Nordic walking improves functional capacity in people with heart disease

Cardiovascular rehabilitation and exercise training programs following major cardiovascular events are associated with considerable improvements in functional capacity and cardiorespiratory fitness, as well as mental health. However, some individuals do not enjoy monotonous forms of exercise, such as walking and stationary cycling, and therefore may stop exercising once their cardiovascular rehabilitation program is completed. Researchers explored more diverse exercise options that might appeal to more people to determine whether they could get more individuals to continue to exercise and what benefits might be achieved.

Growing evidence suggests that non-conventional exercise interventions, such as high-intensity interval training and Nordic walking are more effective than traditional exercise approaches in improving functional capacity measured by a six-minute walk test -- an important predictor of cardiovascular events in patients with coronary artery disease. Nordic walking is an enhanced form of walking exercise that uses specifically designed poles to further engage both the upper and lower body muscles.

"Patients with coronary artery disease frequently demonstrate diminished functional capacity, low quality of life and increased the risk of subsequent cardiovascular events and mortality," explained lead investigator Jennifer L. Reed, PhD, Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute; Faculty of Medicine; and School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.

Investigators compared the prolonged effects of 12-week rehabilitation with 1) high-intensity interval training; 2) moderate-to-vigorous intensity continuous training; and 3) Nordic walking, on functional capacity, quality of life and depression symptoms in patients with coronary artery disease. One hundred and thirty patients were randomized to a 12-week training in one of these three groups followed by a 14-week observation phase.

While all exercise programs improved depression symptoms and quality of life, the improvement in functional capacity was greatest after Nordic walking (+19%) when compared to high-intensity interval training (+13%) and moderate-to-vigorous intensity continuous training (+12%).

"This is a key finding because lower functional capacity predicts higher risk of future cardiovascular events in people with coronary artery disease," noted Dr. Reed. "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."

"No previous study has directly compared the long-term effects of high-intensity interval training, moderate-to-vigorous intensity continuous training and Nordic walking," commented Tasuku Terada, PhD, Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada.

"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 programs that can readily be incorporated into daily exercise. When prescribing exercise for patients with coronary artery disease, patients' preference should be considered. Our findings can impact patient care by providing alternative exercise options based on their interests and needs," he concluded.

In an accompanying editorial, Carl J. Lavie, MD, Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, the University of Queensland School of Medicine, New Orleans, LA, USA, and colleagues noted that the addition of Nordic walking to a cardiovascular rehabilitation program could provide an ideal progression from standard moderate intensity continuous training or traditional walking, especially for deconditioned patients who may not tolerate high intensity exercise, or for patients in whom high-intensity interval training may be contraindicated.

"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," commented Dr. Lavie.

"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," he advised.