Date Published: January 30, 2019
Publisher: Public Library of Science
Author(s): Natalia Andrea Gomeñuka, Henrique Bianchi Oliveira, Edson Soares Silva, Rochelle Rocha Costa, Ana Carolina Kanitz, Giane Veiga Liedtke, Felipe Barreto Schuch, Leonardo A. Peyré-Tartaruga, Thomas Bandholm.
There is physiological and biomechanical evidence suggesting a possible advantage of using poles in walking training programs. The purpose of this proof-of-concept study was to test the hypothesis that untrained elderly training Nordic walking for eight weeks will show higher improvements on the functional mobility, quality of life and postural balance than that training without poles; more likely to occur in self-selected walking speed (primary outcome), and the locomotor rehabilitation index than the quality of life, the static balance and the dynamic stability. It was a two-arm randomized sample- and load-controlled study.
Thirty-three untrained older people were randomly assigned into Nordic walking (n = 16, age: 64.6±4.1 years old) and free walking (n = 17, age: 68.6±3.9 years old) training groups.
Improvements in the self-selected walking speed (primary outcome, p = 0.011, ES = 0.42 95%CI -0.31 to 1.16), locomotor rehabilitation index (p = 0.013, ES = 0.36; (95%CI -0.39 to 1.10), quality of life (p<0.05), static balance (p<0.05) and dynamic variability (p<0.05) were found in both groups. The hypothesis was not supported, our findings indicated that after 8 weeks, the Nordic walking training did not result in greater improvements than free walking training for the primary outcome (self-selected walking speed) and most of the secondary outcomes (including locomotor rehabilitation index, static balance, dynamic stability, and psychological and social participation domains of quality of life). ClinicalTrials.gov NCT03096964.
Physical activity programs for health promotion in elderly are being implemented, such as intervention with aerobic, resistance and flexibility exercises. Consequently, it seems to be essential to know how effective the physical activity interventions are comparatively. As the life expectancy in the worldwide population continues to rise, there is an increasing interest in maintaining and improving the physical activity levels and function in older adults [1–4].
The hypothesis of our study was rejected because eight weeks of NW and FW training promoted similar improvements in SWS, LRI, quality of life, static balance, and dynamic stability parameters. There were some differences between groups that we will report below. We highlight that the positive changes in SWS, LRI, quality of life, static balance and dynamic stability took place in a relatively short period (eight weeks). Also, the participants had a 90% adherence, thus demonstrating the effectiveness of the training program.
In conclusion, our hypothesis (additional benefits from NW in comparison with FW) was rejected. The improvements in SWS (primary outcome), LRI, quality of life, static balance and dynamic stability parameters in older people training NW were similar to that training FW.
It should be noted that it was not possible to collect data from walking with poles on the treadmill. We preferred to take care of the physical integrity of the elderly. However, when collecting without poles, it was possible to evaluate the locomotion in conditions similar to their daily activities.
We believe that the intervention with NW still can be widely explored, and more randomized clinical trials are needed to generate consensus in the scientific community and the health professionals about periodization, intensity, and volume of NW training to be applied, taking into account the purpose to improve physical conditioning. A randomized clinical trial longer is also interesting. Equally, we emphasize that there is still a lack of studies in elderly with associated comorbidities like COPD, intermittent claudication, cardiac diseases, obesity, and still the application of training and monitoring of physical conditioning of pregnant women along pregnancy.