Effects of Nordic walking on cardiovascular performance and quality of life in coronary artery disease.

Abstract

Cardiometabolic effects of physical exercise depend on its intensity, duration, and type. Conventional cardiovascular rehabilitation (CCVR) programs have significant advantages, but non-conventional activities such as Nordic walking (NW) may offer additional health benefits. The aim of this study was to determine the feasibility and effectiveness of NW on cardiovascular performance and quality of life in patients with coronary artery disease (CAD) compared to a CCVR program. This was a pseudo-randomized, prospective, single-blinded, parallel-group trial. The study was conducted at a resort/spa type facility located in a mountainous natural environment, 650 meters above sea level. Eighty-three CAD patients were allocated to either a Nordic walking or a control group. The NW group (N.=53; age 59.1±7.0 years) underwent a three-week outdoor exercise program consisting of 40 minutes of walking four-times per week, whereas the controls performed traditional walking instead of NW. A patient's prescribed exercise intensity was according to exertion tolerance within 50-70% of peak oxygen consumption (VO<inf>2max</inf>); rating of perceived exertion 'mild/moderate' (12 to 14 points) on the 0-20 Borg Scale. Primary endpoint: cardiovascular and functional performance (exercise ergometry [EE], metabolic equivalent of tasks [METs], ejection fraction [EF], Six-Minute Walking Test [6MWT]). Secondary endpoint was quality of life (Short-Form 36 Health Survey). Statistical analysis was performed by generalized estimating equations with Cohen's d effect size (ES). NW led to higher cardiovascular performance compared to CCVR (ΔEE: +11.0% vs. +3.2%, small ES; ΔMETs: +9.8% vs. +1.5%, medium ES) and better functional performance (Δ6MWT: +8.3% vs. +5.1%, small ES). No significant differences were detected in EF (P=0.240) and SF-36 (PCS, P=0.425; MCS, P=0.400). A three-week NW training program had clinically important effects, above and beyond CCVR, on cardiovascular and functional performance in CAD patients. Nordic walking is an accessible, safe, and effective low-threshold cardiac rehabilitation exercise training modality that seems to be particularly well-suited for people with limited functional and motivational capacities.