretical Framework
_ _ _ _ _ _ _ _ _ _ _ _ _ _ FLD
_____________________ NLD
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ LR
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Stressors
Secondary prevention:
Lime therapy and exercise
= ↓ cholesterol, ↓ risk for CVD
Lime & Exercise
RECONSTITUTIONN

12. Research Paradigm
1. Lime Therapy
2. Lime Therapy
with Exercise
Blood Cholesterol Level
Age
Gender
BMI
Independent Variables Dependent Variable
Moderator Variables

13. Research Problem
The study aims to determine the effects
of lime (Citrus Aurantifolia) therapy and
lime therapy with exercise on blood
cholesterol level.

14. Research Design
This study utilized quasi-
experimental design, which used
pretest-posttest of blood
cholesterol level of participants in
lime therapy only group and lime
therapy with exercise group.

15. Specific Question
and Objectives

16. 1. What is the blood cholesterol level
among the groups before and after the
seven days of treatments?
2. Is there a significant difference in the
blood cholesterol level before seven days
of treatment between the group who
received lime therapy only and the group
who received lime therapy with exercise?
3. Is there a significant difference in the
blood cholesterol level after seven days of
treatment between the group who
received lime therapy only and the group
who received lime therapy with exercise?

17. 4. Is there a significant difference in the blood cholesterol level of
the participants before and after the seven days of treatments
in the:
a. Group lime therapy
b. Group lime therapy with exercise
5. Is there a significant difference in the mean gain score of lime
therapy group and lime therapy with exercise group on blood cholesterol
level?
6. Is there a significant difference in the mean blood cholesterol
level of the participants in the group with lime therapy and the
group with lime therapy and exercise when the following
variables are considered:
a. Age c. BMI
b. Gender

18. Research Questions # 1
What is the blood
cholesterol level among the
groups before and after the
seven days of treatments?

19. Mean blood cholesterol level (mg/dl) of participants
before and after seven days treatment of lime
therapy only group
BC
Level
Treatment (mg/dl) % Blood cholesterol values VI
Mean SD Category Range mg/dl
TC Before
After
230.30
205.90
36.48
30.42
10.48
Desirable
Borderline High
High
˂ 200
200-239
≥ 240
Borderline high
Borderline high
LDL-C Before
After
172.61
148.13
29.8
41.55
14.18
Optimal
Above Optimal
Borderline High
High
Very High
˂100
100-129
130-159
160-189
≥ 190
High
Borderline High
HDL-C Before
After
50.30
47.94
16.26
44.34
4.69
Below
Desirable
High
˂ 40
40 (m), 50 (f)
≥ 60
Desirable
Desirable

20. Mean blood cholesterol level (mg/dl) of participants
before and after seven days treatment of lime therapy
with exercise group.
BC
level
Treatment (mg/dl) % Blood cholesterol values VI
Mean SD Category Range mg/dl
TC Before
After
214.30
195.80
35.19
32.75
8.63
Desirable
Borderline High
High
˂ 200
200-239
≥ 240
Borderline High
Desirable
LDL-C Before
After
161.09
141.91
35.89
34.91
11.91
Optimal
Above Optimal
Borderline High
High
Very High
˂100
100-129
130-159
160-189
≥ 190
High
Borderline High
HDL-C Before
After
45.91
46.30
20.06
16.54
.85
Below
Desirable
High
˂ 40
40 (m), 50 (f)
≥ 60
Desirable
Desirable

21. 0
50
100
150
200
250
TC LDL-C HDL-C TC LDL-C HDL-C
Bloodcholesterol(mg/dl)
Mean Blood Cholesterol Level (mg/dl) of participants
before and after seven days of treatment
Before Treatment Mean Before Treatment SD After Teratment Mean
After Teratment SD Expon. (Before Treatment Mean) Expon. (After Teratment Mean)
Lime Therapy Lime Therapy with Exercise

22. The finding of this study is consistent
with the previously study: Kang, Kwon,
Ahn, Lee, Lee, and Jo (2009) showed that
pectin oligosaccharides produced by
irradiation can reduce the levels of
serum triglyceride, total cholesterol,
and LDL-cholesterol in the blood of
mice fed high-cholesterol diets

23. Research Question # 2
Is there a significant difference in
the blood cholesterol level before
seven days of treatment between
the group who received lime
therapy only and the group who
received lime therapy
with exercise?

24. Differences in the blood cholesterol level between
the groups before seven days of lime therapy and
lime therapy with exercise
BC
Level
Group
Therapy
n Mean SD t Sig (2-
tailed)
VI
TC Lime
Lime with
exercise
10
10
230.30
214.30
36.48
3519
.998 .331 Not
Significant
LDL-C Lime
Lime with
exercise
10
10
172.61
161.09
29.08
35.89
.789 .441 Not
Significant
HDL-C Lime
Lime with
exercise
10
10
50.30
45.91
16..26
20.06
.538 .598 Not
Significant

25. Research Questions # 3
Is there a significant difference in the
blood cholesterol level after seven
days of treatment between the group
who received lime therapy only and
the group who received lime therapy
with exercise?

26. Differences in the blood cholesterol level between
the groups after seven days of lime therapy
and lime therapy with exercise
BC
Level
Group
Therapy
n Mean SD t Sig (2-
tailed)
VI
TC Lime
Lime with
exercise
10
10
205.90
195.80
30.42
32.75
.714 .484 Not
Significant
LDL-C Lime
Lime with
exercise
10
10
148.13
141.91
41.55
34.91
.283 .780 Not
Significant
HDL-C Lime
Lime with
exercise
10
10
47.94
46.30
44.34
16.54
.850 .413 Not
Significant

27. Research Questions # 4
Is there a significant difference in
the blood cholesterol level of the
participants before and after the
seven days of treatments in the:
a. Group lime therapy
b. Group lime therapy with
exercise

28. Difference in the blood cholesterol level
before and after seven (7) days
of lime therapy only group
BC
Level
Treat
ment
n Mean
(mg/dl)
SD t Sig (2-
tailed)
VI
TC Before
After
10
10
230.30
205.90
36.48
30.42
2.156 .059 Significant
LDL-C Before
After
10
10
172.61
148.13
29.08
41.55
2.287 .048 Significant
HDL-C Before
After
10
10
50.30
47.94
16.26
44.34
1.098 .301 Not
Significant

29. Hence, the null hypothesis which
states “There is no significant
difference in the blood
cholesterol level (TC, LDL-C) of
the participants before and after
the seven days of treatments in
the lime therapy group” is
rejected.

30. However, the null hypothesis
which states “There is no
significant difference in the
blood cholesterol level (HDL-C)
of the participants before and
after the seven days of
treatments in the lime therapy
group” is accepted.

31. Difference in the blood cholesterol level
before and after seven (7) days of
lime therapy with exercise
BC
Level
Treat
ment
n Mean
(mg/dl)
SD t Sig (2-
tailed)
VI
TC Before
After
10
10
214.30
195.80
35.19
32.75
2.922 .017 Significant
LDL-C Before
After
10
10
161.09
141.91
35.89
34.91
2.665 .026 Significant
HDL-C Before
After
10
10
45.91
46.30
20.06
16.54
-.237 .818 Not
Significant

32. Hence, the null hypothesis that
states “There is no significant
difference in the blood
cholesterol level (TC, LDL-C) of
the participants before and after
the seven days of treatments in
the lime therapy with exercise
group” is rejected.

33. Hence, the null hypothesis that
states “There is no significant
difference in the blood
cholesterol level (HDL-C) of the
participants before and after
the seven days of treatments in
the lime therapy with exercise
group” is accepted.

34. Study by Boshtam, Asgary, Moshtaghian, Naderi,
and Jafari-Dinani (2013)
Evaluate the effects of fresh lime juice
and peel on atherosclerosis progression
in rabbits receiving hypercholesterolemic
diet. They found out that group of rabbits
that receive lime juice has decreased in
serum lipid and presence of fatty streaks
in coronary arteries and aorta of the
intervention group was significantly
decreased compared to the
hypercholesterolemic control group.

35. Research Questions # 5
Is there a significant difference in the
mean gain score of lime therapy
group and lime therapy with exercise
group on blood cholesterol
level?

36. Difference in gain score of the two
groups on blood cholesterol level
Gain Group
Therapy
n Mean SD t Sig (2-
tailed)
VI
TC Lime
Lime with
exercise
10
10
24.40
18.50
35.79
20.02
-.455 .655 Not
significant
LDL-C Lime
Lime with
exercise
10
10
24.48
19.18
33.85
22.76
-.41 .686 Not
Significant
HDL-C Lime
Lime with
exercise
10
10
-2.36
.39
6.80
5.21
1.016 .323 Not
Significant

37. Research Questions # 6
Is there a significant difference in the
mean blood cholesterol level of the
participants in the group with lime
therapy and the group with lime therapy
and exercise when the following
variables are considered:
a. Age c. BMI
b. Gender

38. Difference in blood cholesterol of the
two groups when age is considered
Gain Age n Mean SD t Sig (2-
tailed
VI
TC Young Adult
Middle Adult
3
17
33.33
19.35
27.57
28.82
.804 .483 Not
Significant
LDL-C Young Adult
Middle Adult
3
17
37.43
19.08
22.84
28.74
1.23 .300 Not
Significant
HDL-C Young Adult
Middle Adult
3
17
-5.20
-.24
3.50
6.18
-1.97 .110 Not
Significant

39. Blood cholesterol begins to rise around age 20
and will increase as the age increases. It would
continue to go up until about the age of 60 or
65. Before men reach the age of 50, their total
cholesterol levels tend to be higher than that of
women of the same age. While after the age of
50, the opposite happens. Thus, because of
menopause, women’s LDL-C levels often rise
(NHLBI, 2005; Djohan, 2004).

40. Difference in blood cholesterol of the
two groups when gender is considered
Gain Gender n SD Mean t Sig. (2-
tailed)
VI
TC Female
Male
16
4
29.66
20.21
18.13
34.75
-1.051 .307 Not
Significant
LDL-C Female
Male
16
4
26.97
26.06
16.59
42.78
-1.748 .413 Not
Significant
HDL-C Female
Male
16
4
5.89
7.09
-.413
-3.28
.838 .097 Not
Significant

41. Difference in blood cholesterol level of the two
groups when BMI is considered
BMI n SD Mean f Sig. VI
TC Normal Weight
Overweight
Obese class I
Obese class II
Total
4
13
2
1
20
26.17
22.49
4.24
.
28.39
14.25
13.46
59.00
79.00
21.45
4.697 .015 Significant
LDL-C Normal Weight
Overweight
Obese class I
Obese class II
Total
4
13
2
1
20
27.59
26.47
4.81
.
28.20
19.95
14.35
57.60
55.00
21.83
1.831 .182 Not
Significant
HDL-C Normal Weight
Overweight
Obese class I
Obese class II
Total
4
13
2
1
20
5.98
5.84
1.48
.
6.06
4.48
-1.91
-2.65
-7.50
-.095
2.190 .129 Not
Significant

42. Hence, the null hypothesis that
states “There is no significant
difference in the mean score of
the blood cholesterol level (TC)
of the participants in the lime
therapy group and the lime
therapy with exercise group
considering their BMI” is
rejected.

43. On the other hand, the hypothesis
which states that “There is no
significant difference in the mean
blood cholesterol level (LDL-C, HDL-C)
of the participants in the lime therapy
group and the lime therapy with
exercise group considering their BMI”
is accepted.

44. A study done by Cong et al. (2014)
towards Muslim ethnic Uyghur tried to find out
the relationship of BMI towards major blood
indicator. There were 25 total items that were
measured, and there were 1.452 women aged 21
to 71 years old who completed the data for
analysis. The average BMI among these women
was 24.0±4.0. The result showed that there is a
significant relationship between BMI and total
cholesterol and low-density lipoprotein (LDL-C),
but negatively related to high-density lipoprotein
cholesterol (HDL-C).

45. Conclusion
•Drinking lime juice 1.5 ml/kg body
weight for seven (7) days, with normal
diet or without controlling their food. Is
significant to reduce blood cholesterol
level in terms of:
Total cholesterol (TC)
Low density lipoprotein cholesterol (LDL-C)
And not significant on High density
lipoprotein cholesterol (HDL-C)

46. Conclusion
•Drinking lime juice 1.5 ml/kg body weight
for seven (7) days with exercise six (6)
days, with normal diet or without
controlling their food. Is significant to
reduce blood cholesterol level in terms
of:
Total cholesterol (TC)
Low density lipoprotein cholesterol (LDL-C)
And increased High density lipoprotein
cholesterol (HDL-C) even though not significant

47. Conclusion
•Age and Gender as a moderating
variable made no significant
difference on blood cholesterol
level.
•Body mass index (BMI) made
significant difference on blood
cholesterol level (TC).

48. Recommendations
•Nurse educators in doing their
responsibility need to educate
students the importance of using
natural, accessible, simple and cost
effective intervention available in
the community to address the
common problem such as
hypercholesterolemia.

49. Recommendations cont’d
Nursing Research
•To conduct another study utilizing individuals with lipid
profiles such as TC, LDL-C, HDL-C and Tg to produce more
meaningful result.
•Or individuals with high; TC, LDL-C and Tg were these
three things are necessary to lower. Otherwise individual
with low HDL-C.
•To replicate this study using more participants in other
communities or institution, with increased number of
days for the treatment groups and to consider having a
control group in the study for future evidence. Other
studies can also be done to explore antioxidant properties
of lime.

50. Data Gathering Procedure
1. World Health Organization, Regional office for South-East Asia (WHO, ROSEA), (2011)
Cardiovascular Disease Fact Sheet I Department of Sustainable Development and Healthy
Environments I September 2011
2. Akhtar, S. S. (2013 June) Evaluation of Cardiovascular Effects of Citrus Aurantifolia (Linn.) Fruit.
Available at SSRN: http://ssrn.com/abstract=2279447
3. Tristiyanti, W. (2012). Jeruk nipis bikin langsing?. Anakku. http://www.anakku.net/jeruk-nipis-bikin-
langsing.html
4. Tundis, R., Loizzo, M. R., Bonesi, M., Menichini, M, Mastellone, V., Colica, C, Menichoini, F. (2012).
Comparative study on the antioxidant capacity and cholinesterase inhibitory activity of citrus
aurantifolia swingle, c. aurantium l. and c. bergamia r. Journal of Food and Science. 77 (1): H40-H46
5. Ojiezeh, T.I., Nwachukwu, S. E., & Udoh, S. J. (2011). Antimicrobial effect of citrus aurantifolia juice
and veronica amygdalina on common bacteria isolates. Der Pharma Chemica, 2011, 3(1): 1-7
6. Boshtam, M., Asgary, S., Moshtaghian, J., Naderi, G., Jafari-Dinani, N. (2013). Impactof frech lime
juice and peel on atheroscleoris progression in an animal model. ARYA Atheroscler. 9 (6). 357-362
7. Yaghmaie, P., Parivar, K., & Haftsavar, M. (2011). Effects of Citrus aurantifolia peel essential oil on
serum cholesterol levels in Wistar rats. Journal of Paramedical Sciences (JPS). 2(1); 29-32
8. Goepp, J. (2008). Newly Discovered Health Benefits of Vitamin C. LeeMagasines
9. Whetsell, M., Gonzales,Y., & Moreno-Fergusson, M. (2011). Models and Theories Focused on a
System Approach.In J. Butts, & K.Rich, Philosophoes and Theories for Advanced Nursing Practice
(pp.413-443). United State of America: Jones 7 Bartlett Learning, LLC.
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