Kellner M1, Greisberger A1
1FH Campus Wien, Health Sciences, Vienna, Austria
Background: With approximately 1.2 million persons in Europe, Idiopathic Parkinson´s disease (IPD) is one of the most common neurodegenerative diseases worldwide. Walking disorders are one of the consequences of IPD.
Purpose: The purpose of this review was to systematically review the literature in order to identify studies investigating Nordic Walking training and its effect on gait in persons with IPD. Based on the identified literature recommendations for clinical practice will be made.
Methods: The following databases have been searched: PEDro, PubMed, and Google Scholar. Randomized controlled trials, investigating the effect of Nordic Walking training on gait compared to no or any other training, were included. Gait had to be measured with standardized clinical assessment tools (e.g. 10m walking test). The methodological quality was assessed with the PEDro scale. If enough data was provided the magnitude of change, in terms of clinical relevance, was analyzed by using minimal detectable change scores (MDC). Analyzing training settings lead to advices for clinical practice.
Results: Four studies (PEDro score 5-8/10) with a total of 163 participants have been included in the analysis. Nordic Walking training was performed over a period of 4-24 weeks (2-5 times a week for 25-70 minutes) and was conducted on a treadmill or outside (in a park or in the forest). Control conditions were free walking (on a treadmill or outside), conventional care or a flexibility and relaxation program. Outcome was measured with the Timed Up and Go Test (TUG; 3 studies), walking distance tests (10m, 12m and 24m; 2 studies) and timed walking tests (6 minutes; 2 studies). Furthermore, one study documented stride length and time, double stance phase and gait variance. Significant between groups differences were reported according to the TUG in 3/3studies, according to walking distance tests (2/2 studies) and timed walking tests (2/2 studies), indicating better outcome for the Nordic Walking group compared to the control condition(s). As only two studies reported change scores, analyses of clinical relevance is based on these two studies. Nordic Walking training on a treadmill, as well as treadmill walking without poles, lead to changes greater than established MDC values for the 10m walking test (changes >0.18m/sec), but only the Nordic Walking group changed clinically relevant in its TUG scores (change > 3.5sec).
Conclusion(s): In summary, Nordic Walking training has a positive effect on gait in persons with IPD. This training can reduce the symptoms of continuous gait disorder. However, since the reporting quality of the included studies was partly poor the magnitude of change and therefore its clinical relevance can only be interpreted based on two studies.
Implications: Nordic Walking training performed for 4 weeks, 5 times a week for 60 minutes can lead to clinically relevant change, if measured with the TUG and/or the 10m walking test. However, walking on a treadmill might lead to similar results.
Future studies should adhere to reporting guidelines, in order to enable clinicians to interpret the magnitude of change and deduce clinical relevance.
Keywords: Parkinson, Nordic Walking, clinical relevance
Funding acknowledgements: This work is based on a Bachelor thesis and has not received any funding.
Purpose: The purpose of this review was to systematically review the literature in order to identify studies investigating Nordic Walking training and its effect on gait in persons with IPD. Based on the identified literature recommendations for clinical practice will be made.
Methods: The following databases have been searched: PEDro, PubMed, and Google Scholar. Randomized controlled trials, investigating the effect of Nordic Walking training on gait compared to no or any other training, were included. Gait had to be measured with standardized clinical assessment tools (e.g. 10m walking test). The methodological quality was assessed with the PEDro scale. If enough data was provided the magnitude of change, in terms of clinical relevance, was analyzed by using minimal detectable change scores (MDC). Analyzing training settings lead to advices for clinical practice.
Results: Four studies (PEDro score 5-8/10) with a total of 163 participants have been included in the analysis. Nordic Walking training was performed over a period of 4-24 weeks (2-5 times a week for 25-70 minutes) and was conducted on a treadmill or outside (in a park or in the forest). Control conditions were free walking (on a treadmill or outside), conventional care or a flexibility and relaxation program. Outcome was measured with the Timed Up and Go Test (TUG; 3 studies), walking distance tests (10m, 12m and 24m; 2 studies) and timed walking tests (6 minutes; 2 studies). Furthermore, one study documented stride length and time, double stance phase and gait variance. Significant between groups differences were reported according to the TUG in 3/3studies, according to walking distance tests (2/2 studies) and timed walking tests (2/2 studies), indicating better outcome for the Nordic Walking group compared to the control condition(s). As only two studies reported change scores, analyses of clinical relevance is based on these two studies. Nordic Walking training on a treadmill, as well as treadmill walking without poles, lead to changes greater than established MDC values for the 10m walking test (changes >0.18m/sec), but only the Nordic Walking group changed clinically relevant in its TUG scores (change > 3.5sec).
Conclusion(s): In summary, Nordic Walking training has a positive effect on gait in persons with IPD. This training can reduce the symptoms of continuous gait disorder. However, since the reporting quality of the included studies was partly poor the magnitude of change and therefore its clinical relevance can only be interpreted based on two studies.
Implications: Nordic Walking training performed for 4 weeks, 5 times a week for 60 minutes can lead to clinically relevant change, if measured with the TUG and/or the 10m walking test. However, walking on a treadmill might lead to similar results.
Future studies should adhere to reporting guidelines, in order to enable clinicians to interpret the magnitude of change and deduce clinical relevance.
Keywords: Parkinson, Nordic Walking, clinical relevance
Funding acknowledgements: This work is based on a Bachelor thesis and has not received any funding.
Topic: Neurology: Parkinson's disease; Disability & rehabilitation
Ethics approval required: No
Institution: FH Campus Wien
Ethics committee: Ethics Committee FH Campus Wien
Reason not required: The work ist based on literature only, no persons were involved.
All authors, affiliations and abstracts have been published as submitted.
