A recent study published in the Canadian Journal of Cardiology shows that Nordic walking is superior to other kinds of exercise in cardiovascular rehabilitation for improving long-term functional capacity
In comparison to standard high-intensity interval training and moderate-to-vigorous intensity continuous training, researchers found that Nordic walking in patients with coronary heart disease resulted in a greater improvement in functional capacity, or the ability to carry out activities of daily living. Their randomized clinical trial’s findings have recently been published in the Canadian Journal of Cardiology.
Following severe cardiovascular events, cardiovascular rehabilitation and exercise training programs are linked to significant gains in functional ability, cardiorespiratory fitness, and mental health. However, some people find boring exercises like stationary cycling and walking to be boring and may quit working out after their cardiovascular rehabilitation program is over. In order to find out whether they might encourage more people to keep exercising and what advantages might be obtained, researchers looked at more appealing workout choices that would appeal to a wider audience.
A growing body of research indicates that non-standard exercise interventions, such as Nordic walking and high-intensity interval training, are superior to conventional exercise methods for increasing functional capacity as evaluated by the six-minute walk test, a key indicator of cardiovascular events in people with coronary artery disease. Nordic walking is a more advanced kind of walking exercise that employs poles with specialized designs to better involve the muscles in both the upper and lower body.
“Patients with coronary artery disease frequently demonstrate diminished functional capacity, low quality of life, and increased the risk of subsequent cardiovascular events and mortality,” explained lead investigator Jennifer L. Reed, Ph.D., Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute; Faculty of Medicine; and School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
Investigators compared the prolonged effects of 12-week rehabilitation with 1) high-intensity interval training; 2) moderate-to-vigorous intensity continuous training; and 3) Nordic walking, on functional capacity, quality of life, and depression symptoms in patients with coronary artery disease. One hundred and thirty patients were randomized to a 12-week training in one of these three groups followed by a 14-week observation phase.
While all exercise programs improved depression symptoms and quality of life, the improvement in functional capacity was greatest after Nordic walking (+19%) when compared to high-intensity interval training (+13%) and moderate-to-vigorous intensity continuous training (+12%).
“This is a key finding because lower functional capacity predicts higher risk of future cardiovascular events in people with coronary artery disease,” noted Dr. Reed. “Nordic walking engages core, upper and lower body muscles while reducing loading stress at the knee, which may have resulted in greater improvements in functional capacity.”
“No previous study has directly compared the long-term effects of high-intensity interval training, moderate-to-vigorous intensity continuous training, and Nordic walking,” commented Tasuku Terada, Ph.D., Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada.
“This study is novel in that it simultaneously compared the sustained effects (i.e., 14 weeks after the completion of cardiovascular rehabilitation) of different exercise programs that can readily be incorporated into daily exercise. When prescribing exercise for patients with coronary artery disease, patients’ preferences should be considered. Our findings can impact patient care by providing alternative exercise options based on their interests and needs,” he concluded.
In an accompanying editorial, Carl J. Lavie, MD, Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, the University of Queensland School of Medicine, New Orleans, LA, USA, and colleagues noted that the addition of Nordic walking to a cardiovascular rehabilitation program could provide an ideal progression from standard moderate-intensity continuous training or traditional walking, especially for deconditioned patients who may not tolerate the high-intensity exercise, or for patients in whom high-intensity interval training may be contraindicated.
“The addition of Nordic poles to moderate to vigorous intensity walking is a simple, accessible option to enhance improvements in walking capacity, increase energy expenditure, engage upper body musculature, and improve other functional parameters such as posture, gait, and balance,” commented Dr. Lavie.
“Providing a variety of exercise options enhances patient enjoyment and progression, which is important for adherence and maintenance. Exercise modalities should be prescribed with consideration of patient goals, preferences, and capabilities,” he advised.
The study was funded by the Academic Health Sciences Centres of the Ministry of Ontario, the Heart and Stroke Foundation of Canada, and the Canadian Institutes of Health Research.
Reference: “Sustained Effects of Different Exercise Modalities on Physical and Mental Health in Patients With Coronary Artery Disease: A Randomized Clinical Trial” by Tasuku Terada, Ph.D., Lisa M. Cotie, Ph.D., Heather Tulloch, Ph.D., Matheus Mistura, MSc, Sol Vidal-Almela, MSc, Carley D. O’Neill, Ph.D., Robert D. Reid, Ph.D., Andrew Pipe, MD and Jennifer L. Reed, Ph.D., 14 June 2022, Canadian Journal of Cardiology.
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