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Modern lifestyle, with its lack of everyday physical activity and exercise training, predisposes people to chronic diseases such as diabetes mellitus, obesity, hypertension, and coronary artery diseases. Brisk walking as a simple and safe form of exercise is undisputedly an effective measure to counteract sedentary lifestyle risks even in the most unfit and could lead to a reduction of the prevalence of chronic diseases in all populations. The purpose of this review is to systematically summarize, analyze, and interpret the health benefits of Nordic walking (walking with poles), and to compare it to brisk walking and jogging. A systematic and comprehensive literature search was performed between November 2010 and May 2012. Data were analyzed between April 2011 and May 2012. Sixteen RCTs with a total of 1062 patients and 11 observational studies with 831 patients were identified. The current analysis revealed that with regard to short- and long-term effects on heart rate, oxygen consumption, quality of life, and other measures, Nordic walking is superior to brisk walking without poles and in some endpoints to jogging. Nordic walking exerts beneficial effects on resting heart rate, blood pressure, exercise capacity, maximal oxygen consumption, and quality of life in patients with various diseases and can thus be recommended to a wide range of people as primary and secondary prevention.
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Health Benefits of Nordic Walking
A Systematic Review
Marcus Tschentscher, MSc, David Niederseer, MD, PhD, BSc,
Josef Niebauer, MD, PhD, MBA
Context: Modern lifestyle, with its lack of everyday physical activity and exercise training, predis-
poses people to chronic diseases such as diabetes mellitus, obesity, hypertension, and coronary artery
diseases. Brisk walking as a simple and safe form of exercise is undisputedly an effective measure to
counteract sedentary lifestyle risks even in the most unfıt and could lead to a reduction of the
prevalence of chronic diseases in all populations. The purpose of this review is to systematically
summarize, analyze, and interpret the health benefıts of Nordic walking (walking with poles), and to
compare it to brisk walking and jogging.
Evidence acquisition: A systematic and comprehensive literature search was performed between
November 2010 and May 2012. Data were analyzed between April 2011 and May 2012.
Evidence synthesis: Sixteen RCTs with a total of 1062 patients and 11 observational studies with
831 patients were identifıed. The current analysis revealed that with regard to short- and long-term
effects on heart rate, oxygen consumption, quality of life, and other measures, Nordic walking is
superior to brisk walking without poles and in some endpoints to jogging.
Conclusions: Nordic walking exerts benefıcial effects on resting heart rate, blood pressure, exercise
capacity, maximal oxygen consumption, and quality of life in patients with various diseases and can
thus be recommended to a wide range of people as primary and secondary prevention.
(Am J Prev Med 2013;44(1):7684) © 2013 American Journal of Preventive Medicine
Context
Modern lifestyle, with its lack of everyday physical
activity and exercise training, predisposes people
to chronic diseases including diabetes mellitus,
obesity, hypertension, and coronary artery diseases.
1
De-
spite the fact that the benefıts of regular physical activity are
widely known, the choice of a sedentary lifestyle is increas-
ing in prevalence.
2,3
Therefore, identifying forms of physical
activity that are easily accessible is warranted and can be
performed by a large number and wide range of people for a
suffıcient amount of time and with an appropriate intensity
to induce fıtness and health effects.
Brisk walking as a simple and safe form of exercise is
undisputedly an effective measure to counteract seden-
tary lifestyle risks even in the most unfıt and could lead to
a reduced prevalence of chronic diseases in all popula-
tions.
4
However, it is not considered very fashionable and
has not been adopted by a meaningful proportion of the
population. Nordic walking (walking with poles) was de-
veloped in Scandinavia and introduced in central Europe
nearly 20 years ago. People of all ages quickly were at-
tracted by it.
5
Nordic walking proved to be a simple and
feasible form of physical activity that can be done by
nearly everybody, everywhere, and at almost any time. It
is the same as brisk walking except for the additional use
of specially designed poles that provide the advantage of
actively involving the upper body and arms (Figure 1).
The purpose of this review is to systematically summa-
rize, analyze, and interpret the health benefıts of Nordic
walking in general, and to compare it to brisk walking and
jogging with regard to its effects on heart rate, maximal
oxygen consumption, quality of life, and other health-
related measures.
Evidence Acquisition
Literature Search: Inclusion and Exclusion Criteria
To cover the wide range of possible Nordic walking articles, the
following databases were searched: ISI Web of Knowledge,
PubMed, CENTRAL, CINAHL, and PEDro. The main search
items included “Nordic walking,” “pole walking,” “pole striding,”
From the University Institute of Sports Medicine, Prevention and Rehabil-
itation, Paracelsus Medical University of Salzburg; Institute of Sports Med-
icine of the State of Salzburg; Sports Medicine of the Olympic Center
Salzburg-Rif, Salzburg, Austria
Address correspondence to: Josef Niebauer, MD, PhD, MBA, University
Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus
Medical University of Salzburg, Lindhofstrasse 20, Salzburg, Austria 5020.
E-mail: j.niebauer@salk.at.
0749-3797/$36.00
http://dx.doi.org/10.1016/j.amepre.2012.09.043
76 Am J Prev Med 2013;44(1):7684 © 2013 American Journal of Preventive Medicine Published by Elsevier Inc.
and “exerstriders.” In a second step, all items were amended by
each of the cited diseases. If an article included more than one
search item, it was counted only once during further analysis. The
search was limited to articles written in English and German and a
time range of 1950 to the present. Data collection took place be-
tween November 2010 and May 2012, and data analysis was per-
formed between April 2011 and May 2012. References of all in-
cluded articles were checked for further relevant publications.
Only RCTs and observational studies were included, matching the
search criteria referring to health topics. If studies did not apply a
proper Nordic walking technique or did not use specially designed
Nordic walking poles, they were not considered. Because “exerstrid-
ing” was one of the fırst commercial forms of Nordic walking with an
identical technique, articles on that topic were included and assessed
along with all other papers specifıcally on Nordic walking.
Selection Process and Data Extraction
A total of 211 articles included the search terms used. Of these, 141
had to be excluded on the basis of title and abstract, because they
dealt with Nordic walking in a context other than health. Next,
search results obtained from the fıve databases were compared
for coinciding matches. The remaining 27 articles were accepted
for fınal analysis, including 16 RCTs and 11 observational trials
(Figure 2). Two independent reviewers read all abstracts, and
disagreements on eligibility were later solved by consensus.
Articles were then checked for relevant data, which were ex-
tracted twice and compared for accuracy. Two reviewers per-
formed statistical analyses and citation handling.
Evidence Synthesis
Overall, 16 RCTs were identifıed with a total of 1062
patients (Nordic walking group, n559; control group,
n503), representing the long-term health effects of Nordic
walking. Mean study duration was 3–24 (13.17.3) weeks
(Table 1). Additionally, the data of 11 observational trials
with 831 patients were included in the analyses, to dem-
onstrate the short-term health effects of the sport (Table 2).
In all reviewed articles, maximum heart rate and/or
maximal oxygen uptake were typically measured by a
maximum incremental test.
Healthy Subjects
In 1995, the fırst observational study to demonstrate su-
perior short-term effects of Nordic walking as compared
to brisk walking without poles was carried out in ten
female subjects. It found that 30 minutes of Nordic
walking at a submaximal intensity (6.7 km/hour [i.e.,
1.9 m/second]) led to an 11% greater mean oxygen con-
sumption (VO
2
); 8% higher peak heart rate; a raised
respiratory exchange ratio of 5%; and an 18% higher
energy expenditure as brisk walking at same pace (all
p0.05).
6
Similar increases (VO
2
: 23%; peak heart rate:
18%; energy expenditure: 22%; all p0.05) were found
2 years later in another observational study by Porcari
et al.
7
in 16 women and 16 men on two separate 20-
minute walking protocols at submaximal pace. Jordan
et al.
8
(n10) as well as Church et al.
9
(n22) were able to
confırm these fındings on VO
2
, heart rate, and energy ex-
penditure in separate observational studies (Table 2). In a
further observational study, Aigner et al.
10
observed in ten
women and ten men that Nordic walking resulted in higher
arterial blood lactate (12%) and higher peak heart rate (4%;
all p0.01) than brisk walking on a treadmill.
Schiffer et al.
11
assessed cardiorespiratory parameters in
15 healthy women during Nordic walking, walking, and
Figure 1. Nordic walking, an outdoor sport
211 articles identified 141 excluded based on title and
abstract
70 matched specific inclusion criteria
27 articles included in review
16 RCTs
11 observational studies
43 excluded as duplicates
Figure 2. Selection of articles
Tschentscher et al / Am J Prev Med 2013;44(1):7684 77
January 2013
Table 1. Overview of RCTs on the effects of Nordic walking on chronic diseases
Study State of health N Intervention Intensity Results
Breyer (2010)
22
COPD 60 Int: n30; 60 minutes,
three times per week
NW, 12 weeks
Con: n30; sedentary
NW: 75% HR
max
1walking time (p0.01)
16MWT (p0.01)
2sedentary behavior
(p0.01)
Collins (2005)
21
Peripheral arterial
disease
49 Int: n25; 3 times per
week NW, 24 weeks
Con: n24; sedentary
N/A 1HR
max
(p0.04)
1VO
2peak
(p0.016)
1perceived pain (p0.02)
2BP (p0.001)
van Eijkeren (2008)
28
Parkinson’s
disease
19 Int: n10; 60 minutes,
two times per week
NW, 6 weeks
Con: n9; sedentary
NW: individual
speed
16MWT (p0.01)
1QoL (p0.01)
Figard-Fabre (2010
15
Obesity 11 Int: n6; three times per
week NW, 4 weeks
Con: n5; 3 times per
week walking, 4 weeks
NW and walking:
4 km/h (1.1 m/s)
1HR
max
(p0.001)
1VO
2peak
(p0.001)
1energy consumption
(p0.022)
2RPE (p0.031)
Figard-Fabre (2011)
16
Obesity 23 Int: n12; 45 minutes,
three times per week
NW, 12 weeks
Con: n11; 45 minutes,
three times per week
walking, 12 weeks
NW and walking:
individual speed
1VO
2peak
(p0.005)
1adherence (p0.011)
2body fat (p0.011)
2BP (p0.001)
Gram (2010)
14
Diabetes mellitus
type 2
68 Int1: n22; 45 minutes,
two times per week
NW, 8 weeks
Int2: n24; exercise
group
Con: n22; sedentary
NW and exercise:
40% VO
2peak
2Fat tissue mass
(p0.021)
(2) HbA1c (n.s.)
Hagner (2009)
13
Healthy 168 Int: n168; 12 weeks NW
(65 pre-, 53 peri-,
53 postmenopausal)
Con: none
NW: individual,
moderate speed
1HDL (p0.01)
2LDL (p0.01)
2triglycerides (p0.01)
2BMI (p0.01)
Hartvigsen (2010)
5
Low back and/or
leg pain
136 Int1: n45; 45 minutes,
two times per week
NW, 8 weeks
Int2: n45; self-
controlled NW;
Con: n46; physical
activity counseling
N/A n.s.
Henkel (2008)
24
Neck pain 85 Int1: n28; two times per
week NW, 12 weeks
Int2: n30; one time per
week walking with
MBT
®
shoes
Con: n27; two times per
week spine training
N/A 1QoL (p0.043)
2Neck pain (p0.001)
2functional spine
impairment (p0.011)
Kocur (2009)
18
Post acute
coronary
syndrome
80 Int1: n40; 30 minutes,
four times per week
NW, 3 weeks
Int2: n20; 30 minutes,
four times per week
walking
Con: n20; standard
rehabilitation
NW and walking:
individual
walking speed
1exercise capacity
(p0.025)
(continued on next page)
78 Tschentscher et al / Am J Prev Med 2013;44(1):7684
www.ajpmonline.org
jogging in an observational fıeld test on separate days. Their
data indicate higher VO
2
for Nordic walking than for walk-
ing and jogging at 6.5–7.2 km/hour (1.8–2 m/second;
p0.05). At a comparable speed (up to 8.5 km/hour [i.e.,
2.4 m/second; p0.05), VO
2
and heart rate during Nordic
walking compared well with that during jogging.
In an RCT, Kukkonen-Harjula et al.
12
investigated the
long-term effects of Nordic walking (n60) and walking
(n61) during self-guided training intervention for 12
weeks (40 minutes, four times per week), similar for both
groups, in previously sedentary women at 50% of the
individual maximum heart rate. Maximum heart rate,
respiratory exchange ratio, peak oxygen consumption,
and lactate threshold improved over the training period
but there was no difference found between the groups
(Table 1 shows group-difference CIs).
Hagner et al.
13
divided 168 women into three age
groups according to their menopausal stage for an
RCT. After 12 weeks of Nordic walking, results showed
decreases (all p0.01) in BMI, total fat mass, low-
density lipoproteins, triglycerides, and waist circum-
ference and an increase in high-density lipoproteins in
pre-, peri- and post-menopausal women. No group differ-
ences were reported, and there was no control group.
In summary, these observational studies and RCTs
demonstrate that the short-term as well as long-term
Table 1. (continued)
Study State of health N Intervention Intensity Results
Kukkonen-Harjula
(2007)
12
Sedentary 121 Int: n60; 40 minutes,
four times per week
NW, 13 weeks
Con: n61; 40 minutes,
four times per week
walking, 13 weeks
NW and walking:
50% HR
max
1HR
max
(95% CI–2.3, 1.7)
1RER
(95% CI–0.1, 0.03)
1VO
2peak
(95% CI–1.1, 0.9)
1lactate
(95% CI–0.5, 0.5)
Langbein (2002)
20
Peripheral arterial
disease
52 Int: n27; 30–45
minutes, four times per
week NW, 24 weeks
Con: n25; sedentary
NW: 70%–80%
HR
max
1exercise tolerance
(p0.001)
2claudication pain
(p0.001)
Mannerkorpi
(2010)
23
Fibromyalgia 67 Int: n34; 20 minutes,
two times per week
NW, 15 weeks
Con: 33; 20 minutes, two
times per week walking,
15 weeks
NW: RPE 12
walking: RPE
10–11
16MWT (p0.009)
Reuter (2011)
29
Parkinson’s
disease
90 Int: n30; 70 minutes,
three times per week
NW, 24 weeks
Con I: n30, walking;
Con II: n30, flexibility
exercise
N/A 1walking speed
(p0.001)
1walking distance
(p0.02)
2BP (p0.004)
Sprod (2005)
26
Breast cancer
rehabilitation
12 Int: n6; 20 minutes,
two times per week
NW, 8 weeks
Con: n6; 20 minutes,
two times per week
walking, 8 weeks
NW and W: 40%–
50% HRR
1upper extremity strength
(p0.046)
Suija (2009)
30
Depressed 21 Int: n16; depressed,
30 minutes, three
times per week NW,
24 weeks
Con: n5; healthy,
30 minutes, three
times per week NW,
24 weeks
N/A n.s.
Total 1062
Note: 95% CIs are between groups.
BP, blood pressure; Con, control group; COPD, chronic obstructive pulmonary disease; HR
max
, maximum heart rate; HRR, heart rate reserve;
Int, intervention group; N/A, not available; n.s., not significant; NW, Nordic walking; PDQ-39, Parkinson Disease Questionnaire; QoL, quality of
life; RER, respiratory exchange ratio; RPE, rate of perceived exertion; sig., significant; 6MWT, 6-minute walking test; VO
2peak
, peak oxygen
consumption; 1, increase; 2, decrease
Tschentscher et al / Am J Prev Med 2013;44(1):7684 79
January 2013
effects of Nordic walking are equal or superior to brisk
walking and (in one study) to jogging, in healthy subjects.
Subjects with Selected Diseases
Diabetes mellitus type 2. Only one RCT
14
examined
the effects of Nordic walking in patients with diabetes
mellitus type 2. The Nordic walking group (n22)
trained for 2 months (45 minutes, twice per week),
followed by for an additional 2 months (45 minutes,
once per week; n22). Results were compared to a
sedentary control group (n22) and a second exercise
group (n24) performing 30 minutes per week of
Table 2. Overview of observational studies on the short-term effects of Nordic walking on health
Study State of health N
Testing and
intervention Intensity
Results: NW
compared to walking
Aigner (2004)
10
Healthy 20 Incremental
treadmill test
NW and walking: until
exhaustion
1HR
peak
(p0.01)
1arterial blood
lactate (p0.01)
Baatile (2000)
27
Parkinson’s disease 8 8 weeks NW NW: individual speed 1exercise capacity
(p0.025)
Church (2002)
9
Healthy 22 1600-m walking
test
NW and walking:
individual speed
1HR
peak
(p0.01)
1VO
2
(p0.001)
1energy expenditure
(p0.001)
Jordan (2001)
8
Healthy 10 1600-m walking
test
NW and walking:
75% HR
max
1HR
peak
(p0.05)
1VO
2
(p0.05)
1energy expenditure
(p0.05)
Knobloch (2006)
31
Healthy 137 Total 29,160
hours NW
NW: individual speed Documentation of
injury rates
Leibbrand (2010)
25
Breast cancer 563 3 weeks NW N/A 1shoulder mobility
(pN/A)
1QoL (pN/A)
2sensitivity to pain
(pN/A)
Oakley (2008)
19
Peripheral arterial
disease
20 Treadmill test NW and walking:
3.2 km/h at 4%
gradient
1HR
peak
(p0.001)
1walking distance
(p0.001)
2perceived leg pain
(p0.002)
Porcari (1997)
7
Healthy 32 20-minute, two
times walking
test
NW and walking:
submaximal
1HR
peak
(p0.05)
1VO
2
(p0.05)
1energy expenditure
(p0.05)
Rodgers (1995)
6
Healthy 10 30-minute
walking test
NW and walking:
submaximal
(6.7 km/h, i.e.,
1.9 m/s)
1HR
peak
(p0.05)
1VO
2
(p0.05)
1RER (p0.05)
1energy expenditure
(p0.05)
Schiffer (2006)
11
Healthy 15 Incremental field
test
NW and walking:
1.2 m/s until
exhaustion
Jogging: 1.8 m/s until
exhaustion
1HbA1c (n.s.)
2fatty tissue mass
(p0.021)
Walter (1996)
17
Coronary artery
disease
14 8-minute walking
test
NW and walking:
1.6 m/s
1VO
2
(p0.05)
1HR
peak
(p0.05)
Total 831
HR
peak
, peak heart rate during walking test; N/A, not available; n.s., not significant; NW, Nordic walking; QoL, quality of life; RER, respiratory
exchange ratio; VO
2
, oxygen consumption; 1, increase; 2, decrease
80 Tschentscher et al / Am J Prev Med 2013;44(1):7684
www.ajpmonline.org
unsupervised endurance training for 4 months. There
was no difference between groups with regard to
HbA1c and energy expenditure, but fat tissue mass
decreased (p0.021).
Obesity. In an RCT, Figard-Fabre et al.
15
examined in
11 obese women (mean BMI 33.1) the effect of 4 weeks
(12 sessions) of 5-minute walking exercises (four times
per week) with and without poles at 4 km/hour (1.1
m/second) and various inclinations. The use of poles led
to an increase in heart rate; VO
2
(both p0.001); energy
expenditure (p0.022); and decreased ratings of per-
ceived exertion (p0.031) compared to walking without
poles. In a later RCT, Figard-Fabre et al.
16
could further
demonstrate in 23 obese women (mean BMI 33.3) that
Nordic walking for 12 weeks (30 minutes, three times per
week) also led to a decrease in body mass (p0.011) and
blood pressure (p0.001) compared to a walking group
with similar exercise duration.
Coronary artery disease. In a 1996 observational
study, Walter et al.
17
observed 14 patients in Phase-III
and Phase-IV cardiac rehabilitation in two separate
8-minute walking trials, with and without poles, and they
confırmed Rodgers’s
6
fındings that walking with poles led
to an increased VO
2
(21%; p0.05); peak heart rate (13%;
p0.05); and slightly higher blood pressure during exer-
cise testing. In an RCT, Kocur et al.
18
investigated the
effects of 3 weeks of Nordic walking in addition to a
standardized cardiac rehabilitation program. Eighty
men, 2–3 weeks after an acute coronary syndrome, were
randomized among three groups: (1) cardiac rehabilita-
tion plus Nordic walking (n40; 2.5 km, 4 times per
week); (2) brisk walking in addition to cardiac rehabilita-
tion (n20; 2.5 km, four times per week); and (3) stan-
dard cardiac rehabilitation only (n20). Energy expendi-
ture was higher in both the Nordic walking and the
walking group compared to the control group (10.81.8;
10.01.9; 9.2 2.2 METs, respectively; p0.025). In ad-
dition, the Nordic walking group showed an increase in
lower body endurance and dynamic balance (p0.05).
Peripheral arterial disease. In an observational study
on 20 patients with intermittent claudication, Oakley et
al.
19
confırmed a longer walking distance (p0.001) and
less perceived pain (using a Borg CR 10 scale; p0.002)
despite a higher workload. They also recorded an increase
in cardiopulmonary work capacity, as indicated by an
increase in VO
2
(p0.001). In 2002, Langbein et al.
20
ran
an RCT on 52 peripheral arterial disease patients with
intermittent claudication. After 24 weeks of Nordic walk-
ing (30 45 minutes, three times per week; n27) at an
intensity of 70%–80% maximum heart rate, they found
that training improved peak oxygen consumption as well
as walking duration and decreased perceived level of
claudication pain (Walking Impairment Questionnaire;
all p0.001) compared to a non-exercising control group
(n25).
Collins et al.
21
included 49 patients with intermittent
claudication into an RCT with an identical study proto-
col. After 24 weeks of training, they were able to demon-
strate that total treadmill time (10.34.1 vs 15.14.5
minutes; p0.001); peak oxygen consumption (p0.016);
level of perceived claudication (p0.02) during exertion;
and quality of life (by SF-36 [short-form health survey
with 36 questions] and Walk Impairment Questionnaire;
p0.031) improved.
Chronic obstructive pulmonary disease. Breyer et
al.
22
enrolled 60 chronic obstructive pulmonary disease
(COPD) patients into a 12-week Nordic walking RCT.
The Nordic walking group (n30) trained for 60 minutes
three times per week at an intensity of 75% of maximum
heart rate, compared to a sedentary control group
(n30). Nordic walking increased daily physical activity
and the distance covered in a 6-minute walk test (both
p0.01). Further, Nordic walking decreased exercise-
induced dyspnea (Borg dyspnea score) and anxiety and
depression (Hospital Anxiety and Depression Scale) and
improved quality of life (SF-36 Physical Component
Summary and Mental Component Summary; all
p0.01). No changes in lung function parameters or
medication were reported.
Fibromyalgia syndrome. Mannerkorpi et al.
23
in an
RCT examined the effect of Nordic walking (n34; rate
of perceived exertion [RPE] 12) compared to brisk
walking (n33; RPE: 10–11) on pain in fıbromyalgia in
67 women, 20 minutes, twice per week for 15 weeks.
Nordic walking was found to improve the functional
capacity in a 6-minute walk test (p0.009) and to de-
crease the perceived level of activity limitation (Fibromy-
algia Impact Questionnaire Physical Scale; p0.027).
Nevertheless, individual severity of pain did not change
during the intervention period.
Pain in general. In an RCT, Henkel et al.
24
studied the
effects of twice-per-week Nordic walking for 12 weeks in
27 patients with chronic neck pain and observed a reduc-
tion in unspecifıc, chronic neck pain (p0.001) and in-
creased quality of life (SF-36 questionnaire; p0.043). In
another RCT
5
on patients with lower back pain and/or leg
pain (n136), 8 weeks of Nordic walking twice a week for
45 minutes showed a tendency toward reduced lower
back pain, which resulted in a reduction of oral pain
medication (for both, see Table 1 for controls).
Breast cancer. In a questionnaire observation on fe-
male breast cancer patients, Leibbrand et al.
25
found an
improved shoulder mobility and quality of life while
Tschentscher et al / Am J Prev Med 2013;44(1):7684 81
January 2013
sensitivity to pain in the upper body was reduced within
the group. No worsening of existing preconditions to
lymphedema was described.
Sprod et al.
26
showed in a small RCT on 12 female
breast cancer patients that 8 weeks of Nordic walking for
20 minutes twice a week led to an increase in muscular
endurance of the upper body (p0.046) compared to
walking.
Parkinson’s disease. Baatile et al.
27
performed a Nor-
dic walking observational study for 8 weeks (40 minutes
of walking, three times per week) in six male subjects with
Parkinson’s disease and demonstrated increased func-
tional independence and quality of life by disease-specifıc
questionnaires (Unifıed Parkinson’s Disease Rating
Scale; p0.026); Parkinson Disease Questionnaire–39
(p0.028)). An RCT by van Eijkeren et al.
28
trained 19
Parkinson’s patients (14 women, 5 men) for 6 weeks (60
minutes twice per week). They found an increase in phys-
ical activity and quality of life (both p0.01) compared to
a sedentary control group. In another RCT, Reuter et al.
29
were able to show in 90 Parkinson’s patients that an
exercise program of Nordic walking for 24 weeks (70
minutes three times per week) brought superior effects
on walking speed (p0.02) and distance (p0.001) as
well as on blood pressure (p0.004; Table 1 shows
controls).
Depression. In 16 depressed subjects, Suita et al.
30
in-
vestigated in an RCT the impact of Nordic walking (30
minutes three times per week) over a period of 24 weeks.
Nordic walking led to a nonsignifıcant increase in pa-
tients’ physical activity and mood.
Complications and injuries. Knobloch and Vogt
31
as-
sessed the safety of Nordic walking in 137 healthy, skilled
Nordic walkers (101 women, 36 men; aged 53.5 years;
average BMI 25.6) and documented the incidence of re-
lated injuries through a questionnaire. After a total of
29,160 hours of Nordic walking, the rate of injury was
reported with 0.926 injuries per 1000 hours of training.
This is very low compared to other popular sports such as
basketball or squash (each 14 injuries per 1000 hours).
Rates of upper body injuries were slightly higher as com-
pared to the lower body (0.549 vs 0.344 per 1000 hours).
Most common injuries were strains of the ulnar collateral
ligament; thumb (equivalent to skier’s thumb); and upper
ankle. No data are available on the injury rates of Nordic
walking in patients with specifıc medical disorders.
Discussion
Results of this systematic review clearly identify Nordic
walking as a healthy and well-accepted mode of physical
activity. Nordic walking potentially can be incorporated
into patients’ daily lives and thus help increase their daily
physical activity. Further, because it exerts benefıcial ef-
fects on several relevant parameters such as resting heart
rate, blood pressure, exercise capacity, maximal oxygen
consumption, and quality of life in a wide range of dis-
eases, it is well suited for primary and secondary
prevention.
Nordic walking has gained increasing popularity in the
general population of several northern and central Euro-
pean countries. Numerous observational studies have
shown that the short-term benefıts of Nordic walking in
comparison to brisk walking without poles include an
increased VO
2
of 11%–23%
6–9,11
; peak heart rate of 4%–
18%
6–11
; respiratory exchange ratio of 5%
6
; lactate con-
centration of 12%
10
; and caloric expenditure of 18%–
22%.
6–8,10
Nordic walking generates up to 6.3–7.7 MET
7
at brisk paces whereas walking reaches 3.3–5.0 MET.
32
Nordic walking over the long-term leads to superior car-
diorespiratory fıtness as compared to walking without
poles because of the higher amount of muscle mass used
through additional motor activity of the upper body. This
results in an increased cardiovascular and respiratory
response when walking at the same pace, causing in-
creased energy expenditure.
12
Up to a pace of 8.5 km/
hour (i.e., 2.4 m/second), it even leads to similar or higher
values of VO
2
and heart rate than jogging.
11
Therefore, Nordic walking is a suitable form of aerobic
exercise for most of apparently healthy male and female
subjects aged 40– 60 years who would benefıt from train-
ing at a proper aerobic exercise intensity between 4 and 8
METs, an intensity range that is too high to obtain by
regular walking and too low to achieve while running. In
these subjects, Nordic walking is suitable to close the
intensity gap between walking and jogging and thus pres-
ents an alternative for everybody seeking a sport that
fulfılls the needs of daily physical activity at an optimal
intensity that results in gaining health benefıts while ex-
ceeding personal exertion limits. Previous studies
13,16
have shown that 12 weeks of Nordic walking demon-
strated a decrease in BMI, total fat mass, low-density
lipoproteins, triglycerides and waist circumference and
an increase in high-density lipoproteins in otherwise
healthy postmenopausal women.
The preventive arguments for Nordic walking are ob-
vious. As with physical activity in general,
3,32
Nordic
walking may have similar positive effects on chronic dis-
eases such as diabetes or obesity.
14,15
As part of cardiac
rehabilitation programs, Nordic walking has the same
short-term and long-term cardiorespiratory effect as reg-
ular walking for people suffering from coronary artery
disease.
17,18
For patients with peripheral arterial disease,
walking on a regular basis is recommended.
33
Nordic
walking is a useful exercise strategy for improving
82 Tschentscher et al / Am J Prev Med 2013;44(1):7684
www.ajpmonline.org
walking distance, cardiovascular fıtness, and quality of
life as well as decreasing the level of perceived claudica-
tion pain.
19–21
In COPD, Nordic walking is associated with increased
daily physical activity, functional exercise capacity, and
quality of life. Further, it decreased exercise-induced
dyspnea, anxiety, and depression and is a simple and
effective physical training modality for patients with
COPD.
22,34
Even though little research on Nordic walking in fıbro-
myalgia has been published, combined training sets of
aerobic endurance, strength, and flexibility training have
been shown to bring ease to fıbromyalgia pain; increase
physical functioning, muscular endurance, and strength;
and improve psychological parameters such as self-
esteem and quality of life.
23,35
In patients with chronic pain, strength-training com-
bined with endurance-training has a positive effect on
several kinds of nonspecifıc neck, shoulder, and low-back
pain.
36
Nordic walking, in combination with strength
and mobility training, has been shown to signifıcantly
reduce unspecifıc, chronic neck and lower back pain,
concomitantly increasing quality of life.
24
Regular physical activity positively affects exercise tol-
erance and quality of life in breast cancer patients.
37,38
Nordic walking additionally improves shoulder mobility
and reduces sensitivity to pain in the upper body, without
worsening lymphedema and can be recommended for
breast cancer patients to increase their activity index.
25,26
Also, patients with progressive neurodegenerative
movement disorders such as Parkinson’s disease have
been shown to benefıt from Nordic walking. Results of
small trials revealed that patients benefıt by improved
motor skills, impaired functional mobility, walking
speed, and distance, possibly leading to a reduced rate of
falls and an improved quality of life.
27–29
Regular, mod-
erate endurance exercise training is used also therapeuti-
cally for moderate to severe depressive disorders, and has
been shown to improve patients’ mood.
39–40
With regard
to depression scores as well as quality of life, Nordic
walking showed trends toward improvement.
30
Because
Nordic walking is associated with a comparably low rate
of injuries, it is suitable not only for the experienced but
also for a wide range of newcomers.
31
Taken together, the presented fındings on the health
benefıts of Nordic walking partly derive from small stud-
ies that are sometimes inconsistent or not in keeping with
the fındings of RCTs. Nevertheless, their results can be
viewed as hypothesis generating and are of general inter-
est. However, conclusions have to be drawn and general-
izations have to be made with caution.
Overall, Nordic walking has been shown to be a form of
physical activity with convincing benefıts for health in
general and has superior short-term and long-term ef-
fects on the cardiorespiratory system as compared to
brisk walking. Short-term effects show higher values of
heart rate, VO
2
, respiratory exchange ratio, lactate
thresholds and caloric expenditure,
6–11
as well as a supe-
rior lipid profıle.
13
Current literature unanimously identifıes Nordic
walking as a safe, feasible, and readily available form of
endurance exercise training, which exerts a panoply of
benefıcial effects in a wide range of people with various
diseases and the healthy. Nordic walking can therefore be
recommended to those who wish to increase their daily
physical activity with an effective cardiorespiratory train-
ing routine as part of primary or secondary prevention.
T. Rathgeber and M. Niederseer helped with the literature
search.
No fınancial disclosures were reported by the authors of this
paper.
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... From both a muscular and biomechanical point of view, walking with poles engages the upper body musculature, especially targeting arm joint extensors, and despite there being no agreement on the effect of joint loading, it may also improve the dynamic balance of locomotion (113). Physical activity programs based on Nordic Walking were found to improve exercise capacity, functional status, quality of life cardiorespiratory outcomes and lipid profile, also reducing body weight and chronic pain (114,115). On the other hand, the effects on muscle strength are less clear (114,115). ...
... Physical activity programs based on Nordic Walking were found to improve exercise capacity, functional status, quality of life cardiorespiratory outcomes and lipid profile, also reducing body weight and chronic pain (114,115). On the other hand, the effects on muscle strength are less clear (114,115). ...
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... In this sport, poles and a specific technique for walking are used, maintaining an upright posture and increasing the speed and intensity of effort (Mocera, Aquilino, & Somà, 2018). NW is increasingly recommended for older people because of its relative ease, accessibility and health effects (Tschentscher, Niederseer, & Niebauer, 2013). If NW practitioners monitor the pace of walking, depending on their specific abilities, they improve the effects of exercise (Takeshima et al., 2013). ...
... This is shown in the tablet graphics with a colour change (Humon, 2020). Other authors relate this inflection to the ventilatory threshold (Karatzano et al., 2010), although they indicate that there is a great individual variability due to fat percentage, age, and physical activity (Zwaard et al., 2016). ...
... A lack of research on gait pattern among PAD patients undertaking NW with combined training (NW alternately with isokinetic training) does not allow for verification of the above results. However, based on an analysis of spatiotemporal parameters, NW lengthens the stride, shortens the stride time, improves gait regularity, and decreases the frequency of steps of healthy participants [49,50]. Additionally, research by Kocur et al. [48] confirmed beneficial effects on postural control, which may help to reduce the risk of falls. ...
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Background Health workers are at high risk of developing musculoskeletal pain (MSP). This study aimed to evaluate a multi-faceted intervention in two public tertiary hospitals, encompassing three levels of prevention and health promotion to prevent and manage MSP. Methods A two-armed cluster randomized controlled trial, with a late intervention control group was performed. Clusters were independent hospital units, and participants were the nursing staff. The intervention comprised three components: participatory ergonomics, case management, and health promotion. The control group received usual occupational health care. The intervention lasted one year and data were collected at baseline, 6 and 12 months follow-up. Primary outcomes were self-perceived MSP and its associated sickness absence. The process evaluation included recruitment, context, reach, dose administered and received, fidelity, satisfaction, implementation strategy, and discussion groups of experts and participants. Results Eight clusters, including 445 participants, were randomized. In the intervention group a 20% statistically significant reduction of neck, shoulders and upper back pain compared to the control group (OR=0.37; 95% CI=0.14–0.96) was observed at 12 months follow-up. We found no significant differences in incidence and duration of sickness absence. Organizational culture (secondary outcome) improved significantly in the intervention group in the domains of ‘formal safety audits’, ‘availability of information for safety at work’, and ‘involvement of workers in decisions that affect their safety and health’ compared to the control group. The intervention was implemented with 96.6% fidelity, and participants’ adherence was 75.5%. Participant’s satisfaction was 9.1/10. Conclusions This intervention showed effectiveness to reduce MSP and improve organizational culture, through to an integral management of MSP. Although our results are modest, strategies should focus on multi-faceted interventions, and occupational health services might be excellent opportunity for.
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Overweight and physical inactivity adversely affect endothelial function and are risk factors for atherosclerosis and cardiovascular disease. Both Crataegus extract WS 1442 and physical exercise exert beneficial effects on endothelial function. We investigated whether WS 1442 and Nordic walking (NW) had comparable effects on endothelial function and lipid profile in overweight subjects. In this partially blinded pilot study, overweight, otherwise healthy volunteers aged 45-75 years were randomized into four groups as follows: WS 1442 2x450 mg/day (WS-standard), WS 1442 2x900 mg/day (WS-double), exercise 2x30 minutes/week (NW-low), and exercise 4x45 minutes/week (NW-high) for 12 weeks. Safety was assessed based on adverse events. Endothelial function testing (EndoPAT®), assessment of endothelial progenitor cells, lipid profiles, and treadmill testing were performed. Sixty subjects participated in the study. At baseline, subjects in WS-standard/-double groups had higher lipid levels and greater impairment of endothelial function. Subjects with impaired endothelial function showed improvement regardless of the type of intervention. Subjects in WS-standard and WS-double groups showed a trend towards modest decrease in triglycerides and modest increase in HDL-cholesterol; most changes were within the normal limits. In NW-low/-high groups, values also remained within the normal range. Exercise capacity improved in both NW groups. WS-double showed no additional benefits over WS-standard. All adverse events were unrelated or improbably related to treatment. In conclusion, WS 1442 and exercise training were safe and showed beneficial effects on endothelial function and lipid profile in overweight but otherwise healthy volunteers; exercise capacity improved only by Nordic walking.
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Introduction: Lower urinary tract symptoms (LUTS) caused by chronic prostatitis (CP) are a common condition. Standard antibiotic therapy is often not justified, since bacterial prostatitis is presented in up to 10% of the cases, while there is no effect on the risk factors for the development and relapse of the disease. This study is aimed at one of the main risk factors for LUTS - a sedentary lifestyle. Aim: To increase the effectiveness of treatment for LUTS in men using the Nordic Walking technique. Material and methods: 84 patients with CP were examined, which were divided into 3 groups. The 1st group (control) included 32 patients who received standard antibacterial therapy. In the 2nd group (primary) - 32 patients who received complex therapy (antibiotic therapy + 4-week course of Nordic walking). The third group (comparison) included 20 patients who were prescribed monotherapy - Nordic walking for 4 weeks. The dynamics of clinical manifestations was assessed using CP Symptom Scale (NIH-CPSI) and the international symptom index for diseases of the prostate IPSS; the volume of residual urine, uroflowmetric data, and the level of leukocytes in the secretion of the prostate gland were estimated. Results: Laboratory studies showed a significantly faster decrease in the number of leukocytes in the secretion of the prostate gland on the 7th and 14th day in the primary (2nd) group (p<0.001). Clinical symptoms according to the NIH-CPSI and IPSS scales significantly regressed in the primary group on the 14th and 28th days of therapy. Uroflowmetric data and the volume of residual urine improved more significantly in the primary group by the 14th and 28th days. Conclusion: Patients receiving combined therapy showed significantly better treatment results in the form of faster normalization of prostate secretion, regression of clinical symptoms, improved urine flow rate and a decrease in residual urine volume after 4 weeks of therapy. When choosing management algorithm for patients with LUTS, it is advisable to use an integrated approach: in addition to antibiotic therapy, Nordic walking is recommended 3 times a week for at least 4 weeks.
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Background The number of people with chronic neck pain is growing continuously even though exact epidemiologic numbers and cost analyses for Germany do not yet exist. It has been extensively confirmed that chronic neck pain is caused by fear, agitation, anxiety and depression. The aim of this secondary preventive study was to clarify if three standardized 12-week health programs, back school, Nordic walking and Masai barefoot technology (MBT) shoes, show positive effects on functional health for people in the chronication phase of neck pain. Methods A clinical, randomized, prospective, interventional trial with baseline design was established. A total of 85 participants (mean 50.7 ± 11.1) were randomized into 3 intervention groups: 27 (52. 6± 11.6) were included in the back school, 28 (52.5 ± 11.3) participated in Nordic walking and 30 (47.4 ± 9.9) were assigned to MBT. Analyses were carried out from the assessments SF-36, EQ-5D, FFbH-R and NDI. Results Neck pain (NDI) and functional spine impairment (FFbH-R) were significantly alleviated in all groups. The results of health quality (SF-36) indicated that back school and Nordic walking performed better than MBT. Nordic walking had worse results in state of health (EQ-5D). Discussion The study confirmed that continuous training in groups shows significant improvements in all three programs. The small numbers of participants allow no generalizations. Further studies must be carried out to clarify the situation, because many other programs are on market where the effectiveness is unexplained.
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Background: Nordic pole Walking (NW) as trend sport is asso- ciated with beneficial effects on the cardiovascular system. Data regarding the injury and overload injury rates are pending. Methods: 137 athletes (74 % females, 53 ± 12 years, weight 73 ± 13 kg, height 169 ± 11 cm) were prospectively ask using a two-sided questionnaire. Mean NW experience was 212.8 weeks with 2.9 ± 1.8 hours/week. The overall exposure was 29 160 h. Results: NW injury rate was 0.926/1000 h. Falls were evident in 0.24/1000 h. The upper extremity was involved more frequently (0.549/1000 h) than the lower extremity (0.344/1000 h). The most severe injury was a concomitant shoulder dislocation and luxation of the proximal interphalangeal joint of the index finger after a fall. The most frequent injury in NW was a distorsion of the ulnar collateral ligament of the thumb (0.206/1000 h) after fall. Shoulder injuries account for 0.171/1000 h with 0.069/ 1000 h shoulder dislocations. Distal radius fractures were rare as ankle sprains and shinspints (0.034/1000 h). Muscle injuries were encountered only at the gastrocnemius muscle (0.137/ 1000 h). No knee ligament injuries were noted. In 5 %, NW inju- ries caused interruption of the performance, with all patients re- turning to sport within 4 weeks on the same level as before. Discussion: Nordic Walking is safe. Most frequently, a Nordic walking thumb is encountered during a fall with the athlete holding on to the NW pole until the very last moment before the hand hits the ground with the pole handle as hypomochlium that forces the thumb into abduction and extension. Modifica- tions of the grip construction as well as information of the ath- lete and behaviour changes may be preventive measures. Originalarbeit
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Sturm J, Plöderl M, Fartacek C, Kralovec K, Neunhäuserer D, Niederseer D, Hitzl W, Niebauer J, Schiepek G, Fartacek R. Physical exercise through mountain hiking in high-risk suicide patients. A randomized crossover trial. Objective: The following crossover pilot study attempts to prove the effects of endurance training through mountain hiking in high-risk suicide patients. Method: Participants (n = 20) having attempted suicide at least once and clinically diagnosed with hopelessness were randomly distributed among two groups. Group 1 (n = 10) began with a 9-week hiking phase followed by a 9-week control phase. Group 2 (n = 10) worked vice versa. Assessments included the Beck Hopelessness Scale (BHS), Beck Depression Inventory (BDI), Beck Scale of Suicide Ideation (BSI), and maximum physical endurance. Results: Ten participants of Group 1 and seven participants of Group 2 completed the study. A comparison between conditions showed that, in the hiking phase, there was a significant decrease in hopelessness (P < 0.0001, d = −1.4) and depression (P < 0.0001, d = −1.38), and a significant increase in physical endurance (P < 0.0001, d = 1.0), but no significant effect for suicide ideation (P = 0.25, d = −0.29). However, within the hiking phase, there was a significant decrease in suicide ideation (P = 0.005, d = −0.79). Conclusion: The results suggest that a group experience of regular monitored mountain hiking, organized as an add-on therapy to usual care, is associated with an improvement of hopelessness, depression, and suicide ideation in patients suffering from high-level suicide risk.
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Symptoms of Parkinson's disease (PD) progress despite optimized medical treatment. The present study investigated the effects of a flexibility and relaxation programme, walking, and Nordic walking (NW) on walking speed, stride length, stride length variability, Parkinson-specific disability (UPDRS), and health-related quality of life (PDQ 39). 90 PD patients were randomly allocated to the 3 treatment groups. Patients participated in a 6-month study with 3 exercise sessions per week, each lasting 70 min. Assessment after completion of the training showed that pain was reduced in all groups, and balance and health-related quality of life were improved. Furthermore, walking, and Nordic walking improved stride length, gait variability, maximal walking speed, exercise capacity at submaximal level, and PD disease-specific disability on the UPDRS in addition. Nordic walking was superior to the flexibility and relaxation programme and walking in improving postural stability, stride length, gait pattern and gait variability. No significant injuries occurred during the training. All patients of the Nordic walking group continued Nordic walking after completing the study.
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The effects of a Nordic walking (NW) program compared to those of a walking (W) program on physiological and perceptual variables in obese middle-aged women were investigated. Subjects (n=12 NW group, n=11 W group) trained over 12 weeks 3 times.week (-1). Body mass, body mass index (BMI), body fat, heart rate (HR), resting blood pressure, peak oxygen consumption (V˙O (2peak)) were measured before and after the training period. Moreover, HR, rating of perceived exertion (RPE) and adherence were recorded during all training sessions. After the training period body mass, body fat and diastolic blood pressure decreased in both groups (P<0.05) whereas V˙O (2peak) increased in the NW group (+3.7 ml.min (-1).kg (-1); P=0.005). During the training sessions, mean HR (P=0.021), HR at preferred walking speed (P=0.020) and % of time at high intensity (P=0.031) were higher in NW than in the W group. Finally, RPE was not influenced by the modality of exercise and NW group showed a higher rate of adherence (91±19% vs. 81±29%; P=0.011). To conclude, NW activity in obese women allows an increase in exercise intensity and adherence to a training program without increasing the perception of effort leading to enhanced aerobic capacity.
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Although studies have shown that physically active breast cancer survivors have lower all-cause mortality, the association between change in physical activity from before to after diagnosis and mortality is not clear. We examined associations among pre- and postdiagnosis physical activity, change in pre- to postdiagnosis physical activity, and all-cause and breast cancer-specific mortality in postmenopausal women. A longitudinal study of 4,643 women diagnosed with invasive breast cancer after entry into the Women's Health Initiative study of postmenopausal women. Physical activity from recreation and walking was determined at baseline (prediagnosis) and after diagnosis (assessed at the 3 or 6 years post-baseline visit). Women participating in 9 MET-h/wk or more (∼ 3 h/wk of fast walking) of physical activity before diagnosis had a lower all-cause mortality (HR = 0.61; 95% CI, 0.44-0.87; P = 0.01) compared with inactive women in multivariable adjusted analyses. Women participating in ≥ 9 or more MET-h/wk of physical activity after diagnosis had lower breast cancer mortality (HR = 0.61; 95% CI, 0.35-0.99; P = 0.049) and lower all-cause mortality (HR = 0.54; 95% CI, 0.38-0.79; P < 0.01). Women who increased or maintained physical activity of 9 or more MET-h/wk after diagnosis had lower all-cause mortality (HR = 0.67; 95% CI, 0.46-0.96) even if they were inactive before diagnosis. High levels of physical activity may improve survival in postmenopausal women with breast cancer, even among those reporting low physical activity prior to diagnosis. Women diagnosed with breast cancer should be encouraged to initiate and maintain a program of physical activity.