Lower extremity amputees with peripheral vascular disease: graded exercise testing and results of prosthetic training

Thirty-nine subjects, mean age 72 (range 52 to 89), with a leg amputation because of peripheral vascular disease performed graded exercise testing at the start of their prosthetic training program. Their walking performance at the end of the program was assessed and compared with the test findings. They had a history and rest electrocardiogram (ECG) examination which revealed cardiac problems in 75% of the patients. The exercise test was performed on a specially designed arm ergometer permitting coordinated exercise of arm and trunk muscles. Cardiac condition was judged by the achieved peak heart rate (mean 125 +/- 3.8 beats per minute) and observed ECG abnormalities. In only three patients exercise-induced ECG abnormalities were found at peak workload. The mean peak workload was 52 +/- 1.9W. It was concluded from these results that the average physical and cardiac condition is poor in vascular leg amputees. In 34 patients (87%) the prosthetic training was successful. Fourteen patients needed a walking frame and twenty could walk without a walking frame. The probability of achieving walking without a walking frame was 70% in patients with peak workload above 45W and 30% in those with peak workload lower than 45W.