Health benefits of Nordic walking: a systematic review

Testing an Innovative Gait Training Program in Immersive Virtual Reality for Healthy Older Adults: Protocol for a Randomized Controlled Trial

BACKGROUND

Impaired gait adaptability is one of the major causes of falls among older adults owing to inappropriate gait adjustments in cluttered environments. Training programs designed to improve gait adaptability behavior in a systemic approach may prevent falls in older adults. Recently, virtual reality (VR) technology has been prominent as a relevant gait training tool because of its training implementation potential.

OBJECTIVE

This study was designed to compare the effectiveness of a VR-based gait training program (VR group) for improving gait adaptability behavior and, thus, reducing the risk of falls relative to a conventional training program such as Nordic walking (NW; NW group). We hypothesized that the VR-based gait training program will lead to greater gait adaptability improvements.

METHODS

We will be conducting a randomized controlled trial with pretests, posttests, retention tests, and follow-up. In total, 40 healthy independent-living community dwellers (aged between 65 and 80 years) will be allocated, after a general medical examination, to the VR or the NW group for a training program of 6 weeks. Primary outcomes related to gait adaptability capacities (ie, analysis of adjustments made in different locomotor tasks) and acceptance of the VR device (ie, analysis of acceptance) will be assessed before and after the intervention and 1 month after the completion of the training program (retention). A follow-up will be done during the 12 months after the completion of the gait training program.

RESULTS

Data collection will begin in September 2025, and the first results are expected in December 2025.

CONCLUSIONS

The findings of this study may demonstrate the relative relevance of a gait training program in VR versus a conventional one for improving gait adaptability behavior in healthy older adults and, thus, prevent the chances of a fall.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/57866.

A Six-Month Nordic Walking Program for Adults With Intellectual and Developmental Disabilities: Feasibility and Effect

BACKGROUND

Individuals with intellectual and developmental disabilities tend to engage in low levels of physical activity, which puts them at risk for chronic health conditions, poor balance and gait difficulties. Nordic walking could improve gait, balance, strength, endurance and respiratory function while enjoying nature.

METHOD

Thirty-four adults with intellectual and developmental disabilities were assessed for physical performance and emotional status before and after participating in a six-month intervention comprised of weekly Nordic walking sessions. Five staff members were also interviewed about the programme.

RESULTS

Nordic walking was found to be feasible, with an average monthly attendance of 60.75%. Following the intervention, significant improvements were seen in lower-extremity strength, flexibility and waist-to-hip ratios.

CONCLUSIONS

Nordic walking motivates participants to engage in physical activity, strengthens muscles, and increases flexibility. Thus, people who work with adults with intellectual and developmental disabilities may consider including Nordic walking in their health enhancement and maintenance programmes.

Influence of systematic standard and Nordic walking training on exercise tolerance and body weight components in women over 55 years of age

Background

The most physiological form of movement of human body is walking. The aim of the study was to assess the changes before and after workout programme in body mass components and exercise tolerance in women above 55 years of age, both in standard walking (March training) and walking with poles (Nordic Walking).

Material and methods

77 (55-64 years) women were divided into two groups: I - 37 women, participating in the marching training. II - 40 women participating in the Nordic Walking training. CPET, and body composition analysis were performed in each of the participants before and after workout program.

Results

Significant changes in VO2peak, both in standard walking group and Nordic walking, distance and test duration were observed. The evaluation of body composition Standard and Nordic Walking groups concerned statistically significant changes in the same indicators at the same level of significance: fat content (%), water content inside and outside the cell (%). In Nordic walking group there where some significant correlations between the changes in body fat (%), body weight, visceral obesity and fitness scores, changes in metabolic cost associated with the exercise test, changes in body fat (%) content and increase in the duration of the exercise test, as well as changes in body fat (%) content and increase in the distance of the test.

The Effect of Nordic Walking Intervention (NORDIN-JOY) on Individuals with Intellectual Disabilities and Their Families: A Multicenter Randomized Crossover Study

BACKGROUND

We aim to evaluate the effect of the Nordic Walking program on the quality of life and functionality of individuals with intellectual disabilities; Methods: The NORDIN-JOY study is designed as a multicenter, randomized crossover trial. Participants in the experimental group will engage in a Nordic Walking intervention, while those in the control group will participate in a Fit 5-Fitness Cards intervention. Both physical training programs will consist of two 60 min sessions per week over a three-month period. The study will assess measures of quality of life and physical fitness. Additionally, the feasibility and cost-effectiveness of both programs, as well as the average weekly physical activity levels during the six months following the intervention, will be evaluated; Results: The results of this study are anticipated to provide valuable insights into the effects of structured exercise interventions on individuals with intellectual disabilities. These findings will be disseminated through peer-reviewed journals and academic conferences; Conclusions: This protocol seeks to establish evidence on the impact of exercise programs in individuals with intellectual disabilities. The findings have the potential to inform specific recommendations for healthcare professionals, caregivers, and policymakers, promoting physical activity as a cost-effective strategy for improving care and quality of life in this population.

A systematic review and meta-analysis of Nordic walking for chronic heart failure with low left ventricular ejection fraction

BACKGROUND

Nordic walking (NW) has been reported to be beneficial in various chronic diseases.

OBJECTIVE

To determine whether NW improves function in patients with heart failure (HF) with low left ventricular ejection fraction more than conventional cardiac rehabilitation or usual care.

METHODS

Systematic literature searches in PubMed, ScienceDirect, and Web of Science were conducted. According to patient, intervention, comparison, and outcome (PICO) principles, a stepwise selection process was completed to identify eligible studies. Only randomized controlled trials (RCTs) were included in this systematic review and meta-analysis. Pooled effects were determined using a random effect analysis model for the meta-analysis.

RESULTS

A total of 282 participants from four RCTs were included. The improvement of peak oxygen consumption (peak VO2) was greater in the NW group than in the control group (mean difference [MD] = 2.18 mL/kg/min; 95% confidence interval [CI] = 1.35-3.01; p < .01). The improvement of the 6-minute walk test (6MWT) distance was also greater in the NW group than in the control group (MD = 16.51 meters; 95% CI = 3.23-29.80; p = .01).

CONCLUSION

This systematic review highlights the benefits of NW training in patients with chronic HF, particularly those with systolic dysfunction. Specifically, NW walking was associated with increased peak VO2 and 6MWT improvement compared to conventional cardiac rehabilitation or usual care. These results suggest that NW may be a useful component of cardiac rehabilitation. However, additional larger studies with a wider range of patients are needed.

Values associated with Nordic Walking: An international cross-sectional survey among individuals practicing walking with poles

INTRODUCTION

The article is devoted to the sociological exploration of the social phenomenon that Nordic Walking has become in Europe and worldwide over the recent decades.

AIM

It is based on the results of original international sociological research study on the issue of sociodemographic profiles of Nordic Walkers in the context of the values associated with this sports activity.

METHODS

A cross-sectional quantitative study with convenience sampling study was performed among 416 Poles, 132 Europeans from 11 countries (Germany, the UK, Spain, France, Italy, Portugal, Ireland, Denmark, Austria, Sweden, and Norway), and 212 participants from 5 non-European countries (the USA, Canada, Australia, New Zealand, and Japan). The study used an author's tool that included questions concerning the ways of doing Nordic Walking and its and social and organizational contexts, its classification and interpretation as a health-related, recreational, or sports activity, its position in the space of everyday life and in the sphere of preferred values, motives for walking with poles, meanings attributed to this activity, and the individual and social benefits associated with it.

RESULTS

The values most often associated with practicing Nordic Walking belong to the personal and psychophysical spheres. Their dominant position suggests that this activity is a complex one and that its advantages are not restricted to its motor aspects or to contact with nature. It is not a simple activity of walking with poles, as the initial stereotypes seem to suggest, but a kind of movement with a defined framework and a set of principles, engaging the physical and personal spheres of those who practice it, having a cultural meaning, and marked by cultural rootedness.

CONCLUSION

The research results can be useful for health care experts and for those responsible for building prevention strategies in various social groups. This is because they draw attention to the category of accessible and at the same time effective activities, with high individual and social potential. At the same time, they show that an important element of promotion strategies and social campaigns aimed at popularizing sport and healthy lifestyle should be axiological categories as significant predictors of individuals' actions and decisions.

Influence of Walking, Manual Techniques, and Elastic Resistance Exercise on Shoulder Posture in Healthy Elderly Individuals

In this study, we investigated the effect of regular walking and its combination with manual techniques/resistance exercise. The position of the shoulder girdle was assessed using the acromion-wall distance (AD). The intervention took place twice a week for 4 weeks. A total of 88 seniors over the age of 60 successfully completed the study. The results showed a statistically significant improvement of AD in the left shoulder within the group that underwent walking combined with resistance exercise. The remaining groups did not show any statistically significant change in AD.

BACKGROUND

The world population is rapidly aging; therefore, it is necessary to respond to this challenge in time. One of the typical involutional signs of old age is a hunched posture combined with a forward position of the shoulder girdle. This posture negatively impacts various bodily functions, postural stability, and strain on the musculoskeletal system.

OBJECTIVES

We aimed to evaluate the effect of walking and walking combined with manual therapy/resistance exercise on scapular positioning in healthy elderly individuals.

METHODS

Participants of experimental groups underwent a 4-week training session that involved walking and manual techniques/resistance training applied 2x/week. Participants of the control group maintained their usual daily habits.

RESULTS

Our results showed statistically significant improvement in scapular positioning of the left shoulder in participants who underwent regular walking combined with resistance exercise training.

CONCLUSIONS

These results suggest that regular walking combined with resistance training, when properly dosed, may beneficially influence scapular positioning in healthy elderly individuals.

Cost-Effectiveness of a Multi-faceted Workplace Intervention to Reduce Musculoskeletal Pain in Nursing Staff: A Cluster-Randomized Controlled Trial (INTEVAL_Spain)

PURPOSE

To evaluate the cost-effectiveness of a multifaceted workplace intervention to reduce musculoskeletal pain (MSP) in nursing staff.

METHODS

The study was a 1-year cluster-randomized controlled trial. The intervention combined participatory ergonomics, health promotion, and case management. The control group received usual care. Societal and health system perspectives were used. Costs included direct health and indirect costs. The effects were MSP and quality-adjusted life years (QALYs). MSP was measured using the Standardized Nordic Questionnaire at baseline and 6- and 12-month follow-up. QALYs were measured using the EuroQol-5D-3L at 6- and 12-month follow-up. Incremental costs and QALYs were modelled using generalized linear models. MSP was analysed through generalized logistic models. Incremental cost-effectiveness ratios (ICERs) were calculated, and cost-effectiveness planes and acceptability curves were constructed.

RESULTS

Total mean costs per person were €614 and €216 for the intervention and control group, respectively, with a societal perspective. The intervention mean cost was €38/person. From the societal perspective, the ICER showed that overall additional €68 (€9 from a health system perspective) were required to achieve 1-extra-percentage-point reduction of MSP. ICERs were €34 from the societal and €4 from the health system perspectives for neck, shoulders and upper back pain; €53 and €7 for low back; €179 and €23 for hands; €39 and €5 for legs; €115 and €14 for the knees; €36 and €5 for feet For MSP in the elbows. For participants with pain in the elbow, and for QALYs, the ICER showed that the intervention group was dominated by the control group.

CONCLUSION

This intervention was not cost-effective in terms of QALYs. However, in terms of MSP, with a willingness to pay of €100, the probability of the intervention being cost-effective was around 90%. Further studies incorporating our recommendations are needed to confirm these findings.

STUDY REGISTRATION

ISRCTN15780649, retrospectively registered.

Impacts of a Prescribed Physical Activity Program for People with Chronic Diseases Living in Community Settings in France

BACKGROUND

Sedentary behavior and physical inactivity are modifiable risk factors at the forefront of prevention and health promotion strategies. The health benefits of physical activity (PA) have been widely demonstrated in chronic diseases and have led to the prescription of adapted PA. To date, French scientific data are insufficient to evaluate the effectiveness of prescribing adapted PA. This study aimed (1) to evaluate the effectiveness of a community-based program and (2) to identify patient characteristics at inclusion that could be associated with improved post-program anthropometric data.

METHODS

Our sample was composed of 113 participants with a chronic disease (83.18% women) with a mean age of 55.4 ± 13.9 years. Participants benefited from an 8-week adapted PA program. All participants were evaluated at the beginning and end of the program by anthropometric measurements, a subjective measure of the level of PA and a measure of physical condition.

RESULTS

Almost 86% of the participants were overweight and two-thirds were obese. Statistical analyses showed a significant improvement in physical condition, expressed by a better cardiorespiratory endurance (up to +14% for a 2 min walk test; MT0 = 78.1 m vs. MT1 = 89 m; p < 0.001 with a 2 min walk test), improved flexibility (+12.5%; MT0 = 2.4 vs. MT1 = 2.7; p < 0.001), and increased muscle strength in the lower limbs (+22.7%; MT0 = 11.9 vs. MT1 = 14.6; p < 0.001). The level of physical activity increased significantly for all participants (57.52% of inactive individuals at T0 vs. 5.31% at T1; p = 0.004). Correlational analyses revealed that the decrease in BMI and weight throughout the program correlated positively with age (r = 0.252 and p = 0.007, and r = 0.247 and p = 0.008, respectively) and negatively with BMI from baseline (r = -0.271; p = 0.004).

CONCLUSIONS

The key points of this community-based PA program are the following: (1) It improves participants' physical condition. (2) It improves anthropometric parameters. (3) It modifies physical activity behavior. Furthermore, in the context of the program set up specifically for this purpose, it would appear that elderly and overweight people are more likely to exhibit beneficial effects on anthropometric parameters than younger participants or those with a high level of obesity. However, these results need to be confirmed by a long-term evaluation of the effectiveness of such devices.

Effects of walking interventions in persons with multiple sclerosis-A systematic review

OBJECTIVE

The aim of the present systematic review was to investigate the effects of voluntary walking interventions in persons with multiple sclerosis (pwMS). For this purpose, we developed a framework to describe the components of walking interventions.

DATA SOURCES

Two databases (MEDLINE/PubMed and EMBASE) were searched in January 2023.

STUDY SELECTION

Included studies enrolled pwMS and evaluated walking interventions with a duration of 2 weeks or longer. Further, they evaluated at least one walking-related outcome. Both RCTs and non-controlled studies were enrolled.

DATA EXTRACTION

Data were extracted using a customized spreadsheet, which included detailed information on patient characteristics, interventions, outcomes, and results. Based on the extracted results, the effect sizes (ES, Hedge's g) of the walking interventions were calculated if possible. The methodological quality of the included studies and their reporting was determined using the TESTEX evaluation tool.

DATA SYNTHESIS

Data from a total of n = 200 pwMS was included from N = 7 RCT´s (from 3 we used within-group data) and N = 5 single-group studies. On average 91.7 ± 9.9 % of the planned walking sessions were attended, 8.7 ± 10.5 % of the participants dropped out, and very few adverse events occurred. Walking interventions improved walking performance during short distance walk tests (ES ranging from -0.21 to -0.72, "walking time") and long distance walk tests (ES ranging from 0.27 to 0.72, "walking distance").

CONCLUSIONS

Voluntary walking interventions appear to be safe and effective at improving walking performance in pwMS. However, well-powered walking intervention studies are needed to confirm these promising effects. The simplicity of walking interventions makes them highly relevant for ambulatory pwMS.

Effects of Aerobic Exercise Therapy through Nordic Walking Program in Lactate Concentrations, Fatigue and Quality-of-Life in Patients with Long-COVID Syndrome: A Non-Randomized Parallel Controlled Trial

BACKGROUND

Long-COVID syndrome comprises a variety of signs and symptoms that develop during or after infection with COVID-19 which may affect the physical capabilities. However, there is a lack of studies investigating the effects of Long-COVID syndrome in sport capabilities after suffering from COVID-19 infection. The purpose of the study was to evaluate and compare lactate concentration and quality of life (QoL) in patients with Long-COVID with those who have not developed non-Long-COVID during Nordic walking exercise therapy.

METHODS

Twenty-nine patients (25.5 ± 7.1 years) took part in a non-randomized controlled trial, divided into two groups: a Long-COVID group (n = 16) and a non-Long-COVID control (n = 13). Patients were confirmed as having Long-COVID syndrome if they experienced fatigue or tiredness when performing daily activities and worsening of symptoms after vigorous physical or mental activity. All participants underwent a 12-week Nordic Walking program. Lactate concentration after exercise and distance covered during all sessions were measured. Pre- and Long-Nordic Walking program, the Modified Fatigue Impact Scale (MFIS), the Short Form 36 Health Survey (SF-36), and EURO QoL-5D (EQ-ED) were administered to assess fatigue and quality of life, respectively.

RESULTS

There was a lactate concentration effect between groups (F = 5.604; p = 0.024). However, there was no significant effect as a result of the session (F = 3.521; p = 0.121) with no interaction of group × session (F = 1.345; p = 0.414). The group main effect (F = 23.088; p < 0.001), time effect (F = 6.625; p = 0.026), and group × time (F = 4.632; p = 0.002) interaction on the SF-36 scale were noted. Also, there were a significant group main effect (F = 38.372; p < 0.001), time effect (F = 12.424; p = 0.005), and group × time interaction (F = 4.340; p = 0.014) on EQ-5D. However, there was only a significant group main effect (F = 26.235; p < 0.001) with no effect on time (F = 2.265; p = 0.160) and group × time (F = 1.584; p = 0.234) interaction on the MFIS scale.

CONCLUSIONS

The Long-COVID group showed higher lactate concentration compared with the control group during the 12 weeks of the Nordic Walking program. The Long-COVID group presented a decrease in fatigue with respect to the control group according to the MFIS scale, as well as improvement in quality of life after aerobic exercise therapy.

[Nordic walking and simultaneous physiotherapy for chronic prostatitis]

OBJECTIVE

Scientific substantiation of the advisability of including Nordic walking and simultaneous physiotherapy based on the Tilain-EM device in the complex treatment of chronic prostatitis.

MATERIAL AND METHODS

124 men at the age of 24-51 years old with chronic prostatitis (CP) were divided into three groups by simple randomization: the main group (n=42) was prescribed a complex treatment (basic medications, Nordic walking and simultaneous physiotherapy); the group of comparison (n=42) had basic therapy and Nordic walking; the control group (n=40) received only basic therapy. The dynamics of clinical manifestations of CP (according to specialized NIH-CPSI and IPSS scales) and laboratory parameters (prostatic secretion) was assessed.

RESULTS

The conducted study showed that the use of complex therapy for CP results in a significant regression of clinical symptoms of the disease and an improvement of laboratory data.

CONCLUSION

A new treatment complex for patients with CP has been developed based on the use of Nordic walking and simultaneous physiotherapy from the Tilain-EM device against the background of standard drug therapy. The proposed complex therapy allows to influence not only the leading etiopathogenetic aspects, but also eliminates one of the main risk factors for the development and recurrence of the disease.

Biomechanical comparison of walking with a new, wearable rehabilitation training device to Nordic walking and regular walking in people with chronic low back pain

Physical activity, particularly walking, is commonly used for the treatment of diseases such as low back pain. In this study, the effects of walking wearing the new ToneFit Reha training belt (TFR) were compared to both Nordic walking and regular walking. The TFR is intended to intensify the effects of walking through the integration of two adjustable resistance handles. Ten patients with low back pain performed regular walking, Nordic walking, and walking with the TFR in a movement laboratory. The kinematics of the trunk, upper extremities, and lower extremities were measured, and the activity of the trunk and upper extremity muscles recorded. Data were analyzed by repeated-measures ANOVA and paired t-test. Kinematics indicated that walking with the TFR introduces instability that was mitigated by a delayed peak trunk rotation (peak at 63.3% gait cycle, vs. 52.8% in walking (p = .001) and 51.0% in NW (p = .007)). Upper extremity kinematics (constrained elbow flexion, high peak shoulder abduction) showed movement patterns that need to be considered when training over a longer period. Increased muscle activity was observed especially for upper extremity muscles, when training with TFR. Overall, walking with the TFR was found to be a suitable therapy for use in a rehabilitation setting.

Effect of Bicycle Ergometer Training and Nordic Walking Training on Improving Functional Exercise Capacity in Asthma Patients

Introduction Asthma is a chronic respiratory condition characterized by inflammation of the airway leading to breathlessness. Exercise training has been recognized as a valuable component in the management of asthma, enhancing lung function and overall well-being. Bicycle ergometer training and Nordic walking are two distinct forms of exercise that have been shown to improve cardiovascular fitness and respiratory function. Despite the potential benefits of these exercises, limited research directly compares their efficacy in improving functional capacity specifically in asthma patients. The study thus aims to address this gap by providing personalized, tailored exercise programs for asthma patients. Methods A single-blinded experimental study using a simple random sampling method was conducted. A sample of 40 subjects was recruited for the study based on inclusion and exclusion criteria and were assigned into two groups. Group A subjects were trained with a bicycle ergometer and Group B subjects were trained with Nordic walking. The intervention was given to both groups for 12 weeks. The outcome measures used were the six-minute walk test, Modified Borg Scale, and Mini Asthma Quality of Life Questionnaire. Results A baseline analysis of outcome measures was done, which was followed up by a post-test analysis after 12 weeks. Pre-test and post-test data were compared using a paired t-test. Intergroup analysis was done by an independent t-test. Both groups showed significant improvement in post-test results. On comparing the two groups, Group A showed significant improvement as compared to Group B. Conclusion The study concludes that bicycle ergometer training is effective in improving functional capacity and enhancing the quality of life in asthma patients.

A Simple Exercise Program for Patients With End-Stage Kidney Disease to Improve Strength and Quality of Life: Clinical Research Protocol

Background

Most patients with end-stage kidney disease (ESKD) appreciate the importance of exercise and would like to increase their physical activity; however, they report a few key barriers, including (1) lack of physician advice to do so, (2) lack of safe and convenient programs (ie, appropriate for home or neighborhood), and (3) cost. Importantly, patients indicated in a previous survey that they would prefer an exercise program that improves muscle strength and symptoms, and are less interested in cardiovascular disease prevention.

Objective

To test the feasibility of a simple, prescribed exercise program using Nordic walking poles in patients with ESKD treated with dialysis.

Design

Randomized multicenter pilot trial of an exercise intervention that includes Nordic walking poles, personalized physician exercise prescriptions, pedometers, and access to exercise videos, compared with standard of care, in patients being treated with maintenance dialysis.

Setting

Multicenter tertiary care centers in Canada.

Patients

Ambulatory adult patients with ESKD treated with peritoneal dialysis or hemodialysis (HD) for at least 6 months at participating sites are potentially eligible. Inclusion criteria include ability to use Nordic walking poles (either de novo or in place of mobility aid) and to provide informed consent in English or in French. Exclusion criteria include (1) any absolute contraindication to exercise, (2) baseline step count >8000 steps/day, (3) planned living donor kidney transplant, and (4) participation in another interventional trial that may affect the results of this study.

Methods

This is a randomized multicenter pilot trial of an exercise intervention that consists of a prescription to exercise using Nordic walking poles, a pedometer to track activity, and access to exercise videos, with the comparator of standard of care (dialysis unit staff encouragement to exercise) in patients being treated with maintenance dialysis. Randomization is concealed and uses a 1:1 ratio for group assignment. Our specific aims are to determine the feasibility of patient recruitment, adherence to the exercise program (verified by step counts), and efficacy of the intervention on patient-important outcomes that were assessed as a priority by patients in a prior survey-specifically strength, fatigue, and sleep. We record days spent in hospital and loss of independent living to inform sample size calculations for a definitive trial of exercise in patient with ESKD treated with dialysis. Adverse events are closely monitored.

Outcomes

Primary: Our recruitment goal is 90 to 150 patients over 27 months; adherence success will be defined if >75% of randomized patients, excluding those who are transplanted or deceased, achieve >80% of their prescribed steps at 6 and 12 months. Secondary Efficacy Outcomes: (1) strength-hand grip strength and 5 times sit to stand, (2) energy-Short Form (SF)-36 vitality subscale, and (3) sleep-Pittsburg Sleep Quality Index will be assessed at baseline, 6, and 12 months.

Results

Trial recruitment started before the COVID-19 pandemic and the pandemic led to many interruptions and delays. Online exercise Web sites and a tailored video were added to the protocol to encourage activity when participants were unable or reluctant to walk in public places.

Limitations

This trial was designed to include ambulatory patients with ESKD and does not address the burden of disease in patients with very restricted mobility.

Trial Registration

NCT03787589.

The longitudinal effects of the built environment on transportation and recreational walking, and differences by age and sex: systematic review protocol

BACKGROUND

In high-income countries, the prevalence of physical inactivity and non-communicable diseases is high, and it is now well-established that insufficient physical activity is a risk factor for non-communicable diseases. Walking for recreation and transportation are effective means of improving population levels of physical activity. Research finds that the built environment (BE) can encourage or discourage walking behaviour, and this association varies for different age groups and sexes. This systematic review aims to synthesise longitudinal evidence to better understand how the BE affects recreational and transportation walking for different age groups (above 64 years and 18-64 years) and sexes in high-income countries.

METHOD

We will use Scopus, PubMed, SPORTDiscus with Full Text (EBSCO), Business Source Complete (EBSCO), Art and Architecture Archive (Proquest), Avery Index to Architectural Periodicals (ProQuest), and Art, Design & Architecture Collection (ProQuest) databases to search for relevant studies. Reviewers will screen the search results according to pre-specified eligibility criteria for study inclusion in the review. Required data for the synthesis will be extracted from the included studies to answer the research questions. Further, the methodological quality of the studies included in this systematic review will be evaluated using an established instrument, and the resulting quality scores will be utilized in sensitivity analysis. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) checklist will be followed when reporting the findings.

DISCUSSION

This review will identify BE attributes that are likely to influence transportation and recreational walking for younger and older adults and different sexes in high-income countries. The findings will help policymakers with making decisions around walkable built environments for older and younger adults and different sexes to keep them healthy.

TRIAL REGISTRATION

This protocol of the prospective systematic review is developed following PRISMA-P guidelines and is registered on the Prospective Register of Systematic Reviews (PROSPERO) (registration ID CRD42022351919).

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.

Nordic walking training in persons with Parkinson's disease: Individualized prescription-A case series

INTRODUCTION

Physical therapy interventions for patients with Parkinson's disease prioritize task-specific exercise to address gait and motor dysfunction. Nordic walking (NW) is a moderate intensity exercise promoting walking speed and rhythm. This case series describes the application of customized NW training in individuals with varied severity of Parkinson's gait dysfunction and the outcomes specific to gait, motor and non-motor symptoms; and NW engagement and retention in the follow-up phase.

CASE DESCRIPTION

Three individuals with idiopathic PD (two males and one female; ages 59-69; Hoehn & Yahr stages II-III) participated. Supervised NW training phase included 15 one-hour sessions over 6-weeks, individually progressed for each participant. During the 3-month follow-up phase independent NW exercise was prescribed 3 times a week. Primary outcome measures examined gait function and impairment-based measures assessed Parkinson's motor and nonmotor symptoms.

OUTCOMES

Participants improved in: 10-Meter walk-fast speed (0.13, 0.18, 0.15 m/s; respectively); 6-Minute Walk distance (137.5, 56.4, 129.4 m, respectively); Unified Parkinson's Disease Rating Scale-Motor Score (-6, -7, -14, respectively); and all Timed-Up-Go subtests. Participant 2 had 44.4% decline in freezing episodes and reduced fall rate. Participants' gains were retained at the 3-month follow-up.

DISCUSSION

This case series suggests that NW has therapeutic benefits for three individuals with varied Parkinson's gait dysfunction. Independent NW exercise was sustained post-training and motor and gait function gains were retained.

Prehabilitation in Patients With Breast Cancer Receiving Neoadjuvant Therapy to Minimize Musculoskeletal Postoperative Complications and Enhance Recovery (PREOPtimize): A Protocol for a Randomized Controlled Trial

OBJECTIVE

The aim of this study is to assess the effects of a prehabilitation program (PREOPtimize), consisting of Nordic Walking and resistance training exercises plus health education among patients with breast cancer, who are receiving neoadjuvant therapy to enhance postoperative functionality of the affected arm. A secondary aim will be to compare the short-term effects of the intervention on other patient-reported outcome measures.

METHODS

This will be an assessor-blind, randomized controlled trial with a parallel group design conducted at a tertiary hospital. A sample of 64 patients with breast cancer scheduled for surgery and undergoing neoadjuvant chemotherapy will be recruited for the trial and randomly allocated to either (1) a prehabilitation program consisting of 2 weekly sessions of 75 minutes of Nordic Walking, muscle strengthening exercises, and health education sessions conducted between the fourth month of treatment and surgery or (2) usual care. Patients in both groups will be assessed at baseline, before surgery, and at 1 and 3 months after surgery. Assessed outcomes include functionality of the affected arm (QuickDash), arm volume, range of motion, handgrip strength, pain, fatigue, functional capacity, physical activity levels, and health-related quality of life. Adherence to the intervention in the prehabilitation group and adverse events will also be recorded.

IMPACT

Prehabilitation for patients affected by breast cancer is rarely implemented in clinical practice. The results obtained with the PREOPtimize trial could show that prehabilitation is a feasible intervention for patients with breast cancer receiving neoadjuvant therapy that might enhance postoperative recovery of upper arm function as well as improve overall physical performance and health-related quality of life.

The effects of walking training with poles on walking ability: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

The purpose of this study was to consolidate the level of evidence for the effects of walking training with poles (pole walking; PW) on walking ability using a systematic review and meta-analysis. TYPE: Systematic review and meta-analysis.

LITERATURE SURVEY

Databases including PubMed, Cochrane Library, Physiotherapy Evidence Database (PEDro), Cumulative Index to Nursing and Allied Health Literature databases, and Igaku Chuo Zasshi were searched on June 20, 2021.

METHODOLOGY

Data from randomized controlled trials (RCTs) comparing the effects of PW with walking without poles and/or other exercise interventions in disease-specific and aging populations were collected. Data on walking speed, functional mobility, and walking endurance were collected for the meta-analyses. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated from postintervention means and standard deviations. The PEDro scale was used for assessing the risk of bias, and the Grading of Recommendations Assessment, Development, and Evaluation system was used to determine the quality of evidence.

SYNTHESIS

This study included 13 RCTs comprising 750 participants; of these, six RCTs were included in the meta-analysis. The results showed that moderate-quality evidence supports the positive effects of PW on walking speed in patients with Parkinson disease (walking speed: SMD = 0.42, 95% CI = 0.04-0.80). In contrast, PW did not significantly improve functional mobility in patients with Parkinson disease and walking speed in older adults.

CONCLUSIONS

There was moderate-quality evidence that PW improved walking speed in patients with Parkinson disease.

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.

Association between a Marine Healing Program and Metabolic Syndrome Components and Mental Health Indicators

Background and Objectives: Metabolic syndrome is a growing health concern globally, and its prevalence continues to increase. This study investigated whether a marine healing program could improve metabolic syndrome indicators and mental health in adults with a metabolic syndrome and those at risk of developing it. Materials and Methods: This study enrolled 30 participants who were assigned to either the experimental or control groups. The duration of the study was set at 4 weeks. Both groups received metabolic syndrome management education, and the experimental group additionally participated in two marine healing programs. Anthropometric indicators, biochemical indicators, and mental health indicators were collected before and after the intervention. Results: The findings indicate that the experimental group had significantly lower systolic blood pressure, triglycerides, and body weight, as well as higher levels of high-density lipoprotein (HDL-C) and uric acid. Mental health indicators (Hospital Anxiety and Depression Scale and quality of life measures) additionally showed improvement. Pre-post comparisons between the experimental group and the control group showed that the experimental group had significantly decreased by 1.05 kg in body weight, whereas the control group increased by 0.29 kg in body weight. In addition, HDL-C decreased by 0.91 mg/dL in the control group and increased by 3.7 mg/dL in the experimental group. Conclusions: Overall, these results suggest that marine healing programs could improve metabolic syndrome indicators such as body weight and HDL-C better than the control treatment.

Effects of a 12-week walking intervention on circulating lipid profiles and adipokines in normal weight and abdominal obese female college students

Background/objectives

Regular exercise such as aerobic exercise has been shown to reduce the risk of some diseases such as cardiovascular disease (CVD). However, only few studies have investigated the impact of regular aerobic exercise on non-obese and overweight/obese persons. Therefore, this study was designed to compare the effect of a 12-week 10,000 steps a day walking intervention on the body composition, serum lipids, adipose tissue function, and obesity-associated cardiometabolic risk between normal weight and overweight/obese female college students.

Methods

Ten normal weight (NWCG) and 10 overweight/obese (AOG) individuals were recruited in this study. Both groups performed a regular 10,000 steps a day walk for 12 weeks. Their blood pressure, body mass index, waist-to-hip ratio, and blood lipid profiles were evaluated. Moreover, serum leptin and adiponectin levels were measured using an enzyme-linked immunosorbent assay.

Results

Our results revealed that triglyceride (TG), TG/high-density lipoprotein cholesterol (HDL-C) ratio and leptin were significantly reduced in the AOG group after the 12-week walking intervention. However, total cholesterol, HDL-C, and adiponectin/leptin ratio were significantly increased in the AOG group. There was little or no change in these variables in the NWCG group after the 12-week walking intervention.

Conclusions

Our study demonstrated that a 12-week walking intervention may help improve cardiorespiratory fitness and obesity-associated cardiometabolic risk by decrease resting heart rate, modulating blood lipid profiles, and inducing adipokine alterations in obese individuals. Therefore, our research encourages obese young adults to improve their physical health by participating in a 12-week walking program of 10,000 steps a day.

Assessing the Feasibility and Acceptability of a Primary Care Socio-Ecological Approach to Improve Physical Activity Adherence among People with Type 2 Diabetes: The SENWI Project

Maintaining an active lifestyle is a key health behavior in people with type 2 diabetes (T2D). This study assessed the feasibility and acceptability of a socio-ecological Nordic walking intervention (SENWI) to enhance healthy behaviors in primary healthcare settings. Participants included individuals with T2D (n = 33; age 70 (95% CI 69-74)) and healthcare professionals (HCPs, n = 3). T2D participants were randomly assigned to a SENWI, active comparator, or control group for twelve weeks. Feasibility and acceptability were evaluated based on a mixed methodology. Quantitative data reported adherence information, differences between follow-up and dropout participants and pre- and post-intervention on physical activity, sedentary behavior, and health outcomes. Qualitative data acquisition was performed using focus groups and semi-structured interviews and analyzed using thematic analysis. Thirty-three T2D invited participants were recruited, and twenty-two (66.7%) provided post-intervention data. The SENWI was deemed acceptable and feasible, but participants highlighted the need to improve options, group schedules, gender inequities, and the intervention's expiration date. Healthcare professionals expressed a lack of institutional support and resources. Nevertheless, no significant difference between the SENWI follow-up and dropout participants or pre- and post- intervention was found (only between the active comparator and control group in the physical quality of life domain). Implementing the SENWI in primary healthcare settings is feasible and acceptable in real-world conditions. However, a larger sample is needed to assess the program's effectiveness in improving healthy behaviors and its impact on health-related outcomes in the long term.

Effect of Nordic Walking Training on Physical Fitness and Self-Assessment of Health of People with Chronic Non-Specific Lower Back Pain

In order to determine the impact of a four-week cycle of Nordic Walking (NW) training on the physical fitness of people with chronic non-specific lower back pain and the impact of this form of activity on their self-assessment of health quality, the study included 80 men and women aged 29 to 63 years. The subjects were divided into two equal (40-person) groups: experimental and control. In both study groups the degree of disability in daily activities caused by back pain was assessed with the FFb-H-R questionnaire, the physical fitness was evaluated with the modified Fullerton test and the sense of health quality was assessed with the SF-36 questionnaire. The same tests were repeated after four weeks. In the experimental group NW training was applied between the two studies. During four weeks, 10 training units were carried out, and each training session lasted 60 min with a two-day break between each training. The four-week NW training resulted in a statistically significant sense of disability due to back pain (p < 0.001), significant improvement of physical fitness expressed by improvement in upper (p < 0.001) and lower (p < 0.01) body strength, upper and lower body flexibility (p < 0.001) and ability to walk a longer distance in a 6-min walk test (p < 0.001). The training participants also showed significant improvements in health quality in both physical (p < 0.001) and mental (p < 0.001) components. The four-week NW training has a positive impact on the physical fitness of men and women with chronic lower back pain. Participation in NW training also contributes to a significant reduction in the sense of disability caused by back pain and improvement in the self-assessment of health quality.

Effect of Nordic Walking Training on Walking Capacity and Quality of Life for People With Multiple Sclerosis

BACKGROUND

Although there is emerging evidence that aerobic training improves walking capacity in persons with multiple sclerosis (MS), data are limited about the potential benefits of Nordic walking (NW) for this population. This study evaluates the effectiveness of outdoor NW training on walking capacity and related quality of life for people with MS compared with cycloergometer and treadmill aerobic training.

METHODS

A single-blinded (evaluator), randomized, 2-arm clinical trial was designed.

RESULTS

A total of 57 patients with MS (38 women and 19 men; mean ± SD age, 51.98 ± 9.93 years; mean ± SD disease duration, 14.75 ± 8.52 years) were included. Both therapeutic modalities improved walking distance as measured by the 6-Minute Walk Test after the training period. The NW group showed significant improvement on the physical and emotional subscales of the Multiple Sclerosis Quality of Life-54 compared with the cycloergometer and treadmill group, which showed improvement only on the physical subscale.

CONCLUSIONS

Both training modalities proved to be of equal benefit in improving the walking capacity of people with MS, but outdoor NW training also seems to have a beneficial effect on the emotional component of health-related quality of life.

The Impact of Nordic Walking Pole Length on Gait Kinematic Parameters

Nordic walking (NW) is a popular physical activity used to manage chronic diseases and maintain overall health and fitness status. This study aimed to compare NW to ordinary walking (W) with regard to pole length and to identify kinematic differences associated with different poles' length (55%, 65% and 75% of the subject's height, respectively). Twelve male volunteers (21.1 ± 0.7 years; 1.74 ± 0.05 m; 68.9 ± 6.1 kg) were tested in four conditions (W, NW55, NW65 and NW75) at three different speeds (4-5-6 km∗h^-1). Each subject performed a total of twelve tests in a random order. Three-dimensional kinematics of upper and lower body were measured for both W and NW, while oxygen consumption levels (VO₂) and rating of perceived exertion (RPE) were measured only for NW trials with different poles' length. NW showed a higher step length, lower elbow motion and higher trunk motion (p < 0.05) compared to W. Additionally, NW65 did not show any kinematic or RPE differences compared to NW55 and NW75. Only NW75 showed a higher elbow joint (p < 0.05) and lower pole (p < 0.05) range of motion compared to NW55 and a higher VO₂ (p < 0.05) compared to NW55 and NW65 at 6 km∗h^-1. In conclusion, the use of the poles affects the motion of the upper and lower body during gait. Poles with shorter or longer length do not produce particular changes in NW kinematics. However, increasing the length of the pole can be a smart variation in NW to increase exercise metabolic demand without significantly affecting the kinematics and the RPE.

Does Nordic Walking technique influence the ground reaction forces?

BACKGROUND

Nordic Walking (NW) practice has increased during the last decade, generating great benefits related to the reduction of ground reaction forces (GRF). However, there is still limited evidence regarding how the NW technique could affect GRF.

RESEARCH QUESTION

To analyze the effect of the speed and the differences in ground reaction forces (GRF) between NW with Diagonal technique (DT) versus Alpha technique (AT) and compare them with normal walking (W) METHODS: 29 male physically active sport science students were randomly assigned to one of the training groups: AT (n = 15) or DT (n = 14). After 5 technique familiarization sessions, participants performed 5 experimental trials on a walkway for both NW and W at two different walking speeds, previously randomized. A two-way repeated measures ANOVA analysis was carried out to find differences between speeds (preferred, fast) and gait (NW, W) as within-subject factors and NW techniques (DT vs AT) as between-subject factor.

RESULTS

During NW, both technique groups (AT, DT) showed an increase in GRF variables compared to W, such as in stance time (2.9 % mean increment, p < 0.01, ES = 0.3; 95 %IC[-0.027, -0.008]), vertical force impact or vertical heel strike variables (4.9 % mean increment, p < 0.01, ES = 0.4; 95 %IC[0.101, 0.036]; 7.3 % mean increment, p < 0.01, ES = 0.8; 95 %IC[-0.133, -0.081] respectively). Moreover, AT group experienced significant lower forces at vertical force at midstance (10.1 % mean descent, p = 0.036, ES = 0.3; 95 %IC[-0.083, -0.009]) and higher forces at AP propulsive forces (23.7 % mean increment, p < 0.001, ES = 0.6; 95 %IC[0.078, 0.202) and ML max force (14.0 % mean increment, p = 0.045, ES = 0.3; 95 %IC[0.002, 0.026]) compared to DT group. Walking speed was significantly higher during NW (Preferred: 1.89 ± 0.18 m/s; Fast: 2.17 ± 0.21 m/s) compared to W (Preferred: 1.76 ± 0.15 m/s; Fast: 2.04 ± 0.19 m/s) in both speed conditions.

SIGNIFICANCE

NW favours an increase in GRF and speed in comparison with Walking, independently of the technique, with no evidence that justifies the use of one technique or another.

Motives and Barriers Affecting the Participation of Polish People in the Physical Activity of Nordic Walking

The aim of the study was to identify motives and barriers which have the greatest influence on participation in Nordic Walking (NW) of people with normal body weight and persons who are either overweight or obese (according to their BMI). In the study, the modified Physical Activity and Leisure Motivation Scale (PALMS) was used, which was designed to measure adult physical activity (PA) motivation. PALMS measures eight motives for participation in PA, on a 5-point Likert scale. The study was conducted during a NW competition and during training sessions of its participants. Two groups of respondents were taken into account: the first group with those with normal body weight and the second group with those who were overweight or obese. Respondents with normal body weight were more frequent participants of NW sessions. Enhanced body capacity, concern for one's health, improved body shape and lifespan extension were major motives of practicing NW. Polish people perceive PA as a means of improving the quality of life due to enhanced health and wellbeing. Subjects with normal body weight tended to mention lack of areas suitable for NW and lack of time due to professional work. Overweight or obese persons pointed to other types of PA, shyness and lack of time.

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

Objective

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

Methods

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

Results

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

Conclusions

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

Impact

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

Clinical Trials Registry ID

20-101-H.

A socio-ecological approach to reduce the physical activity drop-out ratio in primary care-based patients with type 2 diabetes: the SENWI study protocol for a randomized control trial

Background

Physical activity (PA) is a key behaviour for patients with type 2 diabetes (T2DM). However, healthcare professionals’ (HCP) recommendations (walking advice), which are short-term and individually focused, did not reduce the PA drop-out ratio in the long run. Using a socio-ecological model approach may contribute to reducing patient dropout and improving adherence to PA. The aim of this study is threefold: first, to evaluate the effectiveness of a theory-driven Nordic walking intervention using a socio-ecological approach with T2DM patients in Spain; second, to explore the feasibility on the PA adherence process in T2DM patients while participating in the SENWI programme; and third, to understand the HCPs’ opinion regarding its applicability within the Spanish healthcare system.

Methods

A three-arm randomized control trial (n = 48 each group) will assess the efficacy of two primary care-based PA interventions (Nordic walking vs. Nordic walking plus socio-ecological approach; two sessions per week for twelve weeks) compared to a control group (usual HCPs’ walking advice on PA). Inclusion criteria will include physically inactive patients with T2DM, older than 40 years and without health contraindications to do PA. PA levels and drop-out ratio, quality of life and metabolic and health outcomes will be assessed at baseline, post-intervention and at 9- and 21-month follow-ups. The effect of the different interventions will be assessed by a two-factor analysis of variance: treatment group vs time. Also, a two-factor ANOVA test will be performed with linear mixed models for repeated measures.

A qualitative analysis using focus groups will explore the reasons for the (in)effectiveness of the new PA interventions. Qualitative outcomes will be assessed at post-intervention using thematic analysis.

Discussion

Compared with the general PA walking advice and Nordic walking prescriptions, integrating a socio-ecological approach into Spanish primary care visits could be an effective way to reduce the PA drop-out ratio and increase PA levels in patients with T2DM. Such interventions are necessary to understand the role that multiple socio-complex process in day-to-day PA behaviour has in patients with T2DM in the Spanish context.

Trial registration

ClinicalTrials.gov NCT05159089. Physical Activity Drop-out Ratio in Patients’ Living with Type 2 Diabetes. Prospectively registered on 15 December 2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06742-7.

Climbing as an Add-On Treatment Option for Patients with Severe Anxiety Disorders and PTSD: Feasibility Analysis and First Results of a Randomized Controlled Longitudinal Clinical Pilot Trial

BACKGROUND

Exercise has considerable effects on physical and psychological health. Anxiolytic effects of climbing exercise have been found in people suffering from depression. However, there are no studies on patients with severe anxiety disorders or post-traumatic stress disorder (PTSD) practicing climbing as add-on treatment. Additionally, many studies on physical therapy fail to use adequate active control groups. Therefore, this study aimed to investigate the feasibility of a four-week climbing exercise program for patients with anxiety disorders or PTSD in comparison to a standard exercise treatment and a social control group.

METHODS

Outpatients diagnosed with anxiety disorders or PTSD (F 40, F 41, F 43.1 according to ICD-10) were randomly assigned to (a) climbing exercise (n = 27), (b) Nordic walking exercise (n = 23), or (c) control condition (n = 23) providing the same amount of social contact for eight sessions of 90 minutes each. Psychological parameters (symptom severity, worry symptoms, self-efficacy, quality of life) and biological parameters were assessed at the beginning and at the end of the four-week program. Additionally, follow-up assessments were conducted three and six months after the program ended.

RESULTS

Sixty outpatients (75% female) aged 18-65 years with a longstanding history of a mental disorder (>10 years) and classified as treatment-resistant (95%) and with averaging 3.8 psychiatric comorbidities completed the pilot trial. After participation, symptoms of anxiety disorders were significantly reduced (p = 0.003), and health-related characteristics significantly improved (depression symptoms: p < 0.001, worry symptoms: p < 0.001, self-efficacy: p < 0.001, quality of life-physical health: p = 0.002, quality of life-psychological health: p = 0.006) in all groups. The feasibility of conducting climbing exercises for the patient groups could be demonstrated, and a general acceptance in the groups was recorded. No significant time-by-group interactions were found. At the completion of the program, psychological parameters improved, while biological parameters remained the same in all three groups.

CONCLUSIONS

Participation in the climbing group as well as in Nordic walking and social contact groups demonstrated beneficial results in patients with anxiety disorders and PTSD with severe mental burden. Nevertheless, climbing did not show any additional clinically relevant benefits compared to Nordic walking or social contact. Studies with larger sample sizes and qualitative insights are needed to further evaluate the possible benefits of climbing in this population.

Effects of Nordic walking in people with Parkinson's disease: A systematic review and meta-analysis

Nordic walking (NW) may be a beneficial treatment for people with Parkinson's disease (PD). Since high-quality research has been published on the effects of NW on people with PD by now, an actualised and comprehensive, in-depth review is recommended to guide practitioners in prescribing this exercise modality. The purpose of this study was to conduct a systematic review and meta-analysis on the effectiveness of NW as a rehabilitation strategy for PD. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a literature search was performed using Pubmed, SportDiscus and Scopus up to May 2021. Randomised controlled trials (RCTs) addressing the impact of a NW intervention on any outcomes in people with PD were included. The critical appraisal of the RCTs was retrieved from the Physiotherapy Evidence Database (PEDro) or evaluated using the PEDro scale. The Cochrane Collaboration's risk of bias tool was also employed. The review was not registered a priori on any database and a review protocol was not published. Twelve studies were included in the review. The investigations were mostly good-to-fair methodological quality, and risk of bias was acceptable. None of the reported statistically significant benefits of NW were clinically meaningful, except for walking ability. Although adherence to NW programs was good, some adverse effects derived from its practice were informed. The practice of Nordic Walking does not lead to clinically significant changes in global motor impairment, functional mobility, balance and physical fitness in patients with PD. This therapy seems to improve walking ability and quality of life, although further research in this latter outcome is needed.

Predictors of Step Length from Surface Electromyography and Body Impedance Analysis Parameters

Step length is a critical hallmark of health status. However, few studies have investigated the modifiable factors that may affect step length. An exploratory, cross-sectional study was performed to evaluate the surface electromyography (sEMG) and body impedance analysis (BIA) parameters, combined with individual demographic data, to predict the individual step length using the GAITRite® system. Healthy participants aged 40−80 years were prospectively recruited, and three models were built to predict individual step length. The first model was the best-fit model (R2 = 0.244, p < 0.001); the root mean square (RMS) values at maximal knee flexion and height were included as significant variables. The second model used all candidate variables, except sEMG variables, and revealed that age, height, and body fat mass (BFM) were significant variables for predicting the average step length (R2 = 0.198, p < 0.001). The third model, which was used to predict step length without sEMG and BIA, showed that only age and height remained significant (R2 = 0.158, p < 0.001). This study revealed that the RMS value at maximal strength knee flexion, height, age, and BFM are important predictors for individual step length, and possibly suggesting that strengthening knee flexor function and reducing BFM may help improve step length.

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

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

Effects of Nordic Walking Training on Anthropometric, Body Composition and Functional Parameters in the Middle-Aged Population

Nordic walking (NW) is an easy physical exercise that is usually proposed for clinical populations and for the elderly. The aim of the present study was to examine the effects of a period of NW training in a non-clinical middle-aged population on anthropometric, body composition and functional parameters. A pre-test/post-test study design was conducted on 77 participants: 56 women (72.7%, age 55.53 ± 9.73 years) and 21 men (27.3%, age 60.51 ± 8.15 years). The measurements were carried out with physical tests at the baseline and at the follow up. Participants did two weekly NW training sessions of about 60 min each. A questionnaire was administered to evaluate their feelings after the training period. Paired Students' test was carried out to evaluate the pre-post differences, and the analysis of variance was performed to evaluate the questionnaire. Participants had significantly less stress and anxiety after the NW training. Body fat parameters showed a significant decrease, especially for women. Phase angle and strength of lower body presented a significant increase in both sexes after the training period. In conclusion, NW shows many potential benefits also for the nonclinical population and could be an important exercise to remain active and to maintain a good health condition.

A Comparison of Acute Effects of Climbing Therapy with Nordic Walking for Inpatient Adults with Mental Health Disorder: A Clinical Pilot Trial

As climbing therapy is increasingly used for mental health disorders, the present study aimed to compare acute effects of a therapeutic climbing intervention (CT) on affective responses, anxiety, and self-efficacy with those of Nordic walking (NW) and a sedentary control condition (SC) in an inpatient setting with persons with depression, anxiety, or obsessive−compulsive disorders. A total of 21 inpatients (32 ± 12.2 years) participated in a clinical trial in all interventions using an experimental within-subject design. Anxiety and self-efficacy were assessed preintervention (t0) and postintervention (t2) using the State-Trait Anxiety Inventory and the General Self-Efficacy Scale, and affective responses were additionally evaluated during (t1) and 180 min after the intervention (t3) using the Feeling Scale, Felt Arousal Scale, and Positive and Negative Affect Schedule. Statistical evaluation was performed with a 3 × 2 or 3 × 4 repeated measures ANOVA. Significant interaction effects were found for affective responses regarding positive affect, affective valence, and perceived activation (p < 0.015) favoring CT over NW and SC. For anxiety, a significant interaction effect was found (F(2.40) = 6.603; p = 0.003; η2 = 0.248), and also perceived self-efficacy increased significantly (F(2.40) = 6.046; p = 0.005; η2 = 0.232). Single CT sessions may enhance affective responses and self-efficacy and reduce anxiety in inpatients with mental health disorders to a higher extent than NW. CT as part of an inpatient therapy program may help to improve key affective mechanisms and should be further studied in comparison with other exercise interventions with comparable intensity.

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

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

Associations of Walking Activity With Hypertensive Mediated Organ Damage in Community-Dwelling Elderly Chinese: The Northern Shanghai Study

Background: Walking, as the most common campaign in older people, is recommended to improve their cardiovascular health. However, the direct association between weekly walking activity and asymptomatic hypertensive mediated organ damage (HMOD) remains unclear.

Methods: 2,830 community-dwelling elderly subjects (over 65 years) in northern Shanghai were recruited from 2014 to 2018. Weekly walking activity was assessed by International Physical Activity Questionnaires (IPAQ). Within the framework of comprehensive cardiovascular examinations, HMOD, including left ventricular mass index, peak transmitral pulsed Doppler velocity/early diastolic tissue Doppler velocity, creatinine clearance rate, urinary albumin–creatinine ratio, carotid-femoral pulse wave velocity (cf-PWV), carotid intima–media thickness (CIMT), arterial plaque, and ankle-brachial index (ABI), were all evaluated.

Results: 1,862 (65.8%) participants with weekly walking activity showed lower CIMT, lower cf-PWV, fewer abnormal ABI, and lower prevalence of hypertension and coronary heart disease (p < 0.05). Walking activity was negatively correlated with age and smokers (correlation coefficient: −0.066, −0.042; both p < 0.05). After adjusting for cardiovascular risk factors and concomitant diseases, walking activity was significantly associated with better indicator of most vascular HMOD in multivariate logistic regressions, including arterial stiffness [odds ratio (OR) = 0.75, p = 0.01], increased CIMT (OR = 0.70, p = 0.03), and peripheral artery disease (OR = 0.72, p = 0.005), but not cardiac or renal HMOD. Subgroup analysis further showed that walking duration ≥1 h/day was significantly associated with decreased risk of most vascular HMOD after adjustment for confounders and moderate-to-vigorous physical activity based on IPAQ (all p < 0.05).

Conclusions: In the community-dwelling elderly Chinese, there was a significant negative association of weekly walking activity with vascular HMOD, but not cardiac or renal HMOD. Increased daily walking duration, but not walking frequency, was significantly associated with improved vascular HMOD. Hence, increasing daily walking duration seems to encourage a healthy lifestyle in terms of vascular protection.

Clinical Trial Registration:ClinicalTrials.gov, identifier: NCT02368938.

Whole-Body EMS Superimposed Walking and Nordic Walking on a Treadmill-Determination of Exercise Intensity to Conventional Exercise

Electrical muscle stimulation (EMS) is an increasingly popular training method and has become the focus of research in recent years. New EMS devices offer a wide range of mobile applications for whole-body EMS (WB-EMS) training, e.g., the intensification of dynamic low-intensity endurance exercises through WB-EMS. The present study aimed to determine the differences in exercise intensity between WB-EMS-superimposed and conventional walking (EMS-CW), and CON and WB-EMS-superimposed Nordic walking (WB-EMS-NW) during a treadmill test. Eleven participants (52.0 ± years; 85.9 ± 7.4 kg, 182 ± 6 cm, BMI 25.9 ± 2.2 kg/m²) performed a 10 min treadmill test at a given velocity (6.5 km/h) in four different test situations, walking (W) and Nordic walking (NW) in both conventional and WB-EMS superimposed. Oxygen uptake in absolute (VO₂) and relative to body weight (rel. VO₂), lactate, and the rate of perceived exertion (RPE) were measured before and after the test. WB-EMS intensity was adjusted individually according to the feedback of the participant. The descriptive statistics were given in mean ± SD. For the statistical analyses, one-factorial ANOVA for repeated measures and two-factorial ANOVA [factors include EMS, W/NW, and factor combination (EMS^*W/NW)] were performed (α = 0.05). Significant effects were found for EMS and W/NW factors for the outcome variables VO₂ (EMS: p = 0.006, r = 0.736; W/NW: p < 0.001, r = 0.870), relative VO₂ (EMS: p < 0.001, r = 0.850; W/NW: p < 0.001, r = 0.937), and lactate (EMS: p = 0.003, r = 0.771; w/NW: p = 0.003, r = 0.764) and both the factors produced higher results. However, the difference in VO₂ and relative VO₂ is within the range of biological variability of ± 12%. The factor combination EMS^*W/NW is statistically non-significant for all three variables. WB-EMS resulted in the higher RPE values (p = 0.035, r = 0.613), RPE differences for W/NW and EMS^*W/NW were not significant. The current study results indicate that WB-EMS influences the parameters of exercise intensity. The impact on exercise intensity and the clinical relevance of WB-EMS-superimposed walking (WB-EMS-W) exercise is questionable because of the marginal differences in the outcome variables.

The Influence of Nordic Walking on Spinal Posture, Physical Function, and Back Pain in Community-Dwelling Older Adults: A Pilot Study

Nordic walking is an increasingly popular form of exercise among the elderly. Using poles is thought to facilitate a more upright posture; however, previous studies primarily investigated the effects of Nordic walking on respiratory function and physical fitness. The aims of this study were to investigate the influence of Nordic walking on spinal posture, physical functions, and back pain in community-dwelling older adults. Thirty-one community-dwelling older adults aged ≥ 60 years participated in a twice weekly Nordic walking training program for 12 weeks. The outcome measures, including spinal posture, physical functions, back pain, and the strength and endurance of back extensor muscles were assessed before and after a 12-week program. After training, spinal posture, back pain, and the strength and endurance of back extensor muscles did not show any statistically significant changes. Among the seven clinical tests of physical function, only the 30 s arm curl test, the 30 s chair stand test, and the single leg stance test showed significant improvements. Nordic walking has limited influence on age-related hyperkyphosis and back pain, but may be effective for physical function. The results of this study can provide useful information for people involved in the prevention and treatment of physical dysfunction in community-dwelling older adults.

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

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

The Impact of Nordic Walking on Bone Properties in Postmenopausal Women with Pre-Diabetes and Non-Alcohol Fatty Liver Disease

This study investigated the impact of Nordic walking on bone properties in postmenopausal women with pre-diabetes and non-alcohol fatty liver disease (NAFLD). A total of 63 eligible women randomly participated in the Nordic walking training (AEx, n = 33), or maintained their daily lifestyle (Con, n = 30) during intervention. Bone mineral content (BMC) and density (BMD) of whole body (WB), total femur (TF), femoral neck (FN), and lumbar spine (L2-4) were assessed by dual-energy X-ray absorptiometry. Serum osteocalcin, pentosidine, receptor activator of nuclear factor kappa-B ligand (RANKL) levels were analyzed by ELISA assay. After an 8.6-month intervention, the AEx group maintained their BMC_TF, BMD_TF, BMC_L2−4, and BMD_L2−4, and increased their BMC_FN (p = 0.016), while the Con group decreased their BMC_TF (p = 0.008), BMD_TF (p = 0.001), and BMD_L2−4 (p = 0.002). However, no significant group × time interaction was observed, except for BMD_L2−4 (p = 0.013). Decreased pentosidine was correlated with increased BMC_WB(r = −0.352, p = 0.019). The intervention has no significant effect on osteocalcin and RANKL. Changing of bone mass was associated with changing of pentosidine, but not with osteocalcin and RANKL. Our results suggest that Nordic walking is effective in preventing bone loss among postmenopausal women with pre-diabetes and NAFLD.

Effects of an unsupervised Nordic walking intervention on cognitive and physical function among older women engaging in volunteer activity

Background

Nordic walking (NW) has been reported as a safe and effective exercise mode. However, the effects of NW on cognitive function are unknown. This study examined the effects of an unsupervised NW intervention on cognitive and physical function among older women engaging in volunteering.

Methods

Forty-seven women aged ≥70 years were enrolled and assigned into three groups (NW (n = 16); walking (n = 19); control group (n = 12)) based on residential areas. Participants in NW and walking groups received a pedometer and recorded daily step counts. The NW group received poles and 2 h of NW instruction. Participants were encouraged to perform the exercise individually more than once a week during the 3-month intervention. As baseline and follow-up assessments, cognitive function (Montreal Cognitive Assessment [MoCA-J] and Trail Making Test), physical function (handgrip strength, walking speed, balance ability, the Timed Up and Go test, and functional capacity), and objective physical activity were evaluated.

Results

In the NW group, physical activity, maximal walking speed, and MoCA-J scores were improved during the intervention period. In the walking group, physical activity was increased after the intervention. Analysis of covariance showed that maximal walking speed among the NW group significantly improved compared with the walking group. Sub-group analysis of participants who exercised more than once a week showed that handgrip strength, gait speed, and MoCA-J scores were significantly improved in the NW compared with the walking group.

Conclusion

NW intervention improved cognitive and physical function compared with simple walking among older women.

Digital Support to Multimodal Community-Based Prehabilitation: Looking for Optimization of Health Value Generation

Prehabilitation has shown its potential for most intra-cavity surgery patients on enhancing preoperative functional capacity and postoperative outcomes. However, its large-scale implementation is limited by several constrictions, such as: i) unsolved practicalities of the service workflow, ii) challenges associated to change management in collaborative care; iii) insufficient access to prehabilitation; iv) relevant percentage of program drop-outs; v) need for program personalization; and, vi) economical sustainability. Transferability of prehabilitation programs from the hospital setting to the community would potentially provide a new scenario with greater accessibility, as well as offer an opportunity to effectively address the aforementioned issues and, thus, optimize healthcare value generation. A core aspect to take into account for an optimal management of prehabilitation programs is to use proper technological tools enabling: i) customizable and interoperable integrated care pathways facilitating personalization of the service and effective engagement among stakeholders; ii) remote monitoring (i.e. physical activity, physiological signs and patient-reported outcomes and experience measures) to support patient adherence to the program and empowerment for self-management; and, iii) use of health risk assessment supporting decision making for personalized service selection. The current manuscript details a proposal to bring digital innovation to community-based prehabilitation programs. Moreover, this approach has the potential to be adopted by programs supporting long-term management of cancer patients, chronic patients and prevention of multimorbidity in subjects at risk.

Objective environmental exposures correlate differently with recreational and transportation walking: A cross-sectional national study in the Netherlands

Background Walking is a good and simple way to increase people's energy expenditure, but there is limited evidence whether the neighborhood environment correlates differently with recreational and transportation walking. AimTo investigate how recreational walking and transportation walking are associated with the natural and built environmental characteristics of the living environment in the Netherlands, and examine the differences in their associations between weekdays and weekends. Method and data We extracted the total duration of daily walking (in minutes per person) for recreation and transportation of adults aged 18 years and above from the Dutch National Travel Survey 2015-2017 (N = 65,785) and analyzed it as an outcome variable. Objective measures of the natural (i.e., normalized difference vegetation index (NDVI), blue space and meteorological conditions) and built environment (i.e., crossing density, land-use mix, and residential building density) around respondents' home addresses were determined for buffers with 300, 600, and 1000 m radii using a geographic information system. To assess associations between recreational and transportation walking and the environmental exposures separately, we fitted Tobit regression models to the walking data, adjusted for multiple confounders. ResultsOn weekdays, people living in areas with less NDVI, higher land-use mix, and higher crossing density were more likely to engage in transportation walking. Recreational walking was negatively associated with NDVI, blue space, crossing density, precipitation and daily average temperature. At weekends, land-use mix supports both recreational and transportation walking. A negative association appeared for NDVI and transportation walking. Daily average rainfall and temperature were inversely correlated with recreational walking. Sensitivity tests indicated that some associations depend on the buffer size. ConclusionsOur findings suggest that the built and natural environments are differently associated with people's recreational and transportation walking. We also found differences in the walking-environment associations between weekdays and weekends. Place-based policies to design walking-friendly neighborhoods may have different implications for different types of walking.

Walking for subjects with type 2 diabetes: a systematic review and joint AMD/SID/SISMES evidence-based practical guideline

Aims

Regular exercise is considered a cornerstone in the management of type 2 diabetes mellitus (T2DM). It improves glucose control and cardiovascular risk factors, contributes to weight loss, and also improves general well-being, likely playing a role in the prevention of chronic complications of diabetes. However, compliance to exercise recommendations is generally inadequate in subjects with T2DM. Walking is the most ancestral form of physical activity in humans, easily applicable in daily life. It may represent, in many patients, a first simple step towards lifestyle changes. Nevertheless, while most diabetic patients do not engage in any weekly walking, exercise guidelines do not generally detail how to improve its use. The aims of this document are to conduct a systematic review of available literature on walking as a therapeutic tool for people with T2DM, and to provide practical, evidence-based clinical recommendations regarding its utilization in these subjects.

Data synthesis

Analysis of available RCTs proved that regular walking training, especially when supervised, improves glucose control in subjects with T2DM, with favorable effects also on cardiorespiratory fitness, body weight, and blood pressure. Moreover, some recent studies have shown that even short bouts of walking, used for breaking prolonged sitting, can ameliorate glucose profiles in diabetic patients with sedentary behavior.

Conclusions

There is sufficient evidence to recognize that walking is a useful therapeutic tool for people with T2DM. This document discusses theoretical and practical issues for improving its use.

Walking for hypertension

BACKGROUND

Increased physical activity has been recommended as an important lifestyle modification for the prevention and control of hypertension. Walking is a low-cost form of physical activity and one which most people can do. Studies testing the effect of walking on blood pressure have revealed inconsistent findings.

OBJECTIVES

To determine the effect of walking as a physical activity intervention on blood pressure and heart rate.

SEARCH METHODS

We searched the following databases up to March 2020: the Cochrane Hypertension Specialised Register, CENTRAL (2020, Issue 2), Ovid MEDLINE, Ovid Embase, CINAHL, PsycINFO, SPORTDiscus, PEDro, the WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov. We also searched the following Chinese databases up to May 2020: Index to Taiwan Periodical Literature System; National Digital Library of Theses and Dissertation in Taiwan; China National Knowledge Infrastructure (CNKI) Journals, Theses & Dissertations; and Wanfang Medical Online. We contacted authors of relevant papers regarding further published and unpublished work. The searches had no language restrictions.

SELECTION CRITERIA

Randomised controlled trials of participants, aged 16 years and over, which evaluated the effects of a walking intervention compared to non-intervention control on blood pressure and heart rate were included.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. Where data were not available in the published reports, we contacted authors. Pooled results for blood pressure and heart rate were presented as mean differences (MDs) between groups with 95% confidence intervals (CIs). We undertook subgroup analyses for age and sex. We undertook sensitivity analyses to assess the effect of sample size on our findings.

MAIN RESULTS

A total of 73 trials met our inclusion criteria. These 73 trials included 5763 participants and were undertaken in 22 countries. Participants were aged from 16 to 84 years and there were approximately 1.5 times as many females as males. The characteristics of walking interventions in the included studies were as follows: the majority of walking interventions was at home/community (n = 50) but supervised (n = 36 out of 47 reported the information of supervision); the average intervention length was 15 weeks, average walking time per week was 153 minutes and the majority of walking intensity was moderate. Many studies were at risk of selection bias and performance bias. Primary outcome We found moderate-certainty evidence suggesting that walking reduces systolic blood pressure (SBP) (MD -4.11 mmHg, 95% CI -5.22 to -3.01; 73 studies, n = 5060). We found moderate-certainty evidence suggesting that walking reduces SBP in participants aged 40 years and under (MD -4.41 mmHg, 95% CI -6.17 to -2.65; 14 studies, n = 491), and low-certainty evidence that walking reduces SBP in participants aged 41 to 60 years (MD -3.79 mmHg, 95% CI -5.64 to -1.94, P < 0.001; 35 studies, n = 1959), and those aged 60 years of over (MD -4.30 mmHg, 95% CI -6.17 to -2.44, 24 studies, n = 2610). We also found low certainty-evidence suggesting that walking reduces SBP in both females (MD -5.65 mmHg, 95% CI -7.89 to -3.41; 22 studies, n = 1149) and males (MD -4.64 mmHg, 95% CI -8.69 to -0.59; 6 studies, n = 203). Secondary outcomes We found low-certainty evidence suggesting that walking reduces diastolic blood pressure (DBP) (MD -1.79 mmHg, 95% CI -2.51 to -1.07; 69 studies, n = 4711) and heart rate (MD -2.76 beats per minute (bpm), 95% CI -4.57 to -0.95; 26 studies, n = 1747). We found moderate-certainty evidence suggesting that walking reduces DBP for participants aged 40 years and under (MD -3.01 mmHg, 95% CI -4.44 to -1.58; 14 studies, n = 491) and low-certainty evidence suggesting that walking reduces DBP for participants aged 41 to 60 years (MD -1.74 mmHg, 95% CI -2.95 to -0.52; 32 studies, n = 1730) and those aged 60 years and over (MD -1.33 mmHg, 95% CI -2.40 to -0.26; 23 studies, n = 2490). We found moderate-certainty evidence that suggests walking reduces DBP for males (MD -2.54 mmHg, 95% CI -4.84 to -0.24; 6 studies, n = 203) and low-certainty evidence that walking reduces DBP for females (MD -2.69 mmHg, 95% CI -4.16 to -1.23; 20 studies, n = 1000). Only 21 included studies reported adverse events. Of these 21 studies, 16 reported no adverse events, the remaining five studies reported eight adverse events, with knee injury being reported five times.

AUTHORS' CONCLUSIONS

Moderate-certainty evidence suggests that walking probably reduces SBP. Moderate- or low-certainty evidence suggests that walking may reduce SBP for all ages and both sexes. Low-certainty evidence suggests that walking may reduce DBP and heart rate. Moderate- and low-certainty evidence suggests walking may reduce DBP and heart rate for all ages and both sexes.