Nordic walking and Parkinson's

A study compared the benefits of flexibility and relaxation training, regular walking, and Nordic walking for people with Parkinson's disease. Overall, all three approaches helped reduce pain and improve balance and quality of life. Walking and Nordic walking led to improvements in overall walking ability and fitness. However, Nordic walking provided the most benefits of the three approaches for improving posture and walking ability.

The researchers' recommendations included this: "Physiotherapists should be encouraged to teach PD [Parkinson's disease] patients NW [Nordic walking] and to provide practise sessions with high intensity."

Read on for details.

How they conducted the study:

• The study involved 90 patients with Parkinson's, 45 men and 45 women.
• The patients were randomly assigned to one of the three groups: flexibility and relaxation training, regular walking, or Nordic walking.

How it turned out:

• Nordic walking required a little more training so that patients could master the skill.
• The patients experienced a decrease in pain during the training.

Some detailed results:

	Flexibility and relaxation	Regular walking	Nordic walking
Pain	Decreased	Decreased	Decreased
Unified Parkinson's disease rating scale (UPDRS)	Some improvement	Significant improvement	Most improvement
Quality of life	Improvement	Improvement	Improvement
Balance	Improvement	Improvement	Improvement
Walking speed	Some improvement	Significant improvement	Significant improvement
Stride length	Some improvement	Significant improvement	Most improvement
Stride variability (consistent stride length to reduce risk of falling) NOTE: As patients walked faster, only Nordic walkers maintained consistent stride lengths; the others got worse at higher walking speeds)	Some improvement	Significant improvement	Most improvement
Stride time (duration between a foot leaving the ground and hitting the ground again that is related to walking speed)	Some improvement	Significant improvement	Most improvement
Double stance (time between each foot hitting the ground)	Some improvement	Significant improvement	Significant improvement
Exercise test (top walking speed patients could achieve)	Some improvement	Significant improvement	Most improvement
Blood pressure	Some improvement	Significant improvement	Significant improvement
Heart rate	Some improvement	Significant improvement	Most improvement
Sustainment of training	50% continued	60% continued walking, 10% stopped, 30% switched to Nordic walking	All had continued training after the study and had formed training groups

What did the researchers in this particular study conclude about Nordic walking?

• "The Nordic walking training resulted in a mean improvement of  points of the UPDRS motor scale, while the walking group failed to reach a 5-point improvement."
• "Neurological signs such as rigidity and tremor were not improved by exercise treatment, but it is to note that walking and Nordic walking had positive effects on some key symptoms of PD such as posture, alternating movements, freezing, and postural stability."
• "Posture and postural instability were most improved by NW [Nordic walking]."
• "The cross country training has possibly improved balance so far that subjects of the NW group are also more stable without poles."
• "…Walking and Nordic walking improved walking speed and gait parameters most."

Some of their conclusions help us keep from thinking of Nordic walking as the panacea that will fix everything:

• "It was expected that Nordic walking is most effective in increasing cardiorespiratory capacity. However, there was no superiority of the NW group."
• "…the physiological effects of NW depend largely on the technical skills of the individuals. Without being competent in using the correct NW technique patients cannot exercise with high intensity."

However, Nordic walking was positively received, as shown by all the patients continuing training and most being joined by their spouses.

NW was most attractive for the patients, and all patients continued the training, which might be a prerequisite to maintain an active life style.

Supportive was that 70% of the spouses took up NW and accompanied the patients after completion of the study. Since social aspects were very important for the PD patients, the participation of the spouses in NW might support further physical activity.