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

Effects of nordic walking training on gait and exercise tolerance in male ischemic heart disease patients

This technique-focused observational study explores the impact of a 6-week Nordic Walking (NW) program on physiological and biomechanical aspects in ischemic heart disease (IHD) patients. Twelve male IHD patients (66.2 ± 5.2 years, 12.2 ± 7.5 years of disease duration) were evaluated pre- and post-training for (i) gait parameters, (ii) exercise tolerance using electrocardiographic (ECG) stress test, (iii) a 6-min walk test (6MWT). The NW training, adhering to IHD patient guidelines, involved a 100-m walk at a self-selected, preferred speed without sticks, with classic NW sticks and mechatronic sticks. A mechatronic measuring system, specifically engineered for measuring, diagnosing and monitoring the patient's gait, was integrated into mechatronic sticks. Post-training, significant enhancements were observed in ECG stress test duration, metabolic equivalency, and 6MWT distance, irrespective of the stick type. However, no significant changes were noted in spatiotemporal parameters concerning the measured side, stick utilisation, or type. The results suggest that NW training boosts exercise capacity and refines gait mechanics in male IHD patients. However, the improvement in exercise capacity was not linked to changes in gait mechanics from NW training but rather to the movement during NW gait. Hence, the key to enhancing exercise capacity in IHD patients is the movement during NW gait, not the quality of gait mechanics.

Do poles really "save the legs" during uphill pole walking at different intensities?

PURPOSE

In sky- and trail-running competitions, many athletes use poles. The aims of this study were to investigate whether the use of poles affects the force exerted on the ground at the feet (Ffoot), cardiorespiratory variables and maximal performance during uphill walking.

METHODS

Fifteen male trail runners completed four testing sessions on different days. On the first two days, they performed two incremental uphill treadmill walking tests to exhaustion with (PWincr) and without poles (Wincr). On the following days, they performed submaximal and maximal tests with (PW80 and PWmax) and without (W80 and Wmax) poles on an outdoor trail course. We measured cardiorespiratory parameters, the rating of perceived exertion, the axial poling force and Ffoot.

RESULTS

When walking on the treadmill, we found that poles reduced maximum Ffoot (- 2.8 ± 6.4%, p = 0.03) and average Ffoot (- 2.4 ± 3.3%, p = 0.0089). However, when outdoors, we found pole effect only for average Ffoot (p = 0.0051), which was lower when walking with poles (- 2.6 ± 3.9%, p = 0.0306 during submaximal trial and - 5.21 ± 5.51%, p = 0.0096 during maximal trial). We found no effects of poles on cardiorespiratory parameters across all tested conditions. Performance was faster in PWmax than in Wmax (+ 2.5 ± 3.4%, p = 0.025).

CONCLUSION

The use of poles reduces the foot force both on the treadmill and outdoors at submaximal and maximal intensities. It is, therefore, reasonable to conclude that the use of poles "saves the legs" during uphill without affecting the metabolic cost.

Cognitive and biomarker responses in healthy older adults to a 18-hole golf round and different walking types: a randomised cross-over study

Introduction

The global burden of age-related cognitive decline is increasing, with the number of people aged 60 and over expected to double by 2050. This study compares the acute effects of age-appropriate cognitively demanding aerobic exercises involving walking, on cognitive functions and exerkine responses such as brain-derived neurotrophic factor (BDNF) and cathepsin B (CTSB) in older, healthy adults.

Methods/design

Healthy older golfers (n=25, 16 male and 9 female, 69±4 years) were enrolled in a 5-day randomised cross-over study and completed three different exercise trials (18-hole golf round, 6 km Nordic walking, 6 km walking) in a real-life environment, in random order and at a self-selected pace. Differences in cognition (the Trail-Making Test (TMT) AB) and exerkines (BDNF and CTSB) were analysed within groups using the Wilcoxon signed-rank test and between groups using the Kruskal-Wallis test.

Results

All exercise types resulted in a significant decrease in the TMT A-test (p<0.05; golf: -4.43±1.5 s, Nordic walking: -4.63±1.6 s, walking: -6.75±2.26 s), where Nordic walking and walking demonstrated a decrease in the TMT B-test (p<0.05; Nordic walking: -9.62±7.2 s, walking: -7.55±3.2 s). In addition, all exercise types produced significant decreases in the TMT AB test scores (p<0.05), and Nordic walking (p=0.035) showed decreases in the TMTB-TMTA-test. There were no immediate postexercise changes in the levels of BDNF or CTSB.

Conclusion

Acute bouts of golf, Nordic walking and walking improved cognitive functions irrespective of exerkines in healthy older adults. In addition, Nordic walking and walking in general enhanced executive functions. No significant effects were seen on the levels of BDNF and CTSB.

Trial registration number

ISRCTN10007294.

A Review of Biomechanical and Physiological Effects of Using Poles in Sports

The use of poles in sports, to support propulsion, is an integral and inherent component of some sports disciplines such as skiing (cross-country and roller), Nordic walking, and trail running. The aim of this review is to summarize the current state-of-the-art of literature on multiple influencing factors of poles in terms of biomechanical and physiological effects. We evaluated publications in the subfields of biomechanics, physiology, coordination, and pole properties. Plantar pressure and ground reaction forces decreased with the use of poles in all included studies. The upper body and trunk muscles were more active. The lower body muscles were either less active or no different from walking without poles. The use of poles led to a higher oxygen consumption (VO2) without increasing the level of perceived exertion (RPE). Furthermore, the heart rate (HR) tended to be higher. Longer poles reduced the VO2 and provided a longer thrust phase and greater propulsive impulse. The mass of the poles showed no major influence on VO2, RPE, or HR. Solely the activity of the biceps brachii increased with the pole mass.

Comparative effectiveness of playing golf to Nordic walking and walking on acute physiological effects on cardiometabolic markers in healthy older adults: a randomised cross-over study

Objectives

The acute effects of aerobic exercise on cardiometabolic markers are well documented in younger healthy individuals, but the same effects in older adults have not been elucidated. As such, this study compares the acute effects of three different types of age-appropriate aerobic exercises on cardiometabolic markers.

Methods

Healthy older golfers (n=25, 16 male and 9 female, 68±4 years) were enrolled in a randomised cross-over experiment. We compared the effects of three different acute aerobic exercises (18-hole golf, 6 km Nordic walk, 6 km walk) on blood pressure, blood glucose and blood lipid profile in a real-life environment.

Results

In the between-group comparison, playing golf resulted in a difference in blood glucose (golf: 0.01±1.0 mmol/L, walk: 1.3±0.9 mmol/L, p<0.001) compared with walking and triglycerides (golf: 0.13±0.2 mmol/L, Nordic walk: 0.31±0.2 mmol/L, walk: 0.23±0.2 mmol, p=0.012) and high-density lipoprotein cholesterol (golf: 0.04±0.06 mmol/L, Nordic walk: -0.02±0.06 mmol/L, walk: -0.02±0.07 mmol/L, p=0.002) compared with Nordic walking and walking. In addition, all groups had significant decreases (p<0.001) in systolic blood pressure, and Nordic walking and walking also demonstrated a decrease in diastolic blood pressure (p<0.05).

Conclusion

Acute bouts of aerobic exercise improved cardiovascular profile in healthy older adults. Despite the lower exercise intensity of golf, the longer duration and higher energy expenditure appeared to have a more positive effect on lipid profile and glucose metabolism compared with Nordic walking and walking.

Trial registration number

ISRCTN10007294.

Nordic walking with an integrated resistance shock absorber affects the femur strength and muscles torques in postmenopausal women

Deterioration of the structure and function of the musculoskeletal system represents a significant problem during aging and intervention with a suitable load of physical activity may improve the quality of life. Nordic walking (NW) has become a popular and easily accessible form of activity, especially for older adults people around the world. Thus, the purpose of the study was to evaluate the influence of an Nordic walking training program with classic poles (NW) and with integrated resistance shock absorber (RSA) on bone mineral density and the peak torques of upper limb muscles and to compare the effects of both intervention programs. 25 women were randomly assigned to two training groups: 10 subjects using RSA (68 ± 4.19 years) and 15 subjects using NW poles (65 ± 3.40 years), which completed 8 weeks of training program. The hip, spine and forearm areal bone mineral density, torques of the flexors and extensors at the elbow and shoulder joints were measured before starting the training programs and after their completion. The most significant effect was found in differences between the two groups of women with respect to the femur strength index (p = 0.047) and the ratio of the flexors to extensors in the elbow (p = 0.049) and shoulder (p = 0.001) joints and peak torque of flexors in the shoulder joint (p = 0.001) for the left arm. A significant difference was also found in the index of torque asymmetry of flexors in the shoulder joint (p = 0.002). The study shows that Nordic walking with RSA poles for postmenopausal women led to beneficial changes in the femur strength index. However, we found no significant influence on bone mineral density values measured on the whole body, the femoral neck, forearm or lumbar spine regions. The occurrence of asymmetry in biomechanical muscle parameters, which was observed using RSA poles, may suggest the necessity of systematic controlling the gait technique to avoid the adverse consequences of asymmetrical rotation of the lumbar spine.

Effects of nordic walking exercise on gait, motor/non-motor symptoms, and serum brain-derived neurotrophic factor in individuals with Parkinson's disease

Objective

The primary purpose of this study was to investigate the immediate and long-term effects of Nordic Walking (NW) exercise on walking function, motor/non-motor Parkinson's Disease (PD) symptoms, and serum brain-derived neurotrophic factor (BDNF) in persons with idiopathic PD.

Methods

Twelve community-dwelling participants with mild to moderate idiopathic PD and varied degrees of gait dysfunction were recruited for this prospective, repeated measures design that examined clinical measures and BDNF levels at baseline (T0), post-intervention (T1) and 3-month follow-up (T2). Participants engaged in 6 weeks of supervised NW exercise training with individualized instruction, followed by 14 weeks of independent NW exercise with remote coaching. Outcome measurements included daily step counts, 6-Minute Walk Test (6-MinWT), 10-Meter Walk Test (10MWT), spatiotemporalparameters, Timed Up and Go Test (TUG), dual-task TUG, Revised-Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Revised-Freezing of Gait Questionnaire, MDS-Nonmotor Symptom scale (NMS), Parkinson's Fatigue Scale, and serum BDNF levels. The Friedman test with post hoc Wilcoxon sign-ranked pairwise comparisons were used to compare baseline to T1, baseline to T2, and T1 to T2 timepoints with a Benjamini-Hockberg correction applied.

Results

Statistically significant improvements found post-training and retained at 3-month follow-up included 6-MinWT, daily step count, 10mWT, MDS-UPDRS, and TUG with effect sizes of 0.57 to 1.03. Serum BDNF at T2 was significantly greater than T0 and T1. Although no statistically significant improvements were observed in the MDS-NMS, 9 of 12 participants had improved non-motor symptoms. There was good adherence, sustained independent exercise engagement, and no adverse events over the 5-month study duration.

Conclusions

This study demonstrated that NW exercise was a safe, feasible, and sustainable mode of aerobic exercise for this sample of participants with varied Parkinson's disease duration and severity. Following an individualized and progressive NW training intervention, significant improvements in walking function, daily activity level, and motor function were observed. Following the supervised NW training phase, independent three-month engagement in NW exercise was sustained with long-term retention of these clinical improvements and an increase in serum BDNF levels over this five-month NW exercise trial.

Impact

Nordic walking exercise may be a safe, feasible and sustainable mode of independent exercise for improving daily ambulatory activity, gait and motor function, and serum BDNF in individuals with mild to moderate PD with varied gait abilities.

Clinical Trials Registry ID

20-101-H.

Intersubjectivity and the meaning of Nordic Walking practice in the view of people with Parkinson’s disease

Aims: whilst Nordic Walking (NW) practice is spreading worldwide, few studies have addressed the issue of intersubjectivity and the perception of PD individuals practicing NW and its possible impact on their daily life across different countries and cultures. This pilot study sought to explore the possible relationship between the habit of practicing NW and the perception of functionality and quality of life in the participants’ cultural context. Methods: the focus group (FG) technique was used, with 10 individuals participating in a NW program. Results: content analysis revealed five main discourse categories: a) “NW benefits for people with PD”; b) “incorporation of the NW poles in daily life”; c) “Belonging to a NW group as a treatment aid”; d) “how PD people feel about their condition”; and, finally, e) “the present and the future: expectations and issues”. Conclusion: in general, NW was found to generates positive content regarding coping with PD, beyond the biomechanical and quantitative functional effects previously studied. We suggest NW might be an important adjuvant resource for improving perceived functionality among people with PD.

The Influence of the Relative Timing between Pole and Heel Strike on Lower Limb Loading among Young and Older Naïve Pole Walkers

Current research is unclear with respect to whether pole walking (PW) reduces lower limb loading when compared to regular walking (RW). Contradictory findings in the literature may be related to the relative timing between pole and foot contact events, which were examined in the current study among naïve pole walkers. Fourteen young (4 F; 25.3 ± 5.4 years) and 8 older adults (4 F; 68.5 ± 3.2 years) performed PW and RW trials along a force plate embedded walkway at two different visits. The time difference between pole and foot contact during both the onset of ground contact and the peak force application was calculated. Several kinetic measures were calculated for the lower limbs and poles. A significant decrease during PW, compared to RW, was found for foot impulse (2.1%; p < 0.01), peak vertical ground reaction force (vGRF) (3.4%; p < 0.01), rate of loading (5.2%; p=0.02), and peak push-off vGRF (2.1%; p=0.01). No difference in pole loading was found between age groups and visits. No significant correlations were found between the relative timing and foot loading measures. Significant low-to-moderate negative correlations were found between peak foot and pole vGRFs (p=0.04), peak foot vGRF and pole strike impulse (p=0.01), peak foot vGRF and pole impulse (p=0.02), and peak foot push-off vGRF and pole impulse (p=0.01), suggesting that as pole loading increased, foot loading decreased. Findings suggest timing between pole and heel contact may not be related to unloading the lower limbs but may be related to other aspects of pole use since PW reduced lower limb loading.

An Intervention of 12 Weeks of Nordic Walking and Recreational Walking to Improve Cardiorespiratory Capacity and Fitness in Older Adult Women

(1) Background: The main aim of this study was to examine the effect of an intervention of 12 weeks in three groups on anthropometric measurement and heart rate (HR) variables, fitness index, and maximal oxygen consumption (VO2max) in older women. (2) Methods: In total, 166 Serbian adult women, aged 50 to 69 years old, participated in this study, comprising a control group (60 participants, μage = 57.8 + 6.6), Nordic-walking (NW) group (53 participants, μage = 57.5 + 6.8), and recreational-walking (RW) group (53 participants, μage = 57.8 + 6.6) in a physical fitness programme for 12 weeks. (3) Results: Anthropometric measurement variables were measured using a stadiometer and an electronic scale. The data showed differences in walking heart rate (bt/min) (p < 0.001; η2 = 0.088) between control, NW, and RW groups in the pretest analysis. Moreover, there were significant differences in walking heart rate (bt/min) (η2 = 0.155), heart rate at the end of the test (bt/min) (η2 = 0.093), total time of fitness index test (min) (η2 = 0.097), fitness index (η2 = 0.130), and VO2max (η2 = 0.111) (all, p < 0.001) between control, NW, and RW groups in the posttest analysis. (4) Conclusions: NW group training resulted in slightly greater benefits than RW group training. The present study demonstrated that both groups could act as modalities to improve the functionality and quality of life of people during the ageing process, reflected mainly in HR variables; UKK test measurements, and VO2max. It also contributes to the extant research on older women during exercise and opens interesting avenues for future research.

Biomechanical responses of Nordic walking in people with Parkinson's disease

In healthy adults, Nordic walking (NW) is known to increase the external mechanical energy fluctuations, though the external work is unaltered due to an improved pendulum-like recovery in comparison with free walking (FW). We aimed to compare mechanical, pendulum-like, and spatiotemporal parameters of gait at different speeds with and without NW poles in people with Parkinson's disease and healthy controls. The study included 11 people (aged 65.6 ± 7.0 years) with idiopathic Parkinson's disease, scoring between 1 and 1.5 on the Hoehn and Yahr scale (H&Y), and nine healthy controls (aged 70.0 ± 5.6 years). All the people were experienced Nordic walkers. Walking tests were performed at 1.8 km h^-1 and 4.7 km h^-1 , on eight 3D force platforms on a walkway. We found greater pendulum-like energy recovery (p < 0.05) in the Parkinson group during NW than in FW, while external mechanical work remained similar (p > 0.05). People with Parkinson's disease showed a major increase in vertical and forward energy fluctuations using poles than in healthy controls. In addition, the Parkinson group showed increased stride frequency and reduced stride length compared to controls in the NW and FW conditions. Our findings partly justify the lower walking economy in Parkinson's disease due to reduced pendulum-like mechanism at commonly used speeds. NW alters gait mechanics similarly in Parkinson group and healthy control, increasing the total mechanical work. Therefore, NW can be a compelling strategy for rehabilitation because of its potential for improving functional mobility, increasing pendulum-like mechanism in Parkinson's disease.

Walking Pole Gait to Reduce Joint Loading post Total Knee Athroplasty: Musculoskeletal modeling Approach

Excessive knee contact loading is precursor to osteoarthritis and related knee ailment leading to knee athroplasty. Reducing contact loading through gait modifications using assisted pole walking offers noninvasive process of medial load offloading at knee joint. In this paper, we evaluate the efficacy of different configuration of pole walking for reducing contact force at the knee joint through musculoskeletal (MSK) modeling. We have developed a musculoskeletal model for a subject with knee athroplasty utilizing in-vivo implant data and computed tibio-femoral contact force for different pole walking conditions to evaluate the best possible configuration for guiding rehabilitation, correlated with different gait phases. Effect of gait speed variation on knee contact force, hip joint dynamics and muscle forces are simulated using the developed MSK model. Results indicate some interesting trend of load reduction, dependent on loading phases pertaining to different pole configuration. Insights gained from the simulation can aid in designing personalized rehabilitation therapy for subjects suffering from Osteoarthritis.

Nordic Walking at Maximal Fat Oxidation Intensity Decreases Circulating Asprosin and Visceral Obesity in Women With Metabolic Disorders

OBJECTIVE

Excess visceral adipose tissue is associated with insulin resistance and other metabolic disorders, including deregulation of adipokine secretion, which may be corrected by aerobic exercise training. Asprosin is a novel adipokine responsible for the regulation of appetite and the release of glucose from the liver, and its levels are pathologically elevated in obesity. The aim of the study was to evaluate the effects of 8-week Nordic walking (NW) training at maximal fat oxidation intensity (FAT max ) on changes in body mass, as well as those in insulin resistance and asprosin levels among young women with visceral obesity and metabolic disorders.

MATERIALS AND METHODS

The study was completed by 14 women (30.14 ± 3.63 years) representing low levels of physical activity, visceral obesity (waist circumference 105.50 ± 14.87 cm, BMI 33.85 ± 5.48 kg/m2) and with metabolic disorders, who for 8 weeks (three times a week, 60 min), participated in NW training at the FAT max intensity (61.92 ± 6.71% HR max , 42.33 ± 8.69% VO2max) controlled on the basis of heart rate (114.21 ± 14.10 bpm).

RESULTS

After 4 and 8 weeks of NW training, a significant decrease in the concentration of asprosin, waist and hip circumference (HC), waist-to-height ratio and body adiposity index (BAI) (p < 0.05, large effect size) were found.

CONCLUSION

The 8-week NW training at an FAT max intensity decreases the concentration of asprosin in the blood as well as visceral obesity in young women with metabolic disorders.

Influence of Nordic Walking Training on Vitamin D Level in the Blood and Quality of Life among Women Aged 65-74

Introduction. Demographic forecasts indicate the progressive aging process of societies in all countries worldwide. The extension of life span may be accompanied by deterioration of its quality resulting from a decrease in physical activity, mental or even social performance, and a deficit in certain chemical compounds responsible for proper functioning of the body. Aim. The aim of the study was to evaluate the influence of a 12-week Nordic walking (NW) training intervention on the level of vitamin D in the blood and quality of life among women aged 65–74 years. Materials and methods. The study comprised 37 women aged 65–74 (x = 68.08, SD = 4.2). The subjects were randomly assigned to 2 groups: experimental group (NW), which consisted of 20 women who underwent an intervention in the form of Nordic walking training for 12 weeks, and the control group (C), including 17 women who underwent observation. In the experimental group, training sessions were held 3 times a week for 1 h. At that time, the C group was not subject to any intervention. The SF−36 questionnaire was used to measure quality of life. Vitamin D was assessed based on the results of biochemical blood tests. The analysed parameters were assessed twice-before and after the completed intervention or observation. Results. Comparison of the results regarding trials 1 and 2 allowed to note statistically significant improvement in quality of life for all health components and factors in the NW group. Analysis of vitamin D levels demonstrated a statistically significant increase in the NW group. In group C, no significant changes in the analysed parameters were observed. Conclusions. Regularly undertaking Nordic walking training significantly influences the improvement of self-evaluation regarding the components of physical and mental health, as well as the concentration of vitamin D in women aged 65–74 years.

The Effects of Nordic Walking Compared to Conventional Walking on Aerobic Capacity and Lipid Profile in Women Over 55 Years of Age

BACKGROUND

The purpose of this study was to investigate the effects of Nordic Walking compared to conventional walking on aerobic capacity, the lipid profile, left ventricular ejection fraction, body mass, and body mass index in women over 55 years old.

METHODS

The study was comprised of 74 women over 55 years of age. Participants were randomized to the Nordic Walking (n = 38) or conventional walking (n = 36) training groups. The echocardiogram, treadmill exercise stress test, lipid profile, and body mass were assessed at baseline (pretest) and after 12 weeks (posttest).

RESULTS

The authors found a significant main effect over time in duration (effect size [ES] = 0.59, P < .0001), distance covered (ES = 0.56, P < .0001), peak oxygen consumption (ES = 0.43, P < .0001), metabolic equivalent (ES = 0.29, P < .0001), peak heart rate (ES = 0.2, P < .0001), peak diastolic blood pressure (ES = 0.11, P = .0045), total cholesterol (ES = 0.26, P < .0001), and low-density lipoprotein cholesterol (ES = 0.16, P = .0005). The authors did not observe a time versus group interaction or the effect between groups. Post hoc tests revealed significant pretraining to posttraining differences in low-density lipoprotein cholesterol after the Nordic Walking training program and in peak diastolic blood pressure after the conventional walking training program. The heart rate, systolic blood pressure, and diastolic blood pressure at rest, peak diastolic blood pressure, somatic parameters (body mass and body mass index), and left ventricular ejection fraction did not change in either group.

CONCLUSIONS

Both training programs resulted in increases in aerobic capacity and decreases in total cholesterol.

Prolonged unsupervised Nordic walking and walking exercise following six months of supervision in adults with overweight and obesity: A randomised clinical trial

BACKGROUND AND AIMS

This study is a randomized trial that examined the effects of 6 months of unsupervised Nordic walking (NW) and walking (W) exercise following 6 months of supervised training in overweight/obese adults.

METHODS AND RESULTS

After a 6-month program of diet and supervised training participants (n = 27) of NW (66 ± 7 yrs, body mass index (BMI) 34 ± 5) and W (66 ± 8 yrs, BMI 32 ± 5) group continue the training without supervision for other 6 months. Steps count and mean heart rate (HR_mean) were performed in each session; anthropometric and body composition, aerobic capacity and strength of the upper and lower limbs were evaluated at baseline, after 6 months of supervised and 6 months of unsupervised training. In the unsupervised training, monthly sessions and steps count decreased over time in both groups (p < 0.05), with no significant changes in HR_mean. Compared to the supervised phase, adherence decreased significantly only in the W group in the last 3 months of unsupervised training. Compared to baseline in both groups BMI did not change, but W group lost total fat; only the NW group maintained (p < 0.05) the gains in arm curl (33%) and chair stand (31%); both groups improved in six-minute walking test (p < 0.05).

CONCLUSION

Despite unsupervised training was not effective for a further increase in performance, participants, especially in NW, maintained some of the improvements achieved during the supervision. However, the presence of instructor that guides training, may enhance adherence and health benefits of NW and W exercise.

CLINICAL TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT03212391 (July 11, 2017).

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.

Estimation of energy expenditure of Nordic walking: a crossover trial

Background

Nordic walking (NW) requires more energy compared with conventional walking (W). However, the metabolic equation for NW has not been reported. Therefore, this study aimed to characterize responses in oxygen uptake, minute ventilation, heart rate, systolic blood pressure, and surface electromyography of the upper and lower limb muscles during NW and W and develop a metabolic equation for energy expenditure (E, mL·kg^− 1·min^− 1) of NW.

Methods

This study was performed in a randomized, controlled, crossover design to test the energy expenditure during NW and W. Fifteen healthy young men were enrolled (aged 23.7 ± 3.0 years). All participants performed two randomly ordered walking tests (NW and W) on a treadmill at a predetermined stepwise incremental walking speed (3–5 km·h^− 1) and grade (0–7%). The oxygen uptake, minute ventilation, heart rate, systolic blood pressure, and surface electromyography signals of the three upper limb muscles and three lower limb muscles in their right body were recorded and compared between NW and W using paired-t test. Multiple linear regression analysis was used to draw estimation of E during W and NW.

Results

Oxygen uptake (+ 15.8%), minute ventilation (+ 17.0%), heart rate (+ 8.4%), and systolic blood pressure (+ 7.7%) were higher in NW than in W (P < .05). NW resulted in increased muscle activity in all of the upper limb muscles (P < .05). In the lower limb, surface electromyography activities in two of the three lower limb muscles were increased in NW than in W only during level walking (P < .05). Energy expenditure during W and NW was estimated as follows: E_NW = 6.1 + 0.09 × speed + 1.19 × speed × grade and E_W = 4.4 + 0.09 × speed + 1.20 × speed × grade.

Conclusion

NW showed higher work intensity than W, with an oxygen consumption difference of 1.7 mL·kg^− 1·min^− 1. The coefficients were not different between the two walking methods. NW involved more muscles of the upper body than W.

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.

Nordic Walking Increases Distal Radius Bone Mineral Content in Young Women

Unlike the lumbar spine and femur, the radius does not bear a gravitational mechanical compression load during daily activities. The distal radius is a common fracture site, but few studies have addressed the effects of exercise on fracture risk. The aim of this study was to determine the effects of the pole push-off movement of Nordic walking (NW) on the bone mineral content (BMC) and areal bone mineral density (aBMD) of the distal radius and the muscle cross-sectional area (CSA) at the mid-humeral and mid-femoral levels. The participants were allocated to two groups: an NW group and a control group. The NW group walked at least 30 min with NW poles three times a week for six months. There were no significant changes in muscle CSA at the mid-humeral or mid-femoral levels between or within groups. There were also no significant changes in BMC or aBMD at 1/3 and 1/6 of the distance from the distal end of the radius in either group. However, the BMC and aBMD at 1/10 of the distance from the distal end of the radius were significantly increased by NW. The NW pole push-off movement provided effective loading to increase the osteogenic response in the ultra-distal radius. The ground reaction forces transmitted through the poles to the radius stimulated bone formation, particularly in the ultra-distal radius.

Nordic walking training in elderly, a randomized clinical trial. Part II: Biomechanical and metabolic adaptations

Background

Nordic walking is an attractive method of endurance training. Nevertheless, the biomechanic response due to the additional contribution of using poles in relation to free walking training has been less explored in the elderly. Purpose: This randomized parallel controlled trial aimed to assess the effects of 8 weeks of Nordic walking and free walking training on the walking economy, mechanical work, metabolically optimal speed, and electromyographic activation in elderly.

Methods

Thirty-three sedentary elderly were randomized into Nordic walking (n = 16) and free walking group (n = 17) with equalized loads. Submaximal walking tests were performed from 1 to 5 km h⁻¹ on the treadmill.

Results

Walking economy was improved in both free and Nordic walking groups (x² 4.91, p = 0.014) and the metabolically optimal speed was increased by approximately 0.5 km h⁻¹ changing the speed-cost profile. The electromyographic activation in lower and upper limbs, pendular recovery, and total, external, and internal mechanical work remained unchanged (p > 0.05). Interestingly, the internal mechanical work associated with arm movement was higher in the Nordic walking group than in the free walking group after training, while the co-contraction from upper limb muscles was reduced similarly to both groups.

Conclusions

Eight weeks of Nordic walking training effectively improved the walking economy and functionality as well as maintained the gait mechanics, similar to free walking training in elderly people. This enhancement in the metabolic economy may have been mediated by a reduction in the co-contraction from upper limb muscles.

Trial registration

ClinicalTrails.gov NCT03096964

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.

Do poles save energy during steep uphill walking?

PURPOSE

In trail running and in uphill races many athletes use poles. However, there are few data about pole walking on steep uphill. The aim of this study was to compare the energy expenditure during uphill walking with (PW) and without (W) poles at different slopes.

METHODS

Fourteen mountain running athletes walked on a treadmill in two conditions (PW and W) for 5 min at seven different angles (10.1°, 15.5°, 19.8°, 25.4°, 29.8°, 35.5° and 38.9°). We measured cardiorespiratory parameters, blood lactate concentration (BLa) and rating of perceived exertion (RPE). Then, we calculated the vertical cost of transport (CoT_vert). Using video analysis, we measured stride frequency (SF) and stride length (SL).

RESULTS

Compared to W, CoT_vert during PW was lower at 25.4°, 29.8° and 35.5° PW ([Formula: see text] 2.55 ± 3.97%; [Formula: see text] 2.79 ± 3.88% and [Formula: see text] 2.00 ± 3.41%, p < 0.05). RPE was significantly lower during PW at 15.5°, 19.8°, 29.8°, 35.5° and 38.9° ([Formula: see text] 14.4 ± 18.3%; [Formula: see text] 16.2 ± 15.2%; [Formula: see text] 16.6 ± 16.9%; [Formula: see text] 17.9 ± 18.7% and [Formula: see text] 18.5 ± 17.8%, p < 0.01). There was no effect of pole use on BLa. However, BLa was numerically lower with poles at every incline except for 10.1°. On average, SF for PW was lower than for W ([Formula: see text] 6.7 ± 5.8%, p = 0.006) and SL was longer in PW than in W (+ 8.6 ± 4.5%, p = 0.008).

CONCLUSIONS

PW on steep inclines was only slightly more economical than W, but the substantially lower RPE during PW suggests that poles may delay fatigue effects during a prolonged effort. We advocate for the use of poles during steep uphill walking, although the energetic savings are small.

Proficiency in pole handling during Nordic walking influences exercise effectiveness in middle-aged and older adults

Nordic walking (NW) is a total body version of walking increasingly used as a health-promoting activity by middle-aged and older adults. The present study examined the relationship between force exerted through the pole and physiological response during NW. In this non-randomized exercise trial, 17 participants comprising 8 middle-aged and older recreationally trained Nordic walkers (NWrec: 63.7 ± 8.1 years) and 9 experienced NW instructors (NWinstr: 57.5 ± 7.8 years) underwent outdoor ordinary walking (OW) and NW bouts as fast as possible for 12 minutes. Walking distance, speed, heart rate (HR), energy expenditure (METs and J/kg/m) and upper and lower limb muscle activities using surface electromyogram (EMG) were assessed. A pole with a built-in load cell measured force applied to the pole with peak pole force, pole contact time, % of pole contact time with respect to the gait cycle, and pole impulse derived. We conducted two-way analysis of covariance adjusted for age and BMI. There was a significant group and walking type interaction for walking distance and speed (P = 0.04), METs (P < 0.01), and HR (P = 0.04) with higher values in the NWinstr group during NW than OW. As expected, upper limb EMG activities increased (P < 0.01) with NW in both groups. All pole force measures were significantly higher in NWinstr than NWrec (P ≤ 0.01). Change in walking distance and speed were correlated with pole peak force (r = 0.67, P < 0.01) and pole impulse (r = 0.63, P = 0.01). Similarly, change in METs was associated with peak pole force (r = 0.66, P < 0.01) and pole impulse (r = 0.56, P = 0.02). These results indicate that planting the pole on the ground more forcefully and for longer periods to derive a driving force in NW enhances the effectiveness of the exercise and potentially the health-derived benefits.