August 2017: Kang, TW., Lee, JH., & Cynn, HS. (2016). Six-Week Nordic Treadmill Training Compared with Treadmill Training on Balance, Gait, and Activities of Daily Living for Stroke Patients: A Randomized Controlled Trial. Journal of Stroke and Cerebrovascular Diseases, 25(4), 848-856. doi:10.1016/j.jstrokecerebrovasdis.2015.11.037
Background: Cerebrovascular disease including stroke is the second leading cause of death. Although many survive, approximately 90% of patients suffer residual functional limitations. This includes impaired balance and a pathological gait. These limitations ultimately increase the risk of falls and result in a reduction in one’s ability to perform activities of daily living. In a non-affected individual, gait involves rhythmic contralateral movement. In hemiplegic patients, imbalanced gait was seen as a result of asymmetric upper and lower limb movement. Thus, this affirms why therapeutic protocols that focus on rhythmic exercises including Nordic walking have been recently investigated.
Methods: 30 post-stroke patients were included as participants. Subjects were divided into 2 groups: Nordic Treadmill Training (NTT) and Treadmill training (TT). Both interventions were applied 30 minutes per day, 5 times a week for a duration of 6 weeks under therapist supervision. A series of 6 tests were conducted on all participants to assess balance, gait ability and ADL. This battery of tests includes: Berg Balance Scale (BBS), Timed up and go test (TUG), 10-meter walk test (10MWT) and 6-minute walk test (6MWT), tetra-ataxiometric posturography (Textrax) and lastly the Modified Barthel Index (MBI). All measurements were taken pre and post intervention.
Results: 6 week test results displayed improvements in both the TT and NTT. However, the NTT group was favored, displaying significant differences from TT in all tests except for the 10MWT. The BBS test observed a 140.5% increase in NTT compared to a 37.7% in the TT group. TUG time decreased significantly by 33.3% in NTT compared to 9.0% in TT group. Significant reductions in Tretrax score were also seen by 43.6% and 25.0% in NTT and TT respectively. 10MWT decreased significantly by 66.6% in the NTT group and 59.0% in the TT group however the two groups were not statistically different from one another post intervention for this one particular test. Distance traveled in the 6MWT increased significantly by 23.3% and 10.3% while the MBI scores significantly increased by 60.9% and 34.3% in NTT and TT groups respectively.
Conclusions: 6 weeks of NTT on stroke patients resulted in increases in balance and gait which translated into improved ability to perform ADL compared to TT solely. The demonstrated response may be associated to the activation of the body’s ‘central pattern generator’, which is responsible for promoting rhythmic activity without sensory input. Thus, the rhythmic nature of Nordic walking may be the reason that NTT was more effective in improving gait ability compared to traditional TT in patients who have suffered a stroke. It is important to consider the limitations of the study. Neither the participants nor the examiners were blinded to study design. Additionally, follow up measures were not recorded thus the long-term effect of NTT is unknown. Lastly, the selected patients were not representative of the whole stroke population as they were all gait ambulatory independent with mild to moderate physical impairments.