The effects on physical performance of therapeutic Nordic Walking in persons with psychosomatic disorders: a clinical randomized controlled trial

Background: Persons with psychosomatic disorders suffermore often formdepression, anxiety disorders, somatoform pain disorders, and social withdrawal than the general population. These disorders can affect everyone, are often triggered by childhood abuse or traumatic injury and usually go together with changes in perception, thinking, behaviour and stress. Purpose: Nordic Walking is popular in the broad population ofNorthern Europe and has been shown to be an effective treatment option for severalmusculoskeletal disorders. So far, no studies have investigated the effectiveness of therapeutic Nordic Walking on improvement of physical performance in persons with psychosomatic disorders. Methods: In this randomized controlled trial with follow up after 12weeks an inpatientmultidisciplinary pain program therapeutic plus therapeutic Nordic Walking was compared to a control group (i.e. multidisciplinary pain program without therapeutic Nordic Walking). As primary outcomes heart rate and rating of perceived exertion from the treadmill walking test were determined. As secondary outcomes amount of steps and walking time in minutes during 24 h were recorded by pedometer. They also had to fill in a self-report questionnaire about their walking habits. Descriptive data were presented as means (m) and standard deviations (SD). The outcomes were analysed with Student t-test and on an intention-to-treat basis. Results: A total of 150 persons were included in this study. In relation to the primary outcomes, no differences in effects were found between the therapeutic Nordic Walking group (n= 76) and the control group (n= 74). Analysis of the secondary outcome measures revealed that at discharge from the hospital the persons in the therapeutic Nordic Walking group performed significantly more steps in 24 h (meansteps = 9891, SD= 3132 versus meansteps = 8936, SD= 3589; p= 0.040) and they believed that they could walk longer without a break (meanwalking time = 43.3minutes, SD= 9.3 versus meanwalking time = 39.2minutes, SD= 8.7; p= 0.030). Conclusion(s): The results of this study suggest that therapeutic Nordic Walking was not superior to usual care in persons with psychosomatic disorders. The increase in steps and walking time might be caused by enhanced motivation and adaptive coping strategies. Implications: Informed clinical decision making is not solely based on best scientific evidence, but also on clinical expertise of the health care professional and patient’s preferences and expectations. Since therapeutic NordicWalking was equally effective as the interventions in the control group and credibility and expectancy of both patient and health care provider play an important role in the process of treatment, additional therapeutic Nordic Walking might be an alternative for some subgroups of persons with psychosomatic disorders. Further research on this topic is strongly recommended.