Peripheral arterial disease - Nordic pole walking

The clinical question

Peripheral arterial disease (PAD) is caused by a build-up of fatty deposits inside the walls of the arteries of the limbs, meaning less blood supply can get through. It usually affects the legs and can often lead to aching in the calves when walking (intermittent claudication).  

Because people with PAD struggle to exercise, they are more likely to become overweight or develop diabetes, which increases their risk of further heart and circulatory diseases. National guidelines recommend that people with PAD should enrol in a three to six-month walking programme. The proven benefits of exercise include improvement in walking distance, cardiovascular fitness, quality of life and life expectancy. However, such programmes are not widely available on the NHS. And walking advice alone is ineffective, as people with claudication often find it difficult to stick to exercise regimens without support and motivation.  

Nordic pole walking is a full-body exercise using special walking poles, which is easy on the joints. The BHF funded a small trial led by Professor Jonathan Beard at the University of Sheffield to test whether a Nordic pole walking programme could help people with PAD to exercise.

What did the study involve?

Between 2011 and 2013, the trial recruited 52 people with intermittent claudication from across the UK. The participants attended a clinic visit with a physiotherapist, where they were taught the technique of Nordic pole walking. They were randomly assigned to either:

• A normal walking programme.
• A Nordic pole walking programme.

The programmes involved walking for at least 30 minutes, 3 times a week for a period of 12 weeks. To help keep the participants motivated, they were given a pedometer to measure the distance they walked. They were also supported by weekly telephone calls from one of the research physiotherapists.

What did the study show?

• The group using Nordic poles could quickly walk further than the standard walking group.
• The maximum walking distance of people in this group kept improving over the 12 weeks of the programme. 
• The standard walking group also improved their maximum walking distance, but this improvement happened later and was smaller compared with the Nordic pole walking group.

The improvement in walking distance was thought to be due to the Nordic pole walking technique reducing impact on the knees and lower body joints. This could lead to decreased calf pain. The longer stride when poles are used may give the calf muscles a longer recovery time, allowing more efficient use of the limited lower limb blood supply.

Further follow up after 1 year showed that many participants kept walking with their poles, and that their maximum walking distance and speed kept improving. 

Why is the study important?

The study showed that Nordic pole walking quickly improves the exercise capacity of people with PAD. By contrast, a standard exercise programme can take several weeks to show any improvement. The instant beneficial effect of walking with Nordic poles may also provide a psychological boost, helping people to stick to an exercise programme.

Although the study was small, it showed that using Nordic poles could help overcome barriers to exercise and improve exercise capacity in an effective and low cost way. Nordic pole walking is now recommended on the NHS website for all people to improve fitness, lose weight and tone the whole body.

Study details

"Is Nordic pole walking more effective than normal walking in improving walking distance in patients with intermittent claudication? A prospective randomised study."
Award reference:  PG/10/92/28646
Principal Investigator: Professor Jonathan Beard, University of Sheffield
Trial registration number: ISRCTN78168304

Publication details

Spafford C, Oakley C, Beard JD. Randomized clinical trial comparing Nordic pole walking and a standard home exercise programme in patients with intermittent claudication. Br J Surg. 2014;101(7):760-7.