Home-based treadmill walking effectively improved gait performance among patients with transfemoral amputation, supporting the application of training interventions beyond the initial rehabilitation phase, according to recently published data.
“Home-based exercise training offers a potentially feasible strategy to continue the rehabilitation process over the longer term… A number of studies have investigated the use of treadmill-based interventions for persons with impaired gait performance associated with neurologic disorders. However, research investigating the effectiveness of treadmill-based training is lacking in persons with [lower extremity amputation],” the researchers wrote. “Therefore, the purpose of this study was to investigate the effectiveness of a task-specific home-based treadmill exercise program focused on improving gait performance in persons with [transfemoral amputation].”
Home-based treadmill training
Researchers included patients who had undergone unilateral, transfemoral amputation at least 3 years prior as a result of limb trauma or cancer. Participants walked on a home-based treadmill for 30 minutes a day, 3 days per week for 8 weeks; each 30-minute training session included five cycles of walking for 2 minutes at three speeds. Primary measures included temporal-spatial gait performance, physiological gait performance and functional gait performance, including self-selected walking speed (SSWS), maximum walking speed (MWS) and 2-minute walk test (2MWT).
Study results showed 8 weeks of home-based training improved temporal-spatial gait symmetry at SSWS but not at MWS. Improved symmetry was produced by a relative interlimb increase in stance duration for the prosthetic limb and proportionally greater increases in step length for the limb taking shorter steps. Within the first 4 weeks of the program, the training effect was significant for the step length symmetry ratio, according to study results.
Researchers also found energy expenditure decreased progressively during the training with nearly 10% improvement observed across the range of walking speeds, while SSWS, MWS and 2MWT increased by 16% to 20%.
“[What was surprising was] the degree to which the metabolic economy improved. It should not be lost that the improvement exceeded what is frequently found in studies examining changes in the prosthetic alignment or components,” Benjamin Darter, PT, PhD, assistant professor of the department of physical therapy at Virginia Commonwealth University, told O&P Business News. “Also, how closely the self-selected walking speed appeared to be linked to the metabolic effort to walk. While identifying the importance of a link between the two is not new, the results reinforced the notion that lessening the metabolic effort to walk can produce significant improvements in the functional performance of a person with an amputation.
“There was a definite health promotion agenda with this study. As indicated, the participants were all healthy and relatively physically active adults who had the amputation years prior,” Darter added. “I hope patients, clinicians and, perhaps most importantly, health insurers see value in providing continued rehabilitation services to maintain or improve functional performance beyond the acute setting.”
Bicycle vs. treadmill
Previous training among lower extremity amputees relied primarily on bicycle ergometers for training, likely selected because it minimizes weight-bearing stresses on the residual limb and reduces the potential for falls, according to the researchers. Although study results showed benefits with bicycle ergometry training, it is believed a walking exercise program would be more beneficial to patients with lower extremity amputation who wanted to improve gait performance. According to researchers, “treadmills offer a convenient task-specific method to control walking conditions and may inherently provide additional benefits, including enhanced temporal-spatial gait symmetry.”
“Traditionally, treadmill walking has been used primarily as exercise to improve aerobic fitness,” Darter said. “This study supports that practitioners can consider using treadmill walking — without any additional features like body weight support, clinician feedback — to also improve walking characteristics. As a bonus, this intervention can be done outside of the clinician’s office, which saves both time and money.” — by Casey Tingle
Disclosure: Darter has no relevant financial disclosures.