14

WALKING

Walking is the most natural form of aerobicexercise. It is also the most gentle. It does not placeundue stress on the musculoskeletal system, becauseone foot is always in contact with the ground.Unlike other forms of exercise, walking can becombined with the daily living routine . It does notrequire any special training, skills, or equipment.

Although walking is basic to almost everyone,there are certain techniques that will enhance itsaerobic benefit.

• Maintain an upright posture with shoulders backand head held up.

• Let the upper body do some of the work byswinging the arms in coordination with the legs.

• Land on the heels of the foot and push off withthe toes.

• Establish a comfortable consistent rhythm.

The aerobic benefits of walking will be furtherimproved by increased pace, length of stride, anddistance walked.

The only equipment needed for walking as anexercise is good shoes (these are especially importantfor a person with a unilateral amputation, sincemuch stress is placed on the sound limb). Specialshoes for pace walking are a somewhat recentdevelopment but, like running shoes, may be foundin most sporting goods stores . Two importantfeatures to look for in walking shoes are firm heelsupport and a flexible forefoot . Walking shoesshould fit comfortably even when new.

The prosthetic components selected for every-

day use will generally be suitable for walking as anaerobic exercise . Most prostheses are designed pri-marily for standing and walking . On occasion, somemodifications or separate prosthetic componentsmay be needed . Additional suspension may beneeded, and energy-storing feet are an advantage formost individuals . A single-axis foot or the combina-tion of a multi-axis ankle with an energy-storingfoot is good for walking down hills and provides forincreased knee stability.

A person with lower limb loss who is comfort-able standing and moving about with a prosthesiswill find that walking is excellent for beginning andmaintaining an aerobic conditioning program . How-ever, some people do experience difficulties as theresult of surgical, prosthetic, or musculoskeletalproblems . In such cases, the physician, prosthetist,and therapist may be able to solve these problems byprescribing a new limb, therapy, or surgery . If theseoptions are not feasible or successful, there are otherforms of aerobic exercise that are even less stressfulto the residual limb . Swimming, bicycling, or row-ing, for example, can be beneficial even without theuse of a prosthesis.

STATIONARY MACHINES

Exercising on a treadmill walking machine is agood way for a person with lower limb loss to trainfor outdoor walking. It is also an excellent way towarm up and exercise for someone who is just

189

190

RRDS Clinical Guide . Physical Fitness : A Guide for Individuals with Lower Limb Loss

DALE TILLY/VAMC SEATTLE, WADistance and time can be monitored while walking on acomputerized treadmill . It is best to hold on to the hand gripswhen beginning in order to establish balance.

beginning a fitness program . A digital computerizedmotor-driven treadmill is best to start with, becauseit is easier to walk on than are many of theself-propelled models.

However, a constant pace must be maintainedin walking on a treadmill machine, and the base ofsupport must remain within a specific area . Thistakes good balance and can be difficult for somepeople wearing a prosthesis . For best results whenfirst using a treadmill, the machine should be setfor a slow pace and gradually adjusted to a fasterpace .

Getting on and off the treadmill may also bedifficult for the prosthesis wearer, so one shouldpractice until balance can be maintained easily . Aside railing for hand support will provide added

DALE TILLY/VAMC SEATTLE, WAA motorized treadmill can be an excellent method ofachieving aerobic fitness for skilled individuals with bilateralAK amputations . The self-propelled walkway creates acontrolled environment that can be monitored . Speed of thewalkway can be gradually increased . It is helpful to hold onto the hand rails and use caution getting on and off themoving belt.

safety in addition to the single handbar in front ofthe walkway.

Treadmill training has advantages over outdoorwalking for the prosthesis wearer . If there is pain oran irritation of the residual limb due to exercising,one does not face the prospect of having to walkback to the starting point, thus causing furtherirritation . One can get off the treadmill, adjust theprosthesis and, if necessary, discontinue exercisinguntil an adjustment can be made by the prosthetist.Also, in many cases, the treadmill "gives" a littlewith each footfall . This helps cushion the impact to

191

Activities for Fitness and Skill : Walking

the residual limb . This is why some people preferwalking on the treadmill to walking outdoors.

The "distance" covered on the treadmill shouldbe gradually increased . Once stamina is built up andprosthetic problems, if any, are solved, walkingoutdoor distances will be safe and enjoyable.

DESIGNING A WALKING ROUTINE

Walking for exercise, whether accomplishedoutdoors or on a treadmill, should be approached ina manner similar to other types of aerobic sports.Walkers should start slowly and gradually build up

e, distance, and speed over a predeterminednumber of weeks of training . The American Collegeof Sports Medicine recommends that the minimumamount of exercise needed to maintain good aerobichealth is 20 minutes, three to four times per week.Walkers should work up to a combined total ofabout 3 hours a week, walking at a pace thatmaintains the heart rate in the targeted zone of70-85 percent of 220 minus their age . (See pp . 24-25in Chapter 4 .)

It is important for a beginner to monitor his orher pulse rate . If the pulse rate during a workout isabove 85 percent of maximum, the walking paceshould be slowed . If the pulse rate is well below70 percent, the walking pace or the rate of thearm swing should be increased . It is beneficial tokeep a log of pulse rate at the beginning, middle,and end of each workout. The length of recoverytime after each walk should be noted along with theamount of time walked and the distance covered.(Recovery time is the time it takes for the pulse toreturn to its normal rate after one exercises . Asphysical condition improves, the recovery timeshortens .) More experienced exercisers will not needto monitor the heart rate regularly . They will be ableto feel it when they are exercising within their targetrange.

Some individuals, particularly older people,may find they cannot maintain their heart rate at70-85 percent of maximum for as long as 20-30minutes . In this case, similar fitness levels can beachieved by exercising at a lower intensity level for alonger period of time. For example, a person maywork to achieve 60 percent of maximum heart ratefor 40 minutes or 50 percent of maximum for 50minutes .

DALE TILLYNAMC SEATTLE, WAWith practice, a steady pace will improve the aerobicbenefits of the treadmill . The graphite Endolite prosthesisshown has a CAT-CAM Suction AK socket, polyethyleneinner socket, and polypropylene outer frame attached to theEndolite Stance Phase Flexion Stabilized Knee, MauchSwing Phase Hydraulik Knee Unit, Endolite Bouncy Knee,Endolite Multiflex Ankle, and graphite foot.

Three hours of walking per week is generallyadequate for most individuals to maintain goodaerobic fitness . Certainly one can gain additionalbenefits by training for more than 3 hours a week,but it is not necessary unless one is interested incompetitive activities . It is best for beginning walk-ers to train every other day with a rest day inbetween. This allows the muscles to relax andrecover. In the beginning, it is more important forthe walker to concentrate on the length of time he orshe is able to maintain the target heart rate than tobe concerned with distance covered . As strength and

192

RRDS Clinical Guide . Physical Fitness : A Guide for Individuals with Lower Limb Loss

stamina are improved, those who wish to may walk

muscle soreness . Even with such exercises, as speedbriskly for exercise every day .

is increased and the arm swing becomes moreWalking for aerobic fitness is more demanding

vigorous, muscles in the legs, upper arms, andthan ordinary walking ; warm-up and stretching

shoulders may become sore. If soreness is problem,exercises before and after walking will help prevent

one should progress at a slower rate.

AP/WIDE WORLD PHOTOSJeff Keith, right, is shown at the beginning of his successful cross-country run in Boston on June 4, 1984 . With himis his friend, Ted Kennedy, Jr . (left), who ran along for the first mile . Keith, who lost his leg to cancer, said he madethe run to prove that "disabled" does not mean "unable ."