Integrating walking into fitness and wellness programs

From an abstract about how to integrate walking into fitness programs (I looked up the article in a library data base), a common dilemma for fitness instructors and venues: "By mid-March, most of the 'New Year's resolution members' have vanished."

From the rest of the article, why walking should be among the portfolio of programs:

• Reasons for walking.
• Not dependent on location.
• Everyone knows how to walk. When it comes to Nordic walking, the skill to learn is synchronizing use of the poles with one's stride.
• Low impact.
• Low cost.
• Physical benefits, e.g., "...weight and blood pressure management, decreased risk of heart attack and stroke, higher HDL levels, reduced risk of breast cancer and type II diabetes, relief from arthritis and back pain, and stronger muscles, bones, and joints. Walking may also contribute to reducing the risk of Alzheimer's disease and dementia."
• Psychological benefits, e.g., "…Stress reduction and improvements asleep, endorphin production, problem-solving capabilities and self-esteem.

Research on the effects of Nordic walking on Parkinson’s patients

Compared with flexibility/relaxation programs and walking programs, Nordic walking programs had some positive outcomes for Parkinson’s patients.
Points made:

• “Assessment after completion of the training showed that pain was reduced in all groups, and balance and health-related quality of life were improved.”
• “…walking, and Nordic walking improved stride length, gait variability, maximal walking speed, exercise capacity at submaximal level, and PD disease-specific disability on the UPDRS [Unified Parkinson Disease Rating Scale]"…”
• “Nordic walking was superior to the flexibility and relaxation programme and walking in improving postural stability, stride length, gait pattern and gait variability.”

To me, the most important outcome was “All patients of the Nordic walking group continued Nordic walking after completing the study.”

Comparison of Nordic walking with brisk walking and jogging

Here’s a study that discusses the relative advantages Nordic walking over a couple of other forms of aerobic exercise.

Specifics:

• “Short-term as well as long-term effects of Nordic walking are equal or superior to brisk walking and (in one study) to jogging, in healthy subjects.”
• Diabetes mellitus type 2: “no difference between groups with regard to HbA1c and energy expenditure, but fat tissue mass decreased.”
• Obesity: “…increase in heart rate; VO2…: energy expenditure…; and decreased ratings of perceived exertion… decrease in body mass and blood pressure.”
• Coronary artery disease: “…increased VO2…; peak heart rate…; and slightly higher blood pressure…Energy expenditure was higher…increase in lower body endurance and dynamic balance...”
• Peripheral arterial disease: “…longer walking distance…less perceived pain… increase in cardiopulmonary work capacity…increase in VO2… improved peak oxygen consumption as well as walking duration… decreased perceived level of claudication pain…”
• Chronic obstructive pulmonary disease: “increased daily physical activity and…distance covered…decreased exercise-induced dyspnea [shortness of breath]…and anxiety and depression…and improved quality of life…No changes in lung function parameters or medication were reported.”
• Fibromyalgia syndrome: “…improve the functional capacity in a 6-minute walk test… decrease the perceived level of activity limitation…individual severity of pain did not change during the intervention period.”
• Pain in general: “…in 27 patients with chronic neck pain… reduction in unspecific, chronic neck pain…and increased quality of life… on patients with lower back pain and/or leg pain…tendency toward reduced lower back pain, which resulted in a reduction of oral pain medication…”
• Breast cancer: “…improved shoulder mobility and quality of life while sensitivity to pain in the upper body was reduced within the group. No worsening of existing preconditions to lymphedema was described… increase in muscular endurance of the upper body.”
• Parkinson's disease: “…increased functional independence and quality of life… increase in physical activity and quality of life…superior effects on walking speed…and distance…as well as on blood pressure…”
• Depression: “…nonsignificant increase in patients' physical activity and mood.” What this means is while patients improved during the study, the researchers couldn’t say if the results couldn’t have happened by chance.
• Complications and injuries: “…rate of injury was reported with 0.926 injuries per 1000 hours of training. This is very low compared to other popular sports such as basketball or squash (each 14 injuries per 1000 hours). Rates of upper body injuries were slightly higher as compared to the lower body (0.549 vs 0.344 per 1000 hours). Most common injuries were strains of the ulnar collateral ligament; thumb (equivalent to skier's thumb); and upper ankle.” Overall, a very safe form of exercise.

The overall comparative results were Nordic walking had more positive results than brisk walking, and both had more positive results than sedentary people.