Effects of a nordic walking program on balance, cognitive function, and mobility in elderly women with knee osteoarthritis: 
A randomized controlled trial protocol

Panjalizad, Susan; Gandomi, Farzaneh; Sofivand, Parviz

doi:10.22034/27.2.79

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Volume 27, Issue 2 (7-2025)

EBNESINA 2025, 27(2): 79-92

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Effects of a nordic walking program on balance, cognitive function, and mobility in elderly women with knee osteoarthritis: A randomized controlled trial protocol

Susan Panjalizad

, Farzaneh Gandomi ^*

, Parviz Sofivand

Departement of Sport Injuries and Corrective Exercises, Sport Sciences Faculty, Razi University, Kermanshah, Iran , gandomi777@gmail.com

Keywords: knee osteoarthritis, Nordic walking, pain, posture balance, cognitive function

Full-Text [PDF 1754 kb] (65 Downloads) | Abstract (HTML) (163 Views)

Type of Study: Original | Subject: Military Psychiatry
Received: 2025/01/11 | Revised: 2025/09/29 | Accepted: 2025/06/29 | Published: 2025/07/2

Extended Abstract: (15 Views)

Introduction

Knee osteoarthritis is a leading cause of chronic joint pain and disability, significantly impacting the quality of life for millions of individuals worldwide [1]. This degenerative joint disease is characterized by the progressive destruction of articular cartilage, a condition that worsens with age, leading to increased pain, stiffness, and functional limitations [2]. As the global population ages, the prevalence of knee osteoarthritis continues to rise, making it a pressing public health concern. In light of this, there is a growing need to develop and implement non-invasive, cost-effective strategies to manage symptoms and improve the overall well-being of affected individuals.
One such strategy is regular physical activity, which has been shown to enhance both physical and mental health in patients with knee osteoarthritis [7]. While pharmacological treatments can provide short-term relief, they are often expensive and may come with undesirable side effects. In contrast, non-drug interventions, such as exercise and muscle-strengthening programs, are increasingly recommended for their long-term benefits in managing pain, fatigue, and functional decline associated with the disease [7]. Among these interventions, walking has emerged as a particularly accessible and effective form of exercise.
Recently, Nordic walking has gained attention as a promising alternative to traditional walking for individuals with knee osteoarthritis [9]. This form of walking involves the use of lightweight poles, which are employed to enhance lower limb mobility and distribute weight more evenly across the body. Research indicates that Nordic walking results in a 22% higher energy expenditure compared to regular walking, which may contribute to weight loss—a key factor in reducing the burden on affected joints [11]. Additionally, the use of poles provides added stability, increasing confidence in knee joint function and improving overall balance. These benefits suggest that Nordic walking could be more effective than conventional walking, which is already widely recommended as a routine exercise for older adults. The potential of Nordic walking to mitigate the complications of knee osteoarthritis warrants further investigation.
The primary objective of this study is to compare the effects of Nordic walking and regular walking on pain, balance, cognitive function, and disability in middle-aged women with knee osteoarthritis. By examining these outcomes, we aim to provide evidence-based recommendations for optimizing exercise interventions in this population.

Methods

The present study is designed as a randomized, single-blind, controlled clinical trial with a pretest-posttest, parallel-group structure. A total of 45 eligible women will be recruited, meeting specific inclusion criteria based on clinical and radiological assessments. These criteria include a score of II or lower on the Kallgren and Lawer scale, morning stiffness and dryness, chronic knee pain persisting for at least three months, and a pain score of at least 4 on the visual analog scale. Participants must also exhibit joint space narrowing or osteophytes on radiographs and fall within the age range of 45 to 65 years [9]. Exclusion criteria include uncontrolled diabetes, a body mass index (BMI) of 40 kg/m² or higher, a history of knee surgery, orthopedic injuries in the lower limbs, or neuromuscular disorders [16, 17].
Participants will be randomly assigned to one of three groups: Nordic walking (n = 15), regular walking (n = 15), and a control group (n = 15). The experimental groups will undergo a six-week intervention consisting of three 60-minute sessions per week, conducted in a park environment to simulate real-world conditions. The control group will not engage in any structured exercise during the study period but will be offered the opportunity to participate in Nordic walking sessions after the study concludes [9]. The key distinction between the Nordic walking and regular walking programs lies in the use of poles. The Nordic walking poles are adjustable, with lengths ranging from 79 cm to 135 cm, and feature an I-shaped design [9].
The primary outcome of this study is pain, which will be assessed using the McGill Pain Index. Secondary outcomes include balance, measured with the Technobody device; muscle strength, evaluated using a dynamometer; proprioception, assessed with an inclinometer; and motor function, tested via the Womack, three-meter, and 4-meter walk tests. Cognitive function will be measured with the Montreal Cognitive Assessment (MoCA) questionnaire, while quality of life will be evaluated using the Osteoarthritis Knee and Hip Quality of Life (OAKHQoL) questionnaire. Additionally, the risk of falls will be determined using the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) questionnaire, developed by the U.S. Centers for Disease Control and Prevention.
Data analysis will be performed using SPSS version 25 software. Assuming a normal distribution of data, a two-way ANOVA test will be employed to examine within-group (time) and between-group (intervention type) effects. The study design follows a 3x2 framework, with three groups and two time points (pretest and posttest). If a significant interaction effect is detected, paired t-tests will be used to analyze within-group changes, while one-way ANOVA tests will assess between-group differences. Sample size calculations were conducted using G*Power software version 1.3, with an alpha level of 0.05, statistical power of 0.80, and an estimated effect size of 0.5 for pain and function [5]. Based on these parameters, a sample size of 42 participants was determined, which was increased to 45 to account for a potential 5% dropout rate.

Discussion and Conclusion

In recent years, the World Health Organization has revised its physical activity guidelines to reflect the growing emphasis on maintaining health through dynamic, enjoyable activities such as walking [9]. Extensive evidence supports the role of walking programs in preserving and enhancing health, particularly for individuals with chronic conditions like knee osteoarthritis [10]. Emerging research suggests that Nordic walking may offer additional benefits, including improved quality of life and greater engagement due to its enjoyable and low-cost nature. This study seeks to explore whether Nordic walking can serve as an effective, accessible, and sustainable intervention for middle-aged women with knee osteoarthritis, potentially surpassing the benefits of traditional walking.

Ethical Considerations

This study protocol has undergone rigorous review and approval by the Ethics Committee for Biological Research at Razi University (approval number IR.RAZI.REC.1403.031). Additionally, the Iranian Clinical Trials Center has evaluated and approved the study (IRCT20241027063512N1). Participation in the study is entirely voluntary, and all participants will provide informed consent before enrollment. Ethical considerations, including participant confidentiality and the right to withdraw at any time, have been prioritized throughout the study design.

Funding

There is no funding support.

Authors’ Contribution

Authors contributed equally to the conceptualization and writing of the article. All of the authors approved the content of the manuscript and agreed on all aspects of the work.

Conflict of Interest

Authors declared no conflict of interest.

Acknowledgments

We would like to express our gratitude to the research team and the dedicated members of the executive and administrative groups at Razi University for their efforts.

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Ethics code: IR.RAZI.REC.1403.031

Clinical trials code: IRCT20241027063512N1

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Panjalizad S, Gandomi F, Sofivand P. Effects of a nordic walking program on balance, cognitive function, and mobility in elderly women with knee osteoarthritis: A randomized controlled trial protocol. EBNESINA 2025; 27 (2) :79-92
URL: http://ebnesina.ajaums.ac.ir/article-1-1381-en.html

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