An interventional study of Nordic Walking in Heart Failure, sponsored by Ottawa Heart Institute Research Corporation. Completed at 1 site in Canada. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-08-13.
Sponsored by Ottawa Heart Institute Research Corporation · Not applicable, Interventional, and Treatment
The main purpose of our project is to see if a 12-week program of Nordic walking is better than standard exercise therapy for increasing exercise capacity (measured by how far people can walk in 6 minutes) and increasing quality of life (measured by having people fill out two questionnaires). We will also see if Nordic walking: improves heart performance (measured by heart ultrasound); improves how active people are (measured by an activity monitor); increases aerobic fitness (measured by a treadmill test); improves body composition (measured by waist size); and reduces hormone levels in the blood.
A single-site, parallel-group, randomized controlled trial will be conducted (Appendix C) at the University of Ottawa Heart Institute (UOHI). Patients with stable HF referred to cardiac rehabilitation will undergo baseline assessment and then be randomly assigned (1:1) to either standard exercise therapy (consisting of regular walking and a resistance exercise program) or Nordic walking. Follow-up measures will be taken at the end of intervention (12 weeks) and after a 14-week no-intervention observation period (26 weeks). After initial randomization to treatment group, participants will be stratified by treatment group and randomly assigned to one of three follow-up measurement conditions at 12 weeks: echocardiograph and cardiopulmonary test (N=80); cardiopulmonary test only (N=60); or no follow-up echocardiograph or cardiopulmonary test (N=76). The primary outcomes will be: a) changes in exercise capacity measured by 6MWT; and b) changes in disease-specific HRQL measured by the MLHFQ. Additional measures will examine the effects of the exercise interventions on: cardiac performance; leisure time activity; cardio-respiratory fitness; body composition; neurohormonal activation; and generic HRQL
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This study's enrollment of 77 is close to the median of 72 across 3,736 interventional studies indexed under Heart Failure.
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Exclusion Criteria:
Participants in the Nordic walking group will be provided with walking poles (GymstickTM Nordic Walking Poles, Gymstick International OY, Lahti, Finland) for the duration of the study. They will attend on-site exercise classes twice weekly for 12 weeks. The on-site exercise training classes will be one hour in length and include the following components: a 15 minute chair warm-up that excludes resistance exercises; 10-15 minutes of walking with Nordic walking poles for the first 3 weeks, progressing to 30 minutes of continuous walking with poles for the remaining 9 weeks; and 15 minutes of cool down exercises. Participants will be instructed to take the walking poles home and perform 200-400 minutes of Nordic walking per week for 12 weeks
Behavioral: Nordic Walking
Individuals assigned to standard exercise therapy will attend on-site exercise classes twice weekly for 12 weeks. Each on-site class will be one hour in duration and consist of: a 15-minute chair-based warm-up that includes 6-8 upper and lower body resistance training exercises using either hand-held weights or therabands at an intensity of 50-60% of 1- RM with the patient completing one set of 10-12 repetitions progressing to 15 repetitions before increasing the intensity by 5-10%; 10-15 minutes of walking for the first 3 weeks, progressing to 30 minutes of continuous walking for the remaining 9 weeks; and 15 minutes of cool down exercises. A strength training program will be provided to participants and they will be encouraged to do one additional strength training session at home. Participants will also be instructed to complete additional walking sessions at home so that they can accumulate a total of 200-400 minutes of exercise per week.
Participants in the Nordic walking group will be provided with walking poles (GymstickTM Nordic Walking Poles, Gymstick International OY, Lahti, Finland) for the duration of the study. They will attend on-site exercise classes twice weekly for 12 weeks. The on-site exercise training classes will be one hour in length and include the following components: a 15 minute chair warm-up that excludes resistance exercises; 10-15 minutes of walking with Nordic walking poles for the first 3 weeks, progressing to 30 minutes of continuous walking with poles for the remaining 9 weeks; and 15 minutes of cool down exercises. Participants will be instructed to take the walking poles home and perform 200-400 minutes of Nordic walking per week for 12 weeks
Changes in Exercise Capacity Measured by 6 Minute Walk Test
The 6 minute walk test was selected as a primary outcome because this sub-maximal test is a good indicator of the capacity to undertake day-to-day activities in patients with Heart Failure
Time frame: Baseline and 12 weeks.
Minnesota Living With Heart Failure Questionnaire (MLHFQ)
The MLHFQ is a 21-item scale that measures the effects of HF-related symptoms, functional limitations, and psychological distress on an individual's quality of life. Participants are asked to indicate using a 6-point, zero to five, Likert scale how much each of 21 factors prevent them from living as they desire. Each item is scored 0-5, and the total scores is the summed score of all items, totaling 0 - 105. Higher scores represent lower quality of life.
Time frame: Baseline and 12 weeks
Health Related Quality of Live Using the Medical Outcomes Study Short Form (SF-36)
Total scale is split into 2 subscales: physical component summary (PCS) and mental composition summary (MCS). Each subscale ranges from 0-100. Higher scores represent better quality of life.
Time frame: Baseline and 12 weeks
Hospital Anxiety and Depression Scale (HADS)
Split into 2 subscales: anxiety and depression. Each subscale has 7 items, scored from 0-3, with the total score of each subscale being 0-21 each. Higher scores indicate greater anxiety or depression. 0-7 indicates a normal range.
Time frame: Baseline and 12 weeks
Physical Activity
Physical activity includes any type of exercise. For example, walking, swimming, biking etc. Identification of "light", "moderate" or "vigourous" activity is determined by the participant based on perceived effort. Results are collected from exercise journals.
Time frame: Baseline and 12 weeks
Left Ventricular Filling Pressures
The left ventricular filling pressure is the pressure inside the left ventricle of the heart during the resting phase of the heart beat when the chamber fills with blood. It is assessed by echocardiography and calculate as an E/e' ratio, where E = the peak velocity of early diastolic blood flow across the mitral valve, and e' = the peak velocity of mitral valve annulus during early diastole, which is a measure of how fast the heart muscle relaxes. Valus \<8 are considered normal, 8-14 indicates potentially normal, but is baseline and requires further evaluation and \>/= 15 suggests elevated pressures and presence of diastolic dysfunction or heart failure with preserved ejection fraction.
Time frame: Baseline and 12 weeks
Cardiopulmonary Fitness by VO2 Peak
assessed using CPET
Time frame: Baseline and 12 weeks
Body Mass Index
Time frame: Baseline and 12 weeks
Calf Circumference
Time frame: Baseline and 12 weeks
Waist Circumference
Time frame: Baseline and 12 weeks
Blood Levels of N-terminal Pro B-type Natriuretic Peptide (NTproBNP)
Time frame: Baseline and 12 weeks
| Milestone | Nordic Walking Group | Standard Exercise Therapy |
|---|---|---|
| Started | 38 | 38 |
| Completed | 26 | 26 |
| Not completed | 12 | 12 |
The 6 minute walk test was selected as a primary outcome because this sub-maximal test is a good indicator of the capacity to undertake day-to-day activities in patients with Heart Failure
| meters walked | Nordic Walking Group | Standard Exercise Therapy |
|---|---|---|
| Baseline | 443.1 ± 17.2 | 437 ± 17.0 |
| 12 Weeks | 511.2 ± 21.0 | 490.4 ± 20.7 |
Total scale is split into 2 subscales: physical component summary (PCS) and mental composition summary (MCS). Each subscale ranges from 0-100. Higher scores represent better quality of life.
| Scores on subscales | Standard Exercise Therapy | Nordic Walking Group |
|---|---|---|
| Baseline PCS subscale | 43.1 ± 1.3 | 41.9 ± 1.3 |
| Baseline MCS subscale | 50.6 ± 1.6 | 47.6 ± 1.6 |
| 12 Weeks PCS subscale | 47.5 ± 1.4 | 46.7 ± 1.5 |
| 12 Weeks MCS subscale | 52.2 ± 1.4 | 55.0 ± 1.5 |
The MLHFQ is a 21-item scale that measures the effects of HF-related symptoms, functional limitations, and psychological distress on an individual's quality of life. Participants are asked to indicate using a 6-point, zero to five, Likert scale how much each of 21 factors prevent them from living as they desire. Each item is scored 0-5, and the total scores is the summed score of all items, totaling 0 - 105. Higher scores represent lower quality of life.
| Score on a scale (total) | Standard Exercise Therapy | Nordic Walking Group |
|---|---|---|
| Baseline | 33.5 ± 3.5 | 33.9 ± 3.5 |
| 12 weeks | 20.8 ± 3.0 | 19.6 ± 3.2 |
Split into 2 subscales: anxiety and depression. Each subscale has 7 items, scored from 0-3, with the total score of each subscale being 0-21 each. Higher scores indicate greater anxiety or depression. 0-7 indicates a normal range.
| Score on a subscale | Standard Exercise Therapy | Nordic Walking Group |
|---|---|---|
| Baseline HADS anxiety subscale | 4.8 ± 0.7 | 5.2 ± 0.7 |
| Baseline HADS depression subscale | 4.0 ± 0.5 | 4.3 ± 0.4 |
| 12 Weeks HADS anxiety subscale | 4.1 ± 0.6 | 4.2 ± 0.6 |
| 12 Weeks HADS depression subscale | 3.2 ± 0.4 | 2.7 ± 0.4 |
Physical activity includes any type of exercise. For example, walking, swimming, biking etc. Identification of "light", "moderate" or "vigourous" activity is determined by the participant based on perceived effort. Results are collected from exercise journals.
| minutes per day | Standard Exercise Therapy | Nordic Walking Group |
|---|---|---|
| Baseline - Light Physical Activity | 261.4 ± 15.9 | 253.0 ± 14.9 |
| Baseline - Moderate Physical Activity | 22.1 ± 3.2 | 18.0 ± 3.0 |
| Baseline - Vigorous Physical Activity | 1.4 ± 0.8 | 1.0 ± 0.8 |
| Baseline Moderate to Vigorous Physical Activity (Unbouted) | 23.5 ± 3.4 | 19.0 ± 3.2 |
| Baseline Moderate to Vigorous Physical Activity (bouted) | 11.7 ± 2.3 | 7.2 ± 2.2 |
| 12 Weeks - Light Physical Activity | 268.5 ± 14.9 | 254.9 ± 14.9 |
| 12 Weeks - Moderate Physical Activity | 24.1 ± 4.1 | 22.2 ± 4.3 |
| 12 Weeks - Vigorous Physical Activity | 2.1 ± 0.7 | 0.4 ± 0.8 |
| 12 Weeks - Moderate to Vigorous Physical Activity (Unbouted) | 23.5 ± 3.4 | 19.0 ± 3.2 |
| 12 Weeks - Moderate to Vigorous Physical Activity (bouted) | 14.6 ± 3.5 | 12.1 ± 3.7 |
The left ventricular filling pressure is the pressure inside the left ventricle of the heart during the resting phase of the heart beat when the chamber fills with blood. It is assessed by echocardiography and calculate as an E/e' ratio, where E = the peak velocity of early diastolic blood flow across the mitral valve, and e' = the peak velocity of mitral valve annulus during early diastole, which is a measure of how fast the heart muscle relaxes. Valus \<8 are considered normal, 8-14 indicates potentially normal, but is baseline and requires further evaluation and \>/= 15 suggests elevated pressures and presence of diastolic dysfunction or heart failure with preserved ejection fraction.
| E/e' ratio | Standard Exercise Therapy | Nordic Walking Group |
|---|---|---|
| Baseline | 16.1 ± 2.5 | 10.4 ± 1.8 |
| 12 Weeks | 14.9 ± 2.0 | 8.5 ± 1.3 |
assessed using CPET
| ml/kg/min | Standard Exercise Therapy | Nordic Walking Group |
|---|---|---|
| Baseline | 15.2 ± 1.3 | 17.8 ± 1.1 |
| 12 Weeks | 13.0 ± 1.7 | 17.7 ± 1.2 |
| kg/m^2 | Standard Exercise Therapy | Nordic Walking Group |
|---|---|---|
| Baseline | 30.5 ± 1.1 | 30.5 ± 1.1 |
| 12 Weeks | 31.1 ± 1.1 | 30.7 ± 1.1 |
| centimeters | Standard Exercise Therapy | Nordic Walking Group |
|---|---|---|
| Baseline | 38.1 ± 0.7 | 38.3 ± 0.7 |
| 12 Weeks | 37.9 ± 0.7 | 38.4 ± 0.7 |
| centimeters | Standard Exercise Therapy | Nordic Walking Group |
|---|---|---|
| Baseline | 106.1 ± 2.8 | 108.9 ± 2.8 |
| 12 Weeks | 107.9 ± 2.9 | 109.9 ± 2.9 |
| pg/mL | Standard Exercise Therapy | Nordic Walking Group |
|---|---|---|
| Baseline | 2212.7 ± 797.7 | 3022.5 ± 816.2 |
| 12 Weeks | 1450.3 ± 471.2 | 1679.8 ± 482.3 |
Collected over Baseline to 12 weeks. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Nordic Walking Group | 0/26 (0%) | 0/26 (0%) | 3/26 (11.5%) |
| Standard Exercise Therapy | 0/26 (0%) | 0/26 (0%) | 1/26 (3.8%) |
| Event | Nordic Walking Group | Standard Exercise Therapy |
|---|---|---|
| Event unrelated to interventionGeneral disorders | 3/26 | 1/26 |
| Age, Continuous(years) | Nordic Walking Group | Standard Exercise Therapy | Total |
|---|---|---|---|
| Mean | 64.0 ± 9.8 | 62.9 ± 11.2 | 63.5 ± 10.5 |
| Sex: Female, Male(Participants) | Nordic Walking Group | Standard Exercise Therapy | Total |
|---|---|---|---|
| Female | 8 | 10 | 18 |
| Male | 30 | 28 | 58 |
| Race and Ethnicity Not Collected(Participants) | Nordic Walking Group | Standard Exercise Therapy | Total |
|---|---|---|---|
| Count of participants | — | — | 0 |
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Ottawa Heart Institute Research Corporation