PART ONE

PHYSICALFITNESS

GUIDELINES

NEWSDAY/J . CONRAD WILLIAMS, JR .

INTRODUCTION

This book presents a guide for helping peoplewho have had a lower limb amputation realize fullytheir physical capabilities. It is intended as aresource for the clinical team in rehabilitationmanagement, and provides guidelines for designinga realistic, safe, and enjoyable program of physicalconditioning and exercise.

Its goal is to stimulate a lifelong interest infitness, not only for a sense of physical and mentalwell-being, but to improve longevity . Studies indi-cate that individuals with amputations are moreprone to develop cardiovascular diseases and have asomewhat shorter life expectancy than the generalpopulation. These circumstances may be the resultof inactivity based on perceived restrictions due to adisability and a sedentary lifestyle, predisposingthese individuals to earlier development of degenera-tive diseases.

It is no longer considered wise to discourage orlimit physical activity merely because an individualhas had an amputation . The amputation can oftenbe a stimulus to better physical fitness, even forolder people . Exercise is a form of treatment in therehabilitation process . Unless there is a valid medi-cal reason for limiting even the gentler forms ofexercise, physical disability should not be considereda reason for avoiding exercise.

By far the majority of amputations performedin America and the Western world today are causedby medical conditions : primarily, occlusive diseasesof the arteries to the limbs and diabetes . For themost part these amputations occur in older people .

A program of physical fitness, consistent with thestate of health and physical capabilities of theseolder people, will surely enhance their quality of lifefor the remaining years . While the fitness programsdescribed in this text are described and demon-strated, in general, for the younger physically activeperson, they will provide guidelines for those whoare older and less active . The courage and physicalcapabilities described here provide an inspiration toall with lower limb loss . This positive rehabilitationmessage supersedes in some ways the actual mechan-ics of physical fitness outlined . The message is oneof hope, accomplishment, and resolve.

The major concern of people of all ages whohave undergone a lower limb amputation has beenwhether or not they would be able to regain theirprevious level of physical activity . This need not bea primary concern. Modern prosthetic technologywill allow many individuals a recovery of functionalmost equal to pre-amputation potential . Personswith an amputation can not only participate insports but can in many cases participate in thosesports with their nondisabled teammates.

Competitive sports activities among people withdisabilities are held throughout the world . Perfor-mance is impressive : a person with a lower limbamputation has run 100 meters in 11 .73 seconds,another a 26-mile marathon in less than 3 1 /2 hours.Disabled athletes also compete in organized sportsevents with nondisabled athletes and often surpassthem.

The exercises and many of the sports activities

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neoTenaIBETTMxwwwevvs poOToSCanadian athlete Arnold Boldt leaps over the high jump bar to win a gold medal at the 1888 ParalympicGames in Seoul, Korea .

5

Physical Fitness Guidelines : Introduction

RICHARD LAKIN/NHS, WASHINGTON, DCA variety of disabled individuals participate in the NationalHandicapped Sports fitness clinics across the country.

illustrated in this book are performed by youngpeople with a lower limb amputation . Thus, it mayseem that the book is primarily directed towardyoung adults . That is not the intent . It is equallyimportant—in fact, probably more important—thatolder people be concerned about physical fitness.Often, increasing age implies decreasing activity.This is particularly true in those with lower limbamputation.

Studies of the effects of moderate exercise onolder people have repeatedly indicated that carefulstretching can significantly improve the range ofmotion of joints and that the mineral content ofbone can be increased . Aerobic exercise will stimu-late greater blood flow to the body and brain, whichwill increase acuity and improve reflex time.

Most of the exercises and sports activitiespresented in this book can be performed andenjoyed by persons of all ages who are in good

health. The first step is a complete medical review,regardless of the degree of fitness or pre-amputationactivity. The fitness program should begin withconditioning exercises . As strength and flexibilityare developed, sports activities may be combinedwith the exercises . Over time, athletic ability willincrease and goals may be broadened.

Without reasonable precaution, physical exer-cise and sports can pose a risk of injury, andoverexertion may result in cardiovascular complica-tions . People with a lower limb amputation mustlearn to compensate for impaired balance andmobility; their risk of injury is far greater than thatof nondisabled individuals . A sound limb willusually become stronger through regular physicalactivity. It must be carefully protected from injurybecause dysfunction will result if it is unable tosustain weightbearing . Learning to use protectiveequipment, such as knee braces, and learning toavoid unnecessary risk are integral parts of aphysical conditioning program.

A person who is physically fit has more energy,and this contributes to improved performance inother aspects of life . The best surgery, technology,therapy, and prosthesis cannot provide this energywithout the motivation of the individual to developnew physical strength . This book is intended to helpby stimulating motivation and action.

Chapter 2, The Rehabilitation Process, ad-dresses the purpose and scope of this book as theyrelate to the rehabilitation process . Chapter 3,Components of Physical Conditioning, briefly de-fines and discusses the main components of physicalconditioning : cardiovascular endurance ; flexibility;muscular strength and endurance ; and skill develop-ment. Part Two presents a selection of exercises todevelop flexibility and muscular strength and endur-ance that can be adapted to various skill levels andconditioning needs of people with lower limb ampu-tation . Part Three describes the application of goodphysical conditioning to skill acquisition in severalsports that promote cardiovascular fitness and canbe enjoyed throughout a lifetime . Safety precautionsand assistive modifications are described for theactivities presented in Parts Two and Three.

Along with good physical fitness, diet andnutrition are important factors in total health . Thisbook concentrates on conditioning, however, anddoes not include information on diet and nutrition .