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Nordic Walking: Overview
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MEDICA > NORDIC WALKING...


This page presents a detailed overview of Nordic Walking, an efficient, low-stress exercise technique that involves the use of walking poles to engage the legs and upper body in a total body workout with clinically demonstrated physical and psychological benefits. The origin and health benefits of Nordic Walking are reviewed, followed by an introductory examination of the technique and equipment employed to achieve optimal results. Clinical references are included at the bottom of the page, and related links are presented at right. Sources from which to purchase the poles online are provided for both the United States and Canada.


Exel.net - Nordic Walking

Origins...

The origins of Nordic Walking may be traced to Finland, where, in the early 1930s,1 cross-country skiers began using poles to positive effect during their summer training. In the 1980s, clinical studies correlated the use of trekking poles with fitness levels. Subsequent studies in the 1990s demonstrated that this simple, efficient exercise increased cardiovascular activity, significantly enhanced muscular and aerobic fitness, and improved overall vitality.

Nordic Walking was developed by Finnish sports equipment manufacturer, Exel Oyj, in close cooperation with sports medicine researchers and other fitness professionals.2,3 As a defined fitness exercise with specific training equipment, it was officially launched in 1997. Today, some 760,000 Finns regularly participate in this activity'4 and the trend has since spread throughout Scandinavia and Europe, where it is estimated that about 3.5 million people now do it regularly, urged on by some 3,000 trained instructors.5

As educational programs sponsored by industry leaders promote the benefits achievable through correct use of the technique, interest is growing in other countries around the world, including the Australia and Japan.6  In North America, EXEL, LEKI, ANWA, and others provide organized programs, demonstration clinics and training aids for the growing number of individuals expressing interest in or already practicing the technique, on their own or in a local group.

[...] The reasons for the sport's popularity are many, according to Theo Walther, who runs the Theo Walther Nordic Walking School in Bonn. A trained Nordic Walking instructor since 2002, Walther said a growing interest in preventive medicine in Germany has raised interest in Nordic Walking.

"I think more than 50 percent of Germans have computer jobs. They don’t move enough and have health problems as a result," Walther said. "Nordic Walking can be tailored to people at all ages and stages of fitness or ability... It can be done like a competitive sport, but we also do it with handicapped people and in old age homes." 7

Nordic Walking can be adapted to individual fitness levels. It isn't just for the fitness enthusiast who wants a high-intensity, total body aerobic workout. Virtually everyone who can walk, and many who have difficulty walking, can go Nordic Walking.


Nordic Walking

Why is Nordic Walking better than just walking?

Nordic Walking increases your heart rate, oxygen consumption and caloric expenditure without increasing your perceived rate of exertion. You don't feel like you're working any harder but, in addition to working your legs, you're experiencing a full range of motion that engages the abs, arms, shoulders, upper chest and back muscles. The poles provide additional stability and help reduce stress in the knees and other joints. Bone density can be increased through this sort of resistance training, and posture also improves through use of the proper technique and arm motion. Clinical and anecdotal reports indicate that this type of exercise may prove beneficial in broad range of conditions, including the arthrides, back pain, cardiac syndromes, chronic pain, fibromyalgia, obesity, osteoporosis, repetitive stress injury, thoracic outlet syndrome, depression, mood disorders, and more.

Brian Robinson likes cross-country skiing, so he was intrigued by Nordic walking, a cross between power walking and cross-country skiing.

"I heard you use 90 per cent of your muscles as opposed to 60 per cent when running, and you can burn 40 per cent more calories than in regular walking," says Robinson, director of studies at a Vancouver language school. "I needed to get fit and I heard that this is a full body aerobic workout, but not inside a gym."

Nordic walking -- you use poles -- is low impact and gentle on the joints, but is indeed a full body workout that burns more calories than walking while perceived exertion is about the same. In other words, you burn more calories (about 20 per cent and increasing with poling intensity), work more muscles and gain greater aerobic benefit, but don't feel as though you're working that hard.

"If you're in an office all day, it's good for loosening the area around your shoulders and neck," says Paula Artley, a International Nordic Walking Association master trainer and a consultant with pole manufacturer Exel. "It tones your upper body. You're getting almost a double workout." [Read more]

Many fitness experts are singing the praises of walking with poles too. Famed orthopedic surgeon, J. Richard Steadman of Vail, Colorado, says "Walking with poles is good exercise for everyone, but particularly for those with early-to-advanced degenerative joint disease or those rehabilitating from surgery. Walking with poles also improves balance when walking over uneven terrain, helping prevent slips, ankle and knee injuries and abrasions from falling." He believes walking with poles can help preserve healthy joints because "walking with poles can reduce accumulated force by about 6 tons over the course of a mile."

Walking as Prevention of Health Problems
Walking, the oldest form of transportation, has been shown in numerous studies to have many health benefits. According to the report Physical Activity and Health by the Surgeon General, moderate regular exercise has been found to be associated with decreased risk of cardiovascular diseases, some forms of cancer, and non-insulin dependent diabetes mellitus. By increasing calorie consumption moderate exercise may reduce and prevent overweight.

In addition to benefits for physical health, moderate exercise has been shown to improve mental health by relieving mental stress, anxiety, depression, while improving moods. Thus, moderate exercise, such as walking, improves overall health-related quality of life through both physiological and psychological mechanisms.

Walking as Rehabilitation and Chronic Disease Management
In certain medical conditions, such as myocardial infarction, neurological disorders and traumatic injuries, exercise is used in rehabilitation to restore or compensate for partially or totally lost bodily functions needed in an individual's daily life. In chronic conditions, such as arthritis and pain syndromes, moderate exercise is used to improve the physiological function of the heart, muscles, nervous system, and joints. Exercise can maintain and improve muscle strength and endurance, maintain the range of joint movement, and joint lubrication. In addition, through release of substances called endorphins, exercise may reduce arthritic and muscular pain. There is no clear evidence that exercise can halt bone loss (cause of osteoporosis) in postmenopausal women, but exercise improving muscle strength and balance may decrease risk of falling that ultimately can result in fractures, the dreaded complication of osteoporosis.

According to the Surgeon General, moderate and regular exercise, such as walking 3-5 times a week, for 20 to 30 minutes, is needed to maintain and improve health without increasing the risk of adverse effects, such as musculoskeletal injuries that may be associated with more vigorous exercise forms, such as jogging or running.

The Benefits of Nordic Walking
However, walking at a moderate speed may not be enough to increase the heart rate in individuals at an above-average fitness level. They may have problems with lower extremity joints, especially knees, not uncommon in veteran runners and joggers, that has forced them to abandon their preferred form of exercise. It is here where Nordic Walking comes into the picture, and may help them in exercising for fitness, achieving the same heart rate levels as they would running or jogging. For individuals needing exercise for fitness and disease prevention, or for a medical condition such as those mentioned above, and for those with lower extremity problems, problems with balance, or fear of falling, Nordic walking could be a means of exercising.

Nordic walking is a relatively new form of exercise that has its origin in Nordic cross-country skiing. In Nordic Walking, poles resembling ski poles are used to involve the upper extremities in the walking exercise. The poles are equipped with wrist straps and rubber caps over the metal tips making it possible to use them on pavement while reducing the impact of the hard surface.

Nordic walking has been used for summer training in competitive Nordic skiing to maintain and improve upper extremity strength and endurance as well as maximal oxygen uptake (VO2max). It has been used in the United States at the University of Wisconsin in the rehabilitation of patients after myocardial infarction (MI). In the MI study, the oxygen uptake increased on average 21% compared to walking without poles. In a recent study at the Cooper Institute in Dallas, Texas, preliminary results showed an increase in the oxygen uptake (up to 46% in some individuals). The caloric expenditure increased accordingly.

In addition to the increased energy cost that can have a training effect improving cardiovascular capacity, a recent study found beneficial effects in terms of neck and shoulder pain that are so common in our computerized society. Another study found that using hiking poles in simulation of uphill backpacking resulted in some reduction of the load on knees.

In summary, Nordic walking is an exercise form with many advantages, both for the healthy individual needing a more vigorous exercise form, especially for cardiovascular benefits, and for an individual with restrictions from a medical condition that precludes jogging or running. It can also be advantageous for those with medical conditions of arthritic or neurological origin that make normal walking without support difficult.

Walking Pole Models
Many models of walking poles are available, some with adjustable pole length (telescopic). Others come in different lengths, (one recommendation is pole length = .7 user height). They also come with different wrist strap designs and with specially designed detachable rubber tip caps ("asphalt paws"). The prices range from $60 to $100 dollars. The advantage of telescopic poles is that they are adjustable, especially when used as hiking poles (longer poles downhill, shorter uphill). However, when used for vigorous walking for exercise, the telescopic locking mechanism may fail and cause injuries if the mechanism fails under load and the pole unexpectedly gives way. For exercise, non-telescopic poles, made of composite fiber or other lightweight materials, are recommended.

With all of these possibilities for starting to walk for exercise and health, even if you have a condition mentioned above that has prevented you from walking, why not start today, or at least tomorrow, walking around your neighborhood for half an hour?! Take your spouse or friends along, walk and talk, and have a good time. As an extra bonus, improve not only your own health, but the health of your companions. After a week or two of regular exercise, after overcoming the inertia and initial soreness, you will never stop doing it. You will just get addicted to it, as most members of Fifty-Plus can testify. However, it is a healthy addiction. It just takes the decision, a pair of good shoes, possibly a pair of walking poles and your companions. Get up, out, and walk, today!

Kaj Rekola PhD is a Language Translator and a leader of the weekly Beginners Walk on the Stanford campus.

Testimonial

The cane to which S.G. refers is the LEKI Wanderfreund Trekking single staff, and the walking pole system is a set of LEKI Nordic Walking Poles.

...It has been a year now that I have been using my Leki poles and I am surely a grateful owner. I wanted to let you know that my leki cane is just perfect for small mall trips, etc. I can keep my balance more in a crowd and I feel so much safer. The lightness is wonderful, and the spring really does make a difference. Wayne has taken me walking with the leki walking pole system and I am amazed at how it helps with mobility. I can walk faster and I am not so troubled by an imperfection in the walkway. Having Osteo and Rheumatoid arthritis, my walking is limited. The pole system simply lets me get out into nature with more comfort and ease. Thank you for the special time you spent with me in working out my gait and co-ordination with the poles. It has been such a pleasure to deal with everyone on your team... S.G., CA

 

Nordic Walking has many benefits...

  • Heart rate is 5-17 beats per minute higher (e.g., 130 beats per minute in normal walking, versus 147 beats per minute in Nordic Walking).
  • Increases oxygen consumption and burns approximately 400 calories per hour (compared with 280 calories per hour for normal walking).
  • Releases pain and muscle tension in the neck and shoulder region, increasing the lateral mobility of the neck and spine.
  • Total body workout involves 90% of all muscles; actively engages forearm extensor and flexor muscles, rear part of the shoulder muscles, the large pectoral and broad back muscles; strengthens upper body and creates resistance to build better bone density.
  • Reduces load on knees and other joints.
  • Reduces heel strike force.
  • Consumes approximately 400 calories per hour (compared with 280 calories per hour for normal walking).

Warming UP for Nordic Walking
Source: LIVE TO NORDIC WALK. NORDIC WALK TO LIVE.

QUAD STRETCH

  1. Stand up straight, holding pole for support.
  2. Gently bend your knee behind you to grasp your ankle with the other hand.
  3. Bring ankle towards glutes, hold for 15 seconds, then switch legs.

HAMSTRING STRETCH

  1. Plant both poles shoulder-width apart.
  2. Place straight leg in front, heel on ground, toes pointed up.
  3. Gently bend other knee while leaning forward with straight back. Hold for 15 seconds, switch sides.

CHEST/UPPER SHOULDER STRETCH

  1. Grasp pole behind back, hands a little wider than shoulder width.
  2. Lift pole up towards head until you feel stretch.

LAT/BACK STRETCH

  1. Place poles well out in front of you.
  2. Lean on poles with straight arms.
  3. Bend upper body at waist downward; do not hyper-extend lower back.

TRICEP/ARM STRETCH

  1. Grab the top of the pole grip with one arm.
  2. Bring pole over head and down back; grasp other end with other hand.
  3. Pull down on lower part until you feel stretch in back of arm.

TORSO/LATERAL TWIST

  1. Grab pole with wide grip overhead.
  2. Standing up straight, bend at side, reaching opposite hand over head.
  3. After stretch, change sides, then come back to neutral.
  4. From neutral, gently twist torso until you feel stretch, then turn other way.

The Nordic Walking Technique

Nordic Walking involves a simple enhancement of your normal arm swing, but this must be integrated with your walking movement to achieve the full benefits of the exercise. One of the best presentations available is provided by Bernd Zimmermann, at Nordic Walking Online. Bernd is the Founder and Master Coach of the American Nordic Walking Association (ANWA), which promotes Nordic Walking in the US. His Nordic Walking Instructional DVD/VHS, and his Nordic Walking e-book, can be ordered here.

Bernd distinguishes between what he terms 2-wheel drive, when you're just walking, and 4-wheel drive, which takes you to "a brand new level" as you grip the poles and engage your upper body in the process.

Technique



American Nordic Walking Association

[E]very step should begin with the heel touching the ground and rolling forward to the ball and toe area, where you will push off to propel yourself forward.

The hands should constantly be in a "grip-n-go" state with the pole. They should grip the pole every time the pole hits the ground, then let it go as it is drawn back behind the body, finishing up with an open hand.

As the arms continue to move the poles, the torso and hips should be involved in a counter-swinging motion from the lower body. This effectively works the mid-torso muscle groups. [...]

Some of the typical mistakes beginning Nordic walkers could make might be:

  • Staying in "2-wheel drive"
    By not using the upper torso correctly as part of your workout, you remain in 2-wheel drive.
  • Planting the poles too far from the body.
    Having the poles too wide lowers the effectiveness of your Nordic walking.
  • Walking with Closed Hands
    Keeping your hands closed at all times does not allow for proper blood circulation.
  • Walking with Open Hands
    Walking with hands open all the time reduces the efficiency of your poling.
  • Improper leg and pole placement.
    If the pole and leg are placed on the same side, you are not able to perform the proper diagonal stride with the hips involved in a counter-swinging motion.

Online Training & Nordic Walking VIDEOS

Terri Schneider is a renowned multi-sport endurance athlete and an elite international adventure racer who has raced in more than 30 countries at the world-class level. She has shared her personal experiences, research, and expertise through her work as a coach and speaker at a range of events, including high-profile talk shows, news segments, the Discovery Channel, USA Network, and in popular fitness and outdoor publications. Her website features an informative article entitled Nordic Walking: Information, Technique, and Gear, as well as four free Quicktime™ videos, sponsored by LEKI.

Nordic Walking History 1

Marko Kantaneva demonstrates his original Nordic Walking technique,
developed in 1997.
3 (18.12.08)
The correct way to Nordic walk, enabling you to derive 20% to 50% more benefit from your exercise session. For additional videos by Kanteneva, see his channel page.

The Pioneering Work of Tom Rutlin, in the United States

The following two videos, transferred to DVD from the original 1992 VHS version made by Tom Rutlin, developer of Exerstrider®, describe his approach to fitness walking with specially designed poles (Nordic walking). They were created to "explain" this totally new concept of exercise to people with no prior knowledge of it. "In 1992 I made my first instructional video to distribute along with each pair of poles I sold. From 1988 until that time, those new to Exerstriding had only my early printed instruction manual to use as a learning tool. Having struggled a great deal attempting to learn to Nordic ski with only the aid of a few illustrated books on the subject back in the 70s, as soon as I could afford to buy what was at the time a 'high tech' video recorder, I enlisted the help of my brother-in-law (a photographer) and we put together this rather crudely produced video." This is an important historical record. "As you will see," adds Rutlin, "very little has changed in terms of the technique I have advocated since 1988."
— Source: Tom Rutlin shares his first instructional video, Clair Walter (13.11.08)
Retrieved 19.02.10.

The Equipment...

Specifically designed poles are used to engage the upper body in Nordic Walking. The "grip-n-go" technique requires a wrist attachment that enables grip release when the trailing arm is fully extended. The wrist strap is of unique design, and is one of the factors that distinguishes poles from different manufacturers. The strength and related properties of the pole are also important considerations.

About LEKI...

LEKI, the world’s leading manufacturer of ski, hiking and trekking poles had its start in Kircheim, Germany as a hobby of its founder, Karl Lenhart, an airframe mechanic and avid skier. Lenhart developed an aluminum tempering process that produces a pole shaft of incomparable strength. For over 50 years, LEKI has introduced a series of technological “firsts” including a dual-component adjustable pole-locking technology. Today, LEKI is the world’s leading manufacturer of ski, hiking and trekking poles which can be found in use anywhere from the slopes of Aspen to the summit of Mount Everest. LEKI confidently warranties all Nordic Walking Pole models for life.

Key Features of LEKI Nordic Walking Poles
LEKI Adjustable/Releasable Trigger Strap
LEKI Easy Lock System
LEKI Rubber Tips

Nordic Walking Poles and Products from Different Manufacturers

LEKI EXEL

Sources Cited


Clinical References
& Related Studies

  1. Energy expenditure and comfort during Nordic Walking with different pole lengths.
    Hansen EA, Smith G.
    Journal of Strength and Conditioning Research
    2009 Jun 12.
  2. Physical activity of depressed patients and their motivation to exercise: Nordic Walking in family practice.
    Suija K, Pechter U, Kalda R, Tähepõld H, Maaroos J, Maaroos HI.
    International Journal of Rehabilitation Research
    2009 Jun;32(2):132-8.
  3. Intensity of Nordic Walking in young females with different peak O consumption.
    Jürimäe T, Meema K, Karelson K, Purge P, Jürimäe J.
    Clinical Physiology and Functional Imaging
    2009 May 14.
  4. Energy cost and pole forces during Nordic walking under different surface conditions.
    Schiffer T, Knicker A, Dannöhl R, Strüder HK.
    Medicine and Science in Sports and Exercise
    2009 Mar;41(3):663-8.
  5. Nordic poles immediately improve walking distance in patients with intermittent claudication.
    Oakley C, Zwierska I, Tew G, Beard JD, Saxton JM.
    European Journal of Vascular and Endovascular Surgery
    2008 Dec;36(6):689-94; discussion 695-6 Epub 2008 Oct 1.
  6. Nordic walking improves mobility in Parkinson's disease.
    van Eijkeren FJ, Reijmers RS, Kleinveld MJ, Minten A, Bruggen JP, Bloem BR.
    Movement Disorders
    2008 Nov 15;23(15):2239-43.
  7. Inverse dynamic analysis of the lower extremities during nordic walking, walking, and running.
    Stief F, Kleindienst FI, Wiemeyer J, Wedel F, Campe S, Krabbe B.
    Journal of Applied Biomechanics
    2008 Nov;24(4):351-9.
  8. Nordic Walking does not reduce the loading of the knee joint.
    Hansen L, Henriksen M, Larsen P, Alkjaer T.
    Scandinavian Journal of Medicine & Science in Sports
    2008 Aug;18(4):436-41 Epub 2008 Jan 14.
  9. Nordic walking -- is it suitable for patients with fractured vertebra?
    Wendlova J.
    Bratislavske Lekarske Listy
    2008;109(4):171-6.
  10. Self-guided brisk walking training with or without poles: a randomized-controlled trial in middle-aged women.
    Kukkonen-Harjula K, Hiilloskorpi H, Mänttäri A, Pasanen M, Parkkari J, Suni J, Fogelholm M, Laukkanen R.
    Scandinavian Journal of Medicine & Science in Sports
    2007 Aug;17(4):316-23 Epub 2006 Oct 12.
  11. [Nordic walking: a new form of physical activity in the elderly]
    Turk Z, Vidensek S, Micetic Turk D.
    Acta Medica Croatica
    2007;61 Suppl 1:33-6 Croatian.
  12. Nordic walking and chronic low back pain: design of a randomized clinical trial.
    Morsø L, Hartvigsen J, Puggaard L, Manniche C.
    BMC Musculoskeletal Disorders
    2006 Oct 2;7:77.
  13. Physiological responses to nordic walking, walking and jogging.
    Schiffer T, Knicker A, Hoffman U, Harwig B, Hollmann W, Strüder HK
    European Journal of Applied Physiology 2006 Sep;98(1):56-61 Epub 2006 Jun 24
  14. [Nordic pole walking injuries -- nordic walking thumb as novel injury entity]
    Knobloch K, Vogt PM.
    Sportverletz Sportschaden
    2006 Sep;20(3):137-42. [German]
  15. The effects of walking poles on shoulder function in breast cancer survivors.
    Sprod LK, Drum SN, Bentz AT, Carter SD, Schneider CM.
    Integrative Cancer Therapies
    2005 Dec;4(4):287-93.
  16. Efficiency of walking and stepping: relationship to body fatness.
    Chen KY, Acra SA, Donahue CL, Sun M, Buchowski MS.
    Obesity Research
    2004 Jun;12(6):982-9.
  17. Effects of exercise on anxiety, depression and mood.
    Guszkowska M
    Psychiatria Polska
    2004 Jul-Aug;38(4):611-20 Review Polish
  18. The effects of a 12-week group exercise programme on physiological and psychological variables and function in overweight women.
    Grant S, Todd K, Aitchison TC, Kelly P, Stoddart D.
    Public Health
    2004 Jan;118(1):31-42.
  19. A twelve week exercise program improves the psychological status, quality of life and work capacity in hemodialysis patients.
    Levendoglu F, Altintepe L, Okudan N, Ugurlu H, Gokbel H, Tonbul Z, Guney I, Turk S.
    Journal of Nephrology
    2004 Nov-Dec;17(6):826-32.
  20. Effects of an exercise adherence intervention on outcomes in patients with heart failure.
    Duncan K, Pozehl B.
    Rehabilitation Nursing: Official Journal of the Association of Rehabilitation Nurses
    2003 Jul-Aug;28(4):117-22.
  21. PoleStriding exercise and vitamin E for management of peripheral vascular disease.
    Collins EG, Edwin Langbein W, Orebaugh C, Bammert C, Hanson K, Reda D, Edwards LC, Littooy FN.
    Medicine and Science in Sports and Exercise
    2003 Mar;35(3):384-93.
  22. Energy cost and physiological responses of males snowshoeing with rotating and fixed toe-cord designs in powdered snow conditions.
    Dalleck LC, DeVoe DE, Kravitz L.
    Ergonomics
    2003 Jul 15;46(9):875-81.
  23. Field testing of physiological responses associated with Nordic Walking.
    Church TS, Earnest CP, Morss GM.
    Research Quarterly for Exercise and Sport
    2002 Sep;73(3):296-300.
  24. Physiological and metabolic responses to a hill walk.
    Ainslie PN, Campbell IT, Frayn KN, Humphreys SM, Maclaren DP, Reilly T.
    Journal of Applied Physiology
    2002 Jan;92(1):179-87.
  25. Accumulating brisk walking for fitness, cardiovascular risk, and psychological health.
    Murphy M, Nevill A, Neville C, Biddle S, Hardman A.
    Medicine and Science in Sports and Exercise
    2002 Sep;34(9):1468-74.
  26. Effects of walking poles on lower extremity gait mechanics.
    Willson J, Torry MR, Decker MJ, T Kernozek T, Steadman JR.
    Medicine and Science in Sports and Exercise
    Vol 33, No 1, 2001, pp 142-147.
  27. Exercise and depressive symptoms: a comparison of aerobic and resistance exercise effects on emotional and physical function in older persons with high and low depressive symptomatology.
    Penninx BW, Rejeski WJ, Pandya J, Miller ME, Di Bari M, Applegate WB, Pahor M.
    The Journals of Gerontology Series B, Psychological Sciences and Social Sciences
    2002 Mar;57(2):P124-32.
  28. Mechanics of pole running in subjects with chronic knee problems.
    Kwon YH, Bolt LR, Shim JK.
    Seoul International Sport Science Congress, Seoul, Korea, August 2001, pp 290-295.
  29. Research on the benefits of Nordic walking.
    Research summary compiled by Raija Laukkanen, PhD, Docent Director, Exercise Science, Polar Electro Oy, Finland. This (2001) summary is presented on many Nordic Walking sites. See also PMC Paramedisch Centrum Roosendaal Fysiotherapie ed for additional references.
  30. Utilizing exercise to affect the symptomology of fibromyalgia: a pilot study.
    Meyer BB, Lemley KJ.
    Medicine and Science in Sports and Exercise
    2000 Oct;32(10):1691-7.
  31. Muscular and metabolic costs of uphill backpacking: are hiking poles beneficial?
    Knight CA, Caldwell GE.
    Medicine and Science in Sports and Exercise
    2000 Dec;32(12):2093-101.
  32. Load carriage energy expenditure with and without hiking poles during inclined walking.
    Jacobson BH, Wright T, Dugan B.
    International Journal of Sports Medicine
    2000 Jul;21(5):356-9.
  33. Walking performance and economy in chronic heart failure patients pre and post exercise training.
    Beneke R, Meyer K.
    European Journal of Applied Physiology and Occupational Physiology
    1997;75(3):246-51.
  34. Walking at moderate speed with heel-less shoes increases calf blood flow.
    Yamamoto T, Ohkuwa T, Itoh H, Yamazaki Y, Sato Y.
    Archives of Physiology and Biochemistry
    2000 Dec;108(5):398-404.
  35. The effects of physical exercise on patients with Crohn's disease.
    Loudon CP, Corroll V, Butcher J, Rawsthorne P, Bernstein CN.
    American Journal of Gastroenterology
    1999 Mar;94(3):697-703.
  36. Effects of exercise on fatigue, physical functioning, and emotional distress during radiation therapy for breast cancer.
    Mock V, Dow KH, Meares CJ, Grimm PM, Dienemann JA, Haisfield-Wolfe ME, Quitasol W, Mitchell S, Chakravarthy A, Gage I.
    Oncology Nursing Forum
    1997 Jul;24(6):991-1000.
  37. Walking to health.
    Morris JN, Hardman AE.
    Sports Medicine (Auckland, NZ)
    1997 May;23(5):306-32 Review Erratum in: Sports Med 1997 Aug;24(2):96.
  38. Exercise for patients with congestive heart failure.
    Shephard RJ.
    Sports Medicine (Auckland, NZ)
    1997 Feb;23(2):75-92 Review.
  39. The physiological responses to walking with and without Power Poles on treadmill exercise.
    Porcari JP, Hendrickson TL, Walter PR, Terry L, Walsko G.
    Research Quarterly for Exercise and Sport
    1997 Jun;68(2):161-6.
  40. Acute responses to using walking poles in patients with coronary artery disease.
    Walter PR, Porcari JP, Brice G, Terry L.
    Journal of Cardiopulmonary Rehabilitation
    1996 Jul-Aug;16(4):245-50.
  41. Energy expenditure during submaximal walking with Exerstriders.
    Rodgers CD VanHeest JL, Schachter CL.
    Medicine and Science in Sports and Exercise
    1995 Apr;27(4):607-11.
  42. Physiological and perceptual responses to walking while swinging hand-held towels.
    Michaud TJ.
    The Journal of Sports Medicine and Physical Fitness
    1994 Mar;34(1):38-44.
  43. Effects of a walking program on attributional style, depression, and self-esteem in women.
    Palmer LK.
    Perceptual and Motor Skills
    1995 Dec;81(3 Pt 1):891-8.
  44. Chronic psychological effects of exercise and exercise plus cognitive strategies.
    Brown DR, Wang Y, Ward A, Ebbeling CB, Fortlage L, Puleo E, Benson H, Rippe JM.
    Medicine and Science in Sports and Exercise
    1995 May;27(5):765-75.
  45. The effects of moderate exercise training on psychological well-being and mood state in women.
    Cramer SR, Nieman DC, Lee JW.
    Journal of Psychosomatic Research
    1991;35(4-5):437-49.
  46. Psychological changes accompany aerobic exercise in healthy middle-aged adults.
    Blumenthal JA, Williams RS, Needels TL, Wallace AG.
    Psychosomatic Medicine
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