High-Intensity Interval Nordic Walking for Coronary Artery Disease

(HIIT-NoW Trial)

Overseen By Matheus Mistura, MSc

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Ottawa Heart Institute Research Corporation

Disqualifiers: Unstable angina, Atrial fibrillation, COPD, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 11 weeks

40 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the treatment High-Intensity Interval Nordic Walking for Coronary Artery Disease?

Research shows that Nordic walking, when combined with standard cardiac rehabilitation, improves physical activity levels, aerobic efficiency, and quality of life in patients with coronary artery disease. It also positively affects certain risk factors for heart disease, making it a more effective therapy than standard cardiac rehabilitation alone. ^{1 2 3 4 5}

Is High-Intensity Interval Nordic Walking safe for people with coronary artery disease?

High-Intensity Interval Training (HIIT), which includes High-Intensity Interval Nordic Walking, has shown a low rate of major adverse cardiovascular events in patients with coronary artery disease when used in cardiac rehabilitation settings, with only one major event occurring per 17,083 training sessions. ^{1 2 4 5 6}

How is high-intensity interval Nordic walking different from other treatments for coronary artery disease?

High-intensity interval Nordic walking is unique because it combines the benefits of high-intensity interval training (HIIT) with the full-body engagement of Nordic walking, which uses poles to work more muscle groups. This approach not only improves cardiovascular health but also enhances functional capacity and quality of life, making it a novel option compared to traditional exercise therapies. ^{1 2 3 5 7}

What is the purpose of this trial?

Coronary revascularization, such as heart bypass surgery (CABG) and percutaneous coronary intervention (PCI \[inserting a stent to open up blood vessels\]) improve survival for people with coronary artery disease. Yet, many patients suffer from poor physical and mental health after coronary revascularization. Traditional cardiac rehabilitation involving moderate-to-vigorous intensity continuous training (MICT) improves physical and mental health. However, alternative exercise programs, such as high-intensity interval training (HIIT) and Nordic walking may provide superior benefits. Nordic walking is like Nordic skiing but uses specifically designed poles for walking. Nordic walking involved core, upper and lower body muscles, resulting in greater energy expenditure while reducing loading stress at the knee. To date, HIIT used in cardiac rehabilitation settings has focused on lower body (e.g., leg cycling). The investigators are not aware of HIIT protocols that target both upper and lower body at the same time. An exercise program that combines HIIT and Nordic walking (HIIT-NoW) may offer an alternative time-efficient whole-body exercise to improve physical and mental health. This study will test if HIIT-NoW can be an alternative exercise option to improve physical and mental health in patients with coronary artery disease.

Research Team

Jennifer L Reed, PhD

Principal Investigator

Ottawa Heart Institute Research Corporation

Eligibility Criteria

This trial is for patients at least 40 years old with coronary artery disease who have had a stent inserted or heart bypass surgery. They must be willing to attend exercise sessions on-site, able to perform an exercise test measuring heart and lung function, and not currently in cardiac rehab.

Inclusion Criteria

You can do a special breathing and exercise test.

I am willing to attend exercise sessions in person.

I have had heart artery treatment with stenting or bypass surgery.

Exclusion Criteria

Unable to return for 10-week follow-up visit

I have heart or severe lung conditions like unstable angina or COPD.

You are currently taking part in a clinical research program.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo high-intensity interval Nordic walking training or standard cardiovascular rehabilitation

11 weeks

Weekly sessions

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Treatment Details

Interventions

• High-intensity interval Nordic walking
• Standard cardiovascular rehabilitation

Trial Overview The study is testing if high-intensity interval Nordic walking can improve physical and mental health better than standard cardiovascular rehabilitation. It's a new way of exercising that works the whole body by using special poles while walking.

Participant Groups

Group I: High-intensity interval Nordic walking Experimental Treatment 1 Intervention

Participants will receive high-intensity interval Nordic walking training.

Group II: Control Active Control 1 Intervention

Participants will undergo standard cardiovascular rehabilitation.

Who Is Running the Clinical Trial?

Ottawa Heart Institute Research Corporation

Lead Sponsor

Trials

200

Recruited

95,800+

Findings from Research

Nordic walking (NW) in patients rehabilitated after coronary events demonstrated an exercise intensity of 59% of their VO₂ reserve, indicating it is a safe and effective form of endurance training in cardiac rehabilitation.

The peak heart rate during NW reached similar levels to those observed during treadmill cardiopulmonary exercise tests, suggesting that NW can provide comparable cardiovascular benefits as traditional exercise testing.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Oxygen uptake during Nordic walking training in patients rehabilitated after coronary events. Rybicki, JR., Leszczyńska-Bolewska, BM., Grochulska, WE., et al.[2017]

The study found that the Polar H7, an ECG-based heart rate monitor, showed excellent accuracy in measuring heart rate during both Nordic and conventional walking, with a high concordance correlation coefficient of 0.96 compared to the reference ECG.

In contrast, the Fitbit Charge 2, which uses photoplethysmography, was less accurate during Nordic walking, showing a significantly higher mean absolute difference in heart rate measurements compared to the Polar H7, indicating that ECG-based devices are preferable for monitoring heart rate in this exercise method.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Accuracy of Wearable Devices for Measuring Heart Rate During Conventional and Nordic Walking. Baek, S., Ha, Y., Park, HW.[2021]

A 12-week exercise program of high-intensity interval training (HIIT), moderate-to-vigorous intensity continuous training (MICT), or Nordic walking (NW) led to significant improvements in functional capacity, quality of life, and depression symptoms in patients with coronary artery disease, with effects sustained up to 26 weeks after the program.

Nordic walking was particularly effective, resulting in a greater increase in functional capacity (measured by the 6-minute walk test) compared to HIIT and MICT, suggesting it may be a superior option for enhancing physical performance in these patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Sustained Effects of Different Exercise Modalities on Physical and Mental Health in Patients With Coronary Artery Disease: A Randomized Clinical Trial. Terada, T., Cotie, LM., Tulloch, H., et al.[2022]

In a study of 40 patients aged 56-70 with chronic coronary syndrome after PCI, adding Nordic Walking (NW) to standard cardiac rehabilitation significantly improved physical activity levels and aerobic efficiency compared to the control group.

Patients who participated in NW training reported better quality of life and showed positive changes in biochemical risk factors for atherosclerosis, indicating that NW is a beneficial addition to cardiac rehabilitation for enhancing recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effects of Cardiac Rehabilitation including Nordic Walking in Patients with Chronic Coronary Syndromes after Percutaneous Coronary Interventions in Elective Mode. Januszek, R., Kocik, B., Siłka, W., et al.[2023]

A one-year Nordic walking program for patients with uncontrolled cardiovascular risk factors led to a significant reduction in these risk factors, from an average of 4.78 to 3.

Participants also showed improvements in quality of life and better adherence to medical treatment, indicating that Nordic walking can be an effective intervention in managing cardiovascular health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nordic walking for cardiovascular prevention in patients with ischaemic heart disease or metabolic syndrome. Vehí, C., Falces, C., Sarlat, MÀ., et al.[2017]

High-intensity interval training (HIIT) is as effective, if not more so, than traditional moderate-intensity continuous training (MICT) for patients with cardiovascular disease, based on a systematic review of 23 studies involving 1117 participants.

The safety profile of HIIT in cardiac rehabilitation is promising, with only one major cardiovascular adverse event reported per 17,083 training sessions, indicating that HIIT can be safely implemented in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

High-Intensity Interval Training for Patients With Cardiovascular Disease-Is It Safe? A Systematic Review. Wewege, MA., Ahn, D., Yu, J., et al.[2021]

In a study of 74 women over 55 years old, both Nordic Walking and conventional walking improved aerobic capacity and reduced total cholesterol levels after 12 weeks of training.

While Nordic Walking specifically led to significant improvements in low-density lipoprotein cholesterol, there were no significant differences in outcomes between the two walking methods, indicating both are beneficial for health in older women.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effects of Nordic Walking Compared to Conventional Walking on Aerobic Capacity and Lipid Profile in Women Over 55 Years of Age. Witkowska, A., Grabara, M., Kopeć, D., et al.[2022]

References

1. Poland pubmed.ncbi.nlm.nih.gov

Oxygen uptake during Nordic walking training in patients rehabilitated after coronary events. [2017]

2. United States pubmed.ncbi.nlm.nih.gov

Accuracy of Wearable Devices for Measuring Heart Rate During Conventional and Nordic Walking. [2021]

3. England pubmed.ncbi.nlm.nih.gov

Sustained Effects of Different Exercise Modalities on Physical and Mental Health in Patients With Coronary Artery Disease: A Randomized Clinical Trial. [2022]

4. Switzerland pubmed.ncbi.nlm.nih.gov

The Effects of Cardiac Rehabilitation including Nordic Walking in Patients with Chronic Coronary Syndromes after Percutaneous Coronary Interventions in Elective Mode. [2023]

5. Spain pubmed.ncbi.nlm.nih.gov

Nordic walking for cardiovascular prevention in patients with ischaemic heart disease or metabolic syndrome. [2017]

6. England pubmed.ncbi.nlm.nih.gov

High-Intensity Interval Training for Patients With Cardiovascular Disease-Is It Safe? A Systematic Review. [2021]

7. United States pubmed.ncbi.nlm.nih.gov

The Effects of Nordic Walking Compared to Conventional Walking on Aerobic Capacity and Lipid Profile in Women Over 55 Years of Age. [2022]