Moving Forward: An analysis of the benefits of exercise for lower limb amputees

In the wake of the Paralympic movement's remarkable strides and increased accessibility to sports for individuals with disabilities, the benefits of exercise, particularly for those living with lower limb amputations are now being realised.

An example of this is Julie Rogers, who spoke about her paralympic achievements in a recent discussion with Ruth Graham.

Julie’s story serves as a powerful inspiration, undoubtedly motivating others to embrace sport for both its mental and physical rewards. Nevertheless, participation in sports varies widely among individuals in society, and coping with limb loss presents additional hurdles in maintaining an active lifestyle. So, what of those who do not fall into the category of Paralympian?

A recent study conducted by researchers at the Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), based in Quebec, Canada, analysed the effects of physical exercise on those with lower limb amputations. Published in the Archives of Physical Medicine and Rehabilitation the study sheds light on the profound impact exercise can have on mitigating the multifaceted challenges associated with limb loss.

They acknowledged that exercise had a role to play to 'reduce the negative biopsychoso­cial consequences' of amputation, but noted that while there is extensive evidence of the benefits of exercise in the gen­eral population, there was a lack of research on the benefits of exercise in adults with lower limb amputations.

The paper also noted:

• Lower limb amputation is a permanent condition that affects individuals’ mobility and social participation.
• Lower limb amputation leads to lower levels of physical activity. 
• Most individ¬uals with lower limb amputations do not participate in sufficient physical activity to gain health benefits, leading to greater disability, poor quality of life, and a deterioration of health (eg, cardiovascular health related diseases, reduced cardiopulmonary function).
• Physical activity and exercise have pre¬ventive effects on cardiovascular disease, type 2 diabetes, and degenerative diseases such as osteoporosis and osteoarthritis, which are all common comorbidities associated with lower limb amputation.

The study sought to answer the following questions: 

1. Does physical activity or exercise improve fitness, mobility, and functional capacity among adults with lower limb amputations, and
2. What is the type, minimum dose (fre­quency, intensity and duration) of exercise or physical activity needed to increase fitness, mobility, and functional capacity among adults with lower limb amputations? 

Research involved the collation of 23 different studies covering 408 adults from a number of different countries, the vast majority of whom had sustained transtibial (~60%) and transfemoral (~40%) amputations. A higher proportion of the subjects were male (~76%). Amputees of any etiology (i.e. traumatic, congenital, vascular) were included.

The researchers analysed data concerning physical activity or exercise that met a certain criteria. The activity or exercise could have occurred in the community, or in a clinical context, but all of those included in the study were outside of the prosthetic rehabilitation phase and we're living in the community. 

Their analysis of the data enabled them to conclude with moderate confidence that 1-3 sessions of 20-60 minutes of exercise per week improves balance, walk¬ing speed, walking endurance, and transfer ability in adults with lower limb amputations above the ankle. The highest evidence was for mixed exercise programs; ones combining aerobic exercise, strength and balance, but the researchers found that gait/walking training was also improved.

It's worth mentioning that none of the studies reviewed reported any notable negative outcomes from physical activity or exercise. Out of all 23 studies analysed, only one participant experienced a fall, indicating a remarkably low incidence of adverse events.

What does this mean?

This research holds relevance for practitioners involved in lower limb amputation claims, as it addresses key concerns such as balance, walking distance, and transfer ability. These factors significantly impact decisions regarding care, rehabilitation therapies, and necessary adaptations. 

The study's findings serve to validate the efficacy of community-based exercise in enhancing the capabilities and overall quality of life for individuals with lower limb amputations. Moreover, it underscores the intuitive notion that tailored exercise regimens can be beneficial for injured individuals, regardless of their physical abilities. In doing so, this research not only reinforces existing beliefs but also potentially redefines expectations by demonstrating the transformative power of even minimal exercise.