Physical Activity in Adults With Amputation

February 17, 2022 updated by: Jaclyn Sions, University of Delaware

Metabolic Cost and Physical Activity in Sedentary Adults With a Unilateral Transtibial Amputation as Compared to Controls

This cross-sectional study explores physical activity and energy expenditure among inactive adults with a unilateral transtibial amputation. Results may assist with physical activity prescription for adults with unilateral lower-limb loss.

Study Overview

Status

Terminated

Conditions

Intervention / Treatment

Detailed Description

Up to 48% of adults following a lower-limb amputation will die within the upcoming year. Lack of physical activity (exercise) contributes to high death rates. It is recommended that younger (and middle-aged) adults without a health condition walk 10,000 steps/day to reduce the risk of chronic health conditions, while recommendations are 7,100 steps per day for older adults and those with chronic health conditions. Adults with a lower-limb amputation walking about 21-43% of the recommended 7,100 steps/day. Step activity monitors, such as the StepWatch (a research-grade accelerometer) and the FitBit (a commercially-available monitor) provide a means of evaluating physical activity, which is important since patients tend to over-estimate their level of physical activity. Activity monitor use, however, may not be possible in every healthcare practice setting, as monitors may cost $100-$600 and someone must remove the data from the monitor, interpret the data, and enter the data into the patient's medical record. Therefore, physical activity questionnaires, where the patient self-reports their physical activity, are ideal in a clinical setting. Unfortunately, to date, there has been little research looking at the accuracy of physical activity questionnaires in patients with lower-limb amputations and how these questionnaires measure up to data obtained from step activity monitors.

In addition to 7,100 steps/day, adults with mobility-limiting, chronic conditions (including individuals with lower-limb amputations) should participate in ≥150 minutes of moderate-intensity physical activity per week, with activity in ≥10 minutes per bout. Moderate-intensity activity has been defined as 3 metabolic equivalents (METs). One MET is equal to the amount of oxygen one consumes at rest, so 3 METs means that one is consuming 3 times the amount of oxygen one would consume at rest. In healthy adults without a medical condition this equates to walking 2.6-2.7 mph or 100 steps/minute, while for adults with an amputation of the leg below-the-knee (i.e. a transtibial amputation), 1.47 mph or 86 steps/minute has been reported to equal 3 METs. Maximal walking speeds for adults with lower-limb amputations, specifically those who have lost their limb due to poor blood circulation may be ≤1.67 mph, so one must question if walking 1.47 mph for an extended time is possible for these patients. Investigators believe that 1.47mph is greater than 3 METs for adults with a lower-limb amputation who have other medical issues, such as diabetes and peripheral vascular disease, and who are deconditioned and not participating in physical activity.

It is important to know what speed (mph) and cadence (steps/minute) equals 3 METs in adults with a lower-limb amputation with other medical conditions who are currently inactive. Investigators believe that these patients represent the vast majority of patients that healthcare providers encounter and must council regarding increasing physical activity levels. Providers need to know what speed and cadence is equal to 3 METs for inactive patients with limb loss with other medical conditions, so that providers can appropriately advise their patients and prescribe exercise.

Walking exercise may occur over-ground or on a treadmill. When an individual with a lower-limb amputation is walking over-ground, their right-to-left side walking pattern will be more asymmetrical (uneven) when compared to when they are walking on a treadmill. When walking is more symmetrical side-to-side (even), the patient may have to expend more energy. Energy expenditure can be assessed as the amount of oxygen consumed, which can be obtained while wearing a mask that evaluates the participant's breathing while walking. Among adults with a lower-limb amputation, energy expenditure studies have generally used treadmills to look at energy expenditure. Over-ground versus treadmill conditions, however, are different, and as such, what equals 3 METs (speed, cadence) in each walking condition may vary.

Further, no studies have compared the energy cost of walking in adults who are inactive with a lower-limb amputation to age-, sex-, and body mass index (computed from height and weight) -matched adults without an amputation. While studies have evaluated the impact of aging and limb length of the amputated limb on energy expenditure, few have evaluated modifiable factors that may impact energy expenditure among adults with lower-limb amputation. Similarly, little research has explored modifiable factors that may impact physical activity levels.

The project's goal is to provide knowledge that will improve physical activity prescription for inactive adults with a single, below-the-knee amputation (i.e. transtibial amputation).

Successful completion of the project may provide healthcare providers with (1) a physical activity self-report measure that can be used in clinical practice for patients with a lower-limb amputation, (2) gait speed (mph) for prescribing moderate-intensity over-ground and treadmill walking during the rehabilitation of patients with lower-limb amputations, and (3) cadence (steps/minute), for evaluating and monitoring moderate-intensity physical activity via step activity monitors, for inactive adults with a lower-limb amputation.

Investigators will provide the first objective data that looks at the additional energy expenditure necessary for inactive adults with a lower-limb amputation who are using a prosthesis to walk short-distances as compared to able-bodied adults; this data may be used for the development of future prosthetic components that reduce energy expenditure. Investigators will explore factors that may be linked to energy expenditure and physical activity among adults with and without a lower-limb amputation.

Study Type

Observational

Enrollment (Actual)

3

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • Delaware
      • Newark, Delaware, United States, 19713
        • University of Delaware STAR Campus

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 60 years (ADULT)

Accepts Healthy Volunteers

Yes

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

Investigators will recruit 22 (males and females) with a unilateral (i.e. single limb), transtibial (i.e. below-the-knee) amputation. Given the prevalence of amputations is greater in males, it is expected that the sample will be predominantly male, but there will not be any inclusion/exclusion criteria related to sex. 20 controls will be recruited as age-, sex-, and body mass index-matched controls for those with a unilateral transtibial amputation who complete the entire study evaluation protocol.

Description

Inclusion Criteria (all participants):

  • Ages 18-60 years
  • Able to read and speak English
  • Saltin-Grimby Physical Activity Level of I or II

Inclusion Criteria (individuals with unilateral, transtibial amputations):

  • Unilateral, transtibial (below-the-knee) amputation
  • Currently wearing a prosthesis with use of an assistive device no greater than a cane
  • Wearing prosthetic at least 8 hours per day and inside and outside the home: This criteria will help to ensure that adults are beyond the initial weaning into a prosthetic period and are prosthetic users rather than nonusers.

Inclusion Criteria (controls):

  • Pain-free in the legs and low back regions
  • Able to walk without an assistive device

Exclusion Criteria:

  • Current infections or illnesses that would affect safe participation in the study
  • Past medical history of significant cardiovascular disease (e.g. congestive heart failure or previous heart attacks), significant neurological disease (e.g. Parkinson's, Multiple Sclerosis) significant neurological event (e.g. stroke), or major lung condition (e.g. Chronic obstructive pulmonary disease, emphysema)
  • Uncontrolled high blood pressure
  • Uncontrolled Diabetes Mellitus

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Unilateral Transtibial Amputation
Individuals with a unilateral, transtibial amputation.
Procedure: Metabolic Cost Testing Procedures

The Oxycon Mobile™Portable VO2 Measurement system will be used to measure VO2 uptake during 2 walking tests. Test order will be randomized.

Treadmill Test: Participants will walk on a treadmill at constant speed, based on the participant's self-selected gait speed, for 2.5 minutes in each stage. Walking will occur at 75% of self-selected gait speed in stage 1, 100% in stage 2, and 125% in stage 3.

Over-ground Test: Participants will walk in an uncarpeted corridor on a course consisting of 2 cones, 20-meters apart. Participants will be instructed to walk at a constant speed for 2.5 minutes in each stage. Instructions will be to walk at their "slow" speed in stage 1, their "usual, comfortable" speed in stage 2, and their "brisk" speed in stage 3.
Controls
Healthy adults without a lower-limb amputation who have been matched to participants in the Unilateral Transtibial Amputation group based on age, sex, and body mass index.
Procedure: Metabolic Cost Testing Procedures

The Oxycon Mobile™Portable VO2 Measurement system will be used to measure VO2 uptake during 2 walking tests. Test order will be randomized.

Treadmill Test: Participants will walk on a treadmill at constant speed, based on the participant's self-selected gait speed, for 2.5 minutes in each stage. Walking will occur at 75% of self-selected gait speed in stage 1, 100% in stage 2, and 125% in stage 3.

Over-ground Test: Participants will walk in an uncarpeted corridor on a course consisting of 2 cones, 20-meters apart. Participants will be instructed to walk at a constant speed for 2.5 minutes in each stage. Instructions will be to walk at their "slow" speed in stage 1, their "usual, comfortable" speed in stage 2, and their "brisk" speed in stage 3.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in gait speed pre- and post-walking tests
Time Frame: immediately before/after
self-selected and fast speeds obtained with GaitRite
immediately before/after

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in gait symmetry
Time Frame: immediately before/after
Temporal and spatial gait characteristics obtained with GaitRite
immediately before/after

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Delaware

Investigators

  • Principal Investigator: Jaclyn M Sions, PhD, PT, DPT, University of Delaware

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (ACTUAL)

May 11, 2017

Primary Completion (ACTUAL)

February 17, 2022

Study Completion (ACTUAL)

February 17, 2022

Study Registration Dates

First Submitted

May 1, 2018

First Submitted That Met QC Criteria

October 25, 2018

First Posted (ACTUAL)

October 29, 2018

Study Record Updates

Last Update Posted (ACTUAL)

March 4, 2022

Last Update Submitted That Met QC Criteria

February 17, 2022

Last Verified

February 1, 2022

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • 1046346

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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