Nordic Walking Training Research Articles

Do patients maintain improvement in physical capacity achieved after hybrid telerehabilitation implemented as part of managed care after acute myocardial infarction program at one-year follow-up?

Abstract Background Managed Care after Acute Myocardial Infarction (MC-AMI) is a one-year comprehensive care program dedicated to patients with acute coronary syndrome introduced in Poland. It includes acute intervention, complex revascularization, implantation of cardiovascular electronic devices (in case of indications), rehabilitation or hybrid rehabilitation (HTR) and scheduled outpatient follow-up. HTR is a unique component of MC-AMI program. Purpose The purpose of this study was to evaluate whether the effect of improving physical capacity achieved after 5-week HTR was maintained during one-year follow-up. Methods The study enrolled 84 patients (90% males, aged 57.5 ± 10.2 years, LVEF 54,6 ± 6.8%) who underwent a 5-week HTR based on Nordic walking training and completed the entire one-year MC-AMI program. Unless there were contraindications, HTR began no later than 14 days after discharge from the hospital and consisted of an initial phase (1 week) conducted in an outpatient center and 4 weeks of telemonitored exercise training at home, five times weekly. Exercise capacity was assessed by comparing the exercise test results at baseline (before HTR), immediately after HTR and at the end of one-year MC-AMI program. Results HTR resulted in significant improvement in workload [METS] and workload duration in exercise test. This valuable effects were maintained after one-year follow-up. All results are presented in Table 1 and Figure 1. Conclusion The improvement in physical capacity achieved after 5-week of the hybrid telerehabilitation was maintained in patients who completed MC-AMI program in one-year follow-up.

Unlocking the potential of exercise: harnessing myokines to delay musculoskeletal aging and improve cognitive health.

This review aims to summarize the common physiological mechanisms associated with both mild cognitive impairment (MCI) and musculoskeletal aging while also examining the relevant literature on how exercise regulation influences the levels of shared myokines in these conditions. The literature search was conducted via databases such as PubMed (including MEDLINE), EMBASE, and the Cochrane Library of Systematic Reviews. The searches were limited to full-text articles published in English, with the most recent search conducted on 16 July 2024. The inclusion criteria for this review focused on the role of exercise and myokines in delaying musculoskeletal aging and enhancing cognitive health. The Newcastle‒Ottawa Scale (NOS) was utilized to assess the quality of nonrandomized studies, and only those studies with moderate to high quality scores, as per these criteria, were included in the final analysis. Data analysis was performed through narrative synthesis. The primary outcome of this study was the evaluation of myokine expression, which included IL-6, IGF-1, BDNF, CTSB, irisin, and LIF. A total of 16 studies involving 633 older adults met the inclusion criteria. The current exercise modalities utilized in these studies primarily consisted of resistance training and moderate-to high-intensity cardiovascular exercise. The types of interventions included treadmill training, elastic band training, aquatic training, and Nordic walking training. The results indicated that both cardiovascular exercise and resistance exercise could delay musculoskeletal aging and enhance the cognitive functions of the brain. Additionally, different types and intensities of exercise exhibited varying effects on myokine expression. Current evidence suggests that exercise mediates the secretion of specific myokines, including IL-6, IGF-1, BDNF, CTSB, irisin, and LIF, which establish self-regulatory circuits between the brain and muscle. This interaction enhances cognitive function in the brain and improves skeletal muscle function. Future research should focus on elucidating the exact mechanisms that govern the release of myokines, the correlation between the intensity of exercise and the secretion of these myokines, and the distinct processes by which myokines influence the interaction between muscle and the brain.

A systematic review and meta-analysis of Nordic walking for chronic heart failure with low left ventricular ejection fraction.

Nordic walking (NW) has been reported to be beneficial in various chronic diseases. To determine whether NW improves function in patients with heart failure (HF) with low left ventricular ejection fraction more than conventional cardiac rehabilitation or usual care. Systematic literature searches in PubMed, ScienceDirect, and Web of Science were conducted. According to patient, intervention, comparison, and outcome (PICO) principles, a stepwise selection process was completed to identify eligible studies. Only randomized controlled trials (RCTs) were included in this systematic review and meta-analysis. Pooled effects were determined using a random effect analysis model for the meta-analysis. A total of 282 participants from four RCTs were included. The improvement of peak oxygen consumption (peak VO2) was greater in the NW group than in the control group (mean difference [MD] = 2.18 mL/kg/min; 95% confidence interval [CI] = 1.35-3.01; p < .01). The improvement of the 6-minute walk test (6MWT) distance was also greater in the NW group than in the control group (MD = 16.51 meters; 95% CI = 3.23-29.80; p = .01). This systematic review highlights the benefits of NW training in patients with chronic HF, particularly those with systolic dysfunction. Specifically, NW walking was associated with increased peak VO2 and 6MWT improvement compared to conventional cardiac rehabilitation or usual care. These results suggest that NW may be a useful component of cardiac rehabilitation. However, additional larger studies with a wider range of patients are needed.

Effects of nordic walking training on gait and exercise tolerance in male ischemic heart disease patients.

This technique-focused observational study explores the impact of a 6-week Nordic Walking (NW) program on physiological and biomechanical aspects in ischemic heart disease (IHD) patients. Twelve male IHD patients (66.2 ± 5.2years, 12.2 ± 7.5years of disease duration) were evaluated pre- and post-training for (i) gait parameters, (ii) exercise tolerance using electrocardiographic (ECG) stress test, (iii) a 6-min walk test (6MWT). The NW training, adhering to IHD patient guidelines, involved a 100-m walk at a self-selected, preferred speed without sticks, with classic NW sticks and mechatronic sticks. A mechatronic measuring system, specifically engineered for measuring, diagnosing and monitoring the patient's gait, was integrated into mechatronic sticks. Post-training, significant enhancements were observed in ECG stress test duration, metabolic equivalency, and 6MWT distance, irrespective of the stick type. However, no significant changes were noted in spatiotemporal parameters concerning the measured side, stick utilisation, or type. The results suggest that NW training boosts exercise capacity and refines gait mechanics in male IHD patients. However, the improvement in exercise capacity was not linked to changes in gait mechanics from NW training but rather to the movement during NW gait. Hence, the key to enhancing exercise capacity in IHD patients is the movement during NW gait, not the quality of gait mechanics.

The Impact of a 6-Week Nordic Walking Training Cycle and a 14-Hour Intermittent Fasting on Disease Activity Markers and Serum Levels of Wnt Pathway-Associated Proteins in Patients with Multiple Myeloma.

Background: Multiple myeloma (MM) accounts for about 10-15% of all diagnosed hematologic malignancies and about 1-2% of all cancer cases. Approximately 80-90% of MM patients develop bone disease and the changes rarely regress. It is only possible to stop or slow their progression. A major role in bone destruction in MM is attributed to the Wnt signaling pathway, and its action can be modified by various types of interventions including training and diet. Therefore, the aim of this project was to evaluate the effects of a Nordic Walking (NW) training cycle and intermittent fasting (IF) on the levels of selected bone turnover markers associated with the Wnt pathway in patients with MM. Materials and methods: Results from 35 patients divided into training (NW and IF NW) and non-training (IF and control) groups were included in the analysis. A 6-week training cycle involving 60 min workouts 3 times a week was conducted. Body mass and composition as well as the levels of vitamin D, calcium and phosphorus, beta2-microglobulin, and albumin were examined before and after the completion of the training cycle. Markers of bone turnover were also determined: sclerostin (SOST), Dickkopf-related protein 1 (DKK-1), osteoprotegrin (OPG), osteopontin (OPN), and Tartrate-resistant acid phosphatase 5b (TRACP 5b). Results: There was no negative effect of IF or combined training and fasting on the nutritional status of the patients (the level of albumins was unchanged). Both training groups showed an increase in serum concentrations of the active metabolite of vitamin D (IF NW and NW: p = 0.001 and p = 0.022, respectively). The change in the concentration of this vitamin negatively correlated with the concentration of TRACP 5b (r = -0.413, p = 0.014). Evaluating the concentrations of markers related to bone turnover, a reduction in the concentrations of SOST (time: p = 0.026, time vs. group: p = 0.033) and TRACP 5b (time: p < 0.001, time vs. group p < 0.001) was indicated. Conclusions: The obtained results allow one to indicate the training with the poles as a safe and beneficial form of physical activity that should be recommended to patients suffering from MM. However, the results obtained in the present study are not sufficient to show the beneficial effect of IF applied without trainings.

The Beneficial Effects of Nordic Walking Training Combined with Time-Restricted Eating 14/24 in Women with Abnormal Body Composition Depend on the Application Period.

The aim of the study was to assess the impact of two lengths of Nordic walking (NW) training interventions combined with time-restricted eating (TRE) on improving body-composition parameters, lipid profiles, and levels of selected adipokines in women with elevated body mass. Overweight and obese women (n = 55, age: 21-85) were recruited. Four groups were selected: 6 weeks (SG6, n = 13) and 12 weeks intervention (SG12, n = 13); and two control groups: CON6 (n = 13) and CON12 (n = 13). The training sessions took place three times a week (60 min each) and were conducted outdoors under the supervision of a professional coach. The training intensity was determined individually. The extended NW program combined with TRE induced a significant weight reduction in SG12 by 1.96 kg (p = 0.010) and fat tissue by 1.64 kg (p = 0.05). The proposed interventions did not affect LBM, TBW [kg], VFA, and lipid profile. The LDL/HDL ratio changed with a small size effect. The leptin concentration differed between groups (p = 0.006), but not over time. For resistin, the differentiating factor was time (p = 0.019), with lower results observed after the intervention. The change in leptin concentration was negatively correlated with its baseline concentration (p = 0.025). Extended to 12 weeks, this intervention allows for an improvement in body composition. Neither 6 nor 12 weeks of training and fasting affected the lipoprotein profile. It is, therefore, indicated to recommend prolonged training protocols and to inform patients that beneficial effects will be seen only after prolonged use of training and time-restricted eating.

Nordic walking and arm swing asymmetry in people with Parkinson’s disease: protocol for a randomised clinical trial

People with Parkinson’s disease (PD) face disruptions in arm swing (AS) motion during walking, including a reduction in amplitude and an increase in asymmetry. Both conditions are detrimental to gait...

Iron status determined changes in health measures induced by nordic walking with time-restricted eating in older adults– a randomised trial

Background and aimsThis study evaluated whether stored iron determines the adaptive response induced by Nordic walking (NW) training combined with 10 hours’ time-restricted eating (TRE) in older adults.Trial design and methodsTwenty-four participants underwent 12-week NW training supported by 10 h of TRE. The group was divided due to baseline ferritin concentration low < 75 ng/ml (LF) and high level ≥ 75 ng/ml (HF). Body composition, physical fitness and blood collection were assessed at baseline and post-intervention.ResultsNW + TRE induced a statistically significant decrease in ferritin levels in all participants (p = 0.01). Additionally, statistically significant intergroup differences in the LF vs. HF in the reduction of serum ferritin levels (p = 0.04) were observed. The procedure NW + TRE diminished HbA1c levels (p < 0.01) and glucose in all participants (p = 0.05). The range of HbA1c drop was more pronounced among those participants who experienced a greater decrease in the stored iron (p = 0.04, \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$ {\\eta }_{p}^{2}$$\\end{document}=0.17, F=4.59). Greater changes in body weight and percent of body fat were recorded in the HF group (for both p<0.01).ConclusionBody iron stores determine the effects of a 12-week NW + TRE intervention on serum ferritin. The changes in HbA1c are more pronounced in subjects with a higher decrease in serum ferritin.Trial registrationAll experimental protocols were approved by the Bioethical Committee of the Regional Medical Society in Gdansk, Poland (NKBBN/330/2021) according to the Declaration of Helsinki. We confirm that all methods were carried out in accordance with relevant guidelines and regulations. The trial was registered as a clinical trial (NCT05229835, date of first registration: 14/01/2022, direct link: https://classic.clinicaltrials.gov/ct2/show/NCT05229835). Informed consent was obtained from all subjects.

Is an 8-Week Regimen of Nordic Walking Training Sufficient to Benefit Cognitive Performance in Healthy Older Adults? A Pilot Study.

Nordic walking requires the association of walking and coordination of limbs while orienteering in a natural environment. It has been shown to improve functional capacities more than normal walking. However, its cognitive benefits are less clear. The main hypothesis was that this training improves visuospatial capacities and inhibition functions. A total of 14 healthy older adults were included. The training was performed in three sessions of 75 min a week for 8 weeks. Pre-, intermediate, and post-tests were carried out. Cognitive functions including global cognition (MoCA), executive functions (Color-Word Stroop test), speed of information processing, switching capacities (Trail Making Test A and B), and visuospatial capacities (Rey Complex Figure Copy Task) were assessed. Motor functions including balance control (Unipedal Balance Test), functional mobility (Timed Up and Go), hamstring flexibility (Chair Sit and Reach test), and motor coordination (Four-Square Stepping Test) were evaluated. Physical function, including lower limb strength (Timed Sit-To-Stand) and cardiovascular capacities (Incremental Shuttle Walking Test), was measured. Cardiovascular capacity, strength of lower limbs, and motor coordination were positively affected by training. With respect to cognition, training improved visuospatial capacities, while switching capacities, information processing speed, and executive functions did not improve. A possible explanation is that they needed a longer program duration to show benefits. However, analyses of responders suggested that NW positively affected cognitive functioning in a subset of participants. Eight weeks of NW training produced physical, motor, and cognitive improvements. A longer training duration could be necessary to extend the benefits to executive functions in all participants.

The Effect of Nordic Walking on the Galectin 3 and Some New Metabolic Markers in Elderly Men with Osteosarcopenic Obesity

Background: Sarcopenia is the age-related progressive loss of muscle mass and strength. The main symptom of the condition is muscle weakness. Objectives: The aim of the present study was to determine the effect of 12 weeks of Nordic walking on the expression of the cardiovascular biomarker galectin 3 gene and some new metabolic markers in elderly men with osteosarcopenic obesity. Methods: Twenty elderly men with a Mean age of 60 to 80 years, who had osteosarcopenic obesity with a body mass index (equal to and above 30) and body fat percentage (equal to and above 30) participated in this research and they were randomly divided into 2 Nordic walking training groups and a control group (10 people in each group). The Nordic walking training program was implemented for 12 weeks and 3 days a week. The intensity of the exercises in each session was 50 to 75% of the maximum heart rate and the duration of each exercise session was 60 minutes. Results: 12 weeks of Nordic walking exercises caused a significant decrease in the circulating levels of galectin-3 (P = 0.001) and a decrease in the TyG-BMI index (P = 0.001) in the subjects. But there was no significant effect on the atherogenic index of plasma (AIP) (P = 0.265) and TyG (P = 0.126) and TyG-BMI (P = 0.347) indices of the subjects. Conclusions: Nordic walking exercise plays an important role in reducing cardiovascular risks by reducing galectin 3 biomarker and atherogenic plasma index (AIP).

Current Trends in Physiotherapy Treatment Protocols in Parkinson’s Disease

Objective: Physiotherapy is prescribed for individuals with Parkinson’s Disease (PD). Conventional forms of physiotherapy have been studied extensively, however effectiveness of recent physiotherapy interventions for PD are being evaluated and assessed. Aim: To evaluate the efficacy of conventional and recent physiotherapy interventions for people with Parkinson’s disease. Materials and Methods: A systematic search using CINAHL, Embase, and PubMed, that contrasted physiotherapy with no intervention or sham treatment. Resistance training, treadmill training, strategy training, dance, martial arts, aerobic exercises, hydrotherapy, balance, gait training, dual tasking, exergaming, and Nordic walking, were twelve categories into which trials were divided. Motor symptoms, balance, gait, and quality of life were among the outcomes. To evaluate methodological quality, GRADE (Grading of Recommendations, Assessment, Development and Evaluation) was used. A total of 191 trials, with 7998 participants were taken. Active therapy was included, irrespective of the severity or stage of the disease. Results: Physiotherapy enhanced gait, quality of life, and motor symptoms. Resistance and treadmill training improved gait. Training strategies enhanced gait and balance. Nordic walking, balance and gait training, and others improved gait, balance and motor symptoms. Exergaming and hydrotherapy enhanced life quality and balance. However, none of the outcomes significantly improved by dual task training. Conclusion: This review offers data supporting the efficacy of physiotherapy treatment in Parkinson’s disease, empowering medical professionals to choose treatment based on the best available research. PD affects balance, mobility, gait, fall susceptibility. Conventional and advanced physiotherapy improves these motor symptoms, and augment quality of life.

Effect of Bicycle Ergometer Training and Nordic Walking Training on Improving Functional Exercise Capacity in Asthma Patients.

Introduction Asthma is a chronic respiratory condition characterized by inflammation of the airway leading to breathlessness. Exercise training has been recognized as a valuable component in the management of asthma, enhancing lung function and overall well-being. Bicycle ergometer training and Nordic walking are two distinct forms of exercise that have been shown to improve cardiovascular fitness and respiratory function. Despite the potential benefits of these exercises, limited research directly compares their efficacy in improving functional capacity specifically in asthma patients. The study thus aims to address this gap by providing personalized, tailored exercise programs for asthma patients. Methods A single-blinded experimental study using a simple random sampling method was conducted. A sample of 40 subjects was recruited for the study based on inclusion and exclusion criteria and were assigned into two groups. Group A subjects were trained with a bicycle ergometer and Group B subjects were trained with Nordic walking. The intervention was given to both groups for 12 weeks. The outcome measures used were the six-minute walk test, Modified Borg Scale, and Mini Asthma Quality of Life Questionnaire. Results A baseline analysis of outcome measures was done, which was followed up by a post-test analysis after 12 weeks. Pre-test and post-test data were compared using a paired t-test.Intergroup analysis was done by an independent t-test. Both groups showed significant improvement in post-test results. On comparing the two groups, Group A showed significant improvement as compared to Group B. Conclusion The study concludes that bicycle ergometer training is effective in improving functional capacity and enhancing the quality of life in asthma patients.

The Effect of a Six-Week Nordic Walking Training Cycle on Oxidative Damage of Macromolecules and Iron Metabolism in Older Patients with Multiple Myeloma in Remission-Randomized Clinical Trial.

Multiple myeloma (MM) is an incurable hematologic malignancy originating from clonal plasma cell proliferation within the bone marrow, predominantly affecting older individuals. While anemia serves as a diagnostic criterion for MM, it often ameliorates upon achieving disease remission. Iron metabolism parameters have emerged as potential prognostic indicators in MM. Notably, physical exercise has been established to influence iron metabolism. This study aimed to assess alterations in serum iron, ferritin, and transferrin concentrations, as well as leukocyte gene expression, in MM patients undergoing a six-week cycle of Nordic walking training. Thirty patients divided into an exercise group (NW, n = 15, mean age 63.1 ± 8.4 years) and a control group (CG, n = 15, mean age: 63.5 ± 3.6 years) completed the study protocol. Blood samples were collected at baseline, after three and six weeks of training, and after nine weeks. Serum ferritin, transferrin, and iron concentrations were measured, along with the leukocyte expression of genes. Additionally, serum oxidative damage marker levels were determined. Following the Nordic walking training cycle, a declining trend in serum ferritin concentrations was observed. Intracellular mRNA levels of genes associated with iron metabolism were positively influenced by the training regimen, indicating the potential impact of this physical activity on gene expression and ferritin concentrations. Although positive trends were noted, extended training periods might be requisite for significant changes. To conclude, moderate-intensity exercise induces favorable shifts in the analyzed parameters among MM patients, potentially influencing disease progression. Consequently, Nordic walking training is a safe recommendation for MM patients, though sustained training beyond six weeks could be necessary for notable effects on iron metabolism factors.

Nordic Walking training in BungyPump form improves cognitive functions and physical performance and induces changes in amino acids and kynurenine profiles in older adults.

Although impacts of physical activity on cognitive functions have been intensively investigated, they are still far from being completely understood. The aim of this study was to evaluate the effect of 12 weeks of the Nordic Walking training with BungyPump resistance poles (NW-RSA) on the amino acid and kynurenine profiles as well as selected myokine/exerkine concentrations, which may modify the interface between physical and cognitive functions. A group of 32 older adults participated in the study. Before and after the intervention, body composition, cognitive functions, and physical performance were assessed. Blood samples were taken before and 1 h after the first and last sessions of the NW-RSA training, to determine circulating levels of exercise-induced proteins, i.e., brain-derived neurotrophic factor (BDNF), irisin, kynurenine (KYN), metabolites, and amino acids. The NW-RSA training induced a significant improvement in cognitive functions and physical performance as well as a reduction in fat mass (p = 0.05). Changes were accompanied by a decline in resting serum BDNF (p = 0.02) and a slight reduction in irisin concentration (p = 0.08). Still, changes in irisin concentration immediately after the NW-RSA intervention depended on shifts in kynurenine-irisin dropped as kynurenine increased. The kynurenine-to-tryptophan and phenylalanine-to-tyrosine ratios decreased significantly, suggesting their possible involvement in the amelioration of cognitive functions. No changes of glucose homeostasis or lipid profile were found. Shifts in the concentrations of selected amino acids might have covered the increased energy demand in response to the NW-RSA training and contributed to an improvement of physical performance. Regular Nordic Walking training with additional resistance (BungyPump) improved cognitive functions and physical performance. These positive effects were associated with a reduced BDNF concentration and kynurenine-to-tryptophan ratio as well as changes in the amino acid profile.

EFFECTS OF A NORDIC WALKING INTERVENTION ON WALKING IN NORMAL ADULTS

The purpose of this study was to compare and examine gait parameters, hip joint angle, and lower extremity muscle activity during normal walking before and after Nordic walking (NW) intervention. Nineteen healthy male participants (age 26.3 ± 2.4 years) were included in the study. During walking, we measured gait parameters using the footprint-measuring gait analysis system. Аngular changes of the hip joint were measured with an IMU-type portable three-dimensional motion analyzer and the EMG activity of each muscle. The measurements above were performed before and after a one-hour NW training course. The hip joint angle, muscle activity, and gait parameters were compared before and after the intervention with the same participants. In gait parameters, the stride length and walking speed were significantly greater after the intervention, while the cadence decreased significantly. Both hip flexion and extension angles were significantly greater after the intervention. In terms of muscle activity, the rectus abdominis, the tibialis anterior, and the gastrocnemius were very different after the intervention. According to previous reports, employing a large stride length during NW would affect the normal gait after the training. The use of the Nordic pole may have stimulated a substantial forward movement in the lower extremities using the large range of motion of the hip joints. The benefits of NW include enhanced forward propulsion during gait and additional stability during the stance phase due to the greater support surface provided by the poles.

Investigation of the effects of 8-week Nordic and traditional walking training on blood pressure in prehypertensive postmenopausal women

Objective: This study aimed to investigate the effects of Nordic walking (NW) and traditional walking (TW) training on blood pressure and resting heart rate in prehypertensive postmenopausal women. Materials and Methods: Twenty women aged 57.9 ± 7.2 years participated in the study. Participants were divided into two groups of 10: NW and TW. Exercises were performed three days a week for eight weeks and 50 min/day at 40-60% of the maximum heart rate. Body composition, blood pressure, and resting heart rate values of the participants were measured before and after the 8-week exercise program. Results: Upon comparing the values before and after exercise; body weight, body mass index, hip circumference, systolic and diastolic pressure values decreased significantly (p&lt;0.05), while there was no significant change in the resting heart rate (p&gt;0.05) in the NW group. In the TW group; body weight, body mass index, waist circumference, hip circumference, systolic and diastolic pressure decreased significantly (p&lt;0.05). No significant changes were found in other parameters (p&gt;0.05). The effect size of NW training was found to be higher in body weight, BMI, and systolic and diastolic pressure values. Conclusion: NW training is more effective than TW training in the regulation of blood pressure in prehypertensive postmenopausal women.

Effect of Nordic Walking Training on Physical Fitness and Self-Assessment of Health of People with Chronic Non-Specific Lower Back Pain

In order to determine the impact of a four-week cycle of Nordic Walking (NW) training on the physical fitness of people with chronic non-specific lower back pain and the impact of this form of activity on their self-assessment of health quality, the study included 80 men and women aged 29 to 63 years. The subjects were divided into two equal (40-person) groups: experimental and control. In both study groups the degree of disability in daily activities caused by back pain was assessed with the FFb-H-R questionnaire, the physical fitness was evaluated with the modified Fullerton test and the sense of health quality was assessed with the SF-36 questionnaire. The same tests were repeated after four weeks. In the experimental group NW training was applied between the two studies. During four weeks, 10 training units were carried out, and each training session lasted 60 min with a two-day break between each training. The four-week NW training resulted in a statistically significant sense of disability due to back pain (p < 0.001), significant improvement of physical fitness expressed by improvement in upper (p < 0.001) and lower (p < 0.01) body strength, upper and lower body flexibility (p < 0.001) and ability to walk a longer distance in a 6-min walk test (p < 0.001). The training participants also showed significant improvements in health quality in both physical (p < 0.001) and mental (p < 0.001) components. The four-week NW training has a positive impact on the physical fitness of men and women with chronic lower back pain. Participation in NW training also contributes to a significant reduction in the sense of disability caused by back pain and improvement in the self-assessment of health quality.

P068 The effects of exercise and physical activity in inflammatory rheumatic diseases: a scoping literature review

Abstract Background/Aims Physical activity and exercise for the management of inflammatory rheumatic diseases is well described in the literature and is recommended in the EULAR 2018 physical activity and 2021 self-management guidelines. However, the extent to which physical activity and exercise is beneficial or detrimental in these patients is unclear. The aim of this review is to critically appraise the effects of physical activity and exercise interventions on patient-centred outcomes in a range of inflammatory rheumatic diseases in order to help guide clinical practice. Methods Pre-defined search terms were used to identify randomised controlled trials or systematic reviews published in English, studying any form of physical activity/exercise interventions for inflammatory rheumatic diseases. This included seronegative spondyloarthritis (including axial/psoriatic/enteropathic/reactive arthritis), rheumatoid arthritis, and broadly grouped connective tissue diseases including systemic lupus erythematosus, systemic sclerosis and myositis. Databases included MEDLINE via PubMed, CINAHL, Embase and Cochrane Database of systematic reviews from January 2018 onwards. Quantitative data regarding types of physical activity, any primary or secondary outcome measures and the quality of the evidence was compiled independently by two authors. 427 studies were identified and screened of which 160 were included in the final analysis. Results Numerous benefits of various quality in a range of physical activities across the diseases were identified. Interventions included swimming, aquatic exercises, global posture retraining and land based aerobic exercises (including walking, Nordic walking, Pilates, Tai Chi and High Intensity Interval Training). In terms of high-quality evidence, for seronegative spondyloarthritis, benefits were found for functional outcome scores, fatigue levels and disease activity scores. In rheumatoid arthritis, benefits were seen in fitness, disease activity scores, quality of life, muscle strength and pain reduction. Across the studied connective tissue diseases, benefits were seen in fitness, ability to carry out activities of daily living, muscle strength and fatigue. Low to moderate quality evidence for improvement was seen across all diseases in areas such as mood, sleep quality and flexibility/stiffness. However, there was significant heterogeneity amongst the dose and type of exercise interventions used between identified studies. This therefore precluded a meta-analysis which meant that this review was unable to recommend one specific exercise over another. Importantly, no adverse outcomes to physical activity were found in any of the identified studies. Conclusion It is evident that a range of exercise and physical activity interventions can have an important role in the management of inflammatory rheumatic diseases. Moreover, the wider well-established benefits of physical activity seen in the general population, including those of mental wellbeing and in cardiovascular disease, may be pertinent to the comorbidities associated with inflammatory rheumatic diseases. Future research would benefit from comparing doses and types of exercise interventions against each other in order to help further guide clinical practice. Disclosure R. Amarnani: None. M. Hadjidemetriou: None. A. Mundell: None. S. Katti: None. F. Chiwah: None. K. Ainsworth: None. G.S. Metsios: None. C. Lester: None.

Feasibility of hybrid telerehabilitation as a component of the Managed Care after Acute Myocardial Infarction (MC-AMI) program in a 12-month follow-up: experience from a single center.

Managed Care after Myocardial Infarction (MC‑AMI [KOS-Zawał]), a comprehensive care program dedicated to patients after myocardial infarction, was implemented in Poland in 2017. Hybrid cardiac telerehabilitation (HTR) is a unique component of MC‑AMI. We evaluated the feasibility of HTR as a component of MC‑AMI and assessed its safety and acceptance by patients. One‑year all‑cause mortality among the patients participating and not participating in MC‑AMI was analyzed. The MC‑AMI group included 114 patients who underwent a 5‑week HTR program comprising telemonitored Nordic walking training sessions, and who completed the entire 12‑month MC‑AMI program. The influence of HTR on the physical capacity was assessed by comparing the stress test results before and after HTR. After HTR, the patients completed a satisfaction survey to assess their acceptance of the program. The non-MC‑AMI group was formed using propensity score matching to compare 1‑year all‑cause mortality between the patients participating and not participating in MC-AMI. HTR significantly improved the functional capacity assessed in the stress test and was well‑received by the patients. In the study group, nonfatal non-ST‑segment elevation myocardial infarction, elective coronary percutaneous intervention, and cardiovascular hospitalization occurred in 0.9%, 2.6% and 6.1% of the patients, respectively. There were no deaths among the MC‑AMI participants, whereas in the non-MC‑AMI group, 1‑year all‑cause mortality was 3.5%. The log‑rank test comparing the survival probabilities of matched groups, estimated by the Kaplan-Meier method, showed heterogeneity of the curves (P = 0.04). HTR as a component of MC‑AMI was a feasible, safe, and well‑accepted form of cardiac rehabilitation. Participation in MC‑AMI including HTR was associated with a significantly lower risk of 1‑year all‑cause mortality, as compared with not taking part in the rehabilitation program.

The Effects of Nordic Walking with Poles with an Integrated Resistance Shock Absorber on Red Blood Cell Distribution and Cardiorespiratory Efficiency in Postmenopausal Women—A Randomized Controlled Trial

Age-related reduction in exercise capacity is manifested by a rapid development of fatigue. Research confirmed the adverse prognostic value of red blood cell distribution width (RDW-CV), an independent factor in heart failure, coronary heart disease and myocardial infarction. Physical exercise improves and helps to maintain cardiorespiratory fitness. The aim of our study was to examine the impact of 8 weeks' Nordic walking training with classic poles (NW) and NW training with poles with an integrated resistance shock absorber (NW with RSA) on RDW-CV levels and to assess correlations between RDW-CV levels and cardiorespiratory performance in postmenopausal women. In this study, 32 postmenopausal women (NW-16, NW with RSA-16) participated in eight weeks of walking training. The mean age of women was 66.56 ± 4.23 year. and BMI 26.99 ± 3.86 kg/m2. At the beginning and at the end of the study, spirometry and exercise tests were performed. Haematological parameters were determined in the venous blood. Statistical analysis of differences in post-training changes in the parameters between the groups studied showed a significant difference in change in body weight (∆body weight) (p < 0.05; ES: 0.778), BMI (∆BMI) (p < 0.05; ES: 0.778), waist circumference (∆WC) (p < 0.05; ES: 1.225) and (∆RDW-SD) (p < 0.05; ES: 1.215). There were no changes in electrocardiographic and spirometric parameters. Based on the findings from the present study, it can be assumed that endurance and resistance exercise can significantly reduce disease severity and mortality. A clinical analysis of RDW levels, together with other cardiological and biochemical parameters, can provide practical prognostic information relating to cardiovascular disease, mortality risk and treatment outcomes.