Symptoms of Parkinson's disease (PD) progress despite optimized medical treatment. The present study investigated the effects of a flexibility and relaxation programme, walking, and Nordic walking (NW) on walking speed, stride length, stride length variability, Parkinson-specific disability (UPDRS), and health-related quality of life (PDQ 39). 90 PD patients were randomly allocated to the 3 treatment groups. Patients participated in a 6-month study with 3 exercise sessions per week, each lasting 70？min. Assessment after completion of the training showed that pain was reduced in all groups, and balance and health-related quality of life were improved. Furthermore, walking, and Nordic walking improved stride length, gait variability, maximal walking speed, exercise capacity at submaximal level, and PD disease-specific disability on the UPDRS in addition. Nordic walking was superior to the flexibility and relaxation programme and walking in improving postural stability, stride length, gait pattern and gait variability. No significant injuries occurred during the training. All patients of the Nordic walking group continued Nordic walking after completing the study. 1. Introduction Parkinson’s disease (PD) is one of the most common neurodegenerative diseases with a prevalence of 100–200/100000 people worldwide [1–3]. The risk of developing PD increases with age. The clinical manifestation is characterised by specific motor deficits: bradykinesia, tremor, rigidity, and postural instability. While the UK brain bank criteria require the presence of bradykinesia combined with at least one of the other symptoms [4, 5] for diagnosis of Parkinson’s disease, others do not consider that bradykinesia has to be always present and make the diagnosis of Parkinson’s disease when two of these symptoms are present [6, 7]. The pathological definition of PD includes the loss of dopaminergic cells in the substantia nigra pars compacta with the subsequent lack of the neurotransmitter dopamine [8–12] and the presence of Lewy bodies [13]. Medical and surgical treatments provide symptomatic relief, but even with optimal therapy there is no cure for the disease and symptoms progress further [14]. PD patients tend to adapt a sedentary lifestyle very early in the course of the disease [15, 16] and have lower levels of strength [17, 18] and functional ability. This is caused by a combination of physical impairments, such as walking and balance problems, cognitive dysfunction with focus on executive dysfunction, depression, fatigue, and pain. Therefore, physical treatment gained in
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