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Amputees and Sports

A Systematic Review

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Abstract

Amputation of a limb may have a negative impact on the psychological and physical well-being, mobility and social life of individuals with limb amputations. Participation in sports and/or regular physical activity has a positive effect on the above mentioned areas in able-bodied individuals. Data concerning participation in sports or regular physical activity together with its benefits and risks for individuals with limb amputations are scarce. No systematic review exists that addresses a wide range of outcomes such as biomechanics, cardiopulmonary function, psychology, sport participation and sport injuries. Therefore, the aim of this article is to systematically review the literature about individuals with limb amputations and sport participation.

MEDLINE (PubMed), EMBASE, CINAHL® and SportDiscus® were searched without time or language restrictions using free text words and MeSH terms. The last search date was 31 March 2010. Books, internet sites and references of included papers were checked for papers relevant to the topic under review.

Papers were included if the research topic concerned sports and a minimum of ten individuals with limb amputations were part of the study population. Papers were excluded if they included individuals with amputations of body parts other than upper or lower limbs or more distal than the wrist or ankle, or if they consisted of case reports, narrative reviews, books, notes or letters to the editor.

Title, abstract and full-text assessments were performed by two independent observers following a list of preset criteria.

Of the 3689 papers originally identified, 47 were included in the review. Most of the included studies were older than 10 years and had cross-sectional designs. Study participants were generally younger and often had more traumatic amputations than the general population of individuals with limb amputations. Heterogeneity in population characteristics, intervention types and main outcomes made data pooling impossible. In general, sports were associated with a beneficial effect on the cardiopulmonary system, psychological well-being, social reintegration and physical functioning. Younger individuals with unilateral transtibial amputations achieve better athletic performance and encounter fewer problems when participating in sports compared with older individuals with bilateral transfemoral amputations. Regardless of their amputation level, individuals with limb amputations participate in a wide range of recreational activities. The majority of them were not aware of the sport facilities in their area and were not informed about available recreational activities. Sport prosthetic devices were used mostly by competitive athletes. For football, the injury rate and pattern of the players with an amputation were similar to those of able-bodied players.

Individuals with limb amputations appear to benefit both physically and psychologically from participation in sports and/or regular physical activity. Therefore, sports should be included in rehabilitation programmes, and individuals with limb amputations should be encouraged to pursue a physically active life following hospital discharge.

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Fig. 1
Table I

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Notes

  1. Authors’ note: the literature search was updated on 21 February 2011. Following the same inclusion/exclusion criteria as described in section 1, we identified four more studies eligible for inclusion in the current systematic review.[33,50,66,67] These studies were added to table I under the relevant characteristics analyses. The results of these studies did not influence the conclusion of this review and therefore they were not brought up for discussion.

References

  1. Chin T, Sawamura S, Fujita H, et al. Physical fitness of lower limb amputees. Am J Phys Med Rehabil 2002; 81 (5): 321–5

    Article  PubMed  Google Scholar 

  2. Horgan O, MacLachlan M. Psychosocial adjustment to lower-limb amputation: a review. Disabil Rehabil 2004; 26 (14-15): 837–50

    Article  PubMed  Google Scholar 

  3. Cansever A, Uzun O, Yildiz C, et al. Depression in men with traumatic lower part amputation: a comparison to men with surgical lower part amputation. Mil Med 2003; 168 (2): 106–9

    PubMed  Google Scholar 

  4. Kashani JH, Frank RG, Kashani SR, et al. Depression among amputees. J Clin Psychiatry 1983; 44 (7): 256–8

    PubMed  CAS  Google Scholar 

  5. Singh R, Hunter J, Philip A. The rapid resolution of depression and anxiety symptoms after lower limb amputation. Clin Rehabil 2007; 21 (8): 754–9

    Article  PubMed  Google Scholar 

  6. Dillingham TR, Pezzin LE, MacKenzie EJ. Limb amputation and limb deficiency: epidemiology and recent trends in the United States. South Med J 2002; 95 (8): 875–83

    PubMed  Google Scholar 

  7. Ziegler-Graham K, MacKenzie EJ, Ephraim PL, et al. Estimating the prevalence of limb loss in the United States: 2005 to 2050. Arch Phys Med Rehabil 2008; 89 (3): 422–9

    Article  PubMed  Google Scholar 

  8. Bijnen FC, Caspersen CJ, Feskens EJ, et al. Physical activity and 10-year mortality from cardiovascular diseases and all causes: the Zutphen elderly study. Arch Intern Med 1998; 158 (14): 1499–505

    Article  PubMed  CAS  Google Scholar 

  9. Shephard RJ. Benefits of sport and physical activity for the disabled: implications for the individual and for society. Scand J Rehabil Med 1991; 23 (2): 51–9

    PubMed  CAS  Google Scholar 

  10. Powell KE, Thompson PD, Caspersen CJ, et al. Physical activity and the incidence of coronary heart disease. Annu Rev Public Health 1987; 8: 253–87

    Article  PubMed  CAS  Google Scholar 

  11. Pate RR, Pratt M, Blair SN, et al. Physical activity and public health: a recommendation from the centers for disease control and prevention and the American College of Sports Medicine. JAMA 1995; 273 (5): 402–7

    Article  PubMed  CAS  Google Scholar 

  12. Modan M, Peles E, Halkin H, et al. Increased cardiovascular disease mortality rates in traumatic lower limb amputees. Am J Cardiol 1998; 82 (10): 1242–7

    Article  PubMed  CAS  Google Scholar 

  13. Webster JB, Levy CE, Bryant PR, et al. Sports and recreation for persons with limb deficiency. Arch Phys Med Rehabil 2001; 82 (3 Suppl.1): 38–44

    Google Scholar 

  14. Buckley JG. Sprint kinematics of athletes with lower-limb amputations. Arch Phys Med Rehabil 1999; 80 (5): 501–8

    Article  PubMed  CAS  Google Scholar 

  15. Sanderson DJ, Martin PE. Joint kinetics in unilateral belowknee amputee patients during running. Arch Phys Med Rehabil 1996; 77 (12): 1279–85

    Article  PubMed  CAS  Google Scholar 

  16. Czerniecki JM, Gitter A. Insights into amputee running: a muscle work analysis. AmJ Phys Med Rehabil 1992; 71 (4): 209–18

    Article  CAS  Google Scholar 

  17. Tomaszewska J, Hildebrandt M. Badania tetna, cisnienia tetniczego krwi, oddychania i sily miesni przeprowadzone podczas kursu narciarskiego u amputowanych na konczynach dolnych. Chir Narzadow Ruchu Ortop Pol 1965; 30 (5): 557–61

    PubMed  CAS  Google Scholar 

  18. Laboute E, Lassalle A, Letallec H, et al. Stress fractures in lower limb amputees practicing handi-sport athletics. J Traumatol Sport 2003; 20 (3): 155–61

    Google Scholar 

  19. Nolan L. Carbon fibre prostheses and running in amputees: a review. Foot Ankle Surg 2008; 14 (3): 125–9

    Article  PubMed  Google Scholar 

  20. van Velzen JM, van Bennekom CAM, Polomski W, et al. Physical capacity and walking ability after lower limb amputation: a systematic review. Clin Rehabil 2006; 20 (11): 999–1016

    Article  PubMed  Google Scholar 

  21. Kemper HGC, Ooijendijk WTM, Stiggelbout M. Consensus over de Nederlandse norm voor gezond bewegen. Tijdschr Soc Gezondheidsz 2000; 78: 180–3

    Google Scholar 

  22. World Health Organization. Physical activity-definition [online]. Available from URL: http://www.who.int/topics/physical_activity/en/ [Accessed 2008 Dec 4]

  23. Osborough CD, Payton CJ, Daly DJ. Relationships between the front crawl stroke parameters of competitive unilateral arm amputee swimmers, with selected anthropometric characteristics. J Appl Biomech 2009; 25 (4): 304–12

    PubMed  Google Scholar 

  24. Engsberg JR, Lee AG, Tedford KG, et al. Normative ground reaction force data for able-bodied and trans-tibial amputee children during running. Prosthet Orthot Int 1993; 17 (2): 83–9

    PubMed  CAS  Google Scholar 

  25. Enoka RM, Miller DI, Burgess EM. Below-knee amputee running gait. Am J Phys Med 1982; 61 (2): 66–84

    Article  PubMed  CAS  Google Scholar 

  26. Gavron SJ. Biomechanical analysis of elite sprinters with below-knee amputations. BIJAPER 1995; 2 (1): 1–14

    Google Scholar 

  27. Nolan L, Lees A. Touch-down and take-off characteristics of the long jump performance of world level above- and belowknee amputee athletes. Ergonomics 2000; 43 (10): 1637–50

    Article  PubMed  CAS  Google Scholar 

  28. Nolan L, Lees A. Prosthetic limb versus intact limb take-off in the amputee long jump. In: Proceedings of the XXIII International Symposium on Biomechanics in Sports; 2005 Aug 22-27; Beijing. 2005: 305–8 [online]. Available from URL: http://w4.ub.uni-konstanz.de/cpa/issue/view/ISBS2005 [Accessed 2011 Jul 25]

    Google Scholar 

  29. Nolan L, Patritti BL, Simpson KJ. A biomechanical analysis of the long-jump technique of elite female amputee athletes. Med Sci Sports Exerc 2006; 38 (10): 1829–35

    Article  PubMed  Google Scholar 

  30. Nolan L, Lees A. The influence of lower limb amputation level on the approach in the amputee long jump. J Sports Sci 2007; 25 (4): 393–401

    Article  PubMed  Google Scholar 

  31. Patritti BL, Simpson KJ, Nolan L. Approach velocity profiles of elite male and female lower-limb amputee long jumpers. In: Proceedings of the XXth Congress of the International Society of Biomechanics; 2005 Jul 31-Aug 5; Cleveland (OH). Cleveland (OH): The Cleveland Clinic Foundation 2005: 823

    Google Scholar 

  32. Simpson KJ, Williams SL, DelRey P, et al. Locomotor characteristics exhibited during paralympic long jump competitions of classifications “below-” and “above-knee amputee”. Int J Appl Sport Sci 2001; 13 (1): 1–17

    Google Scholar 

  33. Osborough CD, Payton CJ, Daly DJ. Influence of swimming speed on inter-arm coordination in competitive unilateral arm amputee front crawl swimmers. Hum Mov Sci 2010; 29 (6): 921–31

    Article  PubMed  Google Scholar 

  34. van Alste JA, Cruts HEP, Huisman K, et al. Exercise testing of leg amputees and the result of prosthetic training. Int Rehab Med 1985; 7 (3): 93–8

    Google Scholar 

  35. Pitetti KH, Snell PG, Stray-Gundersen J, et al. Aerobic training exercises for individuals who had amputation of the lower limb. J Bone Joint Surg Am 1987; 69 (6): 914–21

    PubMed  CAS  Google Scholar 

  36. Alaranta H, Niittymaki S, Karhumaki L, et al. Physische belastungstests bei amputierten skilaufern. Med Sport 1988; 28: 112–6

    Google Scholar 

  37. Chin T, Sawamura S, Fujita H, et al. The efficacy of the oneleg cycling test for determining the anaerobic threshold (AT) of lower limb amputees. Prosthet Orthot Int 1997; 21 (2): 141–6

    PubMed  CAS  Google Scholar 

  38. Kurdibaylo SF, Bogatykh VG. Swimming as a means of enhancing the adaptive potentials of the disabled after amputation of the lower extremities. Vopr Kurortol Fizioter Lech Fiz Kult 1997; 1: 25–8 [in Russian; online]. Available from URL: http://lib.sportedu.ru/Document.idc?DocID=91670&DocQuerID=5048925&DocTypID=NULL&QF=Simple&Pg=20&Cd=Win&Tr=0&On=0&DocQuerItmID= [Accessed 2011 Jul 25]

    Google Scholar 

  39. Hutzler Y, Ochana S, Bolotin R, et al. Aerobic and anaerobic arm-cranking power outputs of males with lower limb impairments: Relationship with sport participation intensity, age, impairment and functional classification. Spinal Cord 1998; 36 (3): 205–12

    Article  PubMed  CAS  Google Scholar 

  40. Chin T, Sawamura S, Fujita H, et al. Effect of endurance training program based on anaerobic threshold (AT) for lower limb amputees. J Rehabil Res Dev 2001; 38 (1): 7–11

    PubMed  CAS  Google Scholar 

  41. Kobzev IA, Khramov VV. Some features of reaction of cardiovascular system on physical load in physically handicapped amputee engaged in sports. Sportivnaia Medicina 2002; 7: 13–6 [in Russian; online]. Available from URL: http://lib.sportedu.ru/Document.idc?DocID=91670&DocQuerID=5048925&DocTypID=NULL&QF=Simple&Pg=20&Cd=Win&Tr=0&On=0&DocQuerItmID= [Accessed 2011 Jul 25]

    Google Scholar 

  42. Huonker M, Schmid A, Schmidt-Trucksass A, et al. Size and blood flow of central and peripheral arteries in highly trained able-bodied and disabled athletes. J Appl Physiol 2003; 95 (2): 685–91

    PubMed  CAS  Google Scholar 

  43. Chin T, Sawamura S, Shiba R. Effect of physical fitness on prosthetic ambulation in elderly amputees. Am J Phys Med Rehabil 2006; 85 (12): 992–6

    Article  PubMed  Google Scholar 

  44. Valliant PM, Bezzubyk I, Daley L, et al. Psychological impact of sport on disabled athletes. Psychol Rep 1985; 56 (3): 923–9

    Article  PubMed  CAS  Google Scholar 

  45. Mastro JV, Burton AW, Rosendahl M. Attitudes of elite athletes with impairments toward one another: a hierarchy of preference. Adapt Phys Act Q 1996; 2 (13): 197–210

    Google Scholar 

  46. Wetterhahn KA, Hanson C, Levy CE. Effect of participation in physical activity on body image of amputees. Am J Phys Med Rehabil 2002; 81 (3): 194–201

    Article  PubMed  Google Scholar 

  47. Lowther J, Lane A, Lane H. Self-efficacy and psychological skills during the amputee soccer world cup. Athletic Insight 2002; 4 (2): 23–34 [online]. Available from URL: http://www.athleticinsight.com/Vol4Iss2/SoccerSelfEfficacy.htm [Accessed 2009 Jul 6]

    Google Scholar 

  48. Sporner ML, Fitzgerald SG, Dicianno BE, et al. Psychosocial impact of participation in the national veterans wheelchair games and winter sports clinic. Disabil Rehabil 2009; 31 (5): 410–8

    Article  PubMed  Google Scholar 

  49. Couture M, Caron CD, Desrosiers J. Leisure activities following a lower limb amputation. Disabil Rehabil 2010; 32 (1): 57–64

    Article  PubMed  Google Scholar 

  50. Tatar Y. Body image and its relationship with exercise and sports in turkish lower-limb amputees who use prosthesis. Sci Sports 2010; 25 (6): 312–7

    Article  Google Scholar 

  51. Kegel B, Carpenter ML, Burgess EM. A survey of lowerlimb amputees: prostheses, phantom sensations, and psychosocial aspects. Bull Prosthet Res 1977; 10 (27): 43–60

    PubMed  CAS  Google Scholar 

  52. Kegel B, Carpenter ML, Burgess EM. Functional capabilities of lower extremity amputees. Arch Phys Med Rehabil 1978; 59 (3): 109–20

    PubMed  CAS  Google Scholar 

  53. Kegel B, Webster JC, Burgess EM. Recreational activities of lower extremity amputees: a survey. Arch Phys Med Rehabil 1980; 61: 258–64

    PubMed  CAS  Google Scholar 

  54. Medhat A, Huber PM, Medhat MA. Factors that influence the level of activities in persons with lower extremity amputation. Rehabil Nurs 1990; 15 (1): 13–8

    Article  PubMed  CAS  Google Scholar 

  55. Pohjolainen T, Alaranta H, Karkkainen M. Prosthetic use and functional and social outcome following major lower limb amputation. Prosthet Orthot Int 1990; 14 (2): 75–9

    PubMed  CAS  Google Scholar 

  56. Gailey R. Recreational pursuits for elders with amputation. Top Geriatr Rehabil 1992; 8 (1): 39–58

    Google Scholar 

  57. Burger H, Marincek C, Isakov E. Mobility of persons after traumatic lower limb amputation. Disabil Rehabil 1997; 19 (7): 272–7

    Article  PubMed  CAS  Google Scholar 

  58. Burger H, Marincek C. The life style of young persons after lower limb amputation caused by injury. Prosthet Orthot Int 1997; 21 (1): 35–9

    PubMed  CAS  Google Scholar 

  59. Legro MW, Reiber GE, Czerniecki JM, et al. Recreational activities of lower-limb amputees with prostheses. J Rehabil Res Dev 2001; 38 (3): 319–25

    PubMed  CAS  Google Scholar 

  60. Rau B, Bonvin F, de Bie R. Short-term effect of physiotherapy rehabilitation on functional performance of lower limb amputees. Prosthet Orthot Int 2007; 31 (3): 258–70

    Article  PubMed  CAS  Google Scholar 

  61. Yazicioglu K, Taskaynatan MA, Guzelkucuk U, et al. Effect of playing football (soccer) on balance, strength, and quality of life in unilateral below-knee amputees. Am J Phys Med Rehabil 2007; 86 (10): 800–5

    Article  PubMed  Google Scholar 

  62. Yari P, Dijkstra PU, Geertzen JHB. Functional outcome of hip disarticulation and hemipelvectomy: a cross-sectional national descriptive study in the Netherlands. Clin Rehabil 2008; 22 (12): 1127–33

    Article  PubMed  Google Scholar 

  63. Walker JL, Knapp D, Minter C, et al. Adult outcomes following amputation or lengthening for fibular deficiency. J Bone Joint Surg Am 2009; 91 (4): 797–804

    Article  PubMed  Google Scholar 

  64. Karmarkar AM, Collins DM, Wichman T, et al. Prosthesis and wheelchair use in veterans with lower-limb amputation. J Rehabil Res Dev 2009; 46 (5): 567–76

    Article  PubMed  Google Scholar 

  65. Kars C, Hofman M, Geertzen JH, et al. Participation in sports by lower limb amputees in the province of Drenthe, the Netherlands. Prosthet Orthot Int 2009; 33 (4): 356–67

    Article  PubMed  Google Scholar 

  66. van den Berg-Emons RJ, Bussmann JB, Stam HJ. Accelerometry- based activity spectrum in persons with chronic physical conditions. Arch Phys Med Rehabil 2010; 91 (12): 1856–61

    Article  PubMed  Google Scholar 

  67. Bekkering WP, Vliet Vlieland TP, Koopman HM, et al. Functional ability and physical activity in children and young adults after limb-salvage or ablative surgery for lower extremity bone tumors. J Surg Oncol 2011; 103 (3): 276–82

    Article  PubMed  Google Scholar 

  68. Kegel B, Malchow D. Incidence of injury in amputees playing soccer. Palaestra 1994; 10 (2): 50–4

    Google Scholar 

  69. Melzer I, Yekutiel M, Sukenik S. Comparative study of osteoarthritis of the contralateral knee joint ofmale amputees who do and do not play volleyball. J Rheumatol 2001; 28 (1): 169–72

    PubMed  CAS  Google Scholar 

  70. Bernardi M, Castellano V, Ferrara MS, et al. Muscle pain in athletes with locomotor disability. Med Sci Sports Exerc 2003; 35 (2): 199–206

    Article  PubMed  Google Scholar 

  71. Desmond D, Gallagher P, Henderson-Slater D, et al. Pain and psychosocial adjustment to lower limb amputation amongst prosthesis users. Prosthet Orthot Int 2008; 32 (2): 244–52

    Article  PubMed  Google Scholar 

  72. Rommers GM, Vos LD, Groothoff JW, et al. Epidemiology of lower limb amputees in the north of the Netherlands: aetiology, discharge destination and prosthetic use. Prosthet Orthot Int 1997; 21 (2): 92–9

    PubMed  CAS  Google Scholar 

  73. Czerniecki JM, Gitter A, Munro C. Joint moment and muscle power output characteristics of below knee amputees during running: the influence of energy storing prosthetic feet. J Biomech 1991; 24 (1): 63–75

    Article  PubMed  CAS  Google Scholar 

  74. Pailler D, Sautreuil P, Piera JB, et al. Evolution in prostheses for sprinters with lower-limb amputation. Ann Readapt Med Phys 2004; 47 (6): 374–81

    Article  PubMed  CAS  Google Scholar 

  75. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I: conceptual framework and item selection. Med Care 1992; 30 (6): 473–83

    Article  PubMed  Google Scholar 

  76. Legro MW, Reiber GD, Smith DG, et al. Prosthesis evaluation questionnaire for persons with lower limb amputations: assessing prosthesis-related quality of life. Arch Phys Med Rehabil 1998; 79 (8): 931–8

    Article  PubMed  CAS  Google Scholar 

  77. Furst L, Humphrey M. Coping with the loss of a leg. Prosthet Orthot Int 1983; 7 (3): 152–6

    PubMed  CAS  Google Scholar 

  78. Durstine JL, Painter P, Franklin BA, et al. Physical activity for the chronically ill and disabled. Sports Med 2000; 30 (3): 207–19

    Article  PubMed  CAS  Google Scholar 

  79. Verbrugge LM. The structure of adult friendship choices. Social Forces 1977; 56 (2,Special Issue): 576–97

    Google Scholar 

  80. Ford R. European and North American sports differences. Scot J Polit Econ 2000; 47 (4): 431–55

    Article  Google Scholar 

  81. Geertzen JHB, Bosmans JC, van der Schans CP, et al. Claimed walking distance of lower limb amputees. Disabil Rehabil 2005; 27 (3): 101–4

    Article  PubMed  Google Scholar 

  82. Pernot HF, de Witte LP, Lindeman E, et al. Daily functioning of the lower extremity amputee: an overview of the literature. Clin Rehabil 1997; 11 (2): 93–106

    Article  PubMed  CAS  Google Scholar 

  83. Manonelles Marqueta P, Arguisuelas Martinez M, Santiago Fernandez R, et al. Number of injuries in high athletics competition of Paralympics sportsmen. Arch Med Deporte 2005; 22 (109): 371–9

    Google Scholar 

  84. Ferrara MS, Peterson CL. Injuries to athletes with disabilities: identifying injury patterns. Sports Med 2000; 30 (2): 137–43

    Article  PubMed  CAS  Google Scholar 

  85. Ferrara MS, Buckley WE, Messner DG, et al. The injury experience and training history of the competitive skier with a disability. Am J Sports Med 1992; 20 (1): 55–60

    Article  PubMed  CAS  Google Scholar 

  86. McCormick DP. Injuries in handicapped alpine ski racers. Phys Sportsmed 1985; 13 (12): 93–7

    Google Scholar 

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Acknowledgements

The authors certify that no party having a direct interest in the results of the research supporting this review has or will confer a benefit on their or on any organization with which they are associated.

No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

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Authors and Affiliations

  1. From the Department of Rehabilitation Medicine, University Medical Centre Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, the Netherlands

    Mihail Bragaru MSc, Rienk Dekker, Jan H. B. Geertzen & Pieter U. Dijkstra

  2. Department of Oral and Maxillofacial Surgery, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands

    Pieter U. Dijkstra

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Bragaru, M., Dekker, R., Geertzen, J.H.B. et al. Amputees and Sports. Sports Med 41, 721–740 (2011). https://doi.org/10.2165/11590420-000000000-00000

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