REsistance and LOADing Exercise for Bone Health

Defence Medical Rehabilitation Centre, UK10 enrolled

Overview

Lower limb amputation, often resulting from military conflict and road traffic accidents, is associated with reduced hip bone mineral density (BMD) and increased risk of hip fractures. This bone loss is attributed to altered mechanical loading and is compounded by an increased falls risk in prosthesis users. While resistance and high-impact exercise interventions have proven effective in enhancing BMD in other populations, no studies have examined their role in amputees. Building on an international Delphi consensus guidelines, this study aims to assess the feasibility and safety of a novel home-based, tele-supervised resistance and high-impact exercise intervention in individuals with unilateral transtibial limb loss. A convenience sample of 10 male prosthesis wearers from the ongoing ADVANCE Study will be involved in the study for 10 weeks and will undertake an 8-week, twice-weekly exercise program including resistance (squat, deadlift, overhead press) and impact-based activities (e.g., multidirectional jumps) (week 2 to week 9 of the study participation). Remote supervision will be provided twice weekly during the first week of exercise and once weekly thereafter. The primary outcomes are feasibility (recruitment, retention, compliance, acceptability, tolerance) and safety (adverse event monitoring). Secondary outcomes include changes in hip muscle strength and neuromuscular performance, assessed at baseline (week 1 of the study participation) and post-intervention (week 10 of the study participation) using isokinetic dynamometry, and force plates, respectively. This study will provide the first evidence on the feasibility and safety of a targeted exercise intervention to stabilise or improve BMD in unilateral transtibial amputees. Findings will inform the design of a subsequent randomised controlled trial to evaluate efficacy, with potential to shape clinical rehabilitation programmes for military and civilian amputee populations at risk of low BMD and related complications.

Study Type

INTERVENTIONAL

Allocation

Purpose

OTHER

Masking

NONE

Eligibility

Sex: MALEMin age: 18 YearsMax age: 55 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Current or previous British Armed Forces Personnel who are members of the ADVANCE Study (Bennett et al., 2020) * Male * Aged ≥ 18 years and ≤ 55 years * History of unilateral below knee limb loss due to trauma * Ambulating with their current prosthetic limb for a minimum of six months * Full-time prosthesis wearer (i.e., wearing the prosthesis every day, for most of the day, removing it mainly for sleeping or when resting for extended periods) * Able to walk independently using a prosthetic limb * Able to perform jumping activities on the prosthetic limb * Able to communicate in English * Access to the internet and a computer/smartphone * Able to drive/be driven to and from the testing location for the purpose of transporting the exercise equipment provided by the research team Exclusion Criteria: * Additional limb loss of the upper and/or lower limb other than the transtibial limb loss * Cardiovascular disease, diabetes, neurological injury * Sickle cell disease * Neurodegenerative disease * Limb loss as a result of a vascular condition * Orthopaedic or neurological issues in the intact/non-amputated limb * Additional neuromusculoskeletal pathology which may affect walking * Pain, irritation, swelling, or skin complaints in the residual limb which inhibit prosthetic use * Diseases affecting bone metabolism (other than osteoporosis/osteopenia; for example, osteomalacia, Paget's disease, hyper/hypoparathyroidism, osteogenesis imperfecta) * Traumatic head injury resulting in cognitive disability * Lack of capacity to give consent * Any contraindications to exercise and/or resistance training * Continuous immobilisation for seven days or more in the month prior to attendance * Use of assistive walking device when utilising the, other than a prosthetic limb * Unable to regularly attend the supervised training program

Outcomes

Primary Outcomes

Adverse events (i.e., safety of the intervention)

The number, seriousness, and severity of adverse events reported during the exercise program.

Time frame: Through study completion, an average of 10 weeks

Recruitment and retention rates

Recruitment rate (percentage of enrolled participants out of eligible participants) and retention rates (percentage of enrolled participants who complete the exercise programme to the end). Reasons for non-enrolment, and attrition (withdrawals or dropouts) will be noted systematically throughout the study.

Time frame: Through study completion, an average of 1 year

Compliance

Determined from individual training diaries. 100% compliance = completion of all exercise sessions

Time frame: Week 2 to week 9

Acceptability

Measured via the Theoretical Framework of Acceptability questionnaire. This scale consists of 8 questions, 1 from each of the TFA constructs asked on a 5-point Likert scale for each question (1 = low acceptability; 5 = high acceptability), for a total composite acceptability score of 40.

Time frame: Week 10

Tolerance

After each exercise session, participants will be asked to complete a post-exercise questionnaire within the training diary containing the Borg Rate of Perceived Exertion, a scale from 6 to 20, where a higher number means more perceived exertion.

Time frame: Week 2 to week 9

Secondary Outcomes

Neuromuscular performance

This will be tested using a pair of portable force plates (1000 Hz recording frequency; Hawkin Dynamics, Portland, Maine, USA). Force outputs from an Isometric Mid-Thigh Pull (IMTP).

Time frame: Baseline (week 1) and follow-up (week 10)

Hip muscles strength

Hip strength. An IsoKinetic Dynamometer (IKD) (System 4, Biodex Medical Systems Inc., New York, USA) will be used for measuring the isometric peak torque of hip flexors, extensors, adductors and abductors (on both sides, tested in a random order).

Time frame: Baseline (week 1) and follow-up (week 10)

REsistance and LOADing Exercise for Bone Health

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes

Central Contacts