In selecting this capstone project, I wanted to choose a topic that I knew little about and that I could investigate both mentally and physically. I was inspired by my active, 91 year-old mother, who has regularly used her two “walking sticks” for her neighborhood walks for over 5 years. Here are videos of her walking with and without poles (click on the lower left hand corners of the black border to start; both can be run at the same time for comparison):
[vimeo]https://vimeo.com/91850463[/vimeo] [vimeo]https://vimeo.com/91879933[/vimeo]Thus began my exploration of walking with poles, starting in the Evidence-Based Practice (EBP) II class with my PICO question: “For elderly adults, does Nordic walking (NW), also referred to as pole walking (PW), improve walking endurance more effectively than regular walking?” All studies supported significant improvements of endurance effects of PW when compared with non-exercise groups, but there were no significant differences between the PW and W (walking) groups in endurance measures. The current evidence, therefore, does not support the superior endurance effects of NW over W for the elderly that was claimed in studies with young adults. Significant upper body strength improvements were noted with the PW group over the W group; this strengthening effect, however, was not as pronounced when compared to a resistive exercise group. Several studies suggested that PW had greater appeal than walking for some elderly participants as a regular or adjunct physical fitness activity, which in turn may help to improve adherence to fitness guidelines, improve community participation, and enhance quality of life. A copy of my EBP summary can be found here: <EBP summary>.
While going through the research, I noted there were relatively few studies in North America compared with Europe, which also coincides with the fact that Nordic walking is far more popular in Europe. I did a quick <Survey> of the 2014 DPT class, and responses indicated that 50% were aware of walking with 2 poles, 33% had seen it, and 17% had seen it used in rehabilitation. Based on these low numbers, I wanted to create a project that both increased the awareness of PW and built future capability at the UNC Division of Physical Therapy to explore, practice, and research the effects of this intervention.
It’s hard to explore an intervention if you don’t have the equipment! I explained my project to several manufacturers of walking poles, which happily resulted in the donation of 15 pairs of various models of poles from 3 different manufacturers. Here is copy of the current UNC inventory resulting from the generous donations of these manufacturers: <Inventory >.
To build awareness of potential values and precautions of pole walking interventions and to take advantage of the best available research, I decided to expand the focus this capstone project to consider studies across the arc of adulthood. Evidence tables were then developed for Young Adults, Middle-Aged Adults, and Older Adults. (A EBT Abbreviation Key is also provided).
A power point presentation was developed, utilizing the references and material provided through the course website to effectively design the ppt for professionals; my Presentation Assessment will provide more specific details of this process. Both of my committee members recommended that I provide PT CEUs for this course, which was arranged to be provided through the UNC Division of PT courtesy of Karen McCulloch, PT, PhD, NCS.* At Dr. McCulloch’s suggestion, and with the permission of Leki (one of the manufacturers), one set of poles was arranged to be given as a door prize to help build interest in the workshop. A Flyer was then posted, distributed and sent by email to DPT students, PT colleagues, and other interested professionals.
A 2-hour workshop was provided at the Seymour Center in Chapel Hill on April 3rd, 2014. Twelve participants attended, with practicing and student PTs as the primary audience. The workshop BPW agenda included a Power Point presentation, demonstration of equipment features and indoor and outdoor practice activities using the poles, discussion, and References and Resources handouts. The workshop ended with a Course Evaluation. [Note: due to the 9MB upload limit for this website, I extracted the walking videos from the ppt and placed these at the beginning of this capstone site].
Overall, the workshop went extremely well; the Course Evaluation Summary reflects the participants’ enthusiasm and support for the workshop, and the suggestions were appreciated. I wish there could have been more time! One suggestion was to show some of the recommended videoclips from the Resources handout, so I will take advantage of this capstone website to present two of the videoclips here.
The first is a short videoclip on learning the basic Nordic walking technique:
[youtube]http://www.youtube.com/watch?v=ZKTufkzpo8E[/youtube]This second clip are excerpts from Jayah Paley’s Poles for Balance & Mobility DVD, which gives a brief overview of how pole walking can assist individuals with mobility challenges. (I purchased this DVD and referenced it in the preparation of my ppt, as well as having a great conversation with her about her work. Her website is in the Resources handout).
[youtube]http://www.youtube.com/watch?v=umjdLSoIY3Y[/youtube]In closing, I want to share how this capstone project has altered my own fitness activity in that I have added Nordic walking to my walking regimen, and I have changed my hiking method to now using two poles instead of one! Special thanks go to my committee members, Charron Andrews, PT and Cherie Rosemond, PhD, PT, MSPT, and faculty advisor, Karen McCulloch, PT, PhD, NCS, for their great suggestions, encouragement, and feedback throughout this process. Extra thanks go to Charron for sharing her valuable time with meeting with me, arranging the workshop location at the lovely Seymour Center, and taking on the poles for distribution and continued use at UNC following the workshop. The workshop and the UNC “pole legacy” would not have been as effective without the generous donations from Leki, KeenFit, and Exerstrider. Thanks to my mother, Dehrabelle, for her willingness to share her experience and videos, and thanks to my sister Doris for taking and sending me videos of Mom from afar (Dallas). The workshop would not have gone as smoothly had it not been for the wonderful assistance of my friend, Cathy Gorton – thank you! Finally, thanks to the workshop participants for their enthusiasm and insights, and a “future thanks” to those who view and respond to this website – I hope you’ll continue to explore walking with poles as a fitness and/or mobility intervention for your patients – and yourself!
* Administrative followup for CEUs: Course Objectives, BPW agenda, Participant Sign-in form, and the CEU Certificate can be referred to here as needed.
13 Responses to “Bilateral Pole Walking: Benefits & Considerations in Adult Fitness & Rehabilitation”
Karen
Debra,
You did an AWESOME job on your project – excellent clinical applicability in so many ways. The feedback on the site from the students who attended your presentation say it all. I’m glad that Marian also was able to attend. Your Mom is TOO adorable out there treking away. Can you believe you’re finally finished!?!
Congratulations!!!!
kmac
Debra Gerber
Hi Michael!
Thanks for visiting my capstone site! I appreciate your comments on the ppt narrative – I was hoping that this format would work for this site. I started out approaching several vendors through their websites, explaining my project through their “Contact Us” function. From there, there were multiple emails and I would share some of the materials as they developed so they would understand the project was legit. Of course, they are not DME vendors, so a little more education was needed on my part, but ALL wanted more exposure for their product, and I’m hoping that their sales will increase to show that. I still have some discount materials available from the vendors (provided at the workshop) for reduced pricing, so if you or anyone else is interested in this, please send me an email (dgerbs1gmail.com). Good until it’s gone!
Cheers,
Debra
Michael Tighe
Dear Debra:
What a great capstone project this turned out to be!
It had everything: nice short, intro videos with a real-life person using the technique; longer videos more professionally rendered to illustrate more advanced concepts; a live presentation with a chance to demo the equipment and techniques; and a great-looking power point presentation! I love the look of the power point show, especially the notes underneath. I think too many times the information included in these notes does little more than re-state what is all read on the slide. In your presentation, all of the notes either presented new information not on the slides, or material that supplemented or “fleshed out” what was on the slide.
I also like how you detailed the phone calls you made to the vendors, as well. I think too many times in this field, the importance of making a phone call or two for information somehow gets lost in the time demands of the job, or in the “us versus them” mentality of therapists and DME vendors, or insurers, or policy makers. A good lesson there, as you even got a set of poles donated for a door prize!
This was obviously a topic you have passion about and enjoyment of…and it shows in the project! Great job!
Michael
Debra Gerber
Hi Cathryn, Audrey, Jason & Delane,
Thanks you for your comments! Cathryn, Audrey, and Jason – I was honored that you could attend. Your participation and enthusiasm made the workshop presentation a breeze!
Jason, I’m so glad that you were able to access the poles for your presentation and have tried them with your patient with PD. Another article that you might be interested in is a RCT by Ebersbach et al, “Comparing exercise in Parkinson’s disease – the Berlin LSVT BIG Study” (2010). In this RCT (n=60) there were 3 groups – LSVT BIG training group (4 1hr/sessions for 4 wks), a NW group (2 1 hr sessions for 8 wks) and a Control group (1 hour education). BIG training came out ahead in this one, but it should also be noted that this was a shorter-term study (8 wks) than the Reuter study (6 months). For patients with PD, I think there may possibly be a time and place for both interventions – the BIG practice indoors, and the PW practice outdoors.
Delane, I was wondering if your husband was going to get the poles for Christmas. I’m so impressed that he’s willing to look at the capstone sites with you! I’d love to know what he thinks about using them….
Thanks again for your comments,
Debra
Delane Clark
Debra,
I wish I could have attended your in-person presentation. I can tell you put a lot of thought and effort into making the experience not only informative but also interactive. You have definitely shown your range as a PT- from peds to adults! Last semester, you gave me suggestions for purchasing poles, and I bought them as a Christmas gift for my husband who gave up running after a second knee surgery. You know your life is really exciting when your and your husband’s weekend entertainment is viewing a classmate’s capstone materials. We learned so much, though! In addition to the PowerPoint, the “how to” video clips from Jayah Paley, and the footage of your mom (very cool) were all well done.
All the best,
Delane
Jason Albright
Debra,
I first would like to say that you did a fantastic job on your capstone. I liked that you took the time to separate the evidence table into age groups. I also liked how you were able to procure enough poles for everyone in the workshop to use. The opportunity you provided to use the poles, helped me realize their value for future patients. I fully intend to use them to treat or at least recommend to patients. I hope there will continue to be more research on Nordic pole walking’s effectiveness, as well as more on how they affect falls in the elderly.
In my presentation on fall prevention, I included Nordic walking as a possible intervention for preventing falls. Thanks to your efforts at procuring sets of poles, I was able to provide a couple sets for participants in my presentation to try. During and after the presentation, I had several individuals express interest and if there were any classes in the area. I’m pretty sure my committee member at the YMCA, who is the director of fitness, will start a class in Nordic pole walking.
I also wanted to let you know that I used a set of poles to treat a patient with parkinsons the other day in clinic. My clinical instructor wanted to give exercises that would focus on BIG movements, and I remember what you said about how pole walking can help increase step lengths. It took the patient a while to get the hang of it, but those of us in your workshop had the same learning curve.
Great job on the research and presentation! I enjoyed learning about pole walking, and I’m definitely an advocate.
Jason
Audrey Osinski
Debra,
I wanted to congratulate you on your fantastic capstone. I’m glad you offered to present to us (DPT students) along with other clinicians, and even the couple of individuals that didn’t have PT backgrounds! Your presentation was easy to follow and appropriate for all attendees – it wasn’t too complicated for all of these individuals that had different backgrounds/experience, and you were extremely engaging.
Being able to practice using the poles was an integral part of your seminar. Just like we need to “feel” or practice other interventions we use with patients, practicing using the poles helps us better understand proper form if we do utilize this equipment in the clinic or if patients come in asking us about how they should use a pair that they may have purchased. I think going outside to practice was a great idea since most patients that would purchase poles would be using them in these various environments (inside, outside, uphill, downhill, etc).
I was extremely impressed by all of the time spent researching this topic. Your evidence tables are fantastic resources for all of us. I can’t believe how many articles you read/analyzed and how easy you were able to refer to them throughout your presentation! I’m fairly certain I would not be able to remember the exact protocols from each of these studies, like you were able to as you answered various questions during the seminar.
Like Cathryn, I thought there might be more discussion regarding the use of poles as assistive devices, but was also pleasantly surprised to learn of the other potential benefits. I plan to work with older adults and will be happy to refer to these resources for recommendations. Additionally, I’m glad you listed many of the terms that can be used to search for evidence related to walking poles (e.g., exerstriding, polestriding). I hadn’t heard of these terms, so hopefully future literature searches will be easier for all of us that want to keep up with the evidence.
I’m so glad I was able to attend your wonderful seminar! Thanks again!
Audrey
Cathryn Ghena
Hi Debra,
I absolutely loved your inservice. I had zero prior exposure to walking poles and now can see how they could be used for a myriad of therapeutic gains. Honestly, I had expected to learn more about them as a potential assistive device, but was pleasantly surprised to see that they could also be used as an intervention/strengthening option. The hands-on component of your presentation was especially valuable as I was able to experience the strengthening component first hand! I loved being able to play around with the height, angulation, grips, etc., as they all changed the exercise a bit.
Your evidence tables were also very beneficial. I like how you broke them based on age, as this will make it easy to find articles for specific patient. You found a ton of great evidence, suggesting that we will see a surge of walking poles in the world of therapy. Another interesting way of organizing the articles would have been by purpose (i.e. aerobic vs balance vs biomechanic) OR by diagnosis (i.e. COPD vs. cardiac rehab vs. Parkinson’s). My guess is that we would need more evidence in each of these areas though.
Overall, I have certainly added all of this valuable information to my ‘clinical toolbox’ and hope to be able to put it to good use in my future practice. I have truly enjoyed learning with and from you over the past year; hopefully our paths will cross again!
Best of luck!
Cathryn
Debra Gerber
Hi Marian and Mike,
Thank you for comments! Marian, I’m so glad you were able to come to the workshop – and I know it was more difficult given that you had to come from Greensboro! Just a little clarification – following the workshop, there were 14 pairs of poles that were donated to the UNC Department of PT– Charron Andrews, one of my committee members and a faculty clinician at the Seymour Center is currently the one to notify if anyone would like to check them out (email: charron_andrews@med.unc.edu). I’m hoping with that number, it will open up possibilities for contrasting and comparing between the different styles, the opportunity to “try before you buy” to make sure you have the best match – as currently many of the poles are only available online, and greater opportunities for individual and group practice and research.
Mike, thank you for comments and for asking about contraindications and precautions. I’m happy you think the poles may have some value at UNC! I also want to thank you for advice early on in this project to help get this project moving!
To start with, I want to provide more details about the 6-month RCT by Reuter (detailed in the Evidence Table for Older Adults) for individuals with Stage II & III Parkinson’s Disease. There were 3 groups of 30 each in this study, divided into a walking group (W), Nordic walking group (NW), and flexibility & relaxation group (FR). Injuries were reported in all three groups for falls (NW-4, W-4, FR-1), exercise induced hypotension for both walking groups (NW=2, W=1), and the 2 shoulder overuse injuries were reported in the NW group. It appears that the NW had a higher rate overall, but all injuries were treated and resolved – and there were no drop-outs in the study! I think it notable in this study that the authors recommended more time in training NW technique/poling methods prior to comparing endurance measures between W & NW groups.
With regard to my own experience of contraindications or precautions for pole use for patients, I can only speak from my own personal experience of trying out NW, which I started last fall – but since I just turned 60, I can now speak as representative of the older adult population ☺. I’ve had some intermittent wrist and shoulder problems prior to this experiment, and I’ve found several strategies to help with this – choosing lighter poles so there is less joint impact, choosing poles with attached gloves for comfort and easier use with the ‘open hand’ technique, and adjusting the pole height and technique to suit the terrain. These changes occurred over several months, and I still find ways to refine my poling technique to have a better rhythm and flow to the walking. Unfortunately, I did not think to take pre & post measures, but I definitely feel the engagement of the upper trunk muscles (especially lats, triceps) and improved postural alignment. The poles that I now use for the NW are very lightweight Leki instructor poles (UNC now has 2 pairs of these) where the poling method is a push-off style you see in the top You-Tube demonstration video, and for hiking I’ll use a sturdier set similar to the Leki Cork-lite poles (UNC has 4 pairs) and use a more forwards pole-pull, pattern.
My other “patient experience” with poling would be my mother, and you’ll note that she doesn’t exactly use a bilateral pattern, but she has found the style that works best for her. With what I learned from this project, I just changed out her walking tips and adjusted her poles a little more, which she found helpful. There are lots of videos online, but I’ve also found there is inaccurate information as well– or at least information that I do not agree with or feel is supported by research. I invite you and others to please keep in touch with me about your experiences and observations – I believe this intervention has definite merits, but it is important to keep assessing and adjusting to learn more about its limits and to get the best results.
Debra
Marian Stein
Debra,
I knew very little about bilateral walking poles before attending your presentation. Did did an excellent job in explaining the benefits of utilizing these to augment walking in several age groups of people. I enjoyed the lab part and the opportunity to see a variety of poles. This helps provide some comparison in options and will help us provide information to patients about what is on the market. I liked how you provided a pair as the door prize. And I am sure that UNC-PT department appreciated a donated pair to their lab. I know you put in a lot of hard work into doing this and it showed.
Mike McMorris
Debra,
I really enjoyed going through your capstone materials. The videos add a lot to your strong work on the other products. Thank you for working with the faculty clinic in coordinating your presentation and selecting to use us as a final resting place for some of the poles associated with your project!
You mentioned in your summary paper, “A few adverse but resolved effects were reported during one 6 month study, including exercise induced hypotension, falls, and shoulder overuse injuries. More research is needed to examine benefits of NW relative to upper body strength, long term physical activity participation, and quality of life for the elderly.” Have you found any contraindications or precautions to using the poles with a patient?
Thanks again!!
Mike M
Debra Gerber
Hi Taylor,
Thank you so much for viewing my capstone and attending the workshop, I’m so glad that you’ve noted the PW can encourage more engagement of the upper body mm. You ask some great questions with regard to the videos – and I’m not sure I have all of the answers, but I went back to the source and asked her as well as my sister. Mom’s immediate response was that she did it to keep the “rhythm” for walking, as it has become more difficult for her to do with some increasing hip and back pain. I do think that her regular practices with pole walking has helped maintain her functional walking skills, as well as help with a little LE unloading to make her walking less painful. The RCT by Reuter (see the Evidence table for details) studied individuals with PD & showed a significant improvement in gait stride length following the intervention – and this was measured during walking only (not the PW). It should be noted that this was a longer (6 month) intervention, and I think longer-term studies are needed to see if and how improved gait measures are retained. I’m hoping that future research will shed more light on this. Thanks again for your participation and questions! Cheers, Debra
Meredith Reed
Debra,
Excellent work on your capstone! I am so glad I attended your 2-hour workshop. I had only previously heard of walking poles for hiking and honestly, never considered them therapeutically. I enjoyed your power point and the how you presented the evidence broken down into age group. I especially appreciated the lab component of your workshop. I think being able to try a variety walking poles both indoors and outdoors on different terrains not only helped me gain a better understanding of pole adjustments but also to feel the difference in muscle activity between walking and pole walking. I could definitely feel my upper body working more with the poles!
The videos of your mother served as a great visualization for pole walking in older adults! She certainly seems steadier and more confident with the poles! She appears to be walking as if she is holding poles in the “without poles” video. Do you think walking with the poles for the last 5 years has greatly affected her gait without the poles? Did she have a similar arm swing before she started using the poles? Lastly, did you find any evidence in carry over from pole walking to walking?
Great job!
M. Taylor Reed