Walking on four limbs: A systematic review of Nordic Walking in Parkinson disease.

Nordic Walking is a relatively high intensity activity that is becoming increasingly popular. It involves marching using poles adapted from cross-country skiing poles in order to activate upper body muscles that would not be used during normal walking. Several studies have been performed using this technique in Parkinson disease patients with contradictory results. Thus, we reviewed here all studies using this technique in Parkinson disease patients and further performed a meta-analysis of RCTs where Nordic Walking was evaluated against standard medical care or other types of physical exercise. Nine studies including four RCTs were reviewed for a total of 127 patients who were assigned to the Nordic Walking program. The majority of studies reported beneficial effects of Nordic Walking on either motor or non-motor variables, but many limitations were observed that hamper drawing definitive conclusions and it is largely unclear whether the benefits persist over time. It would appear that little baseline disability is the strongest predictor of response. The meta-analysis of the 4 RCTs yielded a statistically significant reduction of the UPDRS-3 score, but its value of less than 1 point does not appear to be clinically meaningful. Well-designed, large RCTs should be performed both against standard medical care and other types of physical exercise to definitively address whether Nordic Walking can be beneficial in PD.