a change of lifestyle entailing increased physical activity , quitting smoking and dietary 
 modifications is an effective and inexpensive way of improving individuals health and 
 lowering their cardiovascular risk1,2,3,4 .
physical exercise can be prescribed as 
 therapy in two forms : unsupervised and supervised5 .
there are many models of rehabilitation , even within the scope of 
 treating and preventing cardiovascular diseases1 , 
 4 , 6 , 7 . however , the most important provision is 
 that daily physical activity should not be shorter than thirty minutes3 , 4 .
one of the new and 
 increasingly popular forms of exercise is nordic walking which is a combination of walking 
 and cross - country skiing , walking assisted with poles8 .
the most important elements of nordic walking exercise comprise : 
 thrusting the walking pole , pushing oneself off with the arm holding the pole and lifting a 
 leg off the ground .
these movements , combined in a fluent technique , influence the speed of 
 walking and its effectiveness .
nordic walking utilizes 90% of all muscles ( including lower 
 and upper extremity muscles ) , strengthens the muscles of the upper part of the body and 
 shoulders and increases the mobility of the upper segment of the spine .
walking poles 
 relieve stress on the joints , straighten and relieve stress on the spine and correct faulty 
 posture by strengthening the stabilizing muscles9 , 
 10 . when preforming nordic walking 
 calorie consumption is 2030 or even 67% more intense than during running .
so far 16 randomized ( 1,062 
 participants ) and 11 observational studies ( 831 ) of nordic walking have been carried out . 

these studies have confirmed the positive effects of nordic walking on resting cardiac 
 activity , arterial blood pressure , exercise tolerance , exercise oxygen consumption and 
 quality of life in the course of various diseases of young13 , middle - aged14 
 and elderly persons8 , 15,16,17 .
it was confirmed that this model of rehabilitation , in particular 
 the supervised one5 , extends the walking 
 distance of patients suffering from atherosclerosis in the lower extremities18 , improves the fitness of patients 
 suffering from parkinson s disease19 , 20 , reduces low back pain5 , 21 , 
 symptoms of depression22 and 
 fibromyalgia23 , 24 , improves the quality of sleep , reduces body weight , improves 
 exercise tolerance and attenuates risk factors .
however , these effects pertain primarily to 
 persons with normoglycemia rather than overweight patients suffering from glucose 
 intolerance or diabetes type 216 , 25,26,27,28 
 and a four - month nordic walking rehabilitation program did not improve the level of 
 glycosylated haemoglobin ( hba1c ) in patients suffering from diabetes type 2 and obesity29 .
menopause is connected with numerous hormonal changes which can lead to obesity , lipid and 
 carbohydrate metabolism disorders as well as related increases in risk of cardiovascular 
 events and death .
increasing physical activity is one of the methods used to reduce these 
 risks1 , 3 .
the beneficial influence of 34 cardiological rehabilitation 
 programs on the cardiovascular risk ( or= 0.64 , 95%ci= 0.460.88 ) and general mortality was 
 recently confirmed in the meta - analysis carried out by lawler et al6 .
the positive influence of exercise stems , among other 
 things , from reduction in body weight and insulin resistance which , can result in 
 improvement or even normalization of lipid and carbohydrate metabolism disorders2 .
it was demonstrated that exercise generally 
 lowers the concentration of triglycerides and increases the concentration of hdl 
 cholesterol2 .
however , as yet there is 
 not much data on the hypolipidemic effect of nordic walking rehabilitation11 , 30 .
this is an issue of great importance as hyperlipidemia and obesity 
 are the main modifiable risk factors of atherosclerosis in poland .
a study carried out by 
 natpol plus showed that hyperlipidemia and obesityaffect 61 and 53% of persons , 
 respectively31 , 32 .
the aim of this study was to evaluate the effect of a ten - week nordic walking 
 rehabilitation program on chosen anthropometric parameters and the level of basic lipids in 
 overweight and obese postmenopausal women s blood .
the study subjects were 32 women with an average age of 59.7  5.9  years ( age range : 
 5068 ) .
their basic demographic and clinical data are presented in table 1table 1.measured values at the beginning of the study and after the ten - week nordic 
 walking programparameterat the beginningof the studyafter 10 weeksbody weight ( kg)80.7  14.076.2  14.0 bmi ( kg / m)30.5  4.128.8  4.5 cpk ( u / l)109  47.090  37 total cholesterol ( mg / dl)213.3  34.5194.1  28.4 ldl cholesterol ( mg / dl)133.5  28.8117.2  30.2 hdl cholesterol ( mg / dl)59.4  13.064.9  13.3 triglycerides ( mg / dl)124.6  46.597.8  33.1 quotient of total cholesterol and hdl3.7  0.83.1  0.7 percentage of participants with a total cholesterol concentration 
 of < 190 mg / dl ; n ( % ) 8 ( 25%)12 ( 37.5% ) percentage of participants with ldl cholesterol concentration of 
 < 115 mg / dl ; n ( % ) 7 ( 22%)16 ( 50% ) percentage of participants with hdl cholesterol concentration of  
 46 mg / dl ; n ( % ) 28 ( 87.5%)32 ( 100% ) percentage of participants with a triglyceride concentration of 
 < 150 mg / dl ; n ( % ) 23 ( 71%)29 ( 91% ) percentage of participants with a quotient of total cholesterol 
 concentration and hdl < 5 ; n ( % ) 30 ( 94%)32 ( 100%)cut - off points for concentration of lipids were those of the european society of 
 cardiology2 , 3 .
statistically significant differences between the initial 
 value and after the 10-week nordic walking program .
* p<0.05 ;   p<0.001 . none of the participants suffered from serious somatic or mental diseases . 

additionally , the participants in this study did not take any medication other than 
 metabolically neutral hypotensive drugs .
cut - off points for concentration of lipids were those of the european society of 
 cardiology2 , 3 .
statistically significant differences between the initial 
 value and after the 10-week nordic walking program . the study was carried out following a non - randomized and unsupervised medical experiment 
 model .
the primary intervention consisted of a nordic walking rehabilitation program carried 
 out under a trainer s supervision .
session were conducted 5 times a week for 10 weeks ( in 
 total : 50 sessions , 60 minutes each ) and they complied with the minimum exercise 
 requirements recommended by the european society of cardiology ( esc ) .
prior to commencing 
 the program in the nordic walking training rehabilitation technique was carried out and 
 participants were tested on their mastery of it .
a warm - up was organized before each training session . at the beginning the average 
 distance covered amounted to 3.8  km .
as progress in rehabilitation was made and exercise 
 tolerance improved , the distance increased to 5.3  km .
the average , estimated energy 
 expenditure during each session was 450  kcal . during the entire period of the study each 
 woman was on the same diet ( meals consumed in catering establishments ) .
the participants 
 daily diet consisted of 5 meals with a caloric value of 1,500  kcal .
energy sources were 
 planned as follows : complex carbohydrates  50% , fat  30% , protein  20% .
the participants did not change their 
 medication as it could have that could influenced the studied parameters .
all the participants received a medical examination at the beginning and at the end of the 
 study . during the examination anthropometric parameters ( weight , height , body mass index ) 

the concentration of 
 total cholesterol , ldl , hdl and triglycerides as well as creatine phosphokinase activity 
 ( cpk , a skeletal muscle damage marker ) was examined before and after intervention .
the 
 measurement of biochemical parameters was performed using blood serum collected in the 
 morning , before training , from the cubital fossa vein , with minimum tourniquet pressure , 14 
 hours after the last meal and after 15 minutes of rest .
the effects of the rehabilitation program were measured through the changes in the values 
 of the anthropometric and biochemical parameters described above .
the absolute difference 
 delta and relative changes in parameters ( percentage change ) were calculated .
this study was performed with the approval of the bioethical commission of the nicolaus 
 copernicus university in toru , ludwik rydygier collegium medicum in bydgoszcz ( no . 
 kb/602/2011 ) in september 2011 .
the results are presented as the mean value and standard deviation or the median and range 
 as well as the number ( n ) or percentage of participants  depending on the type of variable 
 ( quantitative , qualitative ) and normality of their distribution .
the significance of 
 difference in the values of categorical variables and variation was carried out using the 
 wilcoxon test .
the mann - whitney u test was used to test differences between subgroups 
 determined by the median age value ( < i  62  years ) , body weight ( < i  75.4  kg ) , 
 height
( < i  162.5  cm ) and bmi ( < i  30  kg / m ) . additionally , the 
 percentage of participants , who achieved the recommended levels of lipids recommended for 
 female subject to a medium risk of cardiovascular diseases ( total cholesterol < 
 190  mg / dl , ldl < 115  mg / dl , hdl46  mg / dl , triglycerides < 150  mg / dl)2 , 3 was 
 calculated .
a comparison of the significance of differences within the scope of the size of 
 groups was carried out using fisher s exact test .
after 
 10 weeks of exercises performed according to the nordic walking model statistically 
 significant reductions in body weight ( on average 4.5  kg , 5.7% ) and bmi ( on average by 
 1.7  kg / m , 5.7% ) were observed .
eighteen participants ( 56% ) lost less than 5% of their body weight , 9 participants 
 ( 28% ) lost 510% of their body weight and 5 ( 16% ) lost 10% of their body weight . in the biochemistry results statistically significant drops in total cholesterol ( median 
 delta
 19.2  mg / dl , 8.5% ) , ldl ( median delta  16  mg / dl ; 12% ) , and triglyceride 
 concentrations ( median delta  26.8  mg / dl ; 0.8% ) were observed .
additionally , the 
 concentration of hdl cholesterol increased ( median delta  5.5  mg / dl , 10% ) ( table 1 ) .
after the rehabilitation program had 
 ended , the percentage of participants with the recommended levels of total cholesterol , ldl , 
 hdl and triglycerides had significantly increased ( table 1 ) . the changes in lipid concentrations in blood serum observed after 
 completion of the 10-week nordic walking program showed considerable individual variation 
 and the ranges are presented in table 
 2table 2.the absolute ( delta ) and relative ( % ) changes in the outcome measures after a 
 10-week nordic walking programparametermean value  standarddeviation95%ciof the mean valuemedianscope(minimum - maximum)d_weight ( kg)4.5  3.45.7 to 3.32.9511.0 to 0.5d_weight_% ( % ) 6  47.3 to 4.13.315 to 0.6d_bmi ( kg / m)1.7  1.22.1 to 1.21.154.2 to 0.2d_bmi_% ( % ) 6  47.3 to 4.13.315 to 0.7d_total cholesterol ( mg / dl)19.2  17.525.5 to 12.912.068.0 to 2.0d - total cholesterol_% ( % ) 8.5  711 to 66.028 to 0.09d - ldl ( mg / dl)16.3  17.722.7 to 9.911.066.0 to 5.0d_ldl_% ( % ) 12  1116.3 to 7.88.850 to 2.9d_hdl ( mg / dl)5.5  6.23.2 to 7.75.02.0 to 30.0hdl_% ( % ) 10  11.56.0 to 14.39.33.7 to 55.6d - triglycerides ( mg / dl)26.8
 25.436.0 to 17.716.586.0 to 0.00d_triglycerides_% ( % ) 19.2  1524.5 to 14.015.655 to 0.00d_tc / hdl(u / i)0.61  0.410.76 to 0.460.522.0 to 0.03d_tc / hdl_% ( % ) 16  919.5 to 12.813.642 to 0.6delta ( d ) = difference at the end of the study presented at the absolute value 
 ( d_parameter ) and the relative value ( parameter_% ) , the percentage change with respect 
 to the initial value ; tc / hdl quotient of total cholesterol and hdl concentration ( the 
 atherogenic lipids in blood serum index ) ; 95% ci confidence interval 95% .. this is the reason influence of chosen clinical and anthropometric factors on 
 the values of studied parameters was evaluated before commencing and after complete on of 
 the nordic walking program .
the values of the studied biochemical parameters were compared 
 in subgroups of women determined by on the median age ( < i  62  years ) , body weight ( < 
 i  75.4  kg ) , height ( < i  162.5  cm ) and bmi ( < i  30 
however , 
 statistically significant differences were found only between the group of overweight and 
 obese women .
overweight participants ( bmi  30  kg / m ) experienced a considerably 
 lower bmi reduction ( 1.3 vs. 2.1  kg / m ; 3.6 vs. 7.8% ; p=0.045 ) .
the initial 
 bmi value correlated with its percentage ( relative ) decrease after completing the 
 intervention ( r = 0.39 , p = 0.026 ) .
the absolute decrease in bmi , on the other hand , 
 correlated with the initial height of participants .
the participants , whose weight loss 
 exceeded 5% showed bigger absolute ( 8.5  8.1 vs. 3.1  2.5  mg / dl ; p = 0.012 ) and relative 
 ( 15.7  15.0% vs. 5.8  4.7% ; p = 0.012 ) increases in hdl concentration after 10 weeks of 
 nordic walking rehabilitation .
delta ( d ) = difference at the end of the study presented at the absolute value 
 ( d_parameter ) and the relative value ( parameter_% ) , the percentage change with respect 
 to the initial value ; tc / hdl quotient of total cholesterol and hdl concentration ( the 
 atherogenic lipids in blood serum index ) ; 95% ci confidence interval 95% .
our results show that after ten weeks of nordic walking rehabilitation 32 overweight and 
 obese postmenopausal women showed a statistically significant loss of body weight , as well 
 as a drops in bmi and concentrations of atherogenic lipids in blood serum . after completing 
 the program the percentage of participants with the recommended levels of total cholesterol , 
 ldl , hdl and triglycerides drastically increased ( table 
 1 ) .
a statistically significant weight loss ( > 5% ) was observed among 44% of the 
 participants , also showed an increase in hdl cholesterol concentration .
moreover , the 
 results demonstrate that participants with a higher degree of obesity experienced a smaller 
 reduction in bmi .
there was no statistical correlation between initial bmi and the 
 hypolipidemic effect of the rehabilitation program .
weight loss after 1012 weeks of nordic walking was also observed by another group of 
 researchers30 .
however , although our 
 program was shorter ( 10 vs. 16 weeks ) , we observed body weight loss and bmi reduction26 .
goodpaster et al.33 carried out a randomized single - blind trial with a 
 one - year observation period , durning which they investigated whether moderately strenuous 
 exercise , of an intensity similar to a quick march , performed 5 times a week for 60 minutes 
 by morbidly obese subjects could increase weight loss compared to diet alone . after 6 months 
 of controlled exercise and dietary intervention ,
it 80% of the participants showed a 5% 
 weight loss to 60% of the participants who were only advised to change their diet . in our 
 study
this 
 suggests that it is necessary to implement a dietary intervention in order to increase the 
 effectiveness of weight loss .
it might be worth involving more specialists ( for example a 
 bariatrist , a bariatric surgery specialist , a psychologist , a psychiatrist , etc . ) who would 
 cooperate just like a cardiological heart team .
our study also showed that a greater weight 
 loss was observed among taller participants which confirms the negative correlation between 
 energy expenditure when doing nordic walking and the length of the poles previously reported 
 in the literature12 .
therefore , it would 
 be beneficial to further analyse the usefulness of complex programs ( dietary intervention , 
 exercises , behavioural therapy ) in treating obesity with respect to the reduction in 
 cardiovascular risk , even when weight loss is small ( 510%)33 . as mentioned above
, the 10-week nordic walking rehabilitation program had a positive effect 
 on the level of basic blood lipids in overweight and obese postmenopausal women ( table 1 ) .
the nordic walking program reduced the 
 total cholesterol , ldl and triglyceride concentrations and increased the concentration of 
 the anti - atherogenic fraction of hdl ( table 2 ) . 

after completion of the rehabilitation program , concentrations of total cholesterol and ldl 
 were lower on average by 19 ( 9% ) and 16 ( 12% ) , respectively .
however , 
 previous epidemiological observations3 , 35 , 36 
 and the results of multicentre randomized intervention studies justify the hypothesis that 
 the observed effects of lipid rehabilitation in the nordic walking model have noticeable 
 health - related benefits .
it is generally accepted that as far as the treatment of the 
 obesity is concerned , health - related advantages are achieved even when weight loss is small 
 510%33 .
moreover , it is known that an 
 increase in total cholesterol of 1% leads to an increase in the cardiovascular event risk of 
 2%35 , 36 . a drop in ldl concentration of 1  mmol / l ( approx .
40  mg / dl ) during 
 statin therapy , on the other hand , correlates with a 10% reduction in the total mortality 
 and a 22% reduction in the risk of death and cardiovascular morbidity rate2 .
in addition , whereas the probability of a 
 serious coronary event reduces by 23% , the risk of cerebral stroke reduces by 17% . a further 
 potential benefit of rehabilitation through nordic walking arises from the increase in hdl 
 cholesterol concentration . an increase in hdl of 1 
mg / dl is reported to reduce the 
 cardiovascular risk by 23%37 . in the 
 present study ,
the increase in hdl cholesterol concentration amounted on average to 
 5.5  mg / dl ( 10% ) which would correspond to an average reduction in cardiovascular death of 
 1015% .
a higher average increase in hdl was achieved by participants whose weight loss 
 exceeded 5% .
these results are consistent with the data presented in the literature showing 
 that weight loss of 1  kg is associated with an increase in the hdl cholesterol concentration 
 of 0.4  mg / dl2 .
an increase in hdl 
 cholesterol can also be achieved through regular physical activity and quitting smoking2 .
it is worth mentioning that the most 
 popular hypolipidemic medicine , statins , increase the level of hdl in a similar way , i.e. by 
 510%2 .
some authors are of the 
 opinion that the level of triglycerides after a meal is a better determinant of 
 cardiovascular risk38 . in the present 
 study triglycerides
were determined on an empty stomach , and their level after 10 weeks of 
 practising nordic walking was 27  mg / dl ( 10% on average ) . according to the literature , 
 reduction in body weight through physical activity should lower the level of triglycerides 
 by 2030%2 .
the fact that our results were 
 poorer than this can be explained the lack of a dietary intervention .
nevertheless , the 
 overall clinical results of the proposed nordic walking rehabilitation program were 
 associated with its hypolipidemic effect , and can be expressed as the potential reduction in 
 cardiovascular risk , estimated to be in the range of least 2025% ( 10% dependent on ldl 
 reduction and 1015% dependent on hdl increase ) , before considering the advantages of the 
 workout and weight loss .
the described effect is achieved with the help of an average dose 
 of statin2 . yet , during the study the 
 response to the suggested rehabilitation program varied significantly among individuals 
 ( table 2 ) .
consequently , future studies of the 
 clinical effectiveness of nordic walking are warranted in order to identify subjects who 
 apart from physical activity , require an additional intervention to reduce their 
 cardiovascular risk .
there is also no certainty that the meals consumed by 
 participants were the only food they consumed .
additionally , we did not use the risk score 
 table to evaluate the initial and final cardiovascular risk . in conclusion ,
 a ten - week nordic walking workout program resulted in a relatively small , yet 
 statistically significant , weight loss , significant reductions in atherogenic serum lipids 
 levels , and an increase in anti - antherogenic hdl cholesterol levels as well as a drop in the 
 skeletal muscle damage index ( cpk ) .
the percentage of participants with the recommended 
 level of lipid fractions had increased at the end of the intervention .
 obese participants showed relatively lower weight loss at the end of the intervention 
 than overweight subjects , and those who lost more than 5% of their body weight showed a 
 bigger hdl cholesterol concentration increase and the end of the nordic walking program .
 overweight and shorter participants probably require a more intense workout and 
 cooperation with a dietician to achieve a statistically significant weight loss .
 [ purpose ] the aim of this study was to evaluate the effect of a ten - week nordic walking 
 ( nw ) rehabilitation program on chosen anthropometric parameters and the level of basic 
 lipids in overweight and obese postmenopausal women s blood . [ subjects and methods ] the 
 subjects were 32 women aged 5068 ( average : 59.7  5.9  years ) . 
 the study was carried out 
 following a non - randomized model and entailed nw rehabilitation 5 times a week , which 
 lasted for 10 weeks , as well as a low - calorie 1,500  kcal diet . 
 the therapeutic results of 
 the study were measured through changes in anthropometric and biochemical parameters . 
 the 
 results were subjected to a statistical analysis . 
 [ results ] after 10 weeks of nw 
 rehabilitation it was observed that participants lost weight and their body mass index 
 dropped . additionally , whereas levels of total cholesterol , ldl and triglycerides dropped , 
 and the level of hdl increased . [ conclusion ] rehabilitation carried out according to the 
 nw model resulted in statistically significant changes in basic lipids in blood which , 
 considerably increased the percentage of persons who achieved the recommended level of 
 blood lipids . 
 obese persons were characterised by a smaller rehabilitation weight loss . 
 
 more intense workouts and cooperation with a dietician are required . 
INTRODUCTION
SUBJECTS AND METHODS
RESULTS
DISCUSSION