Please use the template provided to complete the lit review outline. (already have the full review completed, so it should be easy and short)
Summary of studies evaluating the effects of endurance training on cardiovascular and metabolic function
Study
Andersen et al., (1)
Participants
Five participants
Design
Eight-week training
program:
Outcomes measurements
Results
VO2max, muscle biopsy
VO2max: ↑16%; capillary
density: ↑20%; mean fiber
area: ↑20%; oxidative
enzymes: ↑40%
Bike ergometer for an
average of 40 minutes a
day
Four times a week
80%VO2max
Baekkerud et al., (3)
30 participants
Randomly assigned:
1) Six weeks, 4×4 minute
high intensity interval
training (4HIIT), 8595%HRmax
2) 10×1 minute HIIT
(1HIIT) at VO2max load
3) Moderate continuous
intensity training (MICT)
at 70%HRmax, 45
minutes
VO2max; time to exhaustion (TTE);
citrate synthase (CS) activity;
venous and arterial function, and
blood volume
VO2max: 4HIIT: ↑10%,
significant; 1HIIT: ↑3.3%, not
significant; MICT: ↑3.1%, not
significant
TTE: 4HIIT: ↑198%; 1HIIT:
↑116%; MICT: ↑52%
CS activity (no group
difference), 4HIIT: ↑35%;
1HIIT: ↑35%; MICT: ↑56%
MICT: arterial inflow, ↓15.7%
and venous outflow ↓22.7%
(no group differences)
Burgomaster et al.,
(21)
20 total (10 males
and 10 females
Skeletal muscle carbohydrate:
pyruvate dehydrogenase E1α
protein content)
Lipid oxidation: 3-hydroxyacyl CoA
dehydrogenase maximal activity
Protein: peroxisome proliferatoractivated receptor-γ coactivator-1α
↑mitochondrial skeletal
muscle enzymes (no
significant differences)
Costill et al., 27)
16 runners
6 weeks:
1) Endurance training
(ET), 40-60 minutes of
cycling, five times per
week at 65%VO2max
2) Short interval training
(SIT), 30 second x 4-6
repetitions with four
minutes rest at three
times a week
Testing:
Submaximal runs
between 60-90%VO2max
VO2max, HR and LT
VO2max (mL/kg/min) and
performance in 10-mile road
race, r = -0.91
10-mile road race
%VO2max and HRmax = r = –
0.94
>70%VO2max: less blood
lactate
Daussin et al., (32)
11 participants (6
men and 5 women)
Cross-over and
randomly assigned:
1) Eight-week
continuous training (CT)
2) Eight-week interval
training (IT)
12 weeks of detraining in
between
VO2max, time to exhaustion (TTE),
COmax, skeletal muscle oxidative
capacities (Vmax), capillary density
VO2max: CT: ↑9%; IT: ↑15%
TTE: IT: 68seconds; CT:
54.9seconds
COmax: IT > CT: 18.1L/min to
20.1L/min
Vmax: IT > CT: 3.3µmol
O2/min/g/dw to 4.5µmol
O2/min/g/dw
1
LITERATURE REVIEW
Prosthetic Design and Selection
The field of prosthetics has witnessed revolutionary advancements particularly in the
dimension of prosthesis design. From anatomical realism/accuracy to improved materials,
current generations of prosthetics are greatly advanced rendering them more efficient in the
restoration of limb functionality. For instance, anatomical realism is integral in optimizing
alignment which highly correlates with capacity for locomotor adaptability. Additionally, better
materials such as titanium and aluminium have allowed more lightweight prosthesis which
reduce the pressure during locomotor adaptations. Beyond innovative design, the selection of the
optimal prosthetic option also greatly correlates with the efficiency of restorative function. To
this end, researchers have investigated various types of prostheses for varying scenarios. For
instance, Cherni, Laurendeau, Robert, & Tircot (2022) conduct a case study to determine the
impact on gait adaptation resulting from Transtibial prosthesis types. For their study, the
researchers compare different Transtibial prosthetic options: Variflex, Meridium, Echelon, and
Kinterra. The corresponding kinematic and kinetic parameters for all four prosthetic options are
then analyzed by simulating various common biomechanical movements. The findings of the
study portray varying degrees of propulsive force, knee extension moment, knee abduction
moment and lower support moments. The study thus presents the conclusion that it is paramount
to conduct objective gait analysis to determine the type of prostheses to prescribe to a patient for
maximum fit. The choice of prosthetic should thus not only be informed by anatomical accuracy
or material which is likely to generate a one-size-fits-all scenario. Rather, it should also take into
account the patient’s unique requirements for optimal efficiency.
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Locomotor Adaptability
One of the key areas for advancement in prosthetics has been locomotor adaptability
post-amputation and installation of prosthetics. In technical terms, locomotor adaptability refers
to an error-driven spatiotemporal motor learning process. Basically, this pertains to modified
mannerisms and compensation strategies in gait and motion typically observed with amputees in
learning to accommodate the prosthetic limb to the body’s physiological functioning. Generally,
the necessity of locomotor adaptability is often amplified in more technical tasks such as obstacle
avoidance, walking and limb elevation and less perceptible in terms of gait. In an observational
study, Houdjik, et al., (2012) demonstrate that there is negligible between amputees and controls
in gait adaptability but the differences are more profound in locomotor adaptability. This renders
locomotor adaptability an integral area in the field of prosthetics. Thus far, scientific research
into this dimension has observed that current generations of prosthetics have enabled better
locomotor adaptability post-prosthesis installation.
Darter, et al. (2017) investigate the efficacy of locomotor adaptability in patients with
unilateral Transtibial Amputation (TTA). The researchers designed an experiment involving 10
TTA amputees and a control group of 8 non-amputees engaging in designated physical activities.
The researchers evaluate differences in exercise-induced reactive accommodations and deadaptive responses between the two groups. There are negligible differences in both reactive
accommodations and de-adaptive responses between both groups. The findings of the study thus
conclude that advances in prosthetics have enabled near-natural locomotor adaptability in
persons with TTA. In a similar study, Hill, Patla, Ishac, Adkin, & Barth, (2019) set out to
investigate the alteration of kinetic strategies for the control limbs during obstacle elevation
among below-knee prosthetic patients. For the study, kinematic data during limb elevation and
3
lowering is collected as subjects step over obstacles of varying height along a walking path. The
findings indicated that to allow limb elevation and lowering, accommodations involved inversing
kinetic strategy such that on the amputated side greater work modulation was done at the hip and
not the knee, contrary to the sound side. The study thus concludes that with the appropriate
design of prostheses, the CNS is over time able to incorporate locomotor adaptability to modify
motion as appropriate to avert potential instability.
The achievement of better locomotor adaptability among amputees can be attributed to
advances in prosthetics in inducing and restoring somatosensation. In their paper, Daekyoo,
Triolo, & Charkhkar (2023) note that using implanted neural intafaces in restoring senstations
perceived as original directly from the prosthesis was effective in gait and locomotor
adaptability. Further, their paper demonstrates that restored plantar sensation improves gait
symmetry, and enhances stance time and propulsive force generated from the prosthetic side.
The results of this study thus unequivocally demonstrate that induced restorative
somatosensation is an integral dimension of prosthetics in achieving better locomotor
adaptability.
Alignment
To achieve the restorative intent of prostheses, one of the critical factors determining the
efficacy of such restoration is prosthesis alignment during installation. This pertains to attaining
the optimal placement of the prosthetic on the socket such that it generates the least pressure for
accommodation into physiological functioning. Alignment has been extensively studied in
clinical practice with the aim of enhancing efficiency of prostheses. Nolasco, Silverman, &
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Gates, (2023) investigate the impact of Transtibial prosthetic alignment on body momentum
during functional tasks such as walking, sit-to-stand and stand-to-sit. The researchers designed
an experiment involving different tasks and compared angular momentum, trunk range of motion
and peak ground reaction forces between 10 amputees and 10 non-amputees. The findings
demonstrate that alignment modulates the range of angular momentum during functional tasks
such as walking. The researchers thus conclude that TTA patients can adapt to small translational
alignment changes to maintain dynamic balance during functional tasks. In a similar research,
Hashimoto, Kobayashi, Gao, & Kataoka, (2023) demonstrate the importance of dynamic,
kinesiology-informed alignment in Transtibial prostheses and prescribe a proper sequence based
on socket reaction moments. Ordinarily, TTA patients face balance difficulties during functional
tasks but prosthetic alignment can help correct this limitation. However, it is imperative that the
alignment process be tuned to the optimal spatial relationship of translational planes to achieve
optimal biomechanical capacity. The researchers designed an experiment where Transtibial
amputees walk in different alignment conditions and measured moment changes in the coronal
and sagittal planes. The results of the study demonstrated alignments in all three planes modulate
moment changes in the coronal plane while those of the sagittal plane are only affected by
sagittal alignment changes. The authors thus conclude that prosthesis alignments should be
finalized in the coronal plane.
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References
Cherni, Y., Laurendeau, S., Robert, M., & Tircot, K. (2022). The Influence of Transtibial Prosthesis Type on
Lower-Body Gait Adaptation: A Case Study. International Journal of Environmental Research and
Respiratory Public Health, 20(1). doi:10.3390/ijerph20010439.
Daekyoo, K., Triolo, R., & Charkhkar. (2023). Restored somatosensation in individuals with lower limb
loss improves gait, speed perception, and motor adaptation. Science Robotics, 1-25.
Darter, B., Bastian, A., Wolf, E., Husson, E., Labrecque, B., & Hendershot, B. (2017). Locomotor
adaptability in persons with unilateral transtibial amputation. PLoS ONE, 12(7). Retrieved from
https://doi.org/10.1371/journal.pone.0181120
Hashimoto, H., Kobayashi, T., Gao, F., & Kataoka, M. (2023). A proper sequence of dynamic alignment in
transtibial prosthesis: insight through socket reaction moments. Scientific Reports, 13(458).
doi:10.1038/s41598-023-27438-1
Hill, S., Patla, A., Ishac, M., Adkin, A., & Barth, D. (2019). Altered kinetic strategy for the control of swing
limb elevation over obstacles in unilateral below-knee amputee gait. Journal of Biomechanics,
32(5), 545-549. doi:10.1016/s0021-9290(98)00168-7
Houdjik, H., Ooijen, M., Kraal, J., Wiggerts, H., Polomski, W., Janssen, T., & Roerdink, M. (2012).
Assessing Gait Adaptability in People With a Unilateral Amputation on an Instrumented
Treadmill With a Projected Visual Context. Physical Therapy, 92(11), 1452-1460. Retrieved from
https://doi.org/10.2522/ptj.20110362
Nolasco, L., Silverman, A., & Gates, D. (2023). Transtibial prosthetic alignment has small effects on
whole-body angular momentum during functional tasks. Journal of Biomechanics, 149.
doi:10.1016/j.jbiomech.2023
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