By Mandy Shintani
Nordic walking is set to revolutionize rehabilitation and gait retraining in the USA supported by improved outcomes in 299 independent research studies published on PubMed. Outcomes include improved balance, increased gait speed and stride length, decreased gait variability, and the promotion of an upright posture and fluid contralateral movements. Specialized Nordic walking poles called Activator poles have been prescribed as best practice for improving gait in Canada and more recently in the UK, IR and Australia. Many American rehabilitation professionals, however, are not familiar with Nordic walking and its use as a therapy tool.
Nordic walking is a fitness activity that became popular in Scandinavia as a way for their Olympic cross-country ski teams to train off season, during the summer months. It involves walking with specialized walking poles that prompts the lower body to walk normally while the upper body engages in a technique similar to cross country skiing. The benefit of using the poles for rehabilitation is that Nordic walking replicates the same pattern as functional walking and emphasizes the contralateral movement of opposite arm and leg while increasing arm swing. The poles propel rehabilitation clients forward to achieve an increased stride length and gait speed.
In 2005, based on the concept of Nordic walking, the Activator poles and an alternate technique were designed for rehabilitation and lower functional clients. The Activator poles are equipped with strapless ergonomic handles to minimize the risk of injury and have a higher weight bearing capacity than regular poles. A study by Knobloch & Vogt (2006) found increased injury when the user is still attached to the poles during a fall. There are 10 current studies on the Activator poles in Canada and the UK.
Many of the studies listed in PubMed demonstrate the benefits for gait retraining. According to an RCT study by Reuter et al. (2010) participants who were in the Nordic walking group were superior to the regular walking and balance and flexibility exercises groups, in improving postural stability, stride length, gait pattern and gait variability for participants with Parkinson’s Disease.
These findings were similar to outcomes from a case review using the Zeno Walkway and PKMAS (ProtoKinetics Movement Analysis Software) Gait Analysis System at a gait assessment lab at Montreal’s Jewish General Hospital, which examined the gait outcomes for a geriatric client. The participant was an 88 year old woman residing in a senior living residence, with a significant history of falls. Her medical history included; 2 hip, knee and shoulder replacements as well as a soft tissue ankle injury.
As demonstrated in the first video, the participant is compensating for her fear of falling by extending her arms while using a shuffling gait pattern with a wide stride width and a short step length.
The second video shows the participant using the Activator poles and demonstrates their function in increasing gait speed and stride length, normalizing arm swing and fostering the use of a heel-toe gait pattern. The test results found a 37% increase in gait speed and a 62% increase in gait stride, while stride width decreased by 24.8 cm. Gait variability improved with a eGVI of 136.1 without poles to 117.7 with poles.
Nordic walking has resulted in a change in practice to Activator poles from traditional mobility devices such as canes and to prevent or delay the use of walkers (under the guidelines of a rehab professional). This result has been two-fold: improved self image for therapy clients and increased motivation for clients to adhere to a regular walking regime. The general perception is that walking poles are associated with exercise and physical activity rather than the negative connotation of degeneration which is sometimes associated with passive mobility aids such as canes and walkers.
As with any device, the use of Nordic walking poles should only be recommended after a comprehensive therapist assessment. Possible contraindications include: clients that use walkers or require two canes for ambulation, those in the later stages of neurological conditions, or clients with ataxia or have challenges with dual tasking. Therapists may also determine that a walker or cane is the preferred choice on a regular basis for safety purposes but that these same clients may benefit from using walking poles for daily exercise, during rehabilitation sessions or until their function improves.
Summary
Specialized Nordic walking poles are a new concept in the USA, which has the potential to revolutionize gait retraining. It is an evidence-based tool that demonstrates improved outcomes for all aspects of gait in terms of speed, stride, arm swing, walking tolerance and normalizing gait pattern. They are prescribed extensively in Canada, in all health care therapy continuums, as an effective alternative to traditional passive mobility devices such as canes and to reduce or delay the use of walkers when appropriate.
For more information on Nordic walking research please refer to PubMed.com and for training and Activator poles, please visit www.urbanpoling.com
Mandy Shintani, OT & Gerontologist, founder of Urban Poling Inc and Developer of the ACTIVATOR℗ poles and training programs.
Case Review with a Gait Assessment Lab using the Zeno Walkway.
Roscher P (2018) ProtoKinetics. Unpublished raw data.
Knobloch K & Vogt P M (2006) Nordic Pole Walking Injuries-Nordic Walking Thumb as Novel Injury 1Sportverletz Sportschaden. 2006 Sep;20(3):137-42.
Reuter I1, Mehnert S, Leone P, Kaps M, Oechsner M, Engelhardt M (2011). Effects of a flexibility and relaxation programme, walking, and nordic walking on Parkinson’s disease. J Aging Res. 2011;2011:232473