Research presented at a conference this week suggests heart failure patients can benefit from "Nordic walking",
where people walk with the help of poles as in cross-country skiing. This type of walking, which engages the upper as
well as the lower body, is becoming increasingly popular in Europe: it is safe for older patients, especially those over
65, and after a short introductory course, can be practised outdoors without having to go to the gym.
The lead author of the study is Andrzej Lejczak, a physiotherapist at the Military Hospital in Wroclaw, Poland. He presented the findings on 21 May, in Belgrade, Serbia, to delegates attending the Heart Failure Congress 2012, the main annual meeting of the Heart Failure Association of the European Society of Cardiology.
Previous research has found that aerobic exercise benefits patients with heart failure: it improves their quality of life and reduces the number of times they are admitted to hospital for heart failure.
However, it is not easy to find a safe form of exercise when you have heart failure, one of the main reasons Lejczak has been investigating the potential benefit of Nordic walking for this group. He has already shown in previous studies that it improves heart failure patients' quality of life, aerobic capacity and physical fitness.
Lejczak, who is also studying for a PhD at the University School of Physical Education in Wrocław, told the press:
"In Nordic walking we have a big workload because we use additional muscle groups."
"We walk with four limbs, so we're exercising our arms and legs at the same time - that's why we have such a beneficial response."
For their study, Lejczak and colleagues invited 12 patients with heart failure and 12 healthy adults to do two submaximal six-minute walking tests on a level treadmill at a constant speed of 5km per hour.
The 24 participants did one test walking with Nordic walking poles, and one walking without the poles.
The researchers measured participants' cardiorespiratory responses during both tests.
They found that in the healthy group, Nordic walking (with poles) increased oxygen consumption (VO2) by a median of 37% (amounting to 4.9 ml/kg/minute), and resulted in a higher respiratory quotient with a median increase of 5%, compared to walking without poles.
Furthermore, their peak heart rates, blood pressure and fatigue levels were also higher when walking with poles (20 beats per minute higher, 15 mmHg higher max systolic blood pressure, and 2 points increase on Borg fatigue scale, respectively).
In the participants with heart failure, the researchers found Nordic walking increased VO2 by a median of 14.7% (2.9 ml/kg/minute), and respiratory quotient by 18%. Their peak heart rate was 15 beats per minute higher, maximal BP was 10 mmHg higher, and fatigue level was 2 points higher.
All results for both groups were statistically significant (p=0.05).
Neither the healthy group nor the heart failure group showed signs of cardiac ischaemia, nor were there any signficiant symptoms of arrhythmia during the tests.
Lejczak and colleagues concluded that Nordic walking is a form of exercise that allows not only healthy people but also people with heart failure to increase their exercise intensity and gain more cardiorespiratory benefits safely.
Lejczak said their results suggest it is safe to include Nordic walking in cardiac rehabilitation programmes for patients with heart failure.
To practise this form of exercise you need Nordic walking poles, which typically cost around 50 Euros, and undergo some training, two to three one-hour lessons should suffice, say the researchers.
After that you can safely exercise out of doors, without having to visit the gym.
A definition of Nordic Walking and why it is important to learn the technique correctly in order to get the most health benefit (from the International Nordic Walking Federation - INWA) is available here.
Written by Catharine Paddock PhD