Improves lower limb strength

Evidence summary

Lower limb muscle atrophy and reduced strength is common following a lower limb amputation [1,2]. An RCT demonstrated that an exercise programme incorporating lower limb and core muscle strengthening activities, as well as flexibility, balance and cardiovascular fitness exercises, can significantly increase power generation and absorption in both the intact and remnant limbs [3]. A hip strengthening programme in active, mostly traumatic lower limb amputees that were experienced prosthetic users demonstrated an improved hip strength, enabling a number of participants to run following the intervention [4].

Quality of evidence

Low

Strength of recommendation

Strong

Conclusion

While there is a paucity of high-quality evidence, reduced lower limb muscle strength following an amputation is common. Lower limb strengthening exercises should be advised to lower limb amputees to address this.

Lower limb amputations are performed for a number of clinical indications. Although most evidence around physical activity relates to prosthetic users and for dysvascular amputees, the benefits of physical activity are not exclusive to these groups and should be shared with all lower limb amputees. Lower limb amputees wishing to increase their physical activity levels should be encouraged to do so.

References

1. Isakov E, Burger H, Gregoric M, et al. Isokinetic and isometric strength of the thigh muscles in below-knee amputees. Clinical Biomechanics 1996;11(4):233-35. doi: 10.1016/0268-0033(95)00078-x
2. Nolan L. Lower limb strength in sports-active transtibial amputees. Prosthetics and Orthotics International 2009;33(3):230-41. doi: 10.1080/03093640903082118
3. Schafer ZA, Perry JL, Vanicek N. A personalised exercise programme for individuals with lower limb amputation reduces falls and improves gait biomechanics: A block randomised controlled trial. Gait & Posture 2018;63:282-89. doi: 10.1016/j.gaitpost.2018.04.030
4. Nolan L. A Training Programme to Improve Hip Strength in Persons With Lower Limb Amputation. Journal of Rehabilitation Medicine 2012;44(3):241-48. doi: 10.2340/16501977-0921