Cardiorespiratory fitness interventions for individuals with lower limb amputation: a scoping review

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 (VO2max) 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 VO2max and are feasible in persons with a LLA but quality of the studies was weak. Implications for rehabilitation 1. VO2max of persons with a lower limb amputation can improve after cardiorespiratory training. 2. 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. 3. 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. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All included and excluded articles in this scoping review are available upon request to the authors.