The effects of pole walking on health in adults: A systematic review

Does Nordic Walking technique influence the ground reaction forces?

BACKGROUND

Nordic Walking (NW) practice has increased during the last decade, generating great benefits related to the reduction of ground reaction forces (GRF). However, there is still limited evidence regarding how the NW technique could affect GRF.

RESEARCH QUESTION

To analyze the effect of the speed and the differences in ground reaction forces (GRF) between NW with Diagonal technique (DT) versus Alpha technique (AT) and compare them with normal walking (W) METHODS: 29 male physically active sport science students were randomly assigned to one of the training groups: AT (n = 15) or DT (n = 14). After 5 technique familiarization sessions, participants performed 5 experimental trials on a walkway for both NW and W at two different walking speeds, previously randomized. A two-way repeated measures ANOVA analysis was carried out to find differences between speeds (preferred, fast) and gait (NW, W) as within-subject factors and NW techniques (DT vs AT) as between-subject factor.

RESULTS

During NW, both technique groups (AT, DT) showed an increase in GRF variables compared to W, such as in stance time (2.9 % mean increment, p < 0.01, ES = 0.3; 95 %IC[-0.027, -0.008]), vertical force impact or vertical heel strike variables (4.9 % mean increment, p < 0.01, ES = 0.4; 95 %IC[0.101, 0.036]; 7.3 % mean increment, p < 0.01, ES = 0.8; 95 %IC[-0.133, -0.081] respectively). Moreover, AT group experienced significant lower forces at vertical force at midstance (10.1 % mean descent, p = 0.036, ES = 0.3; 95 %IC[-0.083, -0.009]) and higher forces at AP propulsive forces (23.7 % mean increment, p < 0.001, ES = 0.6; 95 %IC[0.078, 0.202) and ML max force (14.0 % mean increment, p = 0.045, ES = 0.3; 95 %IC[0.002, 0.026]) compared to DT group. Walking speed was significantly higher during NW (Preferred: 1.89 ± 0.18 m/s; Fast: 2.17 ± 0.21 m/s) compared to W (Preferred: 1.76 ± 0.15 m/s; Fast: 2.04 ± 0.19 m/s) in both speed conditions.

SIGNIFICANCE

NW favours an increase in GRF and speed in comparison with Walking, independently of the technique, with no evidence that justifies the use of one technique or another.

Effects of Nordic Walking Training on Anthropometric, Body Composition and Functional Parameters in the Middle-Aged Population

Nordic walking (NW) is an easy physical exercise that is usually proposed for clinical populations and for the elderly. The aim of the present study was to examine the effects of a period of NW training in a non-clinical middle-aged population on anthropometric, body composition and functional parameters. A pre-test/post-test study design was conducted on 77 participants: 56 women (72.7%, age 55.53 ± 9.73 years) and 21 men (27.3%, age 60.51 ± 8.15 years). The measurements were carried out with physical tests at the baseline and at the follow up. Participants did two weekly NW training sessions of about 60 min each. A questionnaire was administered to evaluate their feelings after the training period. Paired Students' test was carried out to evaluate the pre-post differences, and the analysis of variance was performed to evaluate the questionnaire. Participants had significantly less stress and anxiety after the NW training. Body fat parameters showed a significant decrease, especially for women. Phase angle and strength of lower body presented a significant increase in both sexes after the training period. In conclusion, NW shows many potential benefits also for the nonclinical population and could be an important exercise to remain active and to maintain a good health condition.

Outdoor Community Ambulation Interventions to Improve Physical and Mental Health in Older Adults: A Systematic Review and Meta-Analysis

Limited community ambulation, defined as independent mobility outside the home, predicts adverse outcomes in older adults. We performed a systematic review and meta-analysis to examine outdoor community ambulation intervention effectiveness in older adults. We searched six databases until October 2021. Studies with an evaluative research objective, older adult population, and outdoor community ambulation interventions were eligible. After reviewing 23,172 records, five studies were included. The meta-analysis found no significant difference in walking endurance and depression outcomes between outdoor community ambulation and comparison interventions. For outcomes not suitable for meta-analysis, studies showed no significant difference in walking activity, anxiety, and general and health-related quality of life, and possible improvements in gait speed and lower extremity function and strength. Most evidence was of low to very low certainty. Considering the limited evidence base, the design, implementation, and evaluation of outdoor community ambulation interventions in older adults should be prioritized in primary research.

The Influence of Nordic Walking on Isokinetic Trunk Muscle Endurance and Sagittal Spinal Curvatures in Women after Breast Cancer Treatment: Age-Specific Indicators

Nordic walking (NW) is a popular form of rehabilitation. NW improves psychophysical condition in breast cancer (BC) survivors. This study aimed to analyze the effects of NW on functional and postural changes of the trunk in women of different ages after BC. We hypothesized that an age relationship would be found. BC survivors (n = 39) were stratified by age as “middle- aged” (45–59 years) or “older” (60–75 years), then randomly allocated to the training intervention. A study group (SG, n = 19) participated in NW and a control group (CG, n = 20) performed general gymnastics. The sagittal spinal curvatures and isokinetic trunk muscle endurance were recorded at two time points, pre- and post-training intervention. Significant within NW group changes (p < 0.05) were found for the total work (TW) and average power (AP) of trunk flexors and extensors and the upper thoracic angle in middle-aged women. In older Nordic walkers, significant increases in TW and AP of the trunk flexor muscles were observed, with a negative increase in the trunk inclination angle. In CG, no significant functional or postural changes were observed in response to general gymnastics. NW improved both functional and postural changes in middle-aged women. This study identified the limitations of NW training in older women.

Walking for subjects with type 2 diabetes: a systematic review and joint AMD/SID/SISMES evidence-based practical guideline

Aims

Regular exercise is considered a cornerstone in the management of type 2 diabetes mellitus (T2DM). It improves glucose control and cardiovascular risk factors, contributes to weight loss, and also improves general well-being, likely playing a role in the prevention of chronic complications of diabetes. However, compliance to exercise recommendations is generally inadequate in subjects with T2DM. Walking is the most ancestral form of physical activity in humans, easily applicable in daily life. It may represent, in many patients, a first simple step towards lifestyle changes. Nevertheless, while most diabetic patients do not engage in any weekly walking, exercise guidelines do not generally detail how to improve its use. The aims of this document are to conduct a systematic review of available literature on walking as a therapeutic tool for people with T2DM, and to provide practical, evidence-based clinical recommendations regarding its utilization in these subjects.

Data synthesis

Analysis of available RCTs proved that regular walking training, especially when supervised, improves glucose control in subjects with T2DM, with favorable effects also on cardiorespiratory fitness, body weight, and blood pressure. Moreover, some recent studies have shown that even short bouts of walking, used for breaking prolonged sitting, can ameliorate glucose profiles in diabetic patients with sedentary behavior.

Conclusions

There is sufficient evidence to recognize that walking is a useful therapeutic tool for people with T2DM. This document discusses theoretical and practical issues for improving its use.

Walking for subjects with type 2 diabetes: A systematic review and joint AMD/SID/SISMES evidence-based practical guideline

AIMS

Regular exercise is considered a cornerstone in the management of type 2 diabetes mellitus (T2DM). It improves glucose control and cardiovascular risk factors, contributes to weight loss, and also improves general well-being, likely playing a role in the prevention of chronic complications of diabetes. However, compliance to exercise recommendations is generally inadequate in subjects with T2DM. Walking is the most ancestral form of physical activity in humans, easily applicable in daily life. It may represent, in many patients, a first simple step towards lifestyle changes. Nevertheless, while most diabetic patients do not engage in any weekly walking, exercise guidelines do not generally detail how to improve its use. The aims of this document are to conduct a systematic review of available literature on walking as a therapeutic tool for people with T2DM, and to provide practical, evidence-based clinical recommendations regarding its utilization in these subjects.

DATA SYNTHESIS

Analysis of available RCTs proved that regular walking training, especially when supervised, improves glucose control in subjects with T2DM, with favorable effects also on cardiorespiratory fitness, body weight and blood pressure. Moreover, some recent studies have shown that even short bouts of walking, used for breaking prolonged sitting, can ameliorate glucose profiles in diabetic patients with sedentary behavior.

CONCLUSIONS

There is sufficient evidence to recognize that walking is a useful therapeutic tool for people with T2DM. This document discusses theoretical and practical issues for improving its use. This article is co-published in the journals Sport Sciences for Health and Nutrition, Metabolism and Cardiovascular Diseases.

The effects of exercise and diet program in overweight people - Nordic walking versus walking

Purpose

Nordic walking (NW) has been recommended as a form of exercise for clinical populations. Despite intervention programs designed to face a clinical status may last several months, no longitudinal studies have compared the effect of NW to another usual form of exercise, like walking (W). We evaluated the effects of diet combined with a long-supervised NW versus W training on body composition, aerobic capacity and strength in overweight adults.

Patients and methods

Thirty-eight participants, randomized into a NW (n=19, 66±7 years, body mass index (BMI) 33±5)) and a W (n=19, 66±8 years, BMI 32±5) group, followed a diet and a supervised training routine 3 times/week for 6 months. The variables assessed at baseline, after 3 and 6 months were: anthropometric indexes (ie, BMI and waist circumference (WC)), body composition, aerobic capacity (oxygen consumption (VO_2peak), peak power output (PPO), 6-min walking test (6MWT)) and strength (maximal voluntary contraction of biceps brachialis (MVC_BB) and quadriceps femoris (MVC_QF), chair stand and arm curl (AC)).

Results

After 6 months both NW and W group decreased significantly BMI (6% and 4%, respectively) and WC (8% and 4%, respectively), but only the NW group reduced (P<0.05) total body fat (8%), android fat (14%) and leg fat (9%). After 6 months, PPO increased (P<0.05) in both groups, but VO_2peak improved (P<0.05) only in the NW group (8%). After 6 months, 6MWT increased (P<0.001) in both groups and only the NW group improved (P<0.05) in MVC_BB (14%), MVC_QF (17%) and AC (35%).

Conclusion

Our results suggest that NW can give in some relevant health parameters, greater and faster benefits than W. Thus, NW can be a primary tool to counteract the obesity and overweight state in middle-aged adults.

Benefits of a Pole Walking Program Offered by Community Organizations on Physical Fitness, Psychological Well-Being, and Cognitive Function Among Older Adults

The authors examined the effects of a 12-week pole walking program on function and well-being in 123 older adults aged 60 years and older, recruited by community organizations. The results showed a significant improvement in the participants' upper and lower limb strength in the experimental groups compared with those in the control groups (p < .05) and a significant deterioration in the walking speed and grip strength in women in the control groups compared with those in the experimental groups (p < .05). Although not statistically significant, the results also showed a trend toward greater improvement in global cognitive function in the participants in the experimental groups (p = .076). These results suggest that a pole walking program provided in natural conditions can improve physical capabilities in older adults. Other studies are warranted to further explore the impact of pole walking programs on older adults offered in such conditions, especially their impact on cognitive functions.

Muscular and metabolic responses to different Nordic walking techniques, when style matters

Due to poling action and upper body engagement, Nordic walking (NW) has additional health benefits with respect to conventional walking. The aim of this study was to evaluate the differences in muscle activation and metabolic responses between NW, performed with the technique suggested by NW instructors, and with some modifications in the way to move upper limb and poles. Ten NW instructors volunteered to walk on a treadmill at 5.5 km•h-1 in five conditions: walking (W), Nordic walking (NW), NW with a weak poling action (NWweak), with straight-upper limbs moving the shoulders (NWshoulder) and with elbow flexion-extension pattern and shoulder freezed (NWelbow). Poling forces, body segments and poles movement, upper and lower body muscle activation, as well as metabolic parameters were measured.All modified NW techniques elicited lower muscular activation and metabolic responses with respect to the suggested NW technique (P < 0.05). All NW techniques elicited higher muscular activation and metabolic responses than W. All parameters observed with the NWweak were lower than NW. A decreased activation of shoulder extensor muscles and increased activation of anterior deltoid muscle were the main features of NWshoulder. Lower triceps brachii muscle activation and reduced propulsive poling action with respect to NW were seen for NWelbow, resulting also in shorter steps.Nordic walking instructors, sport technicians and practitioners should be aware that any deviation from the technique usually suggested might lead to lower benefits. However it is worth to note that any walking technique with poles elicits higher metabolic responses and muscular activation than walking.

Shared and task-specific muscle synergies of Nordic walking and conventional walking

Nordic walking is a form of walking that includes a poling action, and therefore an additional subtask, with respect to conventional walking. The aim of this study was to assess whether Nordic walking required a task-specific muscle coordination with respect to conventional walking. We compared the electromyographic (EMG) activity of 15 upper- and lower-limb muscles of 9 Nordic walking instructors, while executing Nordic walking and conventional walking at 1.3 ms^-1 on a treadmill. Non-negative matrix factorization method was applied to identify muscle synergies, representing the spatial and temporal organization of muscle coordination. The number of muscle synergies was not different between Nordic walking (5.2 ± 0.4) and conventional walking (5.0 ± 0.7, P = .423). Five muscle synergies accounted for 91.2 ± 1.1% and 92.9 ± 1.2% of total EMG variance in Nordic walking and conventional walking, respectively. Similarity and cross-reconstruction analyses showed that 4 muscle synergies, mainly involving lower-limb and trunk muscles, are shared between Nordic walking and conventional walking. One synergy acting during upper limb propulsion is specific to Nordic walking, modifying the spatial organization and the magnitude of activation of upper limb muscles compared to conventional walking. The inclusion of the poling action in Nordic walking does not increase the complexity of movement control and does not change the coordination of lower limb muscles. This makes Nordic walking a physical activity suitable also for people with low motor skill.

Trekking poles reduce downhill walking-induced muscle and cartilage damage in obese women

[Purpose] This study investigated the effect of the use of trekking poles on muscle and cartilage damage and fatigue during downhill walking in obese women. [Subjects and Methods] Subjects included eight obese women who had a body fat percentage greater than 30. Subjects performed downhill walking without a trekking pole (NP) and with a trekking pole (TP) at 50% heart rate reserve for 30 minutes on a treadmill. The treadmill was set at a 15% downhill declination. Blood samples were collected to examine muscle damage (serum creatine kinase [CK] and lactate dehydrogenase [LDH] levels), cartilage damage (serum cartilage oligomeric matrix protein [COMP] levels), and fatigue (plasma lactate levels) at the pre-walking baseline (PWB), immediately after walking (IAW), and 2 hours post-walking (2HPW). [Results] The CK, LDH, COMP, and lactate levels were significantly increased IAW when compared with those at the PWB in both trials. In addition, in the NP trial, the CK, LDH, and COMP levels were significantly increased at 2HPW when compared with those at the PWB. [Conclusion] Downhill walking can cause muscle and cartilage damage, and our results suggest that the use of a trekking pole can reduce temporary muscle and cartilage damage after downhill walking.

Trunk muscles activation during pole walking vs. walking performed at different speeds and grades

Given their functional role and importance, the activity of several trunk muscles was assessed (via surface electromyography-EMG) during Walking (W) and Pole Walking (PW) in 21 healthy adults. EMG data was collected from the external oblique (EO), the erector spinae longissimus (ES), the multifidus (MU), and the rectus abdominis (RA) while performing W and PW on a motorized treadmill at different speeds (60, 80, and 100% of the highest speed at which the participants still walked naturally; PTS60, PTS80 and PTS100, respectively) and grades (0 and 7%; GRADE0 and GRADE7, respectively). Stride length, EMG area under the curve (AUC), muscles activity duration (ACT), and percentage of coactivation (CO-ACT) of ES, MU and RA, were calculated from the averaged stride for each of the tested combinations. Compared to W, PW significantly increased the stride length, EOAUC, RAAUC and the activation time of all the investigated muscles, to different extents depending on treadmill speeds and grades. In addition, MUAUC was higher in PW than in W at GRADE0 only (all speeds, p<0.01), while ESAUC during W and PW was similar at all the speeds and grades. These changes resulted in longer CO-ACT in PW than W, at GRADE0-PTS100 (p<0.01) and GRADE7 (all speeds, p<0.01). In conclusion, when compared to W, PW requires a greater engagement of the abdominal muscles and, in turn, a higher control of the trunk muscles. These two factors taken together may suggest an elevated spinal stability while walking with poles.

Effects of the Swedish physical activity on prescription model on health-related quality of life in overweight older adults: a randomised controlled trial

Background

The effects of physical activity on prescription (PAP) on health-related quality of life (HRQoL) in overweight adults are unclear. We therefore aimed to explore the effects of the Swedish PAP model on HRQoL in overweight older adults.

Methods

Participants were recruited from a cohort of men and women born between 1937 and 1938, and living in Stockholm County. Inclusion criteria were; insufficiently physically active, i.e. <30 min of at least moderate intensity physical activity (PA) per day; body mass index >25 kg/m²; and waist circumference ≥102 cm (men) or ≥88 cm (women). Altogether, 101 individuals, aged 67 years, were randomly assigned to two parallel groups: intervention group (n = 47) receiving individualised PAP or control group (n = 54). The 36-item Short Form Health Survey (SF-36) was administered before and after the six months intervention. Main outcomes were the SF-36 physical component summary (PCS) and mental component summary (MCS) scores. Intention to treat analysis was utilised. Regression analysis was performed to assess whether changes in PA and body weight affected changes in HRQoL.

Results

At the six months follow-up, regarding the MCS score, the intervention group had improved significantly more (median: 4.4 [interquartile range (IQR): −2.4 to 23.3]) vs (median: 0.0 [IQR: −4.0 to 4.9]); p < 0.05) and a higher proportion of participants had attained relevant improvements (OR 2.43 (95 % CI 1.00–5.88) p < 0.05) compared to the controls. A within group improvement in the PCS score (median: 3.8 [IQR: −1.9 to 19.5] p < 0.05) was found in the intervention group. Changes in PA and body weight had a small, but significant, mediating effect on the changes in HRQoL.

Conclusions

PAP had a positive effect on HRQoL, measured by the SF-36 MCS, but no significant between group effect was seen on the PCS in overweight older adults. These effects were, to some extent, mediated by changes in PA and body weight. Our findings support clinical use of the Swedish PAP model.

Trial registration

ClinicalTrials.gov NCT02320760.

Investigating the effect of a 3-month workplace-based pedometer-driven walking programme on health-related quality of life in meat processing workers: a feasibility study within a randomized controlled trial

BACKGROUND

In New Zealand, meat processing populations face many health problems as a result of the nature of work in meat processing industries. The primary aim of this study was to examine the feasibility of using a pedometer-based intervention to increase physical activity and improve health-related outcomes in a population of meat processing workers.

METHODS

A single-blinded randomized controlled trial (RCT) was conducted. A convenience sample of meat workers (n = 58; mean age 41.0 years; range: 18-65) participated in the trial. Participants were randomly allocated into two groups. Intervention participants (n = 29) utilized a pedometer to self monitor their activity, whilst undertaking a brief intervention, and educational material. Control participants (n = 29) received educational material only. The primary outcomes of ambulatory activity, and health-related quality of life, were evaluated at baseline, immediately following the 12-week intervention and three months post-intervention.

RESULTS

Fifty three participants completed the program (91.3% adherence). Adherence with the intervention group was high, 93% (n = 27/29), and this group increased their mean daily step count from 5993 to 9792 steps per day, while the control group steps changed from 5788 to 6551 steps per day from baseline. This increase in step counts remained significant within the intervention group p < 0.005; at three months post-intervention representing a 59% increase over baseline scores. There were significant group changes with large effect sizes for step count change (d = 1.94) and self-reported physical activity (p < 0.005; d = 2.59) at 12 weeks intervention. Further, results showed non-significant between-group differences in physical component (PCS) and mental component (MCS) scores (PCS: p = 0.44; MGD = 0.99, 95% CI, -1.6 to 3.6; ES = 0.14, and

MCS

p = 0.90, MGD = 0.15; 95% CI, -2.3 to 2.6, ES = 0.022) at 12 weeks intervention.

CONCLUSIONS

This research provides important information for a larger (RCT) in the future: results demonstrated that a pedometer-driven walking intervention in combination with goal setting, and self-monitoring supported by weekly e-mails are feasible and potentially effective in increasing step count within the workplace setting over the short term.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12613000087752.

Pole walking down-under: profile of pole walking leaders, walkers and programs in Australia and factors relating to participation

ISSUE ADDRESSED

Although pole walking (PW) has the potential to be a useful health-enhancing physical activity (PA), little is known about by whom or how it is being practised. The aims of this study were to describe (1) the characteristics of PW leaders, pole walkers and PW programs in Australia, and (2) participants' perceptions of PW and their reasons for participation.

METHODS

In 2012, PW leaders (n=31) and walkers (n=107) completed self-administered surveys that included questions about participants' sociodemographic and health characteristics, PW programs and perceptions of PW. Data were analysed using SPSS.

RESULTS

Leaders and walkers were generally born in Australia (leaders, 71%; walkers, 83%), older (leaders, 55 years [s.d. 11.5]; walkers, 65 years [s.d. 10.6]) and female (leaders, 77%; walkers, 79%). Most walkers (82%) walked regularly in groups, approximately once per week for about an hour, at light to moderate intensity. The program's aims most strongly endorsed by PW leaders were to increase participant enjoyment (90%), increase PA levels (81%), provide a positive social experience (77%) and increase PA confidence (71%). The most strongly endorsed motivations for PW among walkers were to remain physically active (63%), improve fitness (62%) and personal and social enjoyment (60%).

CONCLUSIONS

In Australia, PW is being practised by a health conscious, older population. It is perceived as an enjoyable and health-enhancing outdoor activity. SO WHAT?: Health and exercise practitioners may find that PW is a beneficial form of PA for older Australians.

Differences in ground reaction forces and shock impacts between nordic walking and walking

The regular practice of Nordic walking (NW) has increased in recent years, in part thanks to the health benefits described by the scientific literature. However, there is no consensus on the effects of shock-impact absorption during its practice.

PURPOSE

The aim of this study was to compare the levels of impact and ground reaction forces (GRF) between NW and walking (W).

METHOD

Twenty physically active and experienced participants were assessed using a dynamometric platform and accelerometry analysis.

RESULTS

The results show statistically significantly higher levels of acceleration in the tibia (12%) and head (21%) during NW compared with W. Equally, GRF were significantly higher (27%) at the instant of strike compared with W, and a reduction of the forces at the instant of takeoff (8%) was observed.

CONCLUSIONS

During NW, shock impacts and GRF levels increased compared with W, an aspect that should be considered when prescribing health improvement programs.

On your feet: protocol for a randomized controlled trial to compare the effects of pole walking and regular walking on physical and psychosocial health in older adults

Background

Physical activity is associated with better physical and mental health in older adults. Pole walking is a form of walking which may have additional health benefits in older adults, because of the addition of hand held poles, and consequent upper limb involvement. However, few studies have examined the potential additional effects of pole walking on physical and psychosocial health in older adults compared with walking. The aim of this study is to compare the effect of a pole walking program with the effects of a walking program, on physical and psychosocial wellbeing, in older adults in assisted living facilities.

Methods/Design

Sixty men and women from assisted living communities over 65 years will be recruited from senior retirement facilities and randomized into a group based, pole walking program, or walking program. The pole walking group will use the Exerstrider method of pole walking. Total duration of the programs is 12 weeks, with three sessions per week, building from 20 minute to 30 minute sessions.

The primary outcome is physical function, as measured by items from the Seniors Fitness Test and hand grip strength. Secondary outcomes include, physical activity levels, sedentary behaviour, joint pain, and quality of life. All outcomes will be assessed before and after the programs, using valid and reliable measures.

Discussion

The study will add to the evidence base for the effects of pole walking, compared with walking, on physical and psychosocial health and physical function, in healthy older adults. This will improve understanding about the feasibility of pole walking programs and its specific benefits in this population.

Trial registration

Australian New Zealand Clinical Trials Registry ACTRN12612001127897.