Nordic walking in the second half of life.

OBJECTIVES: The objective of this article is to review the literature regarding the effectiveness and safety of Nordic walking (NW) in therapeutic rehabilitation in patients of an advanced age. METHODS: Randomized studies comparing NW with different patterns of long-lasting physical rehabilitation in older adults (average age 65 years) were selected for the review. Studies were identified through a Medline database search covering the last 21 years. RESULTS: Seventy-four studies on this subject were identified, 37 of them fulfilled the required criteria and 27 of these were analyzed in this review. DISCUSSION: Nordic walking provides a safe and effective way to enhance physical activity in the elderly. It could also serve as a method of rehabilitation that improves fitness, the performance and the exercise capacity of aged persons with diseases associated with an advanced age: cardiovascular diseases due to atherosclerosis; metabolic syndrome without diabetes; early stage Parkinson's disease; chronic obstructive pulmonary disease and lowering depression in women with Sjögren's Syndrome.

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.

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.

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.

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.

Peripheral arterial disease decreases muscle torque and functional walking capacity in elderly.

OBJECTIVES: The aim of this study is to compare values of force-velocity and functional walking capacity in elderly patients with intermittent claudication with respect to the control group. MATERIALS AND METHODS: The study involved 135 individuals: 85-peripheral arterial disease (PAD) group diagnosed with stage II chronic lower limb ischemia, according to Fontaine's classification, and 50-control group. The studies included an assessment of walking capacity using a six-minute walk test (6MWT) and measurement of force-velocity parameters (peak torque-PTQ, total work-TW, average power-AVGP) of the lower limbs obtained by means of a functional dynamometry under isokinetic conditions. RESULTS: The peripheral arterial disease group is characterized by significantly lower values of force-velocity parameters compared to the control group (p<0.005). Walking capacity in this group is significantly reduced due to significant differences in the distance covered (p<0.0001), walking speed (p<0.01), and its intensity (p<0.01). Further, a positive correlation was found between the maximum distance specified in the six-minute walk test and lower limb muscle strength in the isokinetic test. CONCLUSIONS: Mean values of all force-velocity parameters and walk distance were significantly higher in the control group than in the peripheral arterial disease group. In the PAD group, in both men and women, the value of the agonist/antagonist ratio of both lower limbs are lower in men and women comparing to the control group. A rehabilitation program for patients with intermittent claudication must consider exercises improving strength, exercise capacity, and endurance in patients with PAD.