There are many factors that contribute to the high energy cost of prosthetic gait. Less muscle mass, shorter lever arms and changes to the vascular system are a few of the intrinsic factors leading to excessive energy expenditure.1 Compensations to combat this start off small and lead to bigger problems. Overuse, muscle imbalance and postural asymmetries can lead to osteoarthritis, osteopenia and chronic low back pain.2 Starting off with the right posture and a strong foundation can help counteract these issues.

As outlined in this educational series, there are key muscle functions that are essential to promoting energy efficient gait. Dynamic, effective hip, pelvis & core stabilization and motion are important to all aspects of the gait cycle and maximizing function of the prosthesis. We’ve established tools for postural correction, strengthening, stretching and prevention from overuse injury. Let’s discuss how to increase endurance.

Aerobic Exercise

Joe Townsend, a British Royal Marine veteran, swims a timed 50-meter freestyle during the first day of practice at the Marine Corps Trials at Camp Pendleton, Calif., Feb. 26, 2013.

Image by rawpixel.com3

Aerobic exercise is important to helping your cardiovascular system get in shape and has been shown to decrease the metabolic cost of prosthetic gait.1,4 In other words, less feelings of fatigue and greater participation in activities. Finding the right activity for you includes exploring your interests, access to activities and possibly trying something new. Potential forms of exercise include walking, swimming, cycling (including stationary bike), recumbent cross trainer machine (try including upper body and trunk rotation), treadmill, upper body ergometer, etc. Any type of exercise where repetitive motion occurs causing your heart rate to rise and increases your demand for oxygen. The question is how do you know if you are working at the proper intensity?

Paralympic running

Image by rawpixel.com6

First and foremost, if you have any concerns about your cardiac status, get clearance from your Doctor before exercising. Start off low and go slow. For some, 10 continuous minutes of low impact exercise at low to moderate intensity (50-65% of maximum heart rate) is just enough to begin.4 As your activity tolerance increases, the goal is to reach at least 150 minutes of moderate to high intensity aerobic activity (65-85% of maximum heart rate) per week.5

How do you calculate maximum heart rate?7 220 minus your age. How do you monitor your response to activity? Use the Rate of Perceived Exertion Scale.8,9 It’s a measure you may have used in rehabilitation that correlates with heart rate. The modified version indicates 0=no exertion, 2=light, 3=moderate, 5=strong, 7=very strong, and 10=maximal. Always include warm up and cool down exercises to protect your heart, lungs, muscles and joints. When in doubt, consult an expert. 

All the best on your road to wellness!

References

  1. van Schaik, Loeke et al. “Metabolic costs of activities of daily living in persons with a lower limb amputation: A systematic review and meta-analysis.” PloS one vol. 14,3 e0213256. 20 Mar. 2019, doi:10.1371/journal.pone.0213256
  2. Gailey, Robert, et al. “Review of Secondary Physical Conditions Associated with Lower-Limb Amputation and Long-Term Prosthesis Use.” Journal of Rehabilitation Research and Development, vol. 45, no. 1, 2008, pp. 15-30.
  3. “Joe Townsend British Royal Marine veteran.” Raw Pixel, https://www.rawpixel.com/image/3319330/free-photo-image-ocean-corps-2013-marine-trials. Accessed April 16, 2023.
  4. Wilhoite, Sydni, , et al. “Rehabilitation, Guidelines, and Exercise Prescription for Lower Limb Amputees”. Strength and Conditioning Journal, vol. 42, no. 2, April 2020, pp. 95-102. doi:10.1519/SSC.0000000000000523
  5. Wezenberg, Daphne, et al. “Cardiorespiratory Fitness and Physical Strain during Prosthetic Rehabilitation After Lower Limb Amputation.” Prosthetics and Orthotics International, vol. 43, no. 4, 2019, pp. 418.
  6. “Man paralympic athlete running with prosthetic legs.” Raw Pixel, https://www.rawpixel.com/image/4088047. Accessed April 16, 2023.
  7. “Calculate your Heart Age.” NYC Health, https://www.nyc.gov/site/doh/health/health-topics/heart-age-calculator.page. Accessed April 16, 2023.
  8. “Perceived Exertion (Borg Rating of Perceived Exertion Scale).” CDC, September 17, 2020,https://www.cdc.gov/physicalactivity/basics/measuring/exertion.htm.
  9. “Rating of Perceived Exertion: Borg Scale.” SRA Lab, November 2014, https://www.sralab.org/sites/default/files/2018-04/Rating_of_perceived_exertion_-_Borg_scale.pdf.
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