Nordic walking enhances heart disease patient’s functional abilities

Nordic walking
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Evidence from a new randomised clinical trial suggests that Nordic walking can effectively boost the functional capacity of people with heart disease.

The University of Ottawa-led study discovered that Nordic walking increased the functional capacity – the ability to perform daily tasks – in patients with coronary heart disease more significantly than standard high-intensity interval training and moderate-to-vigorous intensity continuous training. Nordic walking is an enhanced type of walking that utilises specially designed poles that help to engage the user’s upper and lower body muscles.

The results of the research are published in the Canadian Journal of Cardiology.

Benefits of Nordic walking?

After experiencing a major cardiovascular event, patients will undergo cardiovascular rehabilitation and exercise training programmes to re-establish their functional capacity, cardiorespiratory fitness, and mental health.

However, some individuals struggle to persist with these programmes due to their motivation to perform monotonous exercises, such as walking and stationary cycling, reducing over time. This means that they will usually stop exercising once their rehabilitation programme is completed. To combat this, the team explored a range of exercise alternatives that may be more appealing and help heart disease patients adhere to exercise.

There is increasing evidence that non-conventional exercise interventions, such as Nordic walking and high-intensity interval training, are more impactful than traditional exercise for improving functional capacity. This has been demonstrated in the six-minute walking test – which is an important predictor of cardiovascular events in coronary artery disease patients.

Jennifer L. Reed, PhD, the lead investigator from the University of Ottawa, said: “Patients with coronary artery disease frequently demonstrate diminished functional capacity, low quality of life and increased the risk of subsequent cardiovascular events and mortality.”

Improving functional capacity

The team’s study analysed the prolonged effects of three rehabilitation programmes over a 12-week period in 130 heart disease patients, with participants randomly assigned to either high-intensity interval training, moderate-to-vigorous intensity continuous training, or Nordic Walking. The researchers evaluated their functional capacity, quality of life, and depression symptoms in a 14-week observation phase following the exercise programmes.

Although all of the exercise programmes improved quality of life and depression symptoms, Nordic walking demonstrated the most significant improvement in functional capacity, an increase of 19%, compared to 13% for high-intensity interval training and 12% for moderate-to-vigorous intensity continuous training.

Dr Reed said: “This is a key finding because lower functional capacity predicts higher risk of future cardiovascular events in people with coronary artery disease. Nordic walking engages core, upper and lower body muscles while reducing loading stress at the knee, which may have resulted in greater improvements in functional capacity.”

Tasuku Terada, PhD, of the University of Ottawa Heart Institute, commented: “No previous study has directly compared the long-term effects of high-intensity interval training, moderate-to-vigorous intensity continuous training and Nordic walking.

“This study is novel in that it simultaneously compared the sustained effects (i.e., 14 weeks after the completion of cardiovascular rehabilitation) of different exercise programmes that can readily be incorporated into daily exercise. When prescribing exercise for patients with coronary artery disease, patients’ preferences should be considered. Our findings can impact patient care by providing alternative exercise options based on their interests and needs.”

Researchers from the University of Queensland School of Medicine have reinforced these findings, noting that applying Nordic walking to a cardiovascular rehabilitation programme could allow for a seamless progression from standard moderate intensity continuous training or traditional walking. It could be especially beneficial for deconditioned patients who may not tolerate the high-intensity exercise or for patients that high-intensity interval training may be contraindicated.

Carl J. Lavie, MD, from the University of Queensland School of Medicine, concluded: “The addition of Nordic poles to moderate to vigorous intensity walking is a simple, accessible option to enhance improvements in walking capacity, increase energy expenditure, engage upper body musculature, and improve other functional parameters such as posture, gait, and balance.

“Providing a variety of exercise options enhances patient enjoyment and progression, which is important for adherence and maintenance. Exercise modalities should be prescribed with consideration of patient goals, preferences, and capabilities.”

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