it is believed that physical activity for the prevention of falls should primarily aim to 
 increase the strength of large groups of muscles , mainly in the lower limbs , as well as 
 improve gait , balance , and coordination parameters1 . among the organized exercise systems only tai - chi has been 
 mentioned in this context , and the importance of physiotherapy is emphasized2 . however , it has not been determined which 
 specific forms of rehabilitation activities should be undertaken in order to achieve 
 satisfactory results in this field . it involves marching 
 using poles , and is an adaptation of cross - country skiing . the main purpose of using the 
 poles is to involve the muscles that are not used during normal walking . this enables high 
 intensity exercises to be performed at a relatively low level of perceived exertion . nw is 
 also a form of physical activity which is recommended for the elderly . there is evidence of 
 its importance in the prevention and physiotherapy of musculoskeletal disorders , vascular 
 diseases , cardiovascular diseases and parkinson s disease3 . reported that nw improved all health - related 
 components of fitness of the elderly based on functional tests , however , no improvement of 
 gait parameters was observed4 . takeshima 
 et al . have confirmed the efficacy of a 12-week nw training program and its positive impact 
 on selected fitness parameters on the basis of a physical fitness test and a test on a force 
 platform5 . however , gait parameters were 
 not assessed . in another study it was demonstrated that nw training improved both the 
 strength and walking speed of the elderly , compared to the traditional walking training6 . exercise is recommended to improve abnormal posture control 
 during walking , and the use of exercises focused on performing two independent tasks has a 
 particular impact on the improvement of gait parameters and postural control7 . in this study , a set of objective tests were used to evaluate the fitness elements related 
 specifically to postural control , especially those used during daily routines , such as 
 reaching in various directions or bending the body and gait parameters . this study used a 
 force platform to evaluate performance in specific functional tests the forward reach test 
 ( frt ) and the upward reach test ( urt ) to evaluate the changes in postural control during 
 reaching . moreover , kinematic gait analysis was performed in order to assess the potential 
 impact of nw training on selected gait parameters . our hypothesis was that a long - term nw 
 training would improve gait symmetry , lengthen the gait cycle , and decrease the frequency of 
 the strides made eliciting greater economy of energy and improvement in incorrect gait 
 patterns of the elderly . gait analysis of this study mainly focused on assessment of 
 coordination and symmetry of gait . the aim of the study was to evaluate the effects of 12 
 weeks nordic walking training on selected gait parameters and elements of fitness related to 
 postural control . the subjects were randomly 
 assigned to 2 groups : the experimental group ( nwg ) and the control group ( cg ) ( fig . the tests were conducted by 
 blinded assessors , in a single blind experiment ; the person making the measurements did not 
 know to which study group a given subject belonged . simple random sampling was used , with 
 unmarked envelopes and a 1:1 chance of drawing a group . the flow of participants through the trial sixty - seven volunteers who met the inclusion criteria , were enrolled in the study . the 
 inclusion criteria were : age between 65 and 74  years , no regular physical activity in 
 leisure time , and a willingness to participate in the study . the exclusion criteria were : 
 age , regular forms of physical activity undertaken in leisure time , professional activity , 
 musculoskeletal dysfunctions preventing exercise and walking , acute inflammations possibly 
 associated with a disease , previous episodes of cardiac arrest , uncontrolled arrhythmias , 
 chronic heart failure ( nyha 3 and 4 ) , uncontrolled and untreated high blood pressure ( over 
 140/90  mm / hg at rest ) , uncontrolled asthma , diabetes with insulin treatment , liver or renal 
 failure , neoplastic disease or medical advice against taking exercise . the level of physical activity of all subjects was assessed using a physical activity 
 questionnaires the 7-day physical activity recall ( 7par)8 , in order to compare the initial level of physical activity between 
 the groups at baseline . all the patients were informed about the purpose and procedures of the study in detail and 
 gave their consent to participation in the study . the study received the approval of the 
 local bioethical committee of university of medical sciences no . the subjects of the experimental group and the control group performed the same set of 
 tests at the beginning and at the end of the 12-week training period . the functional equilibrium tests performed on the force platform aimed to evaluate postural 
 control while reaching . the tests were performed with the subjects standing on a force platform ( cq  stab 
 poland ) placed against a wall . measuring tapes were stuck to the wall , in accordance with 
 the diagram presented in the study by row et al9 . the assessed parameters included the length of forward reach 
 ( measured tape affixed horizontally ) and upward reach ( centimetre tape affixed at a 
 45-degree angle ) , and the forward displacement of the centre of pressure ( cop ) in relation 
 to the initial position of the patients , labeled point  0  . point  0  was determined as the 
 vertical projection from the centimetre tape stuck to the wall onto the furthest point of 
 the foot on the force platform . these points were marked with a special tape , which the 
 subjects were not allowed to cross , and were identical for all measurements and subjects . the position of the platform in the baseline and post - intervention tests was identical 
 ( marked with a tape stuck to the floor ) , the position of the feet and the upper limbs also 
 remained unchanged ( the tape stuck to the platform , the measuring tapes stuck to the wall ) . the evaluated parameters included the forward displacement of the cop ( the furthest point in 
 the computer diagram ) , and the forward and upward reach ( forward or upward movement of the 
 fingers on the centimetre tape ) . both in the baseline and post - intervention tests , the 
 patients performed the test 3 times and the best result , in which the patient reached the 
 furthest , was chosen for use in the analysis . gait parameters were evaluated on a zebris fdm - t treadmill ( zebris medical 
 gmbh , germany ) . this treadmill has often been used as a research tool to examine the 
 elderly , and patients with neurological deficits10 , 
 11 . the subjects performed two trials 
 at baseline and post - intervention at a rate of 4  km / h , which reflected their average walking 
 speed . the first trial lasted for 30 seconds and was supposed to prepare the patient for 
 walking on the treadmill , the second lasted for 5  min and the results were used in the 
 analysis . a training session lasted for 75 minutes : 10 minutes of warm - up 
 activities with stretching , 60 minutes of walking and 5 minutes of  cool - down activities 
 with stretching . each session was performed in a group and was supervised by two 
 instructors . the walking distance and pace of the groups were gradually increased by the 
 instructors who took into consideration both the period of the intervention and the level of 
 perceived exertion of the participants ( mean pace : 1st week : 4.20.2  km / h ; 12th week : 
 5.60.2  km / h ) . the pace of walking was monitored by the instructors , using handheld 
 equipment ( polar gps sensor g5 , polar electro oy , kempele ) . in each session , when 
 participants reached half the distance , they had short break during which they performed 
 breathing exercises . the participants in both groups received the recommendation , that they 
 should perform exercise , no less than 12 and no more than 14 points on the perceived 
 exertion scale12 . the subjects of cg 
 received detailed instructions regarding walking training , which they performed unsupervised 
 over the next 12 weeks . moreover , each cg subject was given a gps sensor with instructions 
 to turn it on before starting a walk , and to turn it off after finishing the walk . once a 
 month the data concerning the amount of training and the times of individual training were 
 checked . the subjects of both groups ( nwg and cg ) were told not to take up any additional 
 forms of physical activity , and not to change their current eating and motor habits during 
 the course of the study . before the start of the training , the subjects in nwg were taught 
 to the proper technique of walking with poles ( a 2-hour instruction ) . as data 
 were not normally distributed , comparisons between the two study groups were performed using 
 the mann - whitney test . for paired variables , the subjects of both groups were similar in terms of the basic descriptive characteristics 
 and the level of physical activity as assessed by 7par ( table 1table 1.the descriptive characteristics of the subjects ( mean  sd)featurenordic walking group ( n=28)control group ( n=29)age ( years)70.5  3.771  2.9genderfemale  100%female  100%weight ( kg)67  9.966.4 11.2bmi ( kg / m)27.13  3.726.9  4.5height ( cm)157.2  5.9159.5  5.8the time spent in physical activity during leisure in 
 the week preceding the study ( 7par  hours : min)rest : 45:52rest : 46:00light pa : 84:12light pa : 80:16average pa : 31:02average pa : 30:01high pa : 05:51high pa : 06:45very high pa : 0:00very high pa : 0:00there were no significant differences in any of the parameters between the nordic 
 walking group and the control group . ) . there were no significant differences in any of the parameters between the nordic 
 walking group and the control group . the results obtained in the urt and frt tests demonstrate that after nw training , the nwg 
 subjects showed significant improvement in the range of reach in both tests , compared to the 
 baseline . also the difference between the urt results at the baseline and post - intervention 
 tests proved to be significantly different from that of the control group . neither group 
 showed a statistically significant improvement in the maximum forward cop displacement 
 ( table 2table 2.the results of the forward reach test and the upward reach test performed on a 
 stabilometric platform ( mean sd)testnordic walking groupcontrol groupbaseline test frt ( cm)114.83.4115.93.8end test frt ( cm)115.84.6116.74.1baseline test frt cop ( mm)89.0510.384.813.2end test frt cop ( mm)85.109.480.513.2baseline test urt ( cm)105.55.9105.23.7end test urt ( cm)107.85.5105.94.4baseline test urt cop ( mm)87.1310.384.613.8end test urt cop ( mm)82.012.281.912.8frt : forward reach test , urt : upward reach test , cop : centre of pressure . p < 0.05 in the wilcoxon test.p<0.05 for differences 
 between the groups in the changes from baseline to post - intervention ) . frt : forward reach test , urt : upward reach test , cop : centre of pressure . p < 0.05 in the wilcoxon test.p<0.05 for differences 
 between the groups in the changes from baseline to post - intervention gait analysis failed to identify any significant changes during the evaluation of a single 
 stride and any of its phases . the only parameter which showed a noticeable change was the 
 slightly reduced percentage difference from baseline in the swing phase of the control group 
 at post - intervention . however , the analysis of the full gait cycle showed it was longer ( cm ) 
 at post - intervention in nwg , and this was accompanied by prolongation of the time of strides 
 and a reduction in their frequency compared to cg ( table 3table 3.the treadmill walking parameters ( mean sd)gait parametersnordic walking groupcontrol groupbaselineendbaselineendwidth ( cm)6.21.65.91.65.91.85.81.8the difference in stride length between the left and 
 the right leg ( cm)2.42.32.91.82.41.63.11.3 the difference in stride - making time between the 
 right and the left leg ( sec)0.010.010.010.010.090.010.010.01the percentage difference in the total time of the 
 stance phase between the left and the right leg ( % ) 0.80.50.70.71.10.70.70.4 load response ( % ) 0.90.70.80.91,00.50.70.6 single support ( % ) 0.81.30.60.61.11.10.70.4 pre - swing ( % ) 0.90.70.840.91.00.60.70.5the percentage difference in swing phase time between 
 the left and the right leg ( % ) 0.81.30.70.61.11.10.70.4the percentage of double support time ( % ) 25.02.324.12.425.52.324.82.0the length of the cycle ( cm)101.89.01112.411.2106.212.4108.910.5the time of the cycle ( sec)1.000.11.10.11.00.11.00.1cadence ( strides / min)60.66.955.67.157.75.256.94.3p < 0.05 in the wilcoxon test . p<0.05 for differences 
 between the groups in the changes from baseline to post - intervention ) . p<0.05 for differences 
 between the groups in the changes from baseline to post - intervention the study attempted to evaluate the impact of nordic walking training , on some parameters 
 of functional fitness of women over 65  years of age . the evaluated parameters were 
 associated with postural control , balance and gait , i.e. the elements of fitness which may 
 play important roles in the prevention of falls . in most cases , the obtained results were 
 consistent with the research hypothesis and showed that nordic walking has potential as a 
 form of exercise for the elderly . postural control is defined as the ability 
 to control the body s position in space for the purposes of stability and orientation , and 
 is critical during standing balance and walking tasks13 . postural control was analyzed using a stabilometric platform , 
 which is often used in studies of the elderly and in neurology14 , 15 . however , in 
 the present study it was used as an auxiliary tool to evaluate the displacement of the 
 centre of pressure ( cop ) during two functional tests , urt and frt . moreover , urt has been defined as 
 the more demanding test , reflecting everyday - life activities better than frt9 . drawing on the experience of the authors , 
 the measurements were performed in a similar way , but facilitated by the placement of 
 coloured sticky tapes on the floor and the stabilometric platform , and measuring tapes on 
 the wall , which were not removed throughout the study in order to maintain a uniform 
 standard of research . the results suggest that only nwg subjects improved their range of 
 reach the both in the frt and urt tests , however only significant found between nwg and cg 
 was in the post - intervention changes from baseline in the urt test . no significant changes 
 in the forward displacement of the centre of pressure moreover , the average results indicate that there was a decreasing trend in 
 this result , which may suggest that during trials , the nwg subjects moved cop to their heels 
 and at the same time tried to reach forward and upward more boldly . it is possible that nw 
 training did not increase body control while moving cop forward during the urt and frt 
 tests , but it could have improved muscle strength and trunk stability , thereby improving 
 postural control . the urt or frt tests help to evaluate the ability to maintain balance during a functional 
 task16 , 17 , and perhaps , in the future , these tests should be incorporated 
 into a comprehensive assessment of dynamic balance and postural control . parkatti et 
 al.4 , demonstrated a statistically 
 significant improvement in all the components of the fitness test for the elderly , apart 
 from the  backscratch test  . similar results were reported by lee et al.18 , and by kukkonen - harjula et al . in a study 
 in which the tested women showed improvements in most tests evaluating physical fitness , but 
 each time on the basis of a different set of tests19 . in that study measurements of postural control were not taken into 
 account , and balance was assessed using the standing on one - leg time and walking backwards . it seems that the strength of the trunk muscles plays a vital role in maintaining balance 
 when crossing the circumference of the support base , and during each phase of walking the 
 erector spinae and multifidus muscles are engaged20 . these muscles probably work in a similar way regardless of whether 
 we use poles or not , especially since opinions about the reduced burden on the legs and the 
 trunk during walking with poles were premature21 , 
 22 . the evaluation of the involvement 
 of individual trunk muscles during nw calls for further investigation . studies suggest that gait parameters should be evaluated at least once a year23 , since selected gait parameters may become 
 an important index for determining the risk of falling . our study results are promising , 
 because they demonstrate that in the nordic walking group the length ( cm ) and time ( sec ) of 
 the gait cycle were increased and the frequency of strides decreased . earlier studies have 
 demonstrated that walking training performed once a week , can improve gait speed and 
 performance during the  timed up & go test24 . moreover , the results of our study are consistent with other 
 findings that show that the use of different forms of unconventional walking ( e.g. with 
 music or with exaggerated upper - body involvement ) improves gait parameters25 . the assumptions of the present study seem similar to those made by takeshima et al5 . in their study , it was suggested that nw 
 should be the recommended form of physical activity for improving fitness and reducing the 
 risk of fall in the elderly . in our study however , it seems that the intervention had a 
 greater efficacy among elderly persons with high risk of falls or a history of falls . the subjects of this study were only women ( no man volunteered ) , 
 therefore , it is difficult to draw conclusions for the entire population of the elderly and , 
 in order to draw definitive conclusions , the size of the experimental group needs to be 
 increased . for this reason , an objective and universally recognized functional test should be used at 
 the later stage of the study for the comparison of results . at this stage of the study there 
 was no supervised control group and it was difficult to determine whether walking would not 
 affect the results in a way similar to the nordic walking training . therefore , at a further 
 stage of the study , a group will be created which , instead of the nordic walking training , 
 will perform traditional walking in a supervised form . finally , it is in our opinion that 12-week nw training has a beneficial impact on selected 
 gait parameters and may improve postural control , on the basis of results of selected 
 functional tests performed by women between the ages of 65 and 74 .