Interobserver and intraobserver reliabilities of determining the ventilatory thresholds in subjects with a lower limb amputation and able-bodied subjects during a peak exercise test on the combined arm-leg (Cruiser) ergometer.

The first (VT1) and second ventilator (VT2) (anaerobic) thresholds are used to individually prescribe exercise training programs. The purpose of this research was to analyze inter- and intraobserver reliabilities of determining VT1 and VT2 in subjects with lower limb amputation (LLA) and able-bodied (AB) subjects during a peak exercise test on the arm-leg (Cruiser) ergometer. Previously published data of exercise tests on the Cruiser ergometer of subjects with LLA ( n = 17) and AB subjects ( n = 30) were analyzed twice by two observers. The VT1 and VT2 were determined based on ventilation plots. Differences in determining the VT1 and VT2 between the observers for the first and second analyses were analyzed. To quantify variation in measurement a variance component analysis was performed. Bland-Altmann plots were made, and limits of agreement were calculated. The number of observations in which thresholds could not be determined differed significantly between observers and analysis. Variation in VT1 between and within observers was small (0-1.6%) compared with the total variation, for both the subjects with an LLA and AB subjects. The reliability coefficient for VT1 was more than 0.75, and the limits of agreement were good. In conclusion, based on the results of this study on a population level, VT1 can be used to prescribe exercise training programs after an LLA. In the current study, the determination of VT2 was less reliable than VT1. More research is needed into the clinical application of VT1 and VT2 during a peak exercise test on the Cruiser ergometer.

Feasibility, safety, and reliability of exercise testing using the combined arm-leg (Cruiser) ergometer in subjects with a lower limb amputation.

BACKGROUND: Physical fitness of patients with a lower limb amputation predicts their walking ability and may be improved by physical exercise and training. A maximal exercise test is recommended prior to training in order to determine cardiovascular risks and design exercise programs. A potentially suitable ergometer for maximal exercise testing in patients with a lower limb amputation is the combined arm-leg (Cruiser) ergometer. The aim of this study was to determine feasibility, safety, and reliability of (sub)maximal exercise testing on the Cruiser ergometer in subjects with a lower limb amputation. METHODS AND FINDINGS: Subjects with a lower limb amputation performed 1 submaximal exercise test and 3 maximal exercise tests on the Cruiser ergometer. Feasibility was determined by examining whether key variables such as power output, heart rate and oxygen uptake were correctly and reliably measured, by determining whether a test was a maximal aerobic performance, by studying reasons for non-completion, and by measuring gross efficiency. Safety was analyzed by recording complications, electrocardiogram results, and blood pressure. Reliability was tested by comparing the results of the second and third maximal exercise test. Seventeen subjects (14 men and 3 women) out of 21 preselected subjects completed the study. In general, the maximal Cruiser exercise test was feasible. Almost 75% of the subjects reached a maximal aerobic performance. The test was also safe because no complications occurred, although electrocardiogram and blood pressure could only be reliably recorded in most subjects just before and after the test. Reliability was good: Intraclass correlation was 0.84 for peak oxygen uptake. CONCLUSIONS: The Cruiser ergometer is a feasible, safe, and reliable ergometer for measuring physical fitness of subjects with a lower limb amputation.

One-day low-intensity combined arm-leg (Cruiser) ergometer exercise intervention: cardiorespiratory strain and gross mechanical efficiency in one-legged and two-legged exercise.

This study aims to research whether there is a difference in cardiorespiratory variables and gross mechanical efficiency (GE) in healthy individuals during low-intensity one-legged and two-legged exercise on the combined arm-leg (Cruiser) ergometer and whether motor learning occurs. The outcome of this study will support the use of the Cruiser ergometer in future as a testing and training instrument in the rehabilitation of patients with a lower limb amputation. Twenty-eight healthy men participated in this randomized-controlled trial. One group (n=14) used one leg and both arms during the exercise and the other group (n=14) used both legs and both arms. All participants performed a 1-day low-intensity exercise protocol. This included a standardized pretest and post-test of three bouts of 4 min exercise at 40 W and an exercise intervention of seven bouts of 2×4 min exercise at 40 W. The one-legged and two-legged group differed significantly in the heart rate and GE between the pretest and post-test. At the post-test, the one-legged group showed motor learning. GE improved significantly in both groups over the duration of the three exercise bouts of the pretest, but it did not improve during the post-test. There are differences in cardiorespiratory variables and GE between one-legged and two-legged exercise on the Cruiser ergometer. When using this ergometer in the rehabilitation of patients with a lower limb amputation, it is important to consider these differences and the occurrence of motor learning.

Gross mechanical efficiency of the combined arm-leg (Cruiser) ergometer: a comparison with the bicycle ergometer and handbike.

The combined arm-leg (Cruiser) ergometer is assumed to be a relevant testing and training instrument in the rehabilitation of patients with a lower limb amputation. The efficiency and submaximal strain have not been established and thus cannot be compared with alternative common modes of exercise. A total of 22 healthy able-bodied men (n=10) and women (n=12) were enrolled in four discontinuous submaximal graded exercise tests. Each test consisted of seven bouts of 3 min exercise ranging from 20 to 45 W and was performed on, respectively, the Cruiser ergometer, a bicycle ergometer, a handbike, and again the Cruiser ergometer. Cardiorespiratory parameters were measured and rate of perceived exertion was determined. Gross mechanical efficiency (GE) was determined from power output and submaximal steady-state energy cost. Repeated-measures analysis of variance (P<0.05) was used to evaluate the effects of exercise mode, exercise intensity, and sex. No differences in GE and cardiorespiratory strain were found between both Cruiser tests (GE 45 W: men 13.0%, women 15%) and the bicycle test (GE 45 W: men 13.2%, women 14.6%). GEs of handbiking (45 W: men 11.2%, women 12.2%) were lower compared with the Cruiser and bicycle test results, whereas cardiorespiratory strain in handbiking was consistently higher. Apart from a lower rate of perceived exertion at the second Cruiser test, no differences were found between the repeated Cruiser tests. It can be concluded that GE and cardiorespiratory strain in submaximal Cruiser exercise are comparable with leg cycling, the repeatability was good, and no obvious learning effects were observed. The results of this study form a base for further research in patients with a lower limb amputation.

Prosthetic fitting in a patient with a transtibial amputation due to a congenital vascular malformation of the right leg.

BACKGROUND: The problems of prescribing a prosthesis for a young girl with severe congenital vascular malformation deformity leading to a transtibial amputation. CASE DESCRIPTION AND METHODS: Due to the high risk of recurrent bleeding and limitations regarding full weight bearing of the stump, a normal socket fitting process was not possible. Using a multidisciplinary approach, a prosthesis was designed to enable full weight bearing in a flexed knee position with ischial tuberosity support to prevent full weight bearing on the tibial part of the stump. FINDINGS AND OUTCOMES: After training and adjustments to the design, a definitive prosthesis with a free motion mechanical knee joint could be used. During the training with this prosthesis, no skin problems were observed, and at the end of the rehabilitation, the patient had a high level of activities of daily living and sports. CONCLUSION: The above prosthetic solution with an adjusted socket design proved to be successful in this case. Clinical relevance In a patient with severe congenital vascular malformation deformity leading to a transtibial amputation, fitting of a good prosthesis without full weight bearing of the stump proved to be successful.

Repeatability and validity of the combined arm-leg (Cruiser) ergometer.

The measurement of physical fitness of lower limb amputees is difficult, as the commonly used ergometer tests have limitations. A combined arm-leg (Cruiser) ergometer might be valuable. The aim of this study was to establish the repeatability and validity of the combined arm-leg (Cruiser) ergometer. Thirty healthy volunteers carried out three incremental exercise tests, once on the bicycle ergometer and twice on the Cruiser ergometer. The repeatability of the Cruiser ergometer was assessed by studying the mean values of the test-retest and the validity by studying the mean values of the bicycle and the two Cruiser ergometer tests. The intraclass correlation coefficient for repeated measurements on the Cruiser ergometer was 0.84 for the maximal oxygen consumption (VO2max), and 0.71 for the maximal heart rate (HRmax). The intraclass correlation coefficient for the measurements on the bicycle ergometer and the Cruiser ergometer was 0.86 for the VO2max and 0.73 for HRmax. Bland and Altman plots for VO2max and HRmax showed a bias close to zero and a great accuracy. The conclusion of this study is that the Cruiser ergometer provides a repeatable and valid measurement of physical fitness in healthy volunteers. Its value in clinical practice for lower limb amputees needs to be further established.