[ADAPTIVE FITBUNCH] Cardio Tips for Amputees
This will be the first in a series of articles for Adaptive FitBunch – personal training and coaching for adaptive individuals, specifically amputees – let me know what you think or if there’s anything else you’d like to see covered. If you are an adaptive athlete and would like to guest post, please drop a line to email@example.com
As amputees, it’s incredibly important to keep our cardiovascular systems in optimal shape. With up to 300% more energy consumption than able-bodied person’s of the same size, building and maintaining a high level of cardiovascular strength and endurance is necessary to living an independent and high functioning life as a full-time prosthetic user. There are a number of ways that we can increase our fitness in this area, but arguably the most convenient and easily measurable would be using a treadmill. However, if you can’t safely use a treadmill, there are ways to easily transfer the following tips to free walking, or even to a therapeutic setting. I do not typically prescribe treadmill workouts for everyone (quite the opposite actually, I tell people to stay away from the “dreadmill”) but for an amputee, building strength and endurance specific to your walking mobility is absolutely key. For this reason, the treadmill is a great starting point for almost any level of amputee using prostheses on any basis, from beginners to experienced users. As we continue to increase our stamina and endurance, changing modes of “cardio” (hereinafter referred to as “conditioning”) – to incorporate modalities like free weights, bodyweight movements, kettlebells, etc – is definitely an option, but measured practice at walking, specifically on the treadmill is nearly always good. That being said, there will always be exceptions and not a lot of individuals with amputations are as active as they might like to be. To those of you who fall into that category, I say start today!
And now for the disclaimers: If you’re unable to walk safely on a treadmill (due to gait, stability, etc) don’t! These workouts are easily transferable to simply walking in your house, or even outside. If you require supervision, always have someone nearby (preferably a qualified professional). ALWAYS USE THE TREADMILL’S BUILT IN SAFETY SWITCH. Always ask a doctor’s opinion about whether or not engaging in an exercise program is right for you.
Far and away, the most effective (that is, least time consuming and highest fat burning) form of conditioning is “high intensity interval training” (HIIT) – Don’t let that term scare you though, “high intensity” is a totally relative term. If walking 10-20 steps is going to get you sweating, then that’s high intensity enough! Simply put, HIIT couples periods of “high intensity” with shorter “recovery” periods and will allow you to continue to burn calories for up to 24 hours after you finish your workout. We’ll get into some more specifics later, but keep these details in mind for now.
There are plenty of different ways to measure your intensities, all of which are made more convenient while using a treadmill. If you’re still working in a therapeutic setting, increasing the number of steps you can take without stopping is key for now. The easiest area to seek improvement for anyone able to maintain more than a few dozen steps is TIME. Start by honestly assessing your abilities- if you can walk comfortably at roughly the same speed for 3 minutes now, try to increase your time to 4 minutes. Set a weekly goal to increase your total walking time, until you’re able to walk about ten minutes total (even if it’s at a slow pace). It may take several weeks, but building at least a baseline of endurance is going to be key to success. No, it’s not going to be the easiest thing in the world, but nothing easy is worth it.
As you continue to build endurance, your walking strength and energy levels will increase – you won’t be near as tired as you would be otherwise, and you’ll feel better (along with shedding more body fat – more on that in the near future). Things that were once difficult, will become easier, and you will place less strain on your body doing your day to day activities!
But, what about this high intensity interval training (HIIT) mentioned earlier? Oh yes, here we are. Once you build your endurance to a reasonable point (being able to walk for five minutes is good, ten is even better), changing intensities over the course of your workout is a great way to maximize your results. As we mentioned before, bilateral above the knee amputees burn up to 300% more energy than able bodied individuals of the same size! If you’re living as a single above the knee amputee, you can still look forward to ~70% more energy consumption than an able bodied person, while single below knee amputees will consume between 10-20% more energy. These are some pretty stunning figures! Now that we have some idea of how much energy we use, let’s make the most of it by getting the best workout in the shortest time possible! The great news about HIIT is that there is no set formula for getting the “best” workout – but we want to work towards a 2:1 ratio of work to rest (IE 60 seconds of walking, 30 seconds of rest)- if you’re not there yet, that’s fine, this article is for you too!
For someone who’s able to walk safely for, say 5 minutes, but doesn’t have the stamina to keep up a 2:1 work-rest ratio – Try the following!
1 minute @ 1.2 mph
Repeat 3 rounds of
A) 20 seconds @ 2-2.5 mph
B) 40s @ 1.5 mph
Finish with 1 minute @ 1.2 mph
If you’re lacking a treadmill, that’s fine, you can apply this to your own free walking! The measurements will be a little less objective, as you can’t quite accurately measure your own walking speed, but the results are going to be the same. Instead of speed, you can use your own rate of exertion (think 1-10, one being sitting on the couch relaxing, ten being maximal exertion – you want to walk fast enough to consider yourself at a 7-8). You can set a timer – on your cell phone, or with a stopwatch – and walk as quickly as you comfortably can. Keep in mind, different levels of amputations are going to have different average walking speeds, anywhere from 3 mph for single below-knee amputees, down to 1.5-2mph for bilateral above knee amputees. Also, depending on where you are in terms of rehabilitation and prosthetic use, you’ll have to vary your intensity. The above is simply a starting point, something I believe most amputees performing at the level described above should be able to safely complete.
Spending about two weeks completing the above workout will have an absolutely immense effect on your energy levels as well as your stamina and endurance! Yes, it’s going to be tough – there will be a lot of sweat! But I promise it’s worth it!
Ideally, after a few weeks of performing the workout, you will be able to progress – you can do this any number of ways – try the following…
- increasing the total time – ex. you started with a 5 minute workout. Add another round of walking at 2-2.5mph for 20 seconds with a rest period of 40 seconds, and you’ll have 6 minutes total!
- increasing the speed – ex. instead of working at 2.0 mph, work at 2.2 mph
- decreasing rest periods – ex. my usual progression for a client working for 20 seconds and resting for 40 seconds is 30 seconds of work to 30 seconds of rest
- adding a slight incline to your walk (this is my last step in progressing clients, because it’s the most physically taxing!) – ex. if your treadmill allows you to, add an incline – adding only a 10% slope to your walk DOUBLES your energy expenditure.
Be sure to scale your workouts appropriately, as you want to avoid too much strain on yourself, particularly if you’re just getting acclimated to fitness as an amputee. Listen to your body! You should expect to feel a good amount of soreness, especially if you’re new to walking. If you’re curious as to what I’m getting into today, have a look!
1 minute @ 1.6mph 0% incline
1 minute @ 2.5 mph 0% incline
5 Rounds of
a) 30 sec @ 3.5mph 5% incline
b) 30 sec @ 2.5mph 5% incline
3 rounds of
a) 1 minute @ 4.0 mph 7% incline
b) 30 sec @ 2.0 mph 7% incline
5 minute cooldown @ 2.0mph 2% incline