The Lokomat is a robotic exoskeleton that can be used to train gait function in hemiparetic stroke. To purposefully employ the Lokomat for training, it is important to understand (1) how Lokomat guided walking affects muscle activity following stroke and how these effects differ between patients and healthy walkers, (2) how abnormalities in the muscle activity of patients are modulated through Lokomat guided gait, and (3) how temporal step characteristics of patients were modulated during Lokomat guided walking. Ten hemiparetic stroke patients (>3 months post-stroke) and ten healthy age-matched controls walked on the treadmill and in the Lokomat (guidance force 50%, no bodyweight support) at matched speeds (0.56 m/s). Electromyography was used to record the activity of Gluteus Medius, Biceps Femoris, Vastus Lateralis, Medial Gastrocnemius and Tibialis Anterior, bilaterally in patients and of the dominant leg in healthy walkers. Pressure sensors placed in the footwear were used to determine relative durations of the first double support and the single support phases. Overall, Lokomat guided walking was associated with a general lowering of muscle activity compared to treadmill walking, in patients as well as healthy walkers. The nature of these effects differed between groups for specific muscles, in that reductions in patients were larger if muscles were overly active during treadmill walking (unaffected Biceps Femoris and Gluteus Medius, affected Biceps Femoris and Vastus Lateralis), and smaller if activity was already abnormally low (affected Medial Gastrocnemius). Also, Lokomat guided walking was associated with a decrease in asymmetry in the relative duration of the single support phase. In stroke patients, Lokomat guided walking results in a general reduction of muscle activity, that affects epochs of overactivity and epochs of reduced activity in a similar fashion. These findings should be taken into account when considering the clinical potential of the Lokomat training environment in stroke, and may inform further developments in the design of robotic gait trainers.

The Lokomat is a commercially available exoskeleton for gait training in persons with cerebral palsy (CP). Because active contributions and variability over movement repetitions are determinants of training effectiveness, we studied muscle activity in children with CP, and determined (i) differences between treadmill and Lokomat walking, and (ii) the effects of Lokomat training parameters, on the amplitude and the stride-to-stride variability. Ten children with CP (age 13.2 ± 2.9, GMFCS level II(n = 6)/III(n = 4)) walked on a treadmill (±1 km/h; 0% bodyweight support(BWS)), and in the Lokomat (50% and 100% guidance; ±1 km/h and ±2 km/h; 0% and 50% BWS). Activity was recorded from Gluteus Medius (GM), Vastus Lateralis (VL), Biceps Femoris (BF), Medial Gastrocnemius (MG) and Tibialis Anterior (TA) of the most affected side. The averaged amplitude per gait phase, and the second order coefficient of variation was used to determine the active contribution and stride-to-stride variability, respectively. Generally, the amplitude of activity was lower in the Lokomat than on the treadmill. During Lokomat walking, providing guidance and BWS resulted in slightly lower amplitudes whereas increased speed was associated with higher amplitudes. No significant differences in stride-to-stride variability were observed between Lokomat and treadmill walking, and in the Lokomat only speed (MG) and guidance (BF) affected variability. Lokomat walking reduces muscle activity in children with CP, whereas altering guidance or BWS generally does not affect amplitude. This urges additional measures to encourage active patient contributions, e.g. by increasing speed or through instruction.

BACKGROUND: Individuals with lower limb amputation (LLA) often experience reduced physical capacity and increased aerobic demands during activities of daily living (ADL), which may impact participation and quality of life. Measuring the relative aerobic load of ADL is essential to set realistic rehabilitation goals, however data on short and non-steady-state ADL tasks in this population are limited. OBJECTIVES: To evaluate the feasibility of a newly developed protocol for assessing the relative aerobic load of five selected ADL tasks in individuals with LLA, and to determine the applicability of the excess post-exercise oxygen consumption (EPOC) method for these measurements. METHODOLOGY: Six individuals with unilateral LLA (mean age 59 ± 9 years; five males), including three with transtibial, one with knee disarticulation, and two with transfemoral amputation, all classified as K2–K3 ambulators, were recruited for this pilot study and underwent a cardiopulmonary exercise test (CPET) during the first assessment session. During the second assessment session, within a two-week interval, participants were asked to perform five standardized tests reflecting ADL tasks: the 6-Minute Walk Test (6MWT), Timed Up and Go Test (TUGT), Glittre ADL test, stair ascent, and stair descent. Oxygen consumption was measured using the COSMED K5 system. For each task, average oxygen consumption was computed as the total oxygen uptake during activity and recovery (EPOC) divided by total time, and relative aerobic load was defined as percentage of first ventilatory threshold (%V̇O2-VT1). Data analysis involved descriptive feasibility assessment and intraclass correlation to examine consistency of relative aerobic load across tasks. FINDINGS: The protocol showed to be feasible and no (serious) adverse events occurred during the study and 5 out of 6 participants were able to complete the protocol, demonstrating its practicality. The EPOC method was successfully applied to both short and longer-duration ADL tasks. The results showed relative aerobic loads exceeding 100% V̇O₂-VT₁ for most ADL tasks, indicating substantial physical effort. Agreement of the rankings of the different tasks between participants was observed (intraclass correlation coefficient (ICC) = 0.73, 95% confidence interval (CI) = 0.01-0.97), although the wide confidence interval indicates considerable uncertainty. CONCLUSION: This protocol enables the assessment of relative aerobic load in a heterogeneous group of individuals with LLA and highlights the importance of individualized assessment. Given the large variability in V̇O₂peak and V̇O₂-VT₁ between participants, a generic level of physiological burden for each task cannot be given, instead individualized assessment is crucial to accurately determine physiological burden and avoid under- or overestimation of exercise intensity. The findings support the development of individualized rehabilitation programs tailored to individual capabilities and limitations, potentially improving participation and quality of life. Additionally, future studies with larger cohorts are needed to provide more robust reliability estimates and strengthen the generalizability of these findings. Layman's Abstract Individuals with a lower limb amputation (LLA) often have lower physical ability and need extra effort to do everyday activities such as walking or climbing stairs. This extra effort can lead to fatigue and affect their independence and quality of life. To improve rehabilitation, it is important to understand how physically demanding these activities are. In this pilot study, six individuals with LLA participated in a new test protocol. At the first assessment session, they completed a fitness test. At the second assessment session, conducted within a two-week interval, they performed five common daily tasks: 1) walking for six minutes, 2) standing up and sitting down, 3) climbing stairs, 4) descending stairs, and 5) completing a functional activity course. During these tasks, they wore a portable device that measured oxygen use, showing how hard their body was working. The study showed that the protocol was safe and practical, and five of the six participants completed all tasks without difficulty. It also showed that a method called EPOC (excess post-exercise oxygen consumption) can measure the effort of short and irregular activities such as those above, which is usually hard to assess. Results revealed that most tasks required very high effort, which could lead to fatigue. Importantly, the effort varied greatly between individuals, highlighting the need for individualized assessments. Understanding these physiological differences can help healthcare professionals design rehabilitation programs tailored to each individual’s abilities. This approach can reduce fatigue, improve independence, and hopefully enhance quality of life for individuals with LLA. Future studies with larger groups are needed to confirm these findings and provide stronger evidence of their reliability. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/46249/34696 How To Cite: van Schaik L, van Kammen K, Huiberts S.W.M, Geertzen J.H.B, Houdijk H, Dekker R. Relative aerobic load of daily activities in individuals with lower limb amputation: A pilot study. Canadian Prosthetics & Orthotics Journal. 2025; Volume 8, Issue 2, No. 8. https://doi.org/10.33137/cpoj.v8i2.46249 Corresponding Author: Loeke van Schaik, PhDAffiliation: University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands.E-Mail: L.van.Schaik@umcg.nl ORCID ID: https://orcid.org/0000-0001-5288-1143

Background: This systematic review aims to identify modifiable and non-modifiable predictors of exercise capacity (VO₂peak level or change) in stroke survivors. These insights may further optimize rehabilitation treatment and improve long-term health outcomes. Methods: PubMed (PubMed.gov), EMBASE (Elsevier), CINAHL (EBSCO), and Web of Science (Clarivate) were searched (last search on 7 October 2025). Inclusion criteria were: (1) adults (>18 years) who survived a stroke (ischemic and hemorrhagic), (2) outcome was a measurement of maximum exercise capacity (VO₂peak) measured with CPET (or equivalent), (3) predictors of exercise capacity were measured (e.g., personal factors, disease-related factors, components of rehabilitation), (4) predictors of exercise capacity were analyzed in multivariate regression models, (5) primary research, and (6) full-text available. During the data extraction phase, predictors were categorized into modifiable and non-modifiable predictors. Risk of bias was assessed with the McMaster Critical Review Form for Quantitative Studies. Results: Of 919 unique articles, seventeen were included. Modifiable factors such as BMI (4/8 articles) and fat mass (1/1), lower limb strength (3/3), cardiorespiratory fitness (e.g., baseline VO₂peak (2/4)), training intensity (2/2) and perceived fatigue (1/1) significantly predicted VO₂peak (level or change). Significant non-modifiable predictors were age (3/11), sex (1/8), diabetes (1/2), and stroke-specific (4/8) factors. Conclusions: This systematic review highlights the significant role of modifiable and non-modifiable predictors in optimizing exercise capacity (VO₂peak) for stroke survivors. In addition, considering modifiable and non-modifiable predictors allows for more personalized treatment planning. The findings can guide healthcare professionals in tailoring rehabilitation programs, though further research is needed to develop a comprehensive prediction model.

Purpose: This scoping review aimed to provide an overview of different cardiorespiratory training methods and their effects on cardiorespiratory fitness in persons with a lower limb amputation (LLA). Methods: Studies were searched in PubMed, EMBASE, CINAHL, Cochrane Library and Web of Science. The search strategy comprised four search strings with terms related to ‘amputation’ or ‘limb loss’, ‘lower extremity’, ‘training’ or ‘exercise’, and ‘endurance’ or ‘aerobic’. Studies were included if they reported on persons with a LLA who followed a cardiorespiratory training. The Effective Public Health Practice Project tool was used for quality assessment. Results: Nine studies (88 participants) were included, with weak (7 studies) to moderate (2 studies) quality. Duration of the programmes ranged from 1.5 to 26 weeks, with a frequency of 3-5 sessions per week. The intensity of the workload increased during the programmes in two studies. After training, maximal oxygen uptake (VO ₂ max) had increased in all studies, in three studies significantly. The training effects were inconclusive for resting heart rate, peak heart rate, and blood pressure Conclusions: Cardiorespiratory training methods – with tailored duration and intensity – tended to increase VO ₂ max and are feasible in persons with a LLA but quality of the studies was weak. Implications for rehabilitation: VO ₂ max of persons with a lower limb amputation can improve after cardiorespiratory training. Training methods to improve cardiorespiratory fitness in persons with a lower limb amputation, in which training intensity is tailored to the patient (based on heart rate) are feasible. Due to the low methodological quality of the included studies, this scoping review cannot provide an evidence-based overview of training methods to improve cardiorespiratory fitness in persons with a lower limb amputation.