Development of an Exercise Testing Protocol for Patients with a Lower Limb Amputation: Results of a Pilot Study.
Vestering, M., Schoppen, R., Dekker, R., Wempe, J., & Geertzen, J. (2005). Development of an exercise testing protocol for patients with a lower limb amputation: Results of a pilot study. International Journal of Rehabilitation Research, 28, 237-244.by: Mary Hoffman
This pilot study was designed in an attempt to begin the development of a safe, graded exercise test protocol for persons with lower-limb amputations. Based on the results of a literature search, the combined arm-leg ergometer and the arm ergometer were compared.
The study consisted of five participants. The inclusion criteria were unilateral lower limb amputation at one of five different levels, prior exercise training experience, and participation in a rehabilitation program at a rehabilitation center. The exclusion criteria were bilateral lower limb amputation as well as upper limb amputation and suspicion or evidence of coronary artery disease.
Patients were initially tested on the Cruiser combined arm-leg ergometer and then the Angio arm ergometer with at least a 1-week interval between the two sessions.
Prior to testing, the patients; predicted maximal heart rate (HRmax), minute ventilation (VE max), and oxygen uptake (VO2max) were calculated using prediction equations. During testing maximum power output (W), heart rate (beats/min), maximum ventilation (VE), carbon dioxide output (VCO2), and oxygen consumption (VO2) were measured.
The testing protocol began with a 5-minute still period in order to obtain baseline measurements. Afterward, a 3-minute warm up at 20W was completed followed by 5W increases every minute until one of three termination criteria was met.
The researchers did not use statistical measures to analyze the results. The scoring of the two ergometers included ratings of excellent; good; neither good, nor bad; bad; and very bad. The combined arm-leg ergometry received higher scores than arm ergometry in the areas of determining VO2max, HRmax, ECG, and patient preference. Arm ergometry received a higher score than the combined arm-leg ergometry in the areas of ergometer access and stump support.
Based on the study, both arm ergometry and combined arm-leg ergometry are feasible for exercise testing involving persons with amputations. Rigorous measures of analysis were not used due to the exploratory nature of the study, as well as the small subject number. Future studies should focus on proving reliability and validity.