Nordic Walking Bests Other Workouts on Functional Outcome in CVD

Ashley Lyles

June 29, 2022

Nordic walking was significantly better at improving functional capacity than moderate- to vigorous-intensity continuous training and high-intensity interval training (HIIT) in a single-center randomized controlled trial.

Participants who did Nordic walking saw better improvements in functional capacity, measured using the 6-minute walk test distances, than did individuals doing either of the other exercise strategies (interaction effect, = .010).

From baseline to 26 weeks, the average changes in 6-minute walk test distance were 55.6 m and 59.9 m for moderate- to vigorous-intensity continuous training and HIIT, respectively, but 94.2 m in the Nordic walking group, reported Tasuku Terada, PhD, University of Ottawa Heart Institute, Ontario, Canada, and colleagues.

Previous research looked at these results at the end of a 12-week supervised exercise intervention and showed that although all three strategies were safe and had positive effects on physical and mental health in these patients, Nordic walking had a better effect in raising the 6-minute walk test scores than moderate- to vigorous-intensity continuous training and HIIT, the researchers note.

"This study is a follow-up on the previous study to show that Nordic walking had greater sustained effects even after the observation phase," from 12 to 26 weeks, Terada said in an interview.

"Exercise is a medicine to improve the health of patients, but unfortunately, sometimes it is not as often utilized," Terada told theheart.org | Medscape Cardiology.

Giving patients additional exercise modalities is beneficial because not everyone likes HIIT workouts or long continuous walking, Terada said. "So, if that's the case, we can recommend Nordic walking as another type of exercise and expect a similar or good impact in functional capacity."

The results were published online June 14 in the Canadian Journal of Cardiology.

"I think it honestly supports the idea that, as many other studies show, that physical activity and exercise improve functional capacity no matter how you measure it and have beneficial effects on mental health and quality of life and particularly depression as well," said Carl "Chip" Lavie, MD, University of Queensland School of Medicine, New Orleans, who coauthored an editorial accompanying the publication, in a phone interview.

"Clinicians need to get patients to do the type of exercise that they are going to do. A lot of people ask what's the best exercise, and the best exercise is one that the person is going to do," Lavie said.

Nordic walking is an enhanced form of walking that engages the upper and lower body musculatures, noted Lavie.

"With regard to Nordic walking, I think that now adds an additional option that many people wouldn't have thought about. For many of the patients that have issues that are musculoskeletal, issues with posture, gait, or balance, using the poles can be a way to allow them to walk much better and increase their speed, and as they do that, they become fitter," Lavie continued.

Moreover, these findings support the use of Nordic walking in cardiac rehabilitation programs, the editorialists note.

Cardiac Rehabilitation

The study examined patients with coronary artery disease who underwent cardiac revascularization. They were then referred by their physician to cardiac rehabilitation.

Participants were randomly assigned to one of the following intervention groups: Nordic walking (n = 30), moderate- to vigorous-intensity continuous training (n = 27), and HIIT (n = 29) for a 12-week period. There was then an additional 14-week observation period after the exercise program. Mean age was about 60 years across the intervention groups.

The research team analyzed the extent of participants' depression with Beck Depression Inventory-II, quality of life with Short Form-36 and HeartQoL, and functional capacity with a 6-minute walk test. They assessed functional capacity, depression, and quality of life at baseline, 12 weeks, and 26 weeks.

Using linear mixed models with extended measures, the study authors evaluated sustained effects, which were between week 12 and week 26, and prolonged effects, which were between baseline and week 26.

From baseline to 26 weeks, participants saw significantly better outcomes in quality of life, depression symptoms, and 6-minute walk test (< .05).

Physical quality of life and 6-minute walk test distance rose significantly between weeks 12 and 26 (< .05).

Notably, at week 26, all training groups achieved the minimal clinical threshold difference of 54 m, although participants in the Nordic walking cohort demonstrated significantly greater improvement in outcomes.

Other data indicated the following:

  • From baseline to week 12, physical activity levels rose significantly, and this improvement was sustained through the observation period

  • During the observation period, mental component summary significantly declined while physical component summary outcomes improved

  • After completion of cardiac rehabilitation, functional capacity continued to increase significantly

  • Moderate- to vigorous-intensity continuous training, HIIT, and Nordic walking had positive and significant prolonged effects on depression symptoms and general and disease-specific quality of life, with no differences in the extent of improvements between exercise types.

Some limitations of the study include the fact that women comprised a small portion of the study group, which limits the generalizability of these data, the cohort was recruited from a single medical facility, and there was a short follow-up time, the researchers note.

"Further research is warranted to investigate the efficacy and integration of Nordic walking into home-based exercise after supervised cardiac rehabilitation for maintenance of physical and mental health," the editorialists conclude.

Terada, Lavie, and Taylor report no relevant financial relationships.

Can J Cardiol. Published online June 14, 2022. Abstract, Editorial

Ashley Lyles is an award-winning medical journalist. She is a graduate of New York University's Science, Health, and Environmental Reporting Program. Previously, she studied professional writing at Michigan State University, where she also took premedical classes. Her work has appeared in outlets like The New York Times Daily 360, PBS NewsHour, The Huffington Post, Undark, The Root, Psychology Today, Insider, and Tonic (Health by Vice), among other publications.

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