# Effects of Nordic Walking on Physical Fitness in Patients with Cancer: A Systematic Review

## TL;DR

Nordic Walking may help cancer patients improve muscle strength and physical activity safely, but more research is needed on its broader benefits.

## Contribution

This is the first systematic review evaluating Nordic Walking's effects on physical fitness in cancer patients.

## Key findings

- Nordic Walking significantly improved muscle strength and increased physical activity levels in cancer patients.
- High adherence rates and no serious adverse effects were reported in supervised Nordic Walking sessions.
- Evidence for improvements in cardiorespiratory fitness and quality of life remains limited.

## Abstract

Maintaining regular physical activity during and after cancer treatment can be challenging, despite its known benefits. We investigated whether Nordic Walking, an outdoor exercise using specially designed poles, could offer a practical and engaging way to improve physical fitness in individuals living with and beyond cancer. By systematically reviewing existing clinical trials, we aimed to assess its impact on muscle strength, physical activity levels, quality of life, adherence, and safety. Our findings suggest that Nordic Walking may enhance muscle strength and increase physical activity, particularly among breast cancer survivors, with high adherence rates and no serious adverse effects reported. Although evidence regarding improvements in cardiorespiratory fitness and overall quality of life remains limited, this form of exercise appears to be a feasible and safe option. Further high-quality research is needed to confirm these benefits across a wider range of cancer populations.

Background: Despite evidence supporting exercise in cancer care, adherence remains low. Nordic Walking (NW), a pole-assisted outdoor activity, may overcome barriers and improve fitness. However, a comprehensive synthesis of its effects on physical fitness in cancer patients is lacking. Objective: To evaluate NW’s effects on physical fitness, health-related quality of life (HRQoL), adherence, and safety in patients living with and beyond cancer, compared with no intervention or other exercise programs. Methods: This PRISMA-compliant systematic review and meta-analysis (PROSPERO: CRD42024551608) included randomized or quasi-randomized trials. Five databases were searched through November 2024. Risk of bias (Joanna Briggs Institute) and evidence certainty (GRADE) were assessed. Results: This systematic review included six RCTs comparing NW with no intervention. NW significantly improved overall muscle strength (Std. MD = 0.46, 95%CI:0.14–0.78; low-certainty) and self-reported physical activity (MD = 3181.51 MET-min/week, 95%CI:2085–4278; moderate-certainty). Cardiorespiratory fitness (6-min walk) showed no significant improvement in random-effects modeling (MD = 84.78 m, 95%CI:−35.6–205.19; very low-certainty). HRQoL data were insufficient for meta-analysis. Adherence exceeded 90% in supervised sessions, with no serious intervention-related adverse events. Conclusions: When compared with no intervention NW is feasible and safe, potentially improving muscle strength and physical activity in patients with cancer. Evidence for cardiorespiratory endurance and HRQoL remains inconclusive. To date, no studies have compared NW with other structured exercise programs. Higher-quality RCTs with diverse populations are needed.