ISSN 2423-9208

2019 no. 8
Journal of Nordic Walking

http://www.nordic-walk.info【Ｍｅｄｉｃａｌ Nordic Ｗalking Vol.1】

Journal of Nordic Walking No.8

Journal of Nordic Walking Editorial board-Honorary chairmanMiyashita M

All Japan NW Federation Honorary chairman

Yano HTokyo NW Federation Honorary chairman-ChairmanKawauchi M

Tokyo NW Federation chairman

Mihara Y

Tokyo NW Federation Vice-chairman
Osaka University Graduate School

Kurachi Y(Medicine Professor of Pharmacology

Takeda Y

President of Cognitive Neuroscience Association

Hayashi K

Shimonoseki rehabilitation hospital (director

Marutani R

Midorino Rehabilitation Hospital Deputy Director

Ota T

Dean of Ota Plastic Surgery Hospital

Tuji F

Suita Tokushukai（Regional Healthcare Department

Arai YTokyo NW Federation

Aeba T

Shimonoseki rehabilitation hospital
Kawasaki Medical and Welfare University

Yoshimura H(Associate Professor

Suzuki S

Tokyo NW Federation

Sato KTokyo NW Federation

Sakurai I

Tokyo NW Federation

Information： National Diet Library Collection
Title：Journal of Nordic walking ,J. Nord. Walk
Place of publication (country code)：JP
ISSN：24239208

ISSN-L：24239208

Language:（ISO639-2：jpn : Japanese

Journal of Nordic Walking
Issuer：Kawauchi M

E-mail： nordic-walk@umin.ac.jp

Address of correspondence: 3-5-4 Higashi-Ikebukuro Toshima-ku, Tokyo,
Japan 〒170-0013
Editor： Editor in Chief
Co-Editor

Kawauchi M

Suzuki S ,Sato K ,Sakurai I

C Journal of Nordic Walking All rights reserved○1Journal of Nordic Walking No.8

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Medical Nordic Walking Vol.1 Ｊuly.10.2019▶ Preface▶ Japanese Style Nordic Walking▶ Cardiovascular Disease▶ Orthopedic Disease▶ Neurological Disease▶ Resistance Exercise▶ Infants and Kids

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Kawauchi M
Suzuki S
Sato K
Sakurai I

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Journal of Nordic Walking No.8

▶ Preface
The Nordic Walking technique was developed in Europe. The
Medical Nordic Walking technique was later devised in Japan
Medical Nordic walkers extend their arm forwards and place
their poles while their arms are at the handshake position. Thenthe walkers push the pole softly while stepping forward. The
Medical Nordic walkers exercise their upper body and coremuscles in addition to the leg muscles while relieving some
impact on the lower body.

Nordic Walking and Medical Nordic Walking increase the cardiac
output8-20%compared with usual walking in the same speed.
This relief of the impact as much as30%from the lower body andbenefits the patients with the problems of hip, knee legs andvertebrae. Using the upper limbs, the stride is wider than normal
walking, and the walking speed is also increased. The Nordic
walking has increased ventilation volume, oxygen uptake, andheart rates as compared to walking at the same speed. The samelactic acid concentration, heart rate, oxygen uptake can beachieved at as lower walking speed than usual walking You canwalk slowly and safely with Nordic Walking/Medical Nordic
Walking when doing the same aerobic exercise.
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Journal of Nordic Walking No.8

Nordic Walking is recognized as an aerobic exercise that can be
performed by patients with heart disease, and listed as one of theexercise items in the cardiac rehabilitation guide line inGermany and Europe.

4Journal of Nordic Walking No.8

▶ Japanese Style Nordic Walking
About Japanese style Nordic Walking
The results of rehabilitation by Nordic Walking with patients ofcardiovascular disease were presented at overseas conferences,
but there was a problem in explaining how to walk. When I used
the words Nordic Walking, foreign people thought of thecompetition type Nordic Walking that I learned in Germany.
When I explained to them the details of how to walk with Nordic
poles at my rehabilitation hospital in Japan, they told us thewalking was not Nordic Walking but Japanese-style Nordic
Walking. That's why it became Japanese Style Nordic Walking.
The term Medical Nordic Walking is also great, but I was worried
whether healthy elderly people would use the name or not. We
usually walk smoothly and easily. But if we might be involved in
the traffic accident and get injured, then it would be difficult towalk and long and hard rehabilitation will be required. Once welose our walking capability, our quality of life deteriorates to'Frail'. 'Frailty thy name is woman' is one of the very famouswords of William Shakespeare.

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Journal of Nordic Walking No.8

Various Japanese Nordic walking

Adult

Small kids

100-years-old

Parkinson’s Disease

Cerebral Infarction

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Journal of Nordic Walking No.8

Japanese Style Nordic Walk

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Journal of Nordic Walking No.8

Instructor’s Nordic Walking
Nine Nordic Walking instructors of Japan Nordic Walk League
were analyzed by 3D analysis system(MAC3D)at Japan
Institute of Sports Sciences (JISS).
Their normal walking and Japanese Style Nordic Walking werecompared at comfortable walking speed. Nordic poles used inthis study were devised in Japan.
・Result

Fig. Japanese Style Nordic Walking model8

Journal of Nordic Walking No.8

1. Acromion
From the acromion markers, The axial rotation is larger in
Nordic walking than in normal walking（normal walking vsJ-style Nordic Walking,9.45±2.97 vs.20.50±10.26°)(P<0.05）

2. Pelvis rotation
Pelvis rotation movement, Pelvic rotation is almost same in theNordic Walking and free walking（Free gait vs J-style Nordic
walking, 12.26±3.45°vs. 13.72±4.36°,n.s）.

3. Center of gravity ( COG )The vertical movement of center of the gravity in the Nordic
Walking is larger than that of free walking（Free gait vs J-style
Nordicwalking,1.23±0.04 vs1.24±0.04（cm/TMD）(p<0.05)）.

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Journal of Nordic Walking No.8

4. Stride
As the Nordic Walking increased the Stride（Free gait vs J-stylenordicwalking,43.35±4.84vs45.09±5.13（Step/Lowerlib%）,p<0.05）. And, Nordic Walking also decreased the cadence.
（Free gait vs J-style
Nordicwalking,228.38±20.15vs.208.76±25.77（Step/min）,
p<0.05）.

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Journal of Nordic Walking No.8

▶ Cardiovascular Disease
Exercise for Patients of Cardiovascular Disease
Exercise related sudden death is common in middle-aged andelderly men and it happens during or immediately after exercise.
The mortality during jogging is reported to be seven times ashigh as that of the predicted heart attack rate during normal life.
The main causes of sudden death during sports are ischemic
heart disease and acute heart failure, and also cerebrovasculardisease. Even though middle-aged or elderly men have excellent
exerciseability, it is not the evidence that they have no heartdisease. There is also a report that there were several runners
who died of heart disease within a few weeks after they finishedthe90kmmarathon. If you have symptoms such as chest pain,
heart palpitations, shortness of breath, fatigue, dizziness, you
should not start exercise and consult with your doctor. One
should stop exercise and give priority to treatment. If patientswith impaired cardiac function gain the body weight of 2kg or
more with in 3 days, if the shortness of breath on exertion isexacerbated, there is a high possibility that heart failure has
aggravated. Then the patient should seek the opinion of theirdoctor. On the other hand, the correct exercise therapy not only
improve the risk factors of cardiovascular disease but also
prevent it. Even a person with a cardiac disorder can safely
perform aerobic exercise such as walking or Nordic walking whendescribed properly. It is also reported that the risk of sudden
death does not increase during appropriate exercise.

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Journal of Nordic Walking No.8

So, how much exercise should we do? The aerobic exercise about
20-30 minutes three times a week is recommended. As better
than no, the American Society of Sports Medicine also accepts
exercise for 10 minutes two or three times a day. At the beginningof exercise, it is easy to understand and also safe to start with
exercise intensity (METs )equivalent to the daily life acitivity.

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Journal of Nordic Walking No.8

Nordic Walking for patients with Cardiovascular disease
Paracelsus University in Salzburg Austria reported a systematicand comprehensive literature search performed between
November 2010 and May 2012. Sixteen RCTs with a total of 1062
patients and 11 observational studies with 831 patients wereidentified. The current analysis revealed that with regard to
short- and long-term effects on heart rate, oxygen consumption,
quality of life, and other measures, Nordic walking is superior tobrisk walking without poles and in some endpoints to jogging.
Nordic walking exerts beneficial effects on resting heart rate,
blood pressure, exercise capacity, maximal oxygen consumption,and quality of life in patients with various diseases and can thus
be recommended to a wide range of people as primary andsecondary prevention.
Nordic walking uses the upper body muscle to increase theforward driving power, and the stride and walking speed increase
compared to normal walking, and oxygen consumption also
increases by 20% to 23% of walking. This also means that thesame lactate concentration, heart rate, and oxygen intake can beachieved at a slower rate in Nordic Walking than in walking,which means that you can walk slowly in Nordic Walking, even if
you perform the same aerobic exercise.
J-style Nordic Walking, devised in Japan, targets on preventing
falls and maintaining balance by placing the pole in front of thebody, usually around the forefoot, with emphasis on braking
power rather than driving.

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Journal of Nordic Walking No.8

Walter and Porcari reported in1996 that that at a given speed,
the use of Nordic walking poles can safely increase the intensityof walking exercise in Phase III/IV cardiac rehabilitation patients.
Walking with Nordic poles significantly (P < .05) increased theenergy cost of walking by 21% (3.8 mL/kg/min) compared towalking without poles. There were also significant (P < .05)
increases in HR (14 bpm), SBP (16 mm Hg), and DBP (4 mm Hg)
when comparing conditions. Calculated oxygen pulse (mLO2.heart beat) values indicated that changes in HR wereconsistent with the increase in VO2 and were not related to apressor response mechanism. The only dysrhythmias noted wereisolated PVCs, with no differences in the frequency of occurrence
between trials. There were no adverse ST segment changes witheither trial.
Even in elderly patients with cardiovascular disease in our cases,
it was observed that blood pressure and heart rate increased
during 100m Nordic Walking compared with T-cane walking.

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Journal of Nordic Walking No.8

Hypertension
Treatment of high blood pressure by aerobic exercise is a pillar of
non-drug treatment as well as diet and exercise therapy in mild
hypertension where systolic blood at rest is just more than 140mmHg. Severe hypertension whose systolic blood pressure at restis 180 mmHg, is controlled by drug treatment. However, as far as
the hypertension is well controlled and life style disease, theaddition of exercise therapy is effective not only for the
improvement of high blood pressure itself but also for treatmentof lifestyle-related diseases. When you stop exercising, the effectdisappears.

Not only at the beginning but also during exercise, high bloodpressure is a problem often encountered in aerobic exercise
prescriptions. In patients with high blood pressure, it isrecommended to measure the blood pressure before exercise.
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Journal of Nordic Walking No.8

When the blood pressure is over 180mmHg, only the stretching ispossible and patients should refrain from aerobic exercise. If theblood pressure is more than 200 mmHg before exercise, consult
with a doctor and instruct patients to have treatment. If apatients has symptoms such as chest pain, palpitations,shortness of breath, fatigue, dizziness, lightness etc, you should
not start exercise or stop your exercise and consult with yourdoctor even if the blood pressure is below 180mmHg. If the bloodpressure exceeds 200 mmHg during exercise, reduce the intensity
so that the blood pressure is less than 180 mmHg. In case theblood pressure exceeds 200 mmHg even if the exercise intensity
is reduced, exercise should be discontinued. At the end of theexercise, if the blood pressure is 200 mmHg or more, and if there
are no chest pain, palpitations, shortness of breath, fatigue,dizziness, dizziness or other symptoms, rest slowly about 5-10
minutes, and return home if the blood pressure comes down
below 180 mmHg. Arrange for a doctor's visit for patients who
have blood pressure that is not readily falling or who havesymptoms.

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Journal of Nordic Walking No.8

Ischemic Heart Disease(Angina Pectoris, Myocardial Infarction )Aerobic exercise with appropriate intensity not only improves thephysical condition that triggers ischemic heart disease but also
causes the progression of arteriosclerotic lesions and sometimes
even ameliorates coronary artery stenosis. Nordic Walking islisted as one of the aerobic training events in the guidelines for
cardiac rehabilitation and prevention and treatment ofcardiovascular disease in Germany. In a study of 80 patients withacute myocardial infarction in Poland, significant improvement
in exercise capacity was observed when Nordic walking wasadded to the 3-week hospitalized cardiac rehabilitation program.
Ischemic heart disease is caused by the progression ofarteriosclerosis in the coronary arteries of the heart. Oxygen andenergy necessary for contraction of the heart are supplied
through coronary artery which arises from the root of the aorta.
When metabolism is increased during exercise or bathing, oxygen
demand in the myocardium is increased. Myocardial oxygen
consumption is proportional to the double product which is the
product of systolic blood pressure and heart rate. Aerobic exercise
is an effective method for preventing the arteriosclerosis in thecoronary artery, but it is important to exercise in the range where
systolic blood pressure does not become too high nor heart rateincreases too much.
An 81-year-old man with a history of coronary artery bypass
grafting has a leaning forward standing posture. has a very short
stride, and has a rush type walk. The adjustment of walking
speed was also impossible, and angina and electrocardiogramchange occurred at about 200 m. When his trunk was raised by
Japanese-style Nordic walking and the forward lean posture iscorrected, The static balance was improved, the stride length
also spread, and he walked at a slow pace (2 km / h). Thesechanges made him possible to walk without an increase in heart
rate and blood pressure. And when he continued walking for17

Journal of Nordic Walking No.8

more than 1 km, angina pain and ECG change did not appear. In
addition, a cardiopulmonary exercise test could be conducted andNordic walking at a heart rate below the ischemic threshold of 80/ min was prescribed.

A 72-year-old woman with a history of cardiac bypass surgery for
angina pectoris developed effort angina again. She visited myoutpatient clinic. As the evaluation revealed her disease is mild,
so we decided to use Nordic walking exercise therapy in
combination with an increase in drugs for angina pectoris. I
prescribed Nordic Walking at 100 beats per minute, which was
70% of heart rate when chest pain appeared. Seven years after
the prescription, She can enjoy the Nordic walking of 30-40
minutes without chest pain.

Heart Failure
In patients with chronic heart failure, symptoms such as
breathlessness, sweating, edema, should be checked during
Nordic Walking. Heart failure develops not only during Nordic
Walking but on the following day, or after the following day.
Therefore, heart failure improvement or aggravation is judged byweight change (weight gain of 2 kg or more within 3 days) or
cardiac shadow size of chest radiograph etc. Cardiovascularspecialist should manage such patients. If you have heart disease,even mild, you can consult with your cardiovascular physician
before you begin your Nordic Walking habits.
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Journal of Nordic Walking No.8

Instructors can ask patients with heart disease how things aregoing their daily life. As the exercise intensity in daily life
corresponds on the degree of oxygen uptake, so we can judge how
fast and how long the can walk. For example, A person who caneat and wash by oneself can walk as fast as 30 meters per minute.
You let him walk for 5-10 minutes and observe the his condition.
If you feel he is comfortable and relaxed, you can graduallyextend his Nordic Walking time
A male patient aged 86-year old had a lumbar compression
fracture, and was admitted to our hospital for rehabilitation. He
also had a mitral valve heart disease. First, I performed
stretching exercise and started gait training after alleviating
lumbar back pain. By introducing the Nordic walking, He became
possible to walk 400m after 4 weeks of rehabilitation.

Arteriosclerotic Obstruction (ASO) and Intermittent
Claudication
Arteriosclerotic obstruction is the disease which cause stenosis
and/or obstruction of the arteries in the lower extremities With
the progression of arterial stenosis, if you walk at a distance yourleg muscles may become sore and sore and you will not be able to19

Journal of Nordic Walking No.8

continue walking. When you stop walking, then the pain releases.
But pain relapses at the same distance as resuming walking.
This is intermittent claudication which limits the patient's
walking distance and lowers quality of life. Nordic Walking wasreported to be effective against intermittent claudication. Oakleyreported that Nordic Walking immediately enabled patients withintermittent claudication
further with less pain. Collins
reported that, Nordic Walking of 30-45minutes 3 times a week
decreased the pain in intermittent claudication and increased
traveling distance and walking speed. Thus, the symptoms ofintermittent claudication will be improved by repeating a certain
degree of Nordic Walking. As the coronary artery disease is often
complicated, so it isimportant to obtain the permission of thephysician and monitor the electrocardiogram during exercise.

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Journal of Nordic Walking No.8

Sports Exercise Therapy in Groups
What is the risk of doing sports exercise therapy? Van Camp andothers surveyed 167 cardiac rehabilitation programs in the
United States, within 1 million people x time, there were 8.9
people with cardiac arrest, 3.4 with myocardial infarction and 1.3
with heart death. Makita also reported that in his 12 years of
exercise therapy with of 267 patients (average age 63.5 years,
average rehabilitation participating organization 37 months), he
had experienced no major accident including cardiac death
during exercise.
We have Group Nordic walking in gait training in convalescentrehabilitation. The purposes are creating a place for social
interaction during long hospitalization and acquiring exercise
habits for maintaining health after discharge.. Fifty-six patientswith cerebrovascular disease, 45 patients with orthopedic disease,and three others, a total of 104 people from 29 to 87 years old(average 64.2 years old) have participated so far. Participant
criteria is the ability to walk over 1.2km continuously with
Nordic poles.
There are the 3-course ; Okamoto Taro course (1.85km) Kitahara
Hakushu course (1.85km) navy course (2.35km) inside the Tama
Relic garden just located in front of the hospital. As a part ofoutdoor walking training, one patient will be accompanied by one
therapist. The walking time is about 40 minutes, and it walks
while putting one break and hydration on the way. The averageheart rate increased from 73/minutes to 96/ min. An increase inheart rate of 30% was recognized as the appropriate exercise load.
The age group of the Nordic Walking class is wide, and men andwomen are also involved. There are various purposes such as “Iwant to walk a long distance”, “I am interested”, and “I aminterested in the Nordic walking”, but I enjoy the Nordic walking
peacefully while chatting with the patients and staff. After theNordic Walking class, the voices from the patients were, "Itbecame a good exercise" "I was able to feel the season" "I want to
do a Nordic walking even after discharge" "It became a goodmemory before discharge" "It became a good refreshment" We
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Journal of Nordic Walking No.8

could hear various positive impressions. There are also many
greenery along the Tama cemetery and the Nogawa river, andpatients could do the Nordic walking while feeling the seasons
such as cherry blossoms in spring and autumn leaves in autumn.
Patients also could improve the mental energy for discharge.

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Journal of Nordic Walking No.8

Heart Rate Measurement during Exercise
The aerobic exercise load is usually prescribed as heart rate.
Then we often measure the pulse rate to confirm the exercise
load. On the other hand, the decrease in heart rate one minuteafter aerobic exercise is about 60%. As the heart rate decreases
rapidly after the end of exercise, so if the pulse is not measured
without delay, we can not know whether the excise load isappropriate or not.
In the study of healthy adults, the pulse measurement using
electronic sphygmomanometer after sitting on the chair showedsignificantly lower pulse ratecompared to the pulse count immediately after Nordic walking,The heart rate decay of patients with severe heart disease takes
longer compared to healthy adults, especially the exercise load issevere. Heart rate (pulse) management is mandatory withpatients with heart disease.

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Journal of Nordic Walking No.8

▶ Orthopedic Disease
Compression Fracture (CF)
Nordic walking is reported not only for its exercise effect, but also
for its usefulness in the field of rehabilitation such as spinal
compression fractures.
Wendlova at Dere University calculated the effect of reducing
gravity on the spine,. using a J-style nordic poles with the elbow
at right angles and the tip at right angles to the ground. The 44%of the static pressure due to gravity goes to the poles and then thestatic pressure on the spine is reduced to 56%. Nordic poles
reduce the load on the legs by 30% compared to walking andjogging.

Twenty three patients with vertebral compression fractures, whowere 65 years of age or older were investigated to determine themaximal walking distance with NW compared walking with T
cane. Their average age was 83.2 ± 5.3 years, and they were 3
males, 20 females. The maximum walking distance of the
T-shaped walking stick was 5m-1083m, the average of 238.8m,
and the maximum walking distance of the NW was 50m-1030m,
the average of 325.6m(P <0.01).

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Patients with Spinal Cord Injury
There were also cases with spinal cord injury and in which
independent gait was obtained early by incorporating the Nordic
Walk into the rehabilitation program
A case study: A male patients in his fifties.
He fell from a height of 5m when landing with a hang-up rider,and was injured. A marked decrease in muscle output andsensory impairment below the 4th lumbar level was noted due toparesis in both lower limbs. At the time of admission to ourrehabilitation hospital, he was at the walker-assisted walking
level with the short leg brace attached. Incorporating NW into
the rehabilitation program from the 12th day of admission to our
hospital, we were able to obtain stable and powerful walking.
With regard to stability, it was thought that the light touch effect
was affecting the imbalance caused by severe sensory
impairment from the soles of both legs to the back of the thighs
and lower legs.The light touch effect means that by touching the
fixed point lightly with a finger tip, Nordic pole etc., the posturefluctuation during standing posture is reduced.
His standing balance declined because of the decrease in theankle plantar flexion power. Since a man walks with 4-point
support in NW, the support base surface expanded from T-shaped
cane, and the stability increased. Gradually, both lower extremity
muscle strength, perception impairment, balance ability
improved. From the sixth week of hospitalization, it became
possible to walk by NW within the ward. Finally he walked1.5km
with Nordic poles outside the hospital. After discharge our
hospital, he commutes for reinstatement while using the NW.

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Journal of Nordic Walking No.8

Osteoarthritis
Yoshimura reported the reduction of the lower limbs burden of
the NW for 10 healthy adult men around 20 years old. In the floor
reaction force of the NW, the peak value of the floor resilience at
the mid-term standing decreased by 8.7% of the body weightcompared to the normal walking. Distributing the load to thepoles, the NW decreased the vertical burden on the lower limbs.
Furthermore, NW improves the stability in the horizontal
direction. NW is eligible for walking exercises in various diseases
such as osteoarthritis of the lower extremities, rheumatoid
arthritis, and ataxia.
Yoshimura compared the effect of NW with T-cane walking on
maximum walking distance in postoperative patients with knee
osteoarthritis. The patients were 19 women with age 70 or older(mean age 80.2 ± 4.2)and without cognitive problems.
The maximum walking distance of the NW was 176.4m ± 129.9m,
and was significant longer than that of the T-cane walking stick(112.8m ± 71.7m (p <0.05)).
(m)

TW: T-cane Walking, NW:Nordic Walking

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Journal of Nordic Walking No.8

Degenerative Hip Arthropathy
The usefulness of NW for patients with degenerative hiparthropathy has been proved in a very large number of patients.
Please refer to Dr. Yano's report for details

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Journal of Nordic Walking No.8

Relationship between Nordic Walk and Basic Motion
Tazaki et al. evaluated Relationship between J-style Nordic Walk
Effect and Stand up motion in 20 elderly patients (age85-93）withorthopedic disease. We examined the group of patients who could
improve walking by Nordic Walking (groupA) , and the groupthat decreased walking (groupB). There was a significant
difference in the Stand up motion (X2<0.01).

Fig. Grouping in the immediate effects of the Nordic Walk

Fig. Difference in the Stand up motion
Patients in group A could stand up from the chair independently.
Patients in group B needed to support by hand action their standup motion.

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▶ Neurological Disease
Parkinson’s Disease
NW is known as a very effective method of walking for patientswith Parkinson's disease. We held a symposium with the patientof Parkinson's disease at Walking Grand Festival in Kanazawa
held in 2016. And Dr. Ryuji Marutani gave a lecture on how toteach NW to Parkinson’s disease.
In technical guidance, more than 60 patients with Parkinson's
disease walked at the same time together with Dr. Marutani andinstructors from Tokyo and Ishikawa NW Federation.

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Unilateral Use of Nordic Pole on Patients with Stroke
Comparison with T cane
Since NW is performed by holding the pole on both upper limbs,
it is often excluded when the functional decline of the upper
limbs are accompanied. Hirota Y. et al reported the feasibility of
unilateral Nordic pole (following: NP) use on walking. They
compared unilateral Nordic Walking with the walking practiceusing T-cane based on the result of 10 m walking time and thenumber of steps.
Eight patients, six men and two women, with brain stroke and in
the rehabilitation hospital were included in the study. Theiraverage age is 65.8 ± 12.9 years. The original diseases were
cerebral infarction in 6 patients and cerebral hemorrhage in 2
patients. The exercise capacity were Brunnstrom stage IV in 1
patients, V in 4pts. and VI in 3. Those with severe higher brain
dysfunction, severe cognitive decline, and limited range of motion
were excluded.
Ten-meters walks (comfortable walking speed) were performed
twice using T-cane and using unilateral NP. The height of thecane was adjusted to the height of T-cane for the large trochanterand NP for the height multiplied by 0.63 of body height (Photos 1,2). In addition, the walking style adopted Japanese style Nordic
walking.

Photo131

Photo2

Journal of Nordic Walking No.8

Walking with unilateral Nordic pole showed a significant
decrease in the number of steps for 10 m walking compared withwalking using T-cane (T-cane walking: 23.4 steps on average, NP
walking: 21.2 steps on average, p <0.05) ) .
Although no significant difference was found, the walking time
also tended to be shorter with the unilateral NW. Seven out ofeight patients decreased the number of steps and shortened thewalking time with unilateral NW.

The use of the Nordic poles have been reported to promotes theextension moment of the trunk and influences the extension
angle of the trunk and the hip joint.
The case of unilateral NP, was also considered that the 10m
walking time was shortened and the number of steps was
reduced along with the extension angle of the hip joint during
walking. In addition, the extension of the hip joint raises thecenter of gravity, which means an increase in potential energy,
and along with the extension of the large lumbar muscles thatare hip flexors. As the swinging performance of the pendulum
movement mainly based on the intrinsic inertia force.Tthe
extension angle of the hip joint might also lead to a good results.

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Journal of Nordic Walking No.8

▶ Resistance Training
Since 2000, the American College of Cardiology has
recommended that not only aerobic exercise but also muscle
strengthening (resistance exercise) should be prescribed forpatients with cardiovascular disease. The representative effect of
resistance exercise is not only a muscle strengthening effect, butalso for prevention from fall over in the elderly. And moreover, it
increases the maximal oxygen uptake, especially activating thebasal metabolism.
Not only aerobic exercise but also resistance training ofappropriate strength are safe for patients with cardiovasculardisease. Resistance training is usually assessed on the basis of 1
RM (1 repetition maximum), the maximum load only for one time.
Resistance training, 50-80% of 1 RM, improves muscle strength,balance, endurance. From the hemodynamic point of view, it isconsidered safe even for the patients up to the age of 90.
Resistance trainings are recommended to start from a light load
which can be easily repeated 20 times and “light” in the Borg
index” (20-30% of maximum repetition weight), and thengradually increase the load. For the first, the patients arerecommended to start from ten times a set and progress to 15
times a set.
For elderly people and people with weak muscle, it is desirable toprescribe a light load and increase the number of exercise
thereafter. Fardy introduced in his book “Sports rehabilitation forheart disease”, that Nordic walking is effective in providing
muscle strength and endurance in the upper limbs and is also
extremely useful in improving energy consumption.

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Nordic walking uses the upper body strength as compared tonormal walking, which means that you are already doing upper
body resistance training with Nordic walking. The Nordic poles
can reduce the load of the trunk and legs by 30-40%. Then, theelderly and weak muscle patients can participate resistancetraining with Nordic poles.

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Journal of Nordic Walking No.8

Heart warming up: Resistance Training
1) Heel Raise (Lower thigh triceps)

Raise your heels slowly then transfer your weight on the ball of
the thumb and stand on tiptoe.
1 set 10times. You can wait 5 seconds on tiptoe.
2) Toe Up (Tibialis anterior)

Point the foot up. Put your strength on the muscle in front oflower leg, tibialis anterior muscle. Once at the top, stand still a
moment. Ten times a set.

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Journal of Nordic Walking No.8

3) Lower Thigh Up

Float your right foot, and kick 10 times with your knee joint as
the fulcrum. (Quadriceps)
Let’s also do your left foot 10 times.
Then you kick up behind 10 times for each foot (Biceps femoris)
4) High Knee

Raise your knee up slowly and carefully 10times for each side.
( Iliopsoas muscle) Easy height for those who are not used to do.
The knee will be right angle for those who accustomed.

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Journal of Nordic Walking No.8

5) Body Twist (Trunk Muscle, Oblique muscle)

Carrying Nordic poles on the shoulder behind your neck.
Bend your knees slightly and the turn the trunk right and left.
6) Gluteal Muscle Strength

Stand with your back to the partner. One lifts the right foot andthe other lifts the left foot.And then hold each other’s foot firmly
together. You can support your bodies. Ten seconds for each
side.

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7) Adductor Muscle of the Leg

Open your legs back and forth. Press the inside of your knee withyour partner and push mutually, 10 seconds for each leg.
Advanced training: Press the inside of your ankle with yourpartner and push 10 seconds as well.
8) Abductor muscle of the leg

Press the outside of your knee with your partner. Force on themuscles outside (Gluteus muscle and thighs outside) and push 10
seconds for each leg.
Advanced training: Press the outside of your ankle with yourpartner and push 10 seconds as well.

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9) Plunge Hip Joint

Bend your knee slowly and keep your knee behind the foot. Fivetimes for each side. Let’s drop your waist deeply when you get
used.
10) Squat (Muscles of Body trunk, Hip, Thigh Lower legs)

Keep your feet at the shoulder width, open the toes at 10 and 2
O’clock position. Place the poles in front of your feet. Balance
yourself with your hip backwards and sink your body. Do notstand on your tiptoe while moving up and down. Start with
5times and proceed to 10 times a set.

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11) One Leg Squat

Stand on one leg with your ankle and knee slightly bent. The freeleg come out forward and the knee is at same height withbuttocks. Keeping your trunk straight, bend the buttock, knee,
and ankle of the support leg.
12) Step Climbing

The height setting is 10cm at the begging. Ten times for each leg
alternately.

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▶ Infants and kids
The Nordic Walk, which has been widely used in Japan in recent
years, has also been launched for children and also for infants.
The Nordic Walkng, walking while operating the hand, is also
attractive as an element of children's play. There has been noreport in the infancy stage, then I would like to explore thestructure of the Nordic walking whether it can be introduced as aplay in the infancy stage.

Nordic Walking Growth
Nordic Walking growth process, and pole works. The outward
pole abduction tended to disappear while children grow up. I
showed a response to the Nordic walking in the rapidly
developing early childhood. The Nordic Pole has two simple
shapes, such as holding the hand straight, reaching out andtouching and manipulating the simple NW pole in thesensorimotor phase. As in the recorded gait, children raised theirhand wide and balanced while walking.
<Days age 435 744 1142 >< Days age 569 689 1280>

About Nordic Walking Infant’s movement
We examined Nordic Walking of Infants ( days age: 1578（±
727.6）,weight: 15.9 ㎏（±5.7）, Height: 100.9cm（±17.1））by 3D
analysis system.

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1. Speed
The walking speed in one walking cycle was significantly reducedin the Nordic walking compared to free walking（Speed: free gaitv.s NW, 0.904 (±0.170 ) v.s 0.715 (±0.121) (m/s),p<0.05）（Speed
SD: free gait v.s NW, 0.149 (±0.065) v.s 0.091 (±0.044)(°),p<0.05）.

2. Lateral balance
Nordic Walking significantly expanded to trunk lateral flexion
while walking compared to free walking（free gait v.s NW,
10.30(±3.5) v.s 14.13(±4.87) (°),p<0.05）.

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3. Stride
The Nordic walk showed a decreasing tendency compared to thefree walking during one walking cycle in the right heel（free gaitv.s NW,0.070(±0.156) v.s 0.669(±0.201)(m),n.s）.

Rehabilitation model
In child's posture control, putting Nordic Walking poles on astable floor with a slight force is effective. It will be the influenceof effect of light touch.

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Journal of Nordic Walking No.8

Medical Nordic Walking Vol.1
by

KAWAUCHI Motohiro&

SUZUKI Seiji
SATO Kazuhisa
SAKURAI Ippei
C Journal of Nordic Walking All rights reserved July 10 2019○44