title: Randomized trial of Nordic walking in patients with moderate to severe heart failure.
abstract: BACKGROUND
  Patients with heart failure are a growing population within cardiac rehabilitation. The purpose of this study was to compare, through a single-centre, parallel-group, randomized controlled trial, the effects of Nordic walking and standard cardiac rehabilitation care on functional capacity and other outcomes in patients with moderate to severe heart failure.
  
  
  METHODS
  Between 2008 and 2009, 54 patients (aged 62.4 ± 11.4 years) with heart failure (mean ejection fraction = 26.9% ± 5.0%) were randomly assigned to standard cardiac rehabilitation care (n = 27) or Nordic walking (n = 27); both groups performed 200 to 400 minutes of exercise per week for 12 weeks. The primary outcome, measured after 12 weeks, was functional capacity assessed by a 6-minute walk test (6MWT).
  
  
  RESULTS
  Compared with standard care, Nordic walking led to higher functional capacity (Δ 125.6 ± 59.4 m vs Δ 57.0 ± 71.3 m travelled during 6MWT; P = 0.001), greater self-reported physical activity (Δ 158.5 ± 118.5 minutes vs Δ 155.5 ± 125.6 minutes; P = 0.049), increased right grip strength (Δ 2.3 ± 3.5 kg vs Δ 0.3 ± 3.1 kg; P = 0.026), and fewer depressive symptoms (Hospital Anxiety and Depression Scale score = Δ -1.7 ± 2.4 vs Δ -0.8 ± 3.1; P = 0.014). No significant differences were found for peak aerobic capacity, left-hand grip strength, body weight, waist circumference, or symptoms of anxiety.
  
  
  CONCLUSIONS
  Nordic walking was superior to standard cardiac rehabilitation care in improving functional capacity and other important outcomes in patients with heart failure. This exercise modality is a promising alternative for this population.
authors.affiliation: Minto Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Marja-Leena
authors.initials: ML
authors.lastname: Keast
authors.forename: Monika E
authors.initials: ME
authors.lastname: Slovinec D'Angelo
authors.forename: Chantal R M
authors.initials: CR
authors.lastname: Nelson
authors.forename: Scott E
authors.initials: SE
authors.lastname: Turcotte
authors.forename: Lisa A
authors.initials: LA
authors.lastname: McDonnell
authors.forename: Rebecca E
authors.initials: RE
authors.lastname: Nadler
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Reed
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Pipe
authors.forename: Robert D
authors.initials: RD
authors.lastname: Reid
mesh_terms: D003863:Depression / Q000628:therapy; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D018737:Hand Strength; D006333:Heart Failure / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D016138:Walking