Abstract
Background: The magnitude of the hyperemic response due to repeated thigh stump exercise on incremental contraction intensity might be useful information in localized exercise tolerance for devising cardiovascular physical therapy for amputees. The effect of exercise on amputated leg blood flow (LBF) may potentially be altered due to voluntary muscle contractions after loss of the lower leg compared with the healthy leg. Case Presentation: A 57-year-old male patient with Burger disease attempted 3 min unilateral repeat/dynamic knee extensor exercise at a target muscle contraction frequency (1 s thigh muscle contraction and 1 s relaxation, 90 repetitions) with each leg at six different contraction intensities (rubber resistance belt). Simultaneous measurement of blood velocity/flow (Doppler ultrasound) in the femoral artery, blood pressure, leg vascular conductance (LVC), and peak muscle strength (PMS) were performed during the 3 min exercise period. The maximum voluntary contraction by one-legged isometric knee muscle contraction was 14.7 kg in non-AL and 7.9 kg in the AL with prosthesis. The relative PMS was defined as “PMS/maximum voluntary contraction × 100 (%)”. Pre-exercise LBF was lower in the AL (200 ± 25 ml/min) than the non-AL (275 ± 74 ml/min). Both the non-AL and AL showed good positive linear relationships between absolute-/relative-PMS and LBF or LVC during 30 s at steady-state before the end of the exercise period. Furthermore, there was also similarity seen in the increase rate in LBF and/or LVC for the incremental relative PMS compared with the absolute PMS. Conclusion: In this case, the muscle strength depended on blood flow increase/vasodilation was seen in this “AL” using a TSB prosthesis for repeated dynamic knee extensor exercise. The present amputee’s limb muscle strengthening with the resection stump closely related to the degree of hyperemia in the amputated limb.
Highlights
For leg amputees, physical and exercise therapy can have important roles in promoting activities of daily living for the prevention of joint contracture and walking disability [1] [2] [3] [4]
There was similarity seen in the increase rate in leg blood flow (LBF) and/or leg vascular conductance (LVC) for the incremental relative peak muscle strength (PMS) compared with the absolute PMS
Using the above-mentioned Doppler technique, we have recently reported a clinical intervention for LBF magnitude in an amputated lower leg with a patella tendon bearing (PTB) prosthesis during unilateral dynamic knee extensor exercise at incremental exercise intensity [27]
Summary
Physical and exercise therapy can have important roles in promoting activities of daily living for the prevention of joint contracture and walking disability [1] [2] [3] [4]. There is still a lack of understanding of thigh-stump exercise blood flow and/or vasodilation in relation to amputated limb muscle activity, slight leg passive motion and/or active voluntary muscle contraction could initiate an increase in muscle metabolism with vasodilation relating to “leg oxygen uptake”. The magnitude of the hyperemic response due to repeated thigh stump exercise on incremental contraction intensity might be useful information in localized exercise tolerance for devising cardiovascular physical therapy for amputees. The effect of exercise on amputated leg blood flow (LBF) may potentially be altered due to voluntary muscle contractions after loss of the lower leg compared with the healthy leg. Pre-exercise LBF was lower in the AL (200 ± 25 ml/min) than the non-AL (275 ± 74 ml/min) Both the non-AL and AL showed good positive linear relationships between absolute-/relative-PMS and LBF or LVC during 30 s at steady-state before the end of the exercise period.
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