Home-based telemonitored Nordic walking training is well accepted, safe, effective and has high adherence among heart failure patients, including those with cardiovascular implantable electronic devices: a randomised controlled study

Eur J Prev Cardiol. 2015 Nov;22(11):1368-77. doi: 10.1177/2047487314551537. Epub 2014 Sep 26.


Background: The benefits of rehabilitation in heart failure (HF) patients are well established. Little is known about Nordic walking (NW) training in HF patients especially in those with cardiovascular implantable electronic devices (CIEDs).

Purpose: The purpose of this study was to assess safety, effectiveness, adherence to and acceptance of home-based telemonitored NW in HF patients, including those with CIEDs (i.e. cardiac resynchronisation therapy, implantable cardioverter-defibrillator).

Methods: The study design was a single-centre, prospective, parallel-group, randomised (2:1), controlled trial among 111 HF patients, New York Heart Association (NYHA) II-III; left ventricular ejection fraction (EF) ≤ 40%. The intervention was a home-based telemonitored eight-week NW (training group (TG) n = 77) five times weekly vs usual care alone (control group (CG) n = 34). Outcome measures included a primary end point of functional capacity assessed by peak oxygen consumption (VO2peak). Secondary end points included: workload duration (t) in cardiopulmonary exercise test (CPET), six-minute walking test (6-MWT) distance and quality of life (QoL), Medical Outcome Survey Short Form 36 (SF-36); safety; adherence to and acceptance of NW. Measurements were made before and after intervention.

Results: NW resulted in significant improvement in: VO2peak (16.1 ± 4.0 vs 18.4 ± 4.1(ml/kg/min), p = 0.0001), t (471 ± 141 vs 577 ± 158 (s), p = 0.0001), 6-MWT(428 ± 93 vs 480 ± 87 (m), p = 0.0001) and QoL (79.0 ± 31.3 vs 70.8 ± 30.3 (score), p = 0.0001). We did not observe favourable results in the CG. The differences between the TG and CG were significant in: ΔVO2peak (Δ2.0 ± 2.4 vs Δ-0.2 ± 2.1, p = 0.0004); Δt (Δ108 ± 108 vs Δ0.94 ± 109, p = 0.0031); Δ6-MWT (Δ53.8 ± 63.9 vs Δ22.0 ± 68.7, p = 0.0483). In neither group were there deaths nor necessity for hospitalisation. We did not observe any intervention from CIEDs during NW. All patients in the TG completed rehabilitation and accepted it well.

Conclusion: In HF patients, including those with CIEDs, home-based telemonitored NW is safe and effective. NW was well accepted by patients and adherence was high and promising.

Keywords: Nordic walking training; Telerehabilitation; heart failure.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cardiac Resynchronization Therapy Devices*
  • Cardiac Resynchronization Therapy*
  • Defibrillators, Implantable*
  • Electric Countershock / instrumentation*
  • Exercise Test
  • Exercise Therapy / methods*
  • Exercise Tolerance
  • Female
  • Heart Failure / diagnosis
  • Heart Failure / physiopathology
  • Heart Failure / rehabilitation*
  • Home Care Services, Hospital-Based*
  • Humans
  • Male
  • Middle Aged
  • Oxygen Consumption
  • Patient Compliance*
  • Poland
  • Prospective Studies
  • Quality of Life
  • Recovery of Function
  • Stroke Volume
  • Surveys and Questionnaires
  • Telerehabilitation / methods*
  • Time Factors
  • Treatment Outcome
  • Ventricular Function, Left
  • Walking*