8c55efb6f422c8568119beb7d5bf6b40 337150.pdf 1f6dbbd72a7c4a7b1fb46599d059bf02057d6941 337150.pdf 4b312f6d8caad83ebfaf1ba53742f7e17b46f27a789a110832a63caaf5e75143 337150.pdf Title: Effects of Nordic Walking on Physical Fitness in Patients with Cancer: A Systematic Review Subject: 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. Keywords: Nordic Walking; cancer; exercise; systematic review; meta-analysis; physical fitness; quality of life; physical fitness Author: Anabel Casanovas-Álvarez, Esther Mur-Gimeno, Jaume Masià Ayala, Carles Fernández-Jané and Raquel Sebio-Garcia Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25; modified using OpenPDF 1.4.2 CreationDate: Tue Sep 30 08:08:23 2025 CEST ModDate: Tue Sep 30 08:15:20 2025 CEST Custom Metadata: yes Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 20 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1168006 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- WNWTFR+VnURWPalladioL-Bold Type 1 Custom yes yes yes 184 0 AIRHKL+VnURWPalladioL Type 1 Custom yes yes yes 185 0 TLADSN+URWPalladioL-Bold Type 1 Custom yes yes yes 186 0 ZZQVSS+URWPalladioL-Roma Type 1 Custom yes yes yes 187 0 LJEZBI+CMSY10 Type 1 Builtin yes yes yes 188 0 VCFSIS+URWPalladioL-Ital Type 1 Custom yes yes yes 189 0 CHPHHI+PalatinoLinotype TrueType WinAnsi yes yes no 273 0 DADGBA+PalatinoLinotype TrueType WinAnsi yes yes no 396 0 CHPHHI+PalatinoLinotype TrueType WinAnsi yes yes no 412 0 CHPHHI+PalatinoLinotype TrueType WinAnsi yes yes no 441 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2026-10-31 04:14:19 CET RepresentationInformation: 337150.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2026-10-30 10:11:53 CET Size: 1168006 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 617 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: ViewerPreferences: HideToolbar: false HideMenubar: false HideWindowUI: false FitWindow: true CenterWindow: false DisplayDocTitle: false NonFullScreenPageMode: UseNone Direction: L2R ViewArea: CropBox ViewClip: CropBox PrintArea: CropBox PageClip: CropBox PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Item: Title: Materials and Methods Children: Item: Title: Inclusion and Exclusion Criteria Item: Title: Information Sources and Search Strategies Item: Title: Study Selection Item: Title: Data Extraction Item: Title: Risk of Bias for Individual Studies Item: Title: Measurements of Treatment Children: Item: Title: Efficacy Outcomes Item: Title: Adherence and Safety Outcomes Item: Title: Data Synthesis Item: Title: Publication Bias Item: Title: Summary of Finding and Assessment of the Certainty of the Evidence Item: Title: Results Children: Item: Title: Search Results Item: Title: Characteristics of the Studies Included Children: Item: Title: Publication Characteristics Item: Title: Participant Characteristics Item: Title: Intervention Characteristics Item: Title: Control Group Characteristics Item: Title: Risk of Bias Assessment Item: Title: Efficacy Outcomes Children: Item: Title: Nordic Walking vs. No Intervention Item: Title: Nordic Walking vs. Other Exercise Programs Item: Title: Adherence and Safety Children: Item: Title: Adherence Item: Title: Safety Item: Title: Reporting Bias Item: Title: Cartain of the Evidence Item: Title: Discussion Children: Item: Title: Limitations Item: Title: Implications for Practice, Policy and Future Research Item: Title: Conclusions Item: Title: References Info: Title: Effects of Nordic Walking on Physical Fitness in Patients with Cancer: A Systematic Review Author: Anabel Casanovas-Álvarez, Esther Mur-Gimeno, Jaume Masià Ayala, Carles Fernández-Jané and Raquel Sebio-Garcia Subject: 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. 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