Relationship between morphometric and mechanical properties of superficial lumbosacral soft tissue layers in healthy young adults.

Introduction: It is commonly considered that myotonometry is a non-invasive method capable of quantifying linear elastic and viscoelastic properties of the myofascial tissue through the application of a weak mechanical impulse to the surface of the skin. However, before the impulse can reach the myofascial tissue, it must cross more superficial tissues such as the skin and subcutaneous tissue (ST). All these superficial tissues have different distributions and organizations of structural components. Therefore, the study aimed to examine the potential relationships between the mechanical and morphometric properties of various superficial soft tissues surrounding the lumbar multifidus muscle (LM). Methods: Myotonometric measurements of dynamic stiffness, logarithmic decrement, and creep, and ultrasonographic measurements of thickness and echogenicity of cutaneous, subcutaneous, perimuscular tissue, and LM were obtained from 50 healthy individuals in the resting prone position and during contralateral arm lift. Results: The most important findings were that in both the relaxed and contracted LM state, the dynamic stiffness strongly negatively (r = -0.69; p < 0.001 in relaxation, r = -0.83; p < 0.001 in contraction) and creep strongly positively (r = 0.79; p < 0.001 in relaxation, r = 0.85; p < 0.001 in contraction) correlated with the thicknesses of the ST. Similar but weaker correlations were noticed between both these measures and the perimuscular tissue thickness. Elasticity was uncorrelated to the thicknesses of the tissues. With LM contraction (change from the relaxed to contracted state), the relative increase in dynamic stiffness was correlated with the relative decrease in dermis (r = -0.51; p < 0.001) and ST (r = -0.47; p = 0.001) thickness, and with the relative increase in LM (r = 0.36; p = 0.010) thickness. Moreover, the relative decrease (thinning) in the ST thickness was correlated with the relative increase in logarithmic decrement (i.e., decrease in soft tissue elasticity, r = -0.37, p = 0.011). The mechanical properties of the soft tissues were not related to their echogenicity. Discussion: In conclusion, the thicker the subcutaneous and perimuscular layers, the lesser the stiffness and the greater the time-dependent deformation to the external force of the tissues surrounding the LM during its relaxation and isometric contraction. Moreover, the greater the thinning of the ST and the thickening of the LM during its contraction, the higher the increase in lumbosacral tissue stiffness and the decrease in elasticity. Therefore, one should consider the thickness of the ST before planning or analyzing the outcomes of myotonometric or other external biomechanical measurements to avoid drawing the wrong conclusions about the mechanical properties of the myofascial tissue.

Assessment of myofascial stiffness of flexor digitorum superficialis muscles in rock climbers.

PURPOSE: Myofascial stiffness is the biomechanical property that can be considered as a modifiable risk factor injury of athletes. Moreover, the level of muscle stiffness can be crucial to assessment muscle adaptation to exercise. However, stiffness of flexor muscles in rock climbers has never been investigated. The purpose of this study was to evaluate the myofascial stiffness of the flexor digitorum superficialis (FDS) in the rock climbers. METHODS: The group of rock climbers (n = 16) has been compared to the non-climbers group (n = 16), matched in terms of anthropometric measures and an average level of physical fitness. Moreover, the impact of the one-time rock climbing training on FDS stiffness was assessed in the rock climbers group. The measurement of myotonometric myofascial stiffness of FDS muscles was performed, when the elbow was flexed and fully extended. In both positions, the measurements were taken with the hand open and closed. RESULTS: It has been shown that rock climber's FDS muscle stiffness before training was significantly higher (from 15 to 20%) compared to non-climbers group. Moreover, after climbing myofascial stiffness of FDS muscles increased significantly from 25 to 40%. CONCLUSIONS: Rock climbers have significantly higher stiffness of FDS muscles after rock climbing training. Moreover, the increased stiffness in the FDS differentiates rock climbers from the active and healthy control group. Results may indicate that decrease of muscle stiffness of FDS can be an important factor for the improvement of the climbing effectiveness and prevention of overload in the forearm flexor muscles and their recovery.

Sexual dimorphism of lumbar lordosis and lumbar spine mobility during the period of progressive development.

Objective: The objective of this paper is to present possible differences in spondylometric dimorphic characteristics of lumbar spine in the period of progressive development. Material and methods: The research material included 24,517 individuals of both sexes aged from 3 to 25. Individuals that showed abnormal structure of the motor system and individuals reporting pain in the joints of the spine were excluded. Spondylometric research was carried out using the Penny & Giles electrogoniometric measuring system. Significance tests concerning position measurements (Student's t-test, Welch's t-test) were used as well as biometric profiles formed on the basis of Mollison index for each characteristic in the studied period of ontogenesis. The progress of development of the examined spondylometric characteristics in both sex groups was calculated on the basis of expressing the size of the feature in successive age groups as a percentage of its final size. Using the linear and polynomial regression models, the developmental lines of the studied spondylometric parameters were obtained in males and females. Results: In the development process of the studied spondylometric parameters, dimorphic diversity can be observed essentially only in adolescence. In general, in the whole studied period of ontogenetic development, the greater range of lumbar spine mobility is found in females. Minor sexual dimorphism is also evident in the dynamics of development and in the stage of development of the majority of examined characteristics in individual age ranges in relation to the final values, for the benefit of the female sex.

Psychological factors associated with self-management in multiple sclerosis.

OBJECTIVE: Patient's engagement in their own treatment has been shown to improve clinical outcomes. A better understanding of the association between self-management in multiple sclerosis (MS) and potentially modifiable psychological factors may provide clinicians with strategies to design and stimulate better patient activation for self-managing health. Therefore, in this study, we examined whether cognitive factors, namely self-efficacy, acceptance of illness, optimism, and health locus of control (HLC), are associated with self-management in MS. METHODS: This is a cross-sectional study. A total of 382 patients with MS who completed the MS Self-Management Scale-Revised and the questionnaires that measure self-efficacy, optimism, illness acceptance, and HLC were included in the study. RESULTS: A hierarchical multiple regression revealed that power of others' HLC (b = 0.42, P ≤ .001), optimism (b = 0.27, P ≤ .01), internal HLC (b = -0.11, P = .017), and self-efficacy (b = 0.11, P = .031), together with control variables (longer disease duration and higher disability), explained 30% of the variance in the dependent variable. CONCLUSIONS: In the case of MS, self-management is associated with patient's perception that healthcare professionals control their health, higher self-efficacy, optimism, and, surprisingly, lower internal HLC. The results of this study indicate the vital role of the healthcare staff in encouraging the patients with MS toward activities related to self-management and provide new insights on the psychological intervention aimed at improving self-management by patients.

Vitamin D and Indices of Bone and Carbohydrate Metabolism in Postmenopausal Women Subjected to a 12-Week Aerobic Training Program-The Pilot Study.

The purpose of this study was to assess the effect of Nordic walking training on the indices of bone and carbohydrate metabolism in relation to 25(OH)D levels in postmenopausal women that were subjected to the outdoor systematic physical activity. The study was performed in 10 postmenopausal women, who participated in a 12-week Nordic walking exercise program, taking place during spring months (March to June). Anthropometric and biochemical parameters were measured before and after the training program. Serum concentrations of 25-hydroksycholekalciferol (25(OH)D), parathyroid hormone (PTH), insulin, glucose, osteocalcin (OC), C-terminal telopeptide of type I collagen (CTX), and calcium were determined. After the Nordic walking exercise program, a significant increase in the serum levels of 25(OH)D and CTX and a decrease in body mass, body mass index (BMI), fat mass, and PTH concentrations were observed. The findings of the present study suggest that 25(OH)D, as important metabolic regulator, plays a role in the modification of bone markers' responses after the outdoor training program, independent of the physical activity effects.

Relationship between age, BMI, head posture and superficial neck muscle stiffness and elasticity in adult women.

This study determined relationships between age, BMI and cranio-vertebral angle (CVA) (independent variables) and stiffness and elasticity of sternocleidomasteoid [SCM] and upper trapezius [UT] (dependent variables) muscles in sitting posture in 95 women across adult life. Moreover, a stepwise regression was performed to determine to what extent the dependent variables are explained by age, BMI and CVA. Age was moderately correlated with BMI (r = 0.41), and both age and BMI were moderately negatively correlated with CVA (r = -0.54 and -0.55, respectively). High (r = 0.73) and moderate (r = 0.53) linear relationships were present between age and logarithmic decrement (inversely related to elasticity) and stiffness of SCM muscle, respectively. Low (r = 0.36) and moderate (r = 0.47) relationships were present between age and logarithmic decrement and stiffness of UT muscle, respectively. Age accounted for 53% variance in elasticity and 28.5% variance in stiffness of SCM, and for 13% variance in elasticity and 22% variance in stiffness of UT muscle. Introduction of BMI but not CVA to the model explained the variance of these parameters by additional 0-8%. Among the studied factors age is the major correlate of stiffness and elasticity of neck muscles across the adult life.

Perception of Multiple Sclerosis Impact and Treatment Efficacy Beliefs: Mediating Effect of Patient's Illness and Self-Appraisals.

CONTEXT: Patients with multiple sclerosis (MS) experience many negative, seriously aggravating disease symptoms, and hence, research studies are utmost required to improve their coping with symptoms. Our research is an attempt to show ways to increase participation of patients with MS in the treatment and treatment planning process, as well as in managing the symptoms of the disease. OBJECTIVES: To examine the relationship between perception of MS impact and treatment efficacy beliefs in patients with MS and the extent to which self and illness appraisals can be regarded as mediator variables in this relationship. METHODS: The cross-sectional study included 278 MS patients who completed the Treatment Beliefs Scale, Multiple Sclerosis Impact Scale, Generalized Self-Efficacy Scale, Rosenberg Self-Esteem Scale, and Brief Illness Perception Questionnaire. Demographic and clinical characteristics of the participants were collected with a self-report survey. RESULTS: Illness perception and general self-efficacy mediated the relationship between perception of MS impact and treatment efficacy beliefs under the control of age and time from diagnosis. The standardized indirect effects for illness perception and general self-efficacy were -0.131 95% CI [-0.2029, -0.0739] and -0.086 95% CI [-0.1663, -0.0165], respectively. CONCLUSION: Our results indicate that worse perception of physical condition in patients with MS is associated with more negative treatment efficacy beliefs, and that this association is mediated by self-efficacy and illness perception. To inhibit the increase of negative treatment efficacy beliefs, health care specialists can work on improving self-efficacy and illness appraisals.

Influence of Forward Head Posture on Myotonometric Measurements of Superficial Neck Muscle Tone, Elasticity, and Stiffness in Asymptomatic Individuals With Sedentary Jobs.

OBJECTIVE: The objective of the study was to assess the influence of forward head posture on the mechanical parameters and pressure pain threshold of superficial neck muscles in clinically nonsymptomatic individuals with sedentary jobs. METHODS: Twenty-five office workers with forward head posture and 25 office workers with normal head posture were matched for sex, age, body mass index, and the nature and duration of their work and were compared at a single point. The study participants were divided into study groups on the basis of photometric craniovertebral angle measurements. The upper trapezius, sternocleidomastoid, and splenius capitis mechanical properties were assessed in the sitting position. Primary outcome measures were muscle stiffness (N/m), muscle tone (Hz), and muscle elasticity. The secondary variable was perceived pain threshold. RESULTS: No significant differences between the groups were found for biomechanical properties and perceived pain threshold in the studied muscles. CONCLUSION: Forward head posture has no impact on muscle stiffness, tone, and elasticity, nor does it increase the pressure sensitivity of superficial neck muscles in healthy, mildly symptomatic office workers. It is most likely that not incorrect posture of the cervical spine, but probably other factors combined with forward head posture, like comorbid acute and chronic cervical pain and musculoskeletal disorders or prolonged sitting, contribute to changes in active myofascial tone and tensegrity as well as increased pressure sensitivity of neck muscles.

Female Office Workers With Moderate Neck Pain Have Increased Anterior Positioning of the Cervical Spine and Stiffness of Upper Trapezius Myofascial Tissue in Sitting Posture.

BACKGROUND: Work-related neck disorders are among the most common dysfunctions in office workers. Understanding cervical myofascial mechanical characteristics that differentiate symptomatic from asymptomatic office workers is crucial for the understanding of musculoskeletal dysfunctions in workers with neck pain. OBJECTIVE: To assess the effect of moderate work-related neck disorders on head posture and stiffness and perceived pain threshold of the upper trapezius (UT) and sternocleidomastoid (SCM) muscles. DESIGN: Cross-sectional study. SETTING: Work environment. PARTICIPANTS: Sixteen office workers with diagnosed moderate work-related neck disorders and 16 asymptomatic office workers matched for sex, age, body mass index, and the nature and duration of their work. INTERVENTION: Not applicable. OUTCOME: The primary outcome measure consisted of measurements of head posture using craniovertebral angle and myotonometric muscle stiffness (Newtons per meter) of the UT and SCM muscles. The secondary output variable was the perceived pain threshold algometry of the studied muscles. RESULTS: Compared with controls, subjects with work-related neck pain had a significantly smaller craniovertebral angle (by 8.3%; Cohen d = 0.88, P = .02) and greater stiffness of the UT myofascial tissue (by 11.3%; Cohen d = 1.05, P = .006). No significant differences in perceived pain threshold of the myofascial tissue of the UT or SCM muscles were found between groups. CONCLUSION: In this study female office workers with neck pain had increased anterior positioning of the head and stiffness of the UT muscle in the sitting posture, which was not associated with changes in the pressure pain threshold of this muscle. LEVEL OF EVIDENCE: III.

Postural Stability in Adolescent Girls with Progressive Idiopathic Scoliosis.

The aim of this work was to analyze postural stability of girls having progressive form of idiopathic scoliosis and undergoing specific period of the adolescent growth spurt. Twenty-seven girls, aged 13.4 ± 1.2 years, presenting structural idiopathic scoliosis, thoracic or thoracolumbar pattern, radiological Cobb angle 41.7 ± 17.4° (study group) and 37 healthy girls (control group) were included. The groups were sex, age, height, weight, and BMI matched. Postural stability examination was performed using two stabilometric platforms with visual control (eyes open) at three stages: (1) both legs' stance, (2) left leg stance, and (3) right leg stance. The Center of Pressure (COP) sway path length, the area and the displacement amplitude were compared. For the double stance, no difference in postural stability parameters between the groups was found. However, for the right leg stance, the total sway path length was longer (p = 0.04) and the mean amplitude of the lateral COP displacement was increased (p = 0.03) in the scoliotic group. In conclusion, for double stance, the adolescent girls with progressive form of idiopathic scoliosis revealed fair postural stability compared to control group. An impaired postural control was observed during right leg stance.

The effects of Nordic Walking training on selected upper-body muscle groups in female-office workers: A randomized trial.

BACKGROUND: Regular Nordic Walking training could improve fitness and reduce tenderness in selected muscle groups in office workers. OBJECTIVE: An assessment of the effects of a 12-week Nordic Walking training program on the perceived pain threshold (PPT) and the flexibility of selected upper-body muscle groups in postmenopausal female office workers. METHODS: 39 office workers were selected at random for the treatment group (NWg, n = 20) and the control group (Cg, n = 19). The persons from the NW group completed a 12-week Nordic Walking training program (3 times a week/1 hour). PPTs measurements in selected muscles and functional tests evaluating upper-body flexibility (Back Scratch - BS) were carried out twice in every participant of the study: before and after the training program. RESULTS: A significant increase in PPT (kg/cm2) was observed in the following muscles in the NW group only: upper trapezius (from 1,32 kg/cm2 to 1,99 kg/cm2), mid trapezius (from 2,92 kg/cm2 to 3,30 kg/cm2), latissimus dorsi (from 1,66 kg/cm2 to 2,21 kg/cm2) and infraspinatus (from 1,63 kg/cm2 to 2,93 kg/cm2). Moreover, a significant improvement in the BS test was noted in the NW group compared with the control group (from -1,16±5,7 cm to 2,18±5,1 cm in the NW group vs from -2,52±6,1 to -2,92±6,2 in the control group). CONCLUSIONS: A 12-week Nordic Walking training routine improves shoulder mobility and reduces tenderness in the following muscles: trapezius pars descendens and middle trapezius, infraspinatus and latissimus dorsi, in female office workers.

Effects of aging on mechanical properties of sternocleidomastoid and trapezius muscles during transition from lying to sitting position-A cross-sectional study.

AIM: The aim of this study was to analyze the effects of aging on the viscoelastic properties of the upper trapezius (UT) and the sternocleidomastoid (SCM) muscle during transition from lying to sitting position. MATERIALS AND METHODS: The study included 39 older (mean age 67±5.9years) and 36 younger (21.1±1.8years) women. Tone, stiffness and elasticity of the UT and the SCM were measured by means of myotonometry (MyotonPRO) in lying and then, in sitting position. The results were compared using two-way analysis of variance. RESULTS: Irrespective of the position, older women presented with significantly higher muscle tone, stiffness and elasticity than younger subjects (P<0.05). In both groups, the transition from lying to sitting position resulted in a decrease (P<0.05) in the tone and stiffness, but not the elasticity (P>0.05) of the SCM, and stimulated an increase in the tone, stiffness and elasticity of the UT (P<0.05). The degree of changes in both study groups was similar, except from the absolute value of the UT elasticity, significantly higher increase in older women than in younger subjects (P<0.05). CONCLUSION: Age contributes to an increase in the stiffness and tone of the UT and the SCM, as well as to a decrease in the elasticity of these muscles in female subjects. In contrast, age exerts only a slight effect on the mechanical properties of both muscles during transition from lying to sitting position.

Effects of sensorimotor foot training on the symmetry of weight distribution on the lower extremities of patients in the chronic phase after stroke.

[Purpose] To assess the effects of sensorimotor foot stimulation on the symmetry of weight distribution on the feet of patients in the chronic post-stroke phase. [Subjects and Methods] This study was a prospective, single blind, randomized controlled trial. In the study we examined patients with chronic stroke (post-stroke duration > 1 year). They were randomly allocated to the study group (n=8) or to the control group (n=12). Both groups completed a standard six-week rehabilitation programme. In the study group, the standard rehabilitation programme was supplemented with sensorimotor foot stimulation training. Each patient underwent two assessments of symmetry of weight distribution on the lower extremities with and without visual control, on a treadmill, with stabilometry measurements, and under static conditions. [Results] Only the study group demonstrated a significant increase in the weight placed on the leg directly affected by stroke, and a reduction in asymmetry of weight-bearing on the lower extremities. [Conclusion] Sensorimotor stimulation of the feet enhanced of weight bearing on the foot on the side of the body directly affected by stroke, and a decreased asymmetry of weight distribution on the lower extremities of patients in the chronic post-stroke phase.

Does Nordic walking improves the postural control and gait parameters of women between the age 65 and 74: a randomized trial.

[Purpose] To assess the effect of 12-weeks Nordic walking training on gait parameters and some elements of postural control. [Subjects and Methods] Sixty-seven women aged 65 to 74 years were enrolled in this study. The subjects were divided into a Nordic Walking group (12 weeks of Nordic walking training, 3 times a week for 75 minutes) and a control group. In both study groups, a set of functional tests were conducted at the beginning and at the end of the study: the Forward Reach Test (FRT) and the Upward Reach Test (URT) on a stabilometric platform, and the analysis of gait parameters on a treadmill. [Results] The NW group showed improvements in: the range of reach in the FRT test and the URT test in compared to the control group. The length of the gait cycle and gait cycle frequency also showed changes in the NW group compared to the control group. [Conclusion] A 12-week NW training program had a positive impact on selected gait parameters and may improve the postural control of women aged over 65 according to the results selected functional tests.

Demographic, socioeconomic and clinical correlates of self-management in multiple sclerosis.

PURPOSE: Our aim was to identify demographic, clinical and socioeconomic predictors of self-management in multiple sclerosis (MS). METHODS: The study was performed on a group of 283 patients with multiple sclerosis who completed Multiple Sclerosis Self-Management Scale - Revised (MSSM-R), Multiple Sclerosis Impact Scale (MSIS-29), Actually Received Support Scale (part of Berlin Social Support Scale), Expanded Disability Status Scale (EDSS) and Socioeconomic resources scale. Patients were recruited through cooperation with Multiple Sclerosis Rehabilitation Centre in Borne Sulinowo and Polish Society of Multiple Sclerosis. Demographic and illness-related problems were determined with self-report survey. RESULTS: The group consisted of 185 women and 98 men, with a mean age of 48 years. The level of disability and disease severity varied, mean time elapsed since MS diagnosis was 13 years. The final predictive model of self-management in MS was based on two main predictors: received support and available socioeconomic resources. Patients with MS who received adequate support from the closest relatives (R(2 )= 0.07, F(1, 279) = 21.84, p ≤ 0.01) and had larger available socioeconomic resources (R(2) = 0.11, F(2, 278) = 17.06, p ≤ 0.01), turned out to be the most effective in self-management. Moreover, a relationship between self-management in MS and gender as well as monthly income attributable to one family member was documented. CONCLUSION: We identified a group of MS patients who are at an increased risk of poor self-management and therefore require more attention from medical staff. This group includes patients with low level of received support, low socioeconomic resources and to a lesser degree men, and also persons receiving low monthly income. Implications for Rehabilitation Self-management of chronic illness is a key component of active participation in rehabilitation process. Low self-management in multiple sclerosis (MS) is considered to be one of the most important factors contributing to low rehabilitation efficacy, more severe long-term complications and increase in healthcare costs. Knowledge on predictors of self-management should be used in clinical practice when providing treatment, support, education and rehabilitation for patients with MS. Increasing support and improving social conditions are potentially important targets for interventions aimed at optimization of self-management, and thereby reduction of health care costs and improvement of health.

Deep tissue massage and nonsteroidal anti-inflammatory drugs for low back pain: a prospective randomized trial.

OBJECTIVE: To investigate whether chronic low back pain therapy with deep tissue massage (DTM) gives similar results to combined therapy consisting of DTM and non-steroid anti-inflammatory drugs (NSAID). DESIGN: Prospective controlled randomized single blinded trial. SETTINGS: Ambulatory care of rehabilitation. PARTICIPANTS: 59 patients, age 51.8 ± 9.0 years, with chronic low back pain. Interventions. 2 weeks of DTM in the treatment group (TG) versus 2 weeks of DTM combined with NSAID in the control group (CG). MAIN OUTCOME MEASURES: Visual analogue scale, Oswestry disability index (ODI), and Roland-Morris questionnaire (RM). RESULTS: In both the TG and the CG, a significant pain reduction and function improvement were observed. VAS decreased from 58.3 ± 18.2 to 42.2 ± 21.1 (TG) and from 51.8 ± 18.8 to 30.6 ± 21.9 (CG). RM value decreased from 9.8 ± 5.1 to 6.4 ± 4.4 (TG), and from 9.3 ± 5.5 to 6.1 ± 4.6 (CG). ODI value decreased from 29.2 ± 17.3 to 21.4 ± 15.1 (TG) and from 21.4 ± 9.4 to 16.6 ± 9.4 (CG). All pre-post-treatment differences were significant; however, there was no significant difference between the TG and the CG. CONCLUSION: DTM had a positive effect on reducing pain in patients with chronic low back pain. Concurrent use of DTM and NSAID contributed to low back pain reduction in a similar degree that the DTM did.

[Low back pain in pregnant women]. / Dolegliwosci bólowe dolnego odcinka kregoslupa u kobiet w ciazy.

Pain of lumbosacral segment of the vertebral column and the pelvis concerns about 45% of all pregnant women. The change of the body posture during pregnancy is the result of gravity centre relocation, which affects the musculosceletal system. Development of the joint, ligament and myofascial dysfunctions, as well as the pain in the lumbosacral segment and the pelvis, are the most common reasons of spine pain. The aim of this review is to present the current state of knowledge about lumbar spine pain in pregnant women with special focus on the pain connected with muscular, joint and ligament disorders. Pregnancy is a serious burden for the female osteo-skeletal system. Lumbar pain with different location and intensification is the negative consequence of the position changes during pregnancy. Pharmacotherapy could be useful only in cases of intensive low back pain, with possible application of small spectrum of drugs that are safe during pregnancy. Physical therapy including manual therapy exercises, massage and techniques of local anesthesia are alternative methods in case of low back pain in pregnant women.

Effects of Nordic walking training on exercise capacity and fitness in men participating in early, short-term inpatient cardiac rehabilitation after an acute coronary syndrome--a controlled trial.

OBJECTIVE: To investigate the effects of Nordic Walking training supplemental to a standard, early rehabilitation programme on exercise capacity and physical fitness in men after an acute coronary syndrome. DESIGN: A controlled trial. SETTING: Cardiac rehabilitation service of a provincial hospital. SUBJECTS: Eighty men 2-3 weeks after an acute coronary syndrome, with good exercise tolerance. INTERVENTIONS: Three-week, inpatient cardiac rehabilitation programme (control group) supplemented with Nordic Walking (Nordic Walking group), or with traditional walking training (walking training group). MAIN MEASURES: Exercise capacity was assessed as peak energy cost (in metabolic equivalents) in symptom-limited treadmill exercise test, and physical fitness with the Fullerton Functional Fitness Test. RESULTS: Exercise capacity after the rehabilitation programme was higher in the Nordic Walking group than in the control group (10.8 +/- 1.8 versus 9.2 +/- 2.2 metabolic equivalents, P =0.025). The improvement in exercise capacity in the Nordic Walking group was higher than in the control group (1.8 +/- 1.5 versus 0.7 +/- 1.4 metabolic equivalents, P =0.002). In contrast to the control group, the results of all components of the Fullerton test improved in the Nordic Walking and walking training groups. After the programme, lower body endurance, and dynamic balance were significantly better in the Nordic Walking group in comparison with the walking training and control groups, and upper body endurance was significantly better in the Nordic Walking and walking training groups than in the control group. CONCLUSIONS: Nordic Walking may improve exercise capacity, lower body endurance and coordination of movements in patients with good exercise tolerance participating in early, short-term rehabilitation after an acute coronary syndrome.