A recent study published in the Canadian Journal of Cardiology shows that Nordic walking is superior to other types of exercise in cardiovascular rehabilitation for improving long-term functional capacity
Compared 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 greater improvement in functional ability or ability to perform activities of daily living. The results of their randomized clinical trial were recently published in the Canadian Journal of Cardiology.
Following serious cardiovascular events, cardiovascular rehabilitation and physical training programs are linked to significant gains in functional capacity, cardiorespiratory fitness, and mental health. However, some people find boring exercises like stationary biking and walking boring and may stop working out after completing their cardiovascular rehab program. To find out if they could encourage more people to continue exercising and what benefits might be achieved, the 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 assessed by the test six-minute walk, a key indicator of cardiovascular events in people with coronary heart disease. Nordic walking is a more advanced type of walking exercise that uses poles with specialized designs to better engage upper and lower body muscles.
“Patients with coronary artery disease frequently exhibit reduced functional capacity, poor quality of life, and increased risk of subsequent cardiovascular events and mortality,” explained lead researcher Jennifer L. Reed, Ph.D., Physiology of Exercise and Cardiovascular Health Laboratory, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute; Medical School; and School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
The investigators compared the prolonged effects of a 12-week rehabilitation with 1) high-intensity interval training; 2) continuous moderate to vigorous intensity training; and 3) Nordic walking, on functional capacity, quality of life and symptoms of depression in patients with coronary artery disease. One hundred and thirty patients were randomized to a 12-week training period in one of these three groups followed by a 14-week observation phase.
Although all exercise programs improved symptoms of depression and quality of life, improvement in functional ability was greatest after Nordic walking (+19%) compared to interval training at high intensity (+13%) and moderate to vigorous intensity continuous training (+12%).
“This is a key finding because lower functional capacity predicts a higher risk of future cardiovascular events in people with coronary artery disease,” Dr. Reed noted. “Nordic walking engages core, upper and lower body muscles while reducing load stress at the knee, which may have resulted in greater improvement in functional ability.”
“No previous studies have directly compared the long-term effects of high-intensity interval training, continuous moderate-to-vigorous intensity 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 long-lasting effects (i.e., 14 weeks after completion of cardiovascular rehabilitation) of different exercise programs that can easily be incorporated into exercise daily. When prescribing exercises for patients with coronary heart disease, patient 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, University of Queensland School of Medicine, New Orleans, LA, USA, and colleagues noted that adding Nordic walking to a cardiovascular rehabilitation program could provide an ideal progression between standard moderate-intensity continuous training or traditional walking, especially for deconditioned patients who may not tolerate high-intensity exercise, or for patients in whom high-intensity interval training may be contraindicated.
“Adding Nordic poles to moderate-to-vigorous intensity walking is a simple and accessible option to improve walking ability, 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 goals, preferences, and abilities of the patient,” he advised.
The study was funded by the Ontario Ministry’s Academic Health Sciences Centres, 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., June 14, 2022, Canadian Journal of Cardiology.