A new study in the Canadian Journal of Cardiology demonstrates that Nordic walking provides greater and long-term improvement in functional capacity compared to other forms of exercise in cardiovascular rehabilitation.

Researchers identified a greater increase in functional capacity, the ability to carry out activities of daily living, as a result of Nordic walking in patients with coronary artery disease, compared to standard high-intensity interval training and moderate to training continuous high intensity. The results of their clinical trial are published in Canadian Journal of Cardiology.

Cardiovascular rehabilitation and training programs following major cardiovascular events are associated with significant 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 may therefore stop exercising once their cardiovascular rehabilitation program is complete.

The researchers explored more diverse exercise options that might appeal to more people to determine whether they could persuade more people to continue exercising, namely the potential benefits of movement, indicates Eurek Alert.

The benefits of Nordic walking

Growing evidence suggests that unconventional physical interventions, such as high-intensity interval training and Nordic walking, are more effective than traditional exercise approaches in improving functional capacity as measured by a six-minute walk test—an important predictor of cardiovascular events in patients with coronary heart disease. Nordic walking is an improved form of exercise that uses specially designed poles (such as trekking or hiking poles) to train both the upper and lower body muscles.

“Patients with coronary artery disease frequently demonstrate reduced functional capacity, poor quality of life, and increased risk of subsequent cardiovascular events and mortality,” explained principal investigator Jennifer L. Reed of the Laboratory of Exercise Physiology and Cardiovascular Health, 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, Canada.

The investigators compared the prolonged effects of 12 weeks of rehabilitation with high-intensity interval training and moderate-to-vigorous continuous training, respectively Nordic walking, on functional capacity, quality of life, and depressive symptoms in patients with coronary heart disease. One hundred and thirty patients underwent 12 weeks of training in one of these three groups, followed by a 14-week observation phase.

The link with depression

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

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

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

The novelties discovered by the recent study

“This study is novel in that it simultaneously compared the sustained effects—that is, 14 weeks after completion of cardiovascular rehabilitation—of different exercise programs that can be easily incorporated into daily exercise. When prescribing exercise for patients with coronary artery disease, patient preference should be considered. Our findings may impact patient care by providing alternative exercise options based on their interests and needs,” he concluded.

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

“Adding ski poles to moderate-to-vigorous walking is a simple and affordable option to improve walking capacity, increase energy expenditure, train upper body muscles and improve other functional parameters such as posture, gait and balance,” commented Dr. Lavie. “Providing a variety of exercise options increases patient enjoyment and progress, which is important for adherence and maintenance. Exercise modalities should be prescribed taking into account the patient’s goals, preferences and capabilities,” he advised.

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