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"Nordic Walking" Benefits Heart Failure Patients"

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 Wroclaw, 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."

Nordic walking can produce up to a 46% increase in energy consumption compared to walking without poles (Cooper Institute, Research Quarterly for Exercise and Sports, 2002)

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.

Written by Catharine Paddock PhD

Reference: Article adapted from Medical News today

For COPD Patients, Pulmonary Rehabilitation And Improvement In Exercise Capacity Improve Survival

Pulmonary rehabilitation and improvement in exercise capacity significantly improve survival in patients with chronic obstructive pulmonary disease (COPD), according to a new study from the UK.

"While the short- and medium-term benefits of pulmonary rehabilitation in COPD patients have been shown, its effects on survival have not been studied," said lead author Johanna Williams, MSc, a researcher at the Department of Respiratory Medicine at the University Hospitals of Leicester NHS Trust. "Our analysis shows that completion of pulmonary rehabilitation and a higher level of response in exercise capacity is associated with a significant survival advantage in COPD patients."

The results were presented at the ATS 2012 International Conference in San Francisco.

Of 1,615 patients with COPD in the observational cohort study, 55.4% completed pulmonary rehabilitation. Subjects who completed pulmonary rehabilitation (n = 895), compared with those who did not (n = 720), had significantly higher mean incremental shuttle walking test (ISWT) scores at baseline. Kaplan Meier (KM) survival analysis revealed that there was a statistically significant survival advantage for those who completed rehabilitation when compared with those who didn't complete (p<0.001 by the log rank test).

"These results should be interpreted with caution however," said Ms. Williams "as improved survival is unlikely to be simply a result of completion of rehabilitation but also probably reflects that the sickest patients may be unable to complete and/or may have more co-morbidities so are more likely to die sooner".

For those patients that did complete rehabilitation, 56.3 percent improved by more than 48m, the minimum clinically important difference (MCID) for the ISWT, and were considered responders. After adjustment for a number of prognostic factors including baseline ISWT, survival analysis showed that these responders had a significantly improved survival compared with non-responders (p<0.001 by the log rank test). "It should be remembered however that it is currently unknown whether other factors (possibly genetic) may influence a better training response and thus may be also associated with improved survival" said Ms. Williams.

"Our study shows that pulmonary rehabilitation and the magnitude of response in exercise tolerance following pulmonary rehabilitation in patients with COPD is associated not only with short-term improvements, but possibly also with improved survival," said Ms. Williams. "COPD patients should be encouraged to exercise."

Reference: Article adapted from Medical News today


For Stroke Rehab And Brain Injured Patients, Non-Invasive Brain Stimulation Shown To Impact Walking Patterns

In a step towards improving rehabilitation for patients with walking impairments, researchers from the Kennedy Krieger Institute found that non-invasive stimulation of the cerebellum, an area of the brain known to be essential in adaptive learning, helped healthy individuals learn a new walking pattern more rapidly. The findings suggest that cerebellar transcranial direct current stimulation (tDCS) may be a valuable therapy tool to aid people relearning how to walk following a stroke or other brain injury.

Previous studies in the lab of Amy Bastian, PhD, PT, director of the Motion Analysis Laboratory at Kennedy Krieger Institute, have shown that the cerebellum, a part of the brain involved in movement coordination, is essential for walking adaptation. In this new study, Dr. Bastian and her colleagues explored the impact of stimulation over the cerebellum on adaptive learning of a new walking pattern. Specifically, her team tested how anode (positive), cathode (negative) or sham (none) stimulation affected this learning process.

"We've known that the cerebellum is essential to adaptive learning mechanisms like reaching, walking, balance and eye movements,"says Dr. Bastian. "In this study, we wanted to examine the effects of direct stimulation of the cerebellum on locomotor learning utilizing a split-belt treadmill that separately controls the legs."

The study, published in the Journal of Neurophysiology, found that by placing electrodes on the scalp over the cerebellum and applying very low levels of current, the rate of walking adaptation could be increased or decreased. Dr. Bastian's team studied 53 healthy adults in a series of split-belt treadmill walking tests. Rather than a single belt, a split-belt treadmill consists of two belts that can move at different speeds. During split-belt walking, one leg is set to move faster than the other. This initially disrupts coordination between the legs so the user is not walking symmetrically, however over time the user learns to adapt to the disturbance.

The main experiment consisted of a two-minute baseline period of walking with both belts at the same slow speed, followed by a 15-minute period with the belts at two separate speeds. While people were on the treadmill, researchers stimulated one side of the cerebellum to assess the impact on the rate of re-adjustment to a symmetric walking pattern.

Dr. Bastian's team found not only that cerebellar tDCS can change the rate of cerebellum-dependent locomotor learning, but specifically that the anode speeds up learning and the cathode slows it down. It was also surprising that the side of the cerebellum that was stimulated mattered; only stimulation of the side that controls the leg walking on the faster treadmill belt changed adaptation rate.

"It is important to demonstrate that we can make learning faster or slower, as it suggests that we are not merely interfering with brain function," says Dr. Bastian. "Our findings also suggest that tDCS can be selectively used to assess and understand motor learning."

The results from this study present an exciting opportunity to test cerebellar tDCS as a rehabilitation tool. Dr. Bastian says, "If anodal tDCS prompts faster learning, this may help reduce the amount of time needed for stroke patients to relearn to walk evenly. It may also be possible to use tDCS to help sustain gains made in therapy, so patients can retain and practice improved walking patterns for a longer period of time. We are currently testing these ideas in individuals who have had a stroke."

Reference: Article adapted from Medical News today

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