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Effects of Nordic walking on cardiovascular performance and quality of life in coronary artery disease [with consumer summary]
Nagyova I, Jendrichovsky M, Kucinsky R, Lachytova M, Rus V
European Journal of Physical and Rehabilitation Medicine 2020 Oct;56(5):616-624
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: No; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Cardiometabolic effects of physical exercise depend on its intensity, duration, and type. Conventional cardiovascular rehabilitation (CCVR) programmes have significant advantages, but non-conventional activities such as Nordic walking (NW) may offer additional health benefits. AIM: 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 programme. DESIGN: This was a pseudo-randomised, prospective, single-blinded, parallel-group trial. SETTING: The study was conducted at a resort/spa type facility located in a mountainous natural environment, 650 metres above sea level. POPULATION: 83 CAD patients were allocated to either a Nordic walking or a control group. METHODS: The NW group (n = 53; age 59.1 +/- 7.0 years) underwent a three-week outdoor exercise programme 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 to 70% of peak oxygen consumption -- VO2max; rating of perceived exertion 'mild/moderate' (12 to 14 points) on the 0 to 20 Borg Scale. Primary endpoint: cardiovascular and functional performance (EE -- exercise ergometry; METs -- metabolic equivalent of tasks; EF -- ejection fraction; 6MWT -- six-minute walking test). Secondary endpoint: quality of life (SF-36 -- Short Form Health Survey). Statistical analysis: Generalized Estimating Equations with Cohen's d effect size (ES). RESULTS: NW led to higher cardiovascular performance compared to CCVR (delta EE +11.0% versus +3.2% -- ES small; delta METs +9.8% versus +1.5% -- ES medium) and better functional performance (delta 6MWT +8.3% versus +5.1% -- ES small). No significant differences were detected in EF (p = 0.240) and SF-36 (PCS, p = 0.425; MCS, p = 0.400). CONCLUSIONS: A three-week NW training programme had clinically important effects, above and beyond CCVR, on cardiovascular and functional performance in CAD patients.

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