Impact of walk advice alone or in combination with supervised or home-based structured exercise on patient-reported physical function and generic and disease-specific health related quality of life in patients with intermittent claudication, a secondary analysis in a randomized clinical trial.

BACKGROUND: Supervised exercise is an integral part of the recommended first-line treatment for patients with intermittent claudication (IC). By reflecting the patients' perspectives, patient-reported outcome measurements provide additional knowledge to the biomedical endpoints and are important outcomes to include when evaluating exercise interventions in patients with IC. We aimed to evaluate the one-year impact of three strategies: unsupervised Nordic pole walk advice (WA), WA + six months of home-based structured exercise (HSEP) or WA + six months of hospital-based supervised exercise (SEP) on health-related quality of life and patient-reported physical function in patients with IC. METHODS: This secondary exploratory analysis of a multi-center, randomized clinical trial compared three exercise strategies. The primary outcome of the secondary analysis was the one-year change in the 36-Item Short-Form (SF-36). Secondary outcomes were three- and six-months SF-36 changes alongside three, six- and 12-months changes in the disease-specific Vascular Quality of Life instrument (VascuQoL) and the Patient-Specific Functional Scale (PSFS). The Kruskal-Wallis test with Bonferroni-adjusted post-hoc tests were used for between-group comparisons. Effect size calculations were used to describe the size of observed treatment effects, and the clinical meaningfulness of observed changes in the VascuQoL summary score at one year was studied using established minimally important difference (MID) thresholds. RESULTS: A total of 166 patients with IC, mean age: 72.1 (SD 7.4) years, 41% women, were randomized. No significant between-group differences were observed over time for the SF-36 or the PSFS scores whereas some significant between-group differences were observed in the VascuQoL domain and summary scores over time, favoring SEP and/or HSEP over WA. The observed SF-36 and VascuQoL domain and summary score effect sizes were small to moderate, and many domain score effect sizes also remained unchanged over time. A significantly higher proportion of the patients in the SEP group reached the VascuQoL summary score MID of improvement in one year. CONCLUSION: Clinically important improvements were observed in SEP using the VascuQoL, while we did not observe any significant between-group differences using the SF-36. Whereas effect sizes for the observed changes over time were generally small, a significantly higher proportion of patients in SEP reached the VascuQoL MID of improvement. TRIAL REGISTRATION: NCT02341716, January 19, 2015 (retrospectively registered).

Mechatronic Pole System for Monitoring the Correctness of Nordic Walking.

Marching with Nordic walking (NW) poles is a common form of physical activity. It is recommended in the treatment and rehabilitation of many diseases. NW's wide range of applications in rehabilitation and its effectiveness are limited by the need for experienced physiotherapists to supervise patients during the training. A prerequisite for good rehabilitation results is correctly using the poles during walking. Essential parameters of NW include the angle of inclination of the pole, the force of the pole on the ground, and proper coordination of performed movements. The purpose of this paper is to present the design and operating principle of a mechatronic NW pole system for measuring and recording the gait parameters. The subject of the work was the assessment of the usefulness of the mechatronic NW pole system for phases identified during marching. The study was conducted in field conditions. The study's main objective was to compare the obtained results from the developed system with those of a commercial system for measuring foot pressure distributions on the ground. The paper also presents sample results measuring walkers' gait with NW poles in the field and the resulting gait phase analysis.

The Effects of Cardiac Rehabilitation including Nordic Walking in Patients with Chronic Coronary Syndromes after Percutaneous Coronary Interventions in Elective Mode.

Background: Percutaneous coronary intervention (PCI) in patients with chronic coronary syndrome (CCS) is a worldwide method of coronary revascularisation. The aim of this study was to assess the immediate and long-term effects of Nordic Walking (NW) training added to a standard cardiac rehabilitation programme on physical activity (PA) and capacity and life quality, as well as selected proatherogenic risk factors. Methods: The studied group comprised 50 patients (considering exclusion criteria, 40 patients), aged 56-70, with CCS after elective PCI qualified them for a 6-weeks-long cardiac rehabilitation. The follow-up period lasted 4 months, and control visits occurred at 2 and 4 months. The studied patients were randomly divided into two groups: control group-standard cardiac rehabilitation programme and experimental group-standard cardiac rehabilitation programme additionally combined with NW training. Results: The cardiac rehabilitation programme in the experimental, compared to the control group, increased intense PA (from 731.43 ± 909.9 to 2740 ± 2875.96 vs. from 211.43 ± 259.43 to 582.86 ± 1289.74 MET min/week) and aerobic efficiency-VO2peak (from 8.67 ± 0.88 to 9.96 ± 1.35 vs. from 7.39 ± 2 to 7.41 ± 2.46 METs), as well as quality of life according to the WHOQOL-BREF questionnaire (from 3.57 ± 0.51 to 4.14 ± 0.36 vs. from 3.29 ± 0.47 to 3.57 ± 0.51 points). The walking distance assessed with the 6-min walk test did not differ between the groups before the beginning of the rehabilitation programme. Both at the I follow-up and II follow-up time points, a significant increase in the walking distance was noted in the control and experimental groups compared to baseline, and the difference between both groups was significant at the end of follow-up (378.57 ± 71.35 vs. 469.29 ± 58.07, p = 0.003). Moreover, NW had a positive effect on the modulation within selected biochemical risk factors of atherosclerosis, as well as subjective quality of life and well-being. Conclusions: Introducing NW training into the cardiac rehabilitation process proved to be a more effective form of therapy in patients with CCS treated via PCI, as compared to the standard cardiac rehabilitation programme alone.

[Impact of nordic walking on rehabilitation of the patients after COVID-19]. / Vliyanie skandinavskoi khod'by na reabilitatsiyu patsientov, perenesshikh COVID-19.

In the modern world, one of the biggest challenges to the global health system is the pandemic caused by coronavirus infection. Coronavirus infection (HCoV) is an acute infectious disease of viral nature, which is characterized by severe intoxication and predominant damage to the upper respiratory tract. Therefore, the urgent task is to rehabilitate patients after pneumonia associated with coronavirus infection (COVID-19). The basis of rehabilitation for many diseases, including COVID-19, is therapeutic physical culture (exercise therapy). In order to achieve a more pronounced positive effect of patients recovery and on the basis of the available scientific justification of the positive effect of walking with sticks (Scandinavian walking) on the human body, it was proposed to supplement the rehabilitation of such patients with Nordic walking classes. OBJECTIVE: To study the influence of Nordic walking on some indicators of the somatic status of patients who have had a coronavirus infection. MATERIAL AND METHODS: The study involved 33 people aged 30-70 years, with different stages of the disease. To assess rehabilitation, indicators such as heart rate, oxygen saturation in the blood and peak exhalation rate were selected, and the indicators of the 6-minute walk test (6-minute test), which is the main method for determining exercise tolerance in various chronic diseases, were compared. Changes in indicators were observed in dynamics, before and after the 7-day course of physical therapy, supplemented by Nordic walking classes. RESULTS: Based on the analysis of the data obtained during the 7-day follow-up, 91% of patients showed an increase in oxygen saturation; peak exhalation rate increased by 17% on average; bronchial patency increased. Also, the subjects showed positive dynamics of the results of the 6-minute test, the body's tolerance to physical activity increased, the patients themselves noted a significant improvement in their condition. CONCLUSIONS: Thus, the results obtained can be used to develop rehabilitation programs for patients who have undergone COVID-19 and need restorative treatment.

Gait changes after supervised exercise training in patients with symptomatic lower extremity peripheral artery disease.

This study aimed to investigate the effects of supervised exercise training (SET) on walking performance and spatiotemporal gait changes in patients with symptomatic lower extremity peripheral artery disease (PAD). In this single-arm prospective nonrandomized cohort study, patients with Fontaine stage II PAD following a 3-month SET program were included. Before and after SET, a constant-load treadmill test was performed to determine the pain-free and maximal walking distances (PFWD and MWD, respectively). During this test, spatiotemporal gait parameters were assessed. The ankle-brachial index (ABI) and toe-brachial index (TBI) were also measured. Twenty-seven patients with PAD (64.0 ± 1.9 y, 74% men) were included. Following SET, the PFWD (+68%; p = 0.001) and MWD (+79%; p ⩽ 0.001) significantly increased. The ABI and TBI did not change significantly. Following SET, the stride duration, stride frequency, stride length, and double support phase duration did not change significantly. In contrast, subphases of stance showed significant changes: the loading response (+8%; p = 0.03) and foot-flat (+2%; p = 0.01) phases were significantly longer, whereas the push-off phase (-7%; p = 0.002) was significantly shorter. A significant positive correlation was found between changes in the foot-flat phase and changes in PFWD (r = 0.43, p = 0.03). A significant negative correlation was found between changes in the push-off phase and changes in PFWD (r = -0.39, p = 0.05). No significant correlations were found between changes in relative durations of the subphases of stance and MWD. These results indicate that changes in temporal gait parameters during the foot contact phase potentially constitute an underlying mechanism of delayed claudication distance in patients with symptomatic PAD.

Nordic Walking and Walking in Parkinson's disease: a randomized single-blind controlled trial.

INTRODUCTION: Non-pharmacological interventions are increasingly being acknowledged as valuable options to overcome or reduce functional problems in patients with Parkinson's disease. In the last decades, Nordic Walking was employed and investigated by rehabilitation specialists. Clinical trials on the effect of Nordic Walking on motor and non-motor Parkinson's disease symptoms are few, small, and heterogeneous for inclusion criteria and intervention protocols. As a result, Nordic Walking training cannot be recommended as a standard rehabilitative tool in Parkinson's disease patients. METHODS: This randomized controlled single-blind trial recruited Parkinson's disease patients at a Hoehn and Yahr stage between 2 and 3 assigned to a Nordic Walking vs. Walking group. Subjects were extensively assessed for motor and non-motor symptoms at baseline and after 8 weeks of intervention period. To study the effects of intervention on the overall sample, paired-sample t test and Wilcoxon signed rank test were used, while differences between groups were estimated with general linear models repeated-measure and Mann-Whitney U test. RESULTS: Among 32 patients who ended the study period, improvements were observed in the following assessments: global motor outcome (p 0.001), dynamic and static balance ability (p 0.005; p 0.002), global non-motor symptoms outcome (p 0.003), fatigue (p 0.016), anxiety (p 0.043), and quality of life (p 0.003). The treatment group (Nordic Walking) failed to show any difference compared to the control group (Walking) in all considered outcomes. CONCLUSION: Nordic Walking was not superior compared to Walking in the studied population. Moderate intensity outdoor group activities like Nordic Walking and Walking seem to improve motor and non-motor symptoms parameters in patients with Parkinson's disease.

Process evaluation of a complex workplace intervention to prevent musculoskeletal pain in nursing staff: results from INTEVAL_Spain.

BACKGROUND: INTEVAL_Spain was a complex workplace intervention to prevent and manage musculoskeletal pain among nursing staff. Process evaluations can be especially useful for complex and multifaceted interventions through identifying the success or failure factors of an intervention to improve the intervention implementation. OBJECTIVES: This study performed a process evaluation of INTEVAL_Spain and aimed to examine whether the intervention was conducted according to the protocol, to investigate the fulfilment of expectations and the satisfaction of workers. METHODS: The intervention was a two-armed cluster randomized controlled trial and lasted 1 year. The process evaluation included quantitative and qualitative methods. Quantitative methods were used to address the indicators of Steckler and Linnan's framework. Data on recruitment was collected through a baseline questionnaire for the intervention and the control group. Reach and dose received were collected through participation sheets, dose delivered and fidelity through internal registries, and fulfilment of expectations and satisfaction were collected with two questions at 12-months follow-up. Qualitative methods were used for a content analysis of discussion groups at the end of the intervention led by an external moderator to explore satisfaction and recommendations. The general communication and activities were discussed, and final recommendations were agreed on. Data were synthesized and results were reported thematically. RESULTS: The study was performed in two Spanish hospitals during 2016-2017 and 257 workers participated. Recruitment was 62 and 51% for the intervention and the control group, respectively. The reach of the activities ranged from 96% for participatory ergonomics to 5% for healthy diet. The number of sessions offered ranged from 60 sessions for Nordic walking to one session for healthy diet. Fidelity of workers ranged from 100% for healthy diet and 79% for participatory ergonomics, to 42 and 39% for Nordic walking and case management, respectively. Lowest fidelity of providers was 75% for case management and 82% for Nordic walking. Fulfilment of expectations and satisfaction ranged from 6.6/10 and 7.6/10, respectively, for case management to 10/10 together for the healthy diet session. Discussion groups revealed several limitations for most of the activities, mainly focused on a lack of communication between the Champion (coordinator) and the workers. CONCLUSIONS: This process evaluation showed that the implementation of INTEVAL_Spain was predominantly carried out as intended. Process indicators differed depending on the activity. Several recommendations to improve the intervention implementation process are proposed. TRIAL REGISTRATION: ISRCTN15780649 .

QUALITY OF LIFE IN PATIENTS WITH DIABETIC POLYNEUROPATHY WITH INCREASED PHYSICAL ACTIVITY.

OBJECTIVE: The aim: Is to investigate the impact of comprehensive treatment on diabetic polyneuropathy (DPN) patients' quality of life by including rehabilitation approaches with increased physical activity in standard drug treatment regimens. PATIENTS AND METHODS: Materials and methods: 117 patients with type 2 diabetes and DPN were examined. The patients under examination were divided into 4 groups: the control group (group I) included 32 patients who received medicinal (drug) treatment. 12 supplementary daily treatment procedures with polarized light were additionally prescribed to 32 patients of the second experimental group. In addition to drug treatment and polarizing light procedures, 31 patients of group III and 22 patients of group IV were prescribed dosed therapeutic walking 3 times a week №12 (group III) or Nordic walking 3 times a week №12 (group IV). RESULTS: Results: The supplemental use of dosed therapeutic walking and Nordic walking in addition to the protocol treatment regimens contributes to the positive dynamics of quality of life of patients with DPN-complicated type 2 diabetes mellitus, which is confirmed by significant positive dynamics reflected in the following sections of the EQ-5D-3L questionnaire, such as motor (2.3 times, p<0.05), self-care (1.4 times, p<0.05), resumption of normal daily activities (2.9 times p<0.05) reduction of the frequency of discomfort (4.2 times, p<0.05) and anxiety-depressive states (2.7 times, p<0.05). CONCLUSION: Conclusions: Increased physical activity of patients with DPN significantly affects their life quality and proves to be a clinically effective approach to such patients.

[Personalization of Nordic walking programs in a sanatorium-type medical center]. / Personifikatsiya programm skandinavskoi khod'by v usloviyakh meditsinskogo tsentra sanatornogo tipa.

Nordic walking is a wellness technology available to people of all ages with varying fitness levels and health conditions. The greatest health strengthening effect when using it is achieved in those cases when the program is personified depending on a specific disease taking into account the current functional state of the body and system-forming parameters of activity including the initial vegetative tone. OBJECTIVE: To assess the effectiveness of Nordic walking in adolescent 15-17 years old depending on type of initial vegetative tone and the time of the lessons. MATERIAL AND METHODS: It was examined 60 adolescents aged 15-17 years of the II health group including 30 persons with vagotonic and 30 persons with sympathicotonic type of initial vegetative tone. In each groups the subgroups were identified who were engaged in Nordic walking from 8:00 to 9:00 (morning subgroups, 15 teenagers) and from 18:00 to 19:00 (evening subgroups, 15 teenagers). The course included 21 sessions of 45 minutes daily. Heart rate variability, the level of self-esteem according to D. Keirsey, well-being, activity and mood according to the SAN method, subjective load tolerance according to the Borg scale and general physical endurance according to the results of a test with a 6-minute run were assessed. RESULTS: A significant positive effect was observed with the differentiated use of Nordic walking taking into account the type of the initial vegetative tone and the daily rhythm of physical activity. In adolescent vagotonics training in the evening according to the analysis of heart rate variability, the functional reserve and activity of regulatory systems increased with a tendency to normalize the sympathetic-parasympathetic balance, the indicators of the psychological sphere improved, physical endurance increased, as well as the motivation for training and their subjective tolerance. In sympathicotonic adolescents, a similar positive effect of Nordic walking took place when exercising in the morning. A different distribution of training time (morning hours for vagotonics and evening hours for sympathicotonics) was accompanied by tension in the work of the autonomic nervous system apparatus caused disharmony in the emotional state, did not lead to an increase in physical endurance and worsened subjective load tolerance. CONCLUSION: When planning a course of Nordic walking in adolescents it is necessary to take into account the type of initial vegetative tone and choose the right time for classes: with vagotonia they should be carried out in the evening, with sympathicotonia - in the morning.

Are Trekking Poles Helping or Hindering Your Hiking Experience? A Review.

Hiking is a common recreational activity that provides numerous health benefits, such as reduced risk of heart disease, reduced blood pressure, and improved cardiorespiratory fitness. The use of specifically designed trekking poles has become popular among participants seeking to alleviate sore knees and increase balance and stability while walking. This review provides an overview of physiologic and biomechanical responses elicited when trekking poles are used during outdoor activities, such as hiking or Nordic walking, and discusses the clinical implications of the use of trekking poles. Google Scholar, PubMed, and ScienceDirect databases, as well as university library catalogues, were searched for literature published between 1980 and 2019. The keywords used to search the literature were hiking poles, trekking poles, and Nordic walking and their combination with physiological responses, ground reaction forces, joint forces, spatiotemporal parameters, kinematics, electromyography, and/or balance. The related topics included the academic disciplines of biomechanics, sports science, and wilderness medicine. Reference lists of located studies were also reviewed for additional sources. During free, unloaded walking, users should compare the cost and benefit of using poles: Trekking poles decrease lower extremity loading and forces but increase cardiovascular demand. When carrying a large external load, trekking poles may offer benefit by decreasing lower extremity muscle activity and increasing balance and stability.

[Nordic walking in an integrated approach to improving the quality of life of the elderly.]

The article analyzes the results of the impact of an integrated approach to lifestyle modification, including Nordic walking, rational nutrition and pharmacotherapy, on the quality of life of elderly people (average age 72,5±3,6 years). A significant improvement in the pain scale indicator of the MOS SF-36 was revealed after six months (p=0,001), which was also determined by the end of the year (p=0,0001). A tendency to improve the quality of life was revealed in the Minnesota Questionnaire after six months (p=0,0617). A significant improvement in the Minnesota Quality of Life Questionnaire was found after a year of applying this approach (p=0,0001). The relationship of improving quality of life indicators and a significant decrease in systolic blood pressure (p=0,0016) and diastolic blood pressure (p=0,0032) in elderly people after a one-year practice of an original approach to lifestyle modification is discussed.

Effectiveness of 6-Week Nordic Walking Training on Functional Performance, Gait Quality, and Quality of Life in Parkinson's Disease.

Background and objectives: Motor rehabilitation improves physical mobility and quality of life in Parkinson's disease (PD). As specialized rehabilitation is expensive and resource-consuming, there is a need for simpler, cost-effective methods. The purpose of the study was to determine whether Nordic Walking (NW) training may support the management of motor disability in PD. Materials and Methods: Forty patients (median age 64.0 years, range 50-75 years) with idiopathic PD, Hoehn and Yahr stages II-III, were randomly assigned to NW or standard rehabilitation (SR) programs, comprising twelve rehabilitation sessions conducted bi-weekly throughout the 6-week study period. Results: Median Unified Parkinson's Disease Rating Scale part III scores were significantly reduced with NW, by 8.5, and with SR, by 6.0 points (both p < 0.001), with significantly greater improvement with NW than with SR (p = 0.047). Gait quality and balance control, measured using the Dynamic Gait Index, improved with NW by a median of 8.0 and with SR by 5.5 points (both p < 0.001), with slightly greater improvement with NW, compared to the SR group (p = 0.064). Quality of life, assessed using the Parkinson's Disease Questionnaire (PDQ-39), improved with NW by a median of 15 and with SR by 12 points, p = 0.001 and p = 0.008, respectively. Conclusions: The 6-week Nordic Walking program improves functional performance, quality of gait, and quality of life in patients with PD and has comparable effectiveness to standard rehabilitation.

Nordic walking for women with breast cancer: A systematic review.

Nordic walking (NW) seems to be an interesting rehabilitation strategy for women with breast cancer (BC). No review article that has synthesised and summarised the existing scientific evidence about the effect of NW on BC survivors has been published so far. A systematic review was conducted aimed at identifying the characteristics and methodological quality of the studies that have analysed the effects of NW on women with BC. The critical appraisal of the randomised controlled trials (RCTs) was retrieved from the Physiotherapy Evidence Database (PEDro). The methodological quality of the uncontrolled studies was evaluated by means of the Quality Assessment Tool for Before-After Studies with No Control Group. Nine investigations (four RCTs and five quasi-experimental studies) were included in the final analysis. The RCTs showed a fair methodological quality, while the quasi-experimental studies obtained a score ranging from "fair" to "poor". Judging from the findings of the analysed studies, NW had a significant and positive impact on a number of BC symptoms, including lymphedema, physical fitness, disability and morbid perceptions. No adverse effects were reported. However, due to the methodological limitations observed, further research is needed to confirm such findings.

[Promoting physical activity and strengthening team cohesion]. / Promouvoir l'activité physique et renforcer la cohésion d'équipe.

The inauguration of a fitness path at the Carémeau University Hospital Campus was an opportunity for teams at the Nîmes University Hospital Centre to participate in an inter-service Nordic walking challenge. It was an opportunity to discover a particular sporting discipline, promote team cohesion in services and enjoy physical activity in a friendly atmosphere.

Systematic Review and Meta-analysis of Clinical Trials Examining the Benefit of Exercise Programmes Using Nordic Walking in Patients With Peripheral Artery Disease.

OBJECTIVES: An exercise programme is part of the initial management of peripheral artery disease (PAD). Nordic walking uses poles and a core-focused walking technique to reduce the load on the legs, which may have advantages as an exercise programme for PAD. This systematic review examined the benefit of a Nordic walking programme for treating PAD compared with other programmes. METHODS: A systematic approach was used to identify clinical trials comparing Nordic walking and control programmes in PAD patients. For inclusion, studies had to report maximum walking distance (MWD) measured with a treadmill test or corridor walking test both at entry and follow up. Study quality was appraised using the Cochrane collaboration tool for assessing risk of bias. An inverse variance weighted meta-analysis was performed to compare improvements in MWD. RESULTS: Five independent trials involving 294 patients were identified. In three trials, supervised Nordic walking programmes were compared with supervised standard walking. One trial compared a home based Nordic walking programme with a similar standard walking programme. One trial compared a partly supervised Nordic walking programme with best medical management. Meta-analysis of all data suggested that MWD improvements were similar for patients treated by Nordic and standard walking programmes (standardised mean difference, SMD = 1.31, 95% CI -1.28 to 3.91; p = .322). Findings for completely supervised programmes were similar to the primary analysis (SMD = -0.79, 95% CI -2.81 to 1.24; p = .446) while those from partially supervised or home based programmes favoured Nordic walking (SMD = 4.46, 95% CI 3.39, 5.53; p < .001), mainly due to results from one home based trial. CONCLUSIONS: This systematic review suggests no benefit of Nordic over standard walking as supervised exercise for PAD. Favourable results were reported for one home based Nordic walking programme. A larger trial is needed to assess whether this finding can be replicated or not.

The impact of Nordic walking training on the gait of the elderly.

The purpose of the current study was to define the impact of regular practice of Nordic walking on the gait of the elderly. Thereby, we aimed to determine whether the gait characteristics of active elderly persons practicing Nordic walking are more similar to healthy adults than that of the sedentary elderly. Comparison was made based on parameters computed from three inertial sensors during walking at a freely chosen velocity. Results showed differences in gait pattern in terms of the amplitude computed from acceleration and angular velocity at the lumbar region (root mean square), the distribution (Skewness) quantified from the vertical and Euclidean norm of the lumbar acceleration, the complexity (Sample Entropy) of the mediolateral component of lumbar angular velocity and the Euclidean norm of the shank acceleration and angular velocity, the regularity of the lower limbs, the spatiotemporal parameters and the variability (standard deviation) of stance and stride durations. These findings reveal that the pattern of active elderly differs significantly from sedentary elderly of the same age while similarity was observed between the active elderly and healthy adults. These results advance that regular physical activity such as Nordic walking may counteract the deterioration of gait quality that occurs with aging.

NordicWalking Performance Analysis with an Integrated Monitoring System.

There is a growing interest in Nordic walking both from the fitness and medical point of views due to its possible therapeutic applications. The proper execution of the technique is an essential requirement to maximize the benefits of this practice. This is the reason why a monitoring system for outdoor Nordic walking activity was developed. Using data obtained from synchronized sensors, it is possible to have a complete overview of the users' movements. The system described in this paper is able to measure: the pole angle during the pushing phase, the arms cycle frequency and synchronization and the pushing force applied to the ground. Furthermore, data from a GPS module give an image of the environment where the activity session takes place, in terms of the distance, slope, as well as the ground typology. A heart rate sensor is used to monitor the effort of the user through his/her Beats Per Minute (BPM). In this work, the developed monitoring system is presented, explaining how to use the gathered data to obtain the main feedback parameters for Nordic walking performance analysis. The comparison between left and right arm measurements allowed validating the system as a tool for technique evaluation. Finally, a procedure to estimate the peak pushing force from acceleration measurements is proposed.

Nordic Walking Improves Gait Power Profiles at the Knee Joint in Parkinson's Disease.

We investigated the impact of Nordic walking (NW) on gait patterns in individuals with Parkinson's disease (PD) following a 6-week NW familiarization. Twelve participants with PD and 12 healthy older adults took part in a gait analysis walking with and without poles (NP). Results showed larger knee power (knee extensor: K2) on the most affected leg in NW compared to NP (P = .01). On the less affected side, larger power absorption (knee extensor: K3) was found during preswing (K3) compared to older adults in both NP and NW (P = 0.01). NW showed longer stride length and single support time (P < .01) compared to NP. Walking with poles improved gait spatial-temporal characteristics and power profiles at the knee joint both on the less and most affected sides in individuals with PD. NW could be beneficial to help regain a more functional gait pattern in PD.

[Quality of life and physical activity among elderly and old people.]

This article presents the results of the identification of the main causes of physical inactivity among the elderly and the assessment of the effectiveness of the inclusion of regular Nordic walking into the preventive system for the elderly in order to improve the quality of life. A comparative analysis of the quality of life was used among elderly and old people, regularly engaged in Nordic walking (intervention group) and leading a physically passive lifestyle (control group). It was established that regular physical activity allows the improvement of the quality of life and positively affects health in groups under study, but it is the elderly people who represent the most physically inactive part of the population. The main reasons for the physical inactivity among older people are the presence of diseases, fear of injury and falls, lack of energy and weakness, low level of motivation, lack of partners or friends for joint activities, etc. The above studies have shown that regular practice of Nordic walking improves the quality of life for both elderly and old people. It was evidenced by the results of the SF 36 questionnaire analysis when we compared not only intervention and control groups but the age differences in the quality of life in all groups under study. After 12 months of regular Nordic walking it was registered an increase of the quality of life estimated on the scales of role-playing physical functioning, overall health, role emotional functioning, vitality, psychological health, social functioning, which correlated both with the physical and psychological components of health. The results thus obtained make it possible to recommend Nordic walking as the most simple, accessible and at the same time effective type of physical activity for the elderly population, that helps to overcome the main causes of physical inactivity, restore the functional capabilities of the aging organism. Gerontotechnologies based on the regular activities of Nordic walking are one of the most effective ways to improve and maintain the quality of life and, as a result, the activity, mobility, self-care ability among elderly and old people.

Effect of Physical Rehabilitation on Echocardiographic Parameters in Patients with Acute Coronary Syndrome.

Echocardiographic parameters were assessed in patients with non-ST segment elevation acute coronary syndrome, who underwent emergency percutaneous coronary intervention followed by various outpatient physical cardiac rehabilitation programs. The patients underwent physical rehabilitation for 3 months under conditions of diagnostic centre in the rehabilitation unit according to the standard program including in treadmill or bicycle exercise in the exercise therapy room or with Nordic walking in the main training block. After rehabilitation course, the left ventricular mass index significantly decreased and systolic volume and left ventricular ejection fraction significantly increased in both groups. Nordic walking training for 3 months non-ST segment elevation acute coronary syndrome induced similar positive shifts in the parameters of intracardiac hemodynamics, as standard treadmill or bicycle training program, which allows considering it as an alternative cardiac rehabilitation method.