A comparison of Nordic walking and treadmill walking training outcomes after total knee arthroplasty in older women: a randomized controlled trial

Introduction Evidence on gait training strategies for improving function in patients with knee arthritis after total knee arthroplasty (TKA) remains limited. This study aimed to determine whether Nordic walking training yields better outcomes than treadmill walking training in patients with knee arthritis after TKA. Methods This assessor-blinded trial included 38 female patients (mean age 68.7 ± 2.1 years) who had undergone TKA. Participants were randomly and equally assigned to an experimental (Nordic walking training) or a control (general treadmill walking training) group. Training consisted of 30-min sessions, five times weekly for 4 weeks. In addition, all participants received 60-min sessions of comprehensive physiotherapy five times weekly over the same 4-week period. Primary (stride length and stride, stance, and swing times) and secondary (knee flexion angle and pain score) outcomes were measured before and after the 4-week training period. The Shapiro–Wilk test was used to assess the normality of data distributions. Baseline comparability of the groups was assessed using the independent t-test (normally distributed continuous variables) and Fisher’s exact test (categorical variables). Two-way repeated-measures analysis of variance (ANOVA) was used to examine group × time interactions, and eta-squared (η2) values were calculated to quantify effect sizes. Results The experimental group achieved greater increases in stride length, walking velocity, and knee flexion angle than the control group (+4.5 vs. +1.7 cm, p < 0.01, η2 = 0.62; +3.51 vs. +1.24 cm/s, p < 0.01, η2 = 0.88; +30.7 vs. +20.7°, p < 0.01, η2 = 0.87). Furthermore, the experimental group showed greater reductions in stride, stance, and swing times and in pain scores (–0.23 vs. –0.07 s, p < 0.01, η2 = 0.80; –0.11 vs. –0.09 s, p < 0.01, η2 = 0.16; –0.23 vs. –0.07 s, p < 0.01, η2 = 0.81; –2.5 vs. –1.0 score, p < 0.01, η2 = 0.87). Conclusions Nordic walking training may be more effective at increasing walking function and knee flexion angles and significantly more effective at reducing knee pain than treadmill training in knee arthritis patients after TKA.