Exercise testing and training of persons with dysvascular amputation: Safety and efficacy of arm ergometry

Davidoff, Gary; Lampman, Richard M.; Westbury, Leslie M.; Deron, Jacqueline; Finestone, Hillel M.; Islam, S.

doi:10.1016/0003-9993(92)90006-i

Cited by 54 publications

(12 citation statements)

References 11 publications

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“…Most of these patients (around 94%) have an amputation for peripheral vascular disease (PVD) (Rommers, 2000). Many patients who have an amputation for PVD have had severely limited physical activity for weeks to months prior to the amputation as a result of gangrene, osteomyelitis or vascular claudication (Davidoff et al, 1992;Chin et al, 2002a). In addition, having a lower limb amputation usually means a severe decline in physical fitness, caused by a reduced amount of physical activity (Saltin et al, 1968).…”

Section: Introductionmentioning

confidence: 99%

Development of an exercise testing protocol for patients with a lower limb amputation: results of a pilot study

Vestering¹,

Schoppen²,

Dekker³

et al. 2005

International Journal of Rehabilitation Research

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Due to a decrease in physical activity, lower limb amputees experience a decline in physical fitness. This causes problems in walking with a prosthesis because energy expenditure in walking with a prosthesis is much higher than in walking with two sound legs. Exercise training may therefore increase the functional walking ability of these patients. To generate a safe and effective aerobic training program, exercise testing of amputees is recommended. The objectives of this study were to develop a maximal exercise testing protocol for lower limb amputees and to compare two different testing methods: combined arm-leg ergometry and arm ergometry. The protocols were tested in five amputee patients. Combined ergometry elicited a higher oxygen uptake and heart rate than arm ergometry. Electrocardiography during combined ergometry was easier to read. Combined ergometry was judged most comfortable by the amputees. The exercise testing protocol was useful in lower limb amputees to determine their maximal aerobic capacity and their main exercise limitation. Future exercise training programs may be based on this testing protocol. Combined arm-leg ergometry is appropriate for unilateral amputees without significant claudication of the remaining leg. Continuous arm ergometry is suitable for unilateral amputees with significant claudication of the remaining limb or bilateral amputees.

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Section: Introductionmentioning

confidence: 99%

Development of an exercise testing protocol for patients with a lower limb amputation: results of a pilot study

Vestering¹,

Schoppen²,

Dekker³

et al. 2005

International Journal of Rehabilitation Research

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“…In the past, very few studies have evaluated cardiac risk in amputees. Twenty years ago, Davidoff et al [78] recognized the importance of cardiac risk and tried arm ergometry to detect CAD in lower extremity amputees. This technique was not widely accepted because clinicians favored simpler measures in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Amputation and Cardiac Comorbidity: Analysis of Severity of Cardiac Risk

Nallegowda

Lee

Brandstater

et al. 2012

PM&R

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Objective To evaluate population‐based cardiovascular risk scores and coronary artery calcification scores (CACS) in amputees. Design A retrospective cohort study of 1300 veterans in a cardiac computed tomography database. Setting 1B Veterans Administration medical center. Participants A total of 76 amputees and similar number of age‐, gender‐, and Framingham Risk Scores (FRS)‐matched control subjects. Methods The amputee population was identified and compared for CACS and traditional cardiac risk factors. Two control groups were used: control group 1, with known risk factors including diabetes mellitus, and control group 2, with all risk factors without diabetes mellitus. Main Outcome Measures Statistical associations between amputee and control group FRS scores, CACS, and other cardiac risk factors were assessed. Results The study included 57 nontraumatic and 19 traumatic amputees with an average age of 62.4 years. Sixty‐six amputees were in the low‐to‐intermediate cardiac risk groups according to FRS. Despite this classification, the mean CACS were significantly higher in amputees (1285 ± 18) than in either of the control groups: control group 1 (540 ± 84) and control group 2 (481 ± 11), P < .001. CACS also were significantly higher in the nontraumatic subject group (1595 ± 12) compared with the traumatic group (356 ± 57; P < .001). Upon categorization of CACS based on probability of coronary artery disease (CAD), 76% of amputees had a CACS >100 and 38% of amputees had a CACS >1000. Interestingly, CACS were almost the same in finger/toe amputations compared with an above‐knee amputation, indicating an already ongoing CAD process irrespective of level of amputation. The predominant clinical significant cardiac risk factors in amputees are hypertension (89.5%), P < .005; chronic kidney disease (31.6%), P < .001; dyslipidemia (72.4%), P < .04; and insulin resistance. Total cholesterol, low‐density lipoprotein, and high‐density lipoprotein levels were nonsignificantly low in all amputees. Triglycerides were particularly higher in traumatic patients compared with nontraumatic patients, with the triglycerides/high‐density lipoprotein ratio >7. Conclusion This study demonstrates that amputees have a much greater burden of underlying atherosclerotic disease as detected by CACS than do control subjects matched by Framingham risk stratification. Early screening for CAD and aggressive targeted interventions may be an important part of management to reduce early mortality after amputation.

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“…The test is a criterion for determining cardiorespiratory fitness and maximal oxygen consumption (VO 2 max) [ 16 ]. Treadmills, cycle ergometers, and arm crank ergometers have all been utilized for GXT, and cycle ergometers and even arm crank ergometers (ACEs) have been employed in aerobic capacity studies with prosthesis-wearing participants [ 17 , 18 ]. In addition to measurement of VO 2 max, ACE provides measures of workload (watts) and time to exhaustion (TTE).…”

Section: Introductionmentioning

confidence: 99%

Correlates of Balance and Aerobic Indices in Lower-Limb Prostheses Users on Arm Crank Exercise

Guerra

Smith

2021

Sensors

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Background: The HUMAC Balance System (HBS) offers valid measurement of balance, and the arm crank exercise test (ACE) is a valid measure of physiological capacity. Neither have been used to evaluate associations between balance and physiological capacity in lower-limb amputees. Methods: Thirty-five participants with lower-limb amputations were recruited. Standing balance (center of pressure) was evaluated during eyes opened (EO) and eyes closed (EC) conditions using the HBS. Participants performed ACE graded exercise testing (GXT) to evaluate aerobic capacity. Spearman’s rho was used to identify relationships between variables. Cut-points for three groups were generated for time on ACE. Mann–Whitney U tests were used to explore significant differences in variables of balance and ACE between low and high performers. Results: Relationships between variables of eyes open displacement (EOD), eyes open velocity (EOV), eyes closed displacement (ECD), and eyes closed velocity (ECV) were significant (p < 0.05), and high performers with EO also performed best with EC. Longer exercise times were significantly associated with increased HRpeak, VO2peak, VEpeak, and RERpeak (p < 0.05). HRpeak (143.0 ± 30.6 b/min), VO2peak (22.7 ± 7.9 and 10.6 ± 4.7 mL/kg/min), VEpeak (80.2 ± 22.2 and 33.2 ± 12.7 L/min), and RERpeak (1.26 ± 0.08 and 1.13 ± 0.11) were significantly greater in high performers than low performers, respectively (p < 0.05). There was no significant association among VO2peak and any balance task variables; however, there were significant associations between some balance and physiological variables. Conclusions: Findings differentiated high and low performers; however, participants were still well below able-bodied norms of physical capacity. Training to mitigate deconditioning is suggested.

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Exercise testing and training of persons with dysvascular amputation: Safety and efficacy of arm ergometry

Cited by 54 publications

References 11 publications

Development of an exercise testing protocol for patients with a lower limb amputation: results of a pilot study

Development of an exercise testing protocol for patients with a lower limb amputation: results of a pilot study

Amputation and Cardiac Comorbidity: Analysis of Severity of Cardiac Risk

Correlates of Balance and Aerobic Indices in Lower-Limb Prostheses Users on Arm Crank Exercise

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