Effects of a flexibility and relaxation programme, walking, and nordic walking on Parkinson's disease

Abstract

Symptoms of Parkinson's disease (PD) progress despite optimized medical treatment. The present study investigated the effects of a flexibility and relaxation programme, walking, and Nordic walking (NW) on walking speed, stride length, stride length variability, Parkinson-specific disability (UPDRS), and health-related quality of life (PDQ 39). 90 PD patients were randomly allocated to the 3 treatment groups. Patients participated in a 6-month study with 3 exercise sessions per week, each lasting 70 min. Assessment after completion of the training showed that pain was reduced in all groups, and balance and health-related quality of life were improved. Furthermore, walking, and Nordic walking improved stride length, gait variability, maximal walking speed, exercise capacity at submaximal level, and PD disease-specific disability on the UPDRS in addition. Nordic walking was superior to the flexibility and relaxation programme and walking in improving postural stability, stride length, gait pattern and gait variability. No significant injuries occurred during the training. All patients of the Nordic walking group continued Nordic walking after completing the study.

Figure 1

Study design.

Figure 2

Borg scale: Patients of the Nordic walking group and walking group perceived more exertion than the flexibility and relaxation group suggesting that the training of both groups was more demanding.

Figure 3

Intensity of pain was significantly lower at the second assessment compared to baseline assessment (P < .001). Pain of the back, hands, and legs was more eased by the Nordic walking and walking group. (a) Nordic walking group T0 = first assessment, T1 = second assessment, error bars indicate standard deviations. (b) Intensity of pain in the walking group T0 = first assessment, T1 = second assessment, error bars indicate the standard deviation. (c) Intensity of pain in the flexibility and relaxation group (F&R) T0 = first assessment, T1 = second assessment, error bars indicate standard deviations.

Figure 4

The UPDRS sum score and UPDRS motor score (subscale 3) did not decrease in the flexibility and relaxation group but decreased significantly in the Nordic walking and walking group resulting in a group effect. T0 = first assessment, T1= second assessment, F&R = Flexibility and Relaxation*P < .05, error bars indicate standard deviation.

Figure 5

(a) Stride length increased significantly with increasing walking speed, and improved further on the second assessment (P < .001). Stride length improved significantly more in the Nordic walking and walking groups than in the flexibility and relaxation group (P < .001). T0 = first assessment; T1 = second assessment, error bars indicate the standard deviation. (b) Stride length variability improved most in the Nordic walking group. Nordic walking training was superior to walking (P < .01) and the flexibility and relaxation programme (F&R) (P < .001). T0 = first assessment; T1 = second assessment, error bars indicate the standard deviation. (c) The duration of the double stance phase decreased with increasing walking speed in all groups but significantly more in the Nordic walking and walking group (P < .001); T0 = first assessment, T1 = second assessment, error bars indicate the standard deviation.

Figure 6

(a) The increase of the systolic blood pressure with increasing walking speed was significantly lower after completion of the training programme in the Nordic walking ((a)) and the walking group ((b)) but not in the flexibility and relaxation group; ((c)) T0 = first assessment, T1= second assessment, error bars indicate the standard deviation. (b) Walking group. T0 = first assessment, T1 = second assessment, error bars indicate the standard deviation. (c) Flexibility and relaxation group, there was no difference between the first and second assessment; T0 = first assessment, T1 = second assessment, error bars indicate the standard deviation.

Figure 7

(a) Heart rate increase at submaximal walking speeds was lower in the Nordic walking ((a)) and walking group ((b)) than in the flexibility and relaxation group ((c)) at the second assessment resulting in a significant group effect (P < .001). T0 = first assessment, T1 = second assessment, error bars indicate the standard deviation. (b) Walking group: The heart rate response to exercise was significantly lower on the second assessment. T0 = first assessment, T1= second assessment, error bars indicate the standard deviation. (c) The heart rate of the flexibility and relaxation group (F&R) was only significantly lower at low but not at higher walking speeds. Therefore, the course of heart rate response to exercise was not significantly lower on the second assessment in the F&R group; T0 = first assessment, T1 = second assessment, error bars indicate the standard deviation.