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.

Histological analysis of forearm superficial veins structure

BACKGROUND

The connection between the basilic and cephalic veins of the forearm shows considerable interindividual variation. Depending on its form, the most common types of venous connections are M-, N- or Y-shaped. This study aims to compare the metric traits of the basilic and cephalic veins and the relative content of smooth muscle/collagen fibers/elastic fibers in their walls and to determine the differences between the forearm venous systems.

MATERIALS AND METHODS

The study was performed on 42 veins collected from 26 deceased individuals between the ages of 19 and 50 years. Vein sections were fixed, embedded in paraffin blocks and used to prepare histological slides, stained according to pentachrome Movat's method. Venous metrics were assessed and the percentage of muscle, elastic and collagen fibers was determined using the Trainable Weka segmentation. Statistical analysis compared the M-type vein with the Y- and N-types, which were combined into one category.

RESULTS AND CONCLUSIONS

Analysis showed a greater tunica media thickness in the M-type vein, with a greater lumen circumference in the Y/N types. Correlation analysis showed a correlation of vein metrics with elastic fibre content and a weak inverse correlation with the tunica media thickness. It can be hypothesized that the increased performance of N- and Y-types may be related to elastic fibers content.

Do Mechatronic Poles Change the Gait Technique of Nordic Walking in Patients with Ischemic Heart Disease?

The study aimed to compare the technique of normal gait with the Nordic walking (NW) gait with classical and mechatronic poles in patients with ischemic heart disease. It was assumed that equipping classical NW poles with sensors enabling biomechanical gait analysis would not cause a change in the gait pattern. The study involved 12 men suffering from ischemic heart disease (age: 66.2 ± 5.2 years, body height: 173.8 ± 6.74 cm; body mass: 87.3 ± 10.89 kg; disease duration: 12.2 ± 7.5 years). The MyoMOTION 3D inertial motion capture system (Noraxon Inc., Scottsdale, AZ, USA) was used to collect biomechanical variables of gait (spatiotemporal and kinematic parameters). The subject's task was to cover the 100 m distance with three types of gait-walking without poles (normal gait), walking with classical poles to NW, and walking with mechatronic poles from the so-called preferred velocity. Parameters were measured on the right and left sides of the body. The data were analyzed using two-way repeated measures analysis of variance with the between-subject factor "body side." Friedman's test was used when necessary. For most kinematic parameters, with the exception of knee flexion-extension (p = 0.474) and shoulder flexion-extension (p = 0.094), significant differences were found between normal and walking with poles for both the left and right side of the body and no differences due to the type of pole. Differences between the left and right movement ranges were identified only for the ankle inversion-eversion parameter (gait without poles p = 0.047; gait with classical poles p = 0.013). In the case of spatiotemporal parameters, a reduction in the cadence step value using mechatronic poles and the stance phase using classical poles compared to normal walking was observed. There was also an increase in the values for step length and step time regardless of the type of poles, stride length, and swing phase when using classical poles and stride time when using mechatronic poles. The differences between the right and left sides of the measurement occurred when walking with both types of poles for single support (gait with classical poles p = 0.003; gait with mechatronic poles p = 0.030), stance phase (gait with classical poles p = 0.028; gait with mechatronic poles p = 0.017) and swing phase (gait with classical poles p = 0.028; gait with mechatronic poles p = 0.017). Mechatronic poles can be used in the study of the biomechanics of gait in real-time with feedback on its regularity because no statistically significant differences were found between the NW gait with classical and mechatronic poles in the studied men with ischemic heart disease.

No Influence of Mechatronic Poles on the Movement Pattern of Professional Nordic Walkers

This study compared selected temporal and kinematic parameters of normal gait and Nordic Walking (NW) performed with classic and mechatronic poles (classic poles equipped with sensors). It was assumed that equipping NW poles with sensors for biomechanical gait analysis would not impair the NW walking technique. Six professional NW instructors and athletes, including three women, participated in the study. The MyoMotion MR3 motion analysis system was used to collect gait kinematic variables. The subject's task was to cover a 100-m distance with three types of gait: a gait without poles, a gait with classic NW poles, and a gait with mechatronic poles at the preferred speed. Parameters were measured both on the right and left sides of the body. No significant differences were found between gait types for three temporal parameters: step cadence, step, and stride time. For the other variables, all the differences identified were between free-walking and walking with poles, with no differences between standard and mechatronic poles. For nine kinematic parameters, differences between free-walking and walking with poles for both the left and right sides were found, while no differences were due to the pole type. All temporal parameters were characterized by symmetry, while among kinematic parameters, only two were asymmetrical (shoulder abduction-adduction in walking with regular poles and elbow flexion-extension in walking without poles). Equipping classic NW poles with additional signaling and measuring devices (mechatronic poles) does not impair the NW technique, making it possible to use them in further studies of gait biomechanics.

Effects of Physical Rehabilitation on Spatiotemporal Gait Parameters and Ground Reaction Forces of Patients with Intermittent Claudication

Chronic ischemia of the lower extremities often presents as intermittent claudication characterized by lower limb pain which subsides after a short break. This study aimed to provide an assessment of the spatiotemporal parameters of gait and ground reaction forces in patients with PAD participating in three forms of supervised physical training. A total of 80 subjects completed a three-month supervised physical rehabilitation program with three sessions per week. The subjects were assigned to one of three programs: group 1—standard walking training on a treadmill (TT); group 2—Nordic walking (NW) training; group 3—strength and endurance training comprised of NW with isokinetic resistance training (NW + ISO). Gait biomechanics tests (kinematic and kinetic parameters of gait) and a six-minute walk test were carried out before and after three months of physical training. Nordic walking training led to the greatest improvements in the gait pattern of patients with PAD and a significant increase in the absolute claudication distance and total gait distance. Combined training (NW + ISO) by strengthening the muscles of the lower extremities increased the amplitude of the general center of gravity oscillation to the greatest extent. Treadmill training had little effect on the gait pattern. Nordic walking training should be included in the rehabilitation of patients with PAD as a form of gait training, which can be conducted under supervised or unsupervised conditions.

Influence of the Physical Training on Muscle Function and Walking Distance in Symptomatic Peripheral Arterial Disease in Elderly

INTRODUCTION

A typical symptom of chronic lower-limb ischaemia is lower-limb pain, which occurs during walking forcing the patient to stop, intermittent claudication (IC). Exercise rehabilitation is the basic form of treatment for these patients.

AIM

The aim of this study was to compare the effectiveness of three types of physical training programmes conducted over a 12-week period in patients with chronic lower-limb arterial insufficiency.

MATERIALS AND METHODS

Ninety-five people qualified for the 3-month supervised motor rehabilitation programme, conducted three times a week. The respondents were assigned to three types of rehabilitation programmes using a pseudo-randomization method: Group I (TW), subjects undertaking treadmill walking training; Group II (NW), subjects undertaking Nordic walking training; Group III (RES+NW), subjects undertaking resistance and Nordic walking training. Treadmill test, 6 Minute Walk Test (6MWT), and isokinetic test were repeated after 3 months of rehabilitation, which 80 people completed.

RESULTS

Combined training (RES+NW) is more effective than Nordic walking alone and supervised treadmill training alone for improving ankle force-velocity parameters (p<0.05) in patients with intermittent claudication. Each of the proposed exercise rehabilitation programmes increased walking distance of patients with intermittent claudication (p<0.05), especially in 6MWT (p=0.001). Significant relationships of force-velocity parameters are observed in the maximum distance obtained in 6MWT, both in Group III (RES + NW) and in Group II (NW) at the level of moderate and strong correlation strength, which indicates that if the lower limbs are stronger the walking distance achieved in 6MWT is longer.

CONCLUSIONS

Given both the force-velocity parameters and the covered distance, the training RES + NW gives the most beneficial changes compared to training TW alone and NW alone. All types of training increased walking distance, which is an important aspect of the everyday functioning of people with IC.

Insufficient modification of atherosclerosis risk factors in PAD patients

BACKGROUND

An aggressive reduction of cardiovascular risk factors in patients with intermittent claudication (IC) is extremely important.

OBJECTIVES

The aim of this study was to investigate patients' adherence to current guidelines for the recognition and reduction of atherosclerosis risk factors in peripheral arterial disease (PAD) in Poland.

MATERIAL AND METHODS

The study included 126 patients with PAD stage II, according to the Fontaine Classification, who over a period of 2 years attended an angiological outpatient clinic and were referred for physical rehabilitation.

RESULTS

In the 77% of PAD patients diagnosed with dyslipidemia, 72% had hypertension and 31% had diabetes. Suboptimal treatment was being given to 85.5% of patients with dyslipidemia, to 26% of patients with hypertension and to 95% of diabetics. In this study, a diagnosis of dyslipidemia, hypertension and diabetes was made for the 1st time in 22%, 7% and 4% of patients, respectively. As many as 17.5% of PAD patients with claudication were not receiving any antiplatelet therapy.

CONCLUSIONS

The diagnosis of dyslipidemia was insufficient (about 1/3 of the patients were undiagnosed), and diagnoses of hypertension and diabetes prevailed. It was established that the effective control of risk factors using relevant treatment is insufficient in dyslipidemia, hypertension and diabetes. Antiplatelet therapy was not prescribed in approx. 20% of cases.

Analysis of the dynamics of venous blood flow in the context of lower limb temperature distribution and tissue composition in the elderly

OBJECTIVE

The elderly are particularly vulnerable to degenerative diseases, such as circulatory and respiratory system and vascular system diseases. The objective of this study was therefore to evaluate the distribution of temperature and the dynamics of venous blood flow in the lower limbs (LLs) and to assess the interdependence of these parameters in terms of the somatic components in males and females participating in activities at the University of the Third Age.

MATERIALS AND METHODS

The study included 60 females (mean age 67.4 years) and 40 males (mean age 67.5 years). A body composition assessment was performed using the bioimpedance technique - Tanita BC-418MA. The following parameters were examined: fat%, fat mass, fat-free mass, and total body water. The minimal, maximal, and mean temperature values and their distributions were examined using infrared thermographic camera VarioCAM Head. Measurements of the venous refilling time and the work of the LL venous pump were examined using a Rheo Dopplex II PPG.

RESULTS

In males, the mean value of the right LL temperature was 30.58 and the mean value of the left LL was 30.28; the P-value was 0.805769. In females, the mean value of the right LL temperature was 29.58 and the mean value of the left limb was 29.52; the P-value was 0.864773. In males, the right limb blood flow was 34.17 and the left limb blood flow was 34.67; the P-value was 0.359137. In females, the right limb blood flow was 26.89 and the left limb blood flow was 26.09; the P-value was 0.796348.

CONCLUSION

Research results showed that the temperature distribution and the dynamics of blood flow are not significantly different between the right and left extremities in both males and females. However, significant temperature differences were found between the gender groups. Significantly higher temperature values in both the right and left extremities were recorded in males than in females.

Nordic pole walking improves walking capacity in patients with intermittent claudication: a randomized controlled trial

PURPOSE

The aim of the study was to compare the efficacy of Nordic pole walking (NPW) training with traditional treadmill training (TT) on a claudication (CD) and maximum walking distance (MWD) in patients with peripheral arterial disease (PAD).

METHOD

Patients with intermittent claudication (IC) (n = 70; age=68.27) in the Fontaine class II were randomized into a two three-month rehabilitation programs performed three times per week. TT were finished by 31 patients, NPW by 21. Walking capacity was measured by an exercise treadmill test (ETT) with the Gardner-Skinner protocol (before and after the program) and six minute walk test (6MWT) (before, during and after the program).

RESULTS

In an ETT both groups reached significant increase in CD and MWD (p ≤ 0.005). In 6MWT NPW group reached significant increase in both CD (p = 0.001) and MWD (p = 0.001), whereas the TT group only in MWD (p = 0.001).

CONCLUSIONS

NPW has been shown to be as effective as the standard TT and is much less expensive. It should be the preferred method of exercise for PAD patients with IC.

IMPLICATIONS FOR REHABILITATION

Nordic walking training is a valuable form of rehabilitation for peripheral arterial disease (PAD) patients with intermittent claudication (IC). Nordic walking has been shown to be as efficient as traditional treadmill training. It is however more cost-effective method of rehabilitation in PAD patients.

Effect of nordic walking and water aerobics training on body composition and the blood flow in lower extremities in elderly women

Nordic walking and water aerobics are very popular forms of physical activity in the elderly population. The aim of the study was to evaluate the influence of regular health training on the venous blood flow in lower extremities and body composition in women over 50 years old. Twenty-four women of mean age 57.9 (± 3.43) years, randomly divided into three groups (Nordic walking, water aerobics, and non-training), participated in the study. The training lasted 8 weeks, with one-hour sessions twice a week. Dietary habits were not changed. Before and after training vein refilling time and the function of the venous pump of the lower extremities were measured by photoplethysmography. Body composition was determined by bioelectrical impedance. Eight weeks of Nordic walking training improved the venous blood flow in lower extremities and normalized body composition in the direction of reducing chronic venous disorder risk factors. The average values of the refilling time variable (p = 0.04, p = 0.02, respectively) decreased in both the right and the left leg. After training a statistically significant increase in the venous pump function index was found only in the right leg (p = 0.04). A significant increase in fat-free mass, body cell mass and total body water was observed (p = 0.01), whereas body mass, the body mass index, and body fat decreased (p < 0.03). With regard to water aerobic training, no similar changes in the functions of the venous system or body composition were observed.

Superficial venous anastomosis in the human upper extremity--a post-mortem study

The frequent use of veins in surgery, especially in the replacement of clogged arteries in the lower extremities, persuaded the authors to conduct research concerning the morphology of superficial veins in the human upper extremity. In a post-mortem study a group of 40 male subjects of 22-92 years of age was examined. The preparation of the region of the elbow fossa was performed in order to establish the architecture of superficial veins in the extremity. Many detailed anthropometrical measurements were also carried out, enabling a typological evaluation to be made of the deceased under study. Two characteristic pictures of venous anastomosis were tested, one with symmetrical tributaries to the vena basilica et cephalica and the second characterised by a rich set of tributaries to the vena basilica. The characteristics, calibre and structure of both these suggest a fruitful application of them in vessel surgery. The vena cephalica in particular, taken with efficient valves, may successfully play the role of vessel implant.

[Back pain in pregnant women]

In the paper a problem of spinal ailments in women in the third trimester of pregnancy is presented. The study concerns the changes of both body posture and pulvis position. Some disadvantageous situations pregnant women meet with, which cause feeling of pain in spine are analyzed. The alarming lack of proper knowledge about phenomenon of spinal pain in pregnant women is also pointed out.