Effectiveness of exercise training program on postural control and quality of life in middle-aged men with unilateral lower limb amputation

Masoud Kashfi • Iman Khakroo Abkenar • Ali Fakourian • Giovanni Lombardi

DOI: 10.31382/eqol.211204


This study aimed to investigate whether the exercise-based amputee rehabilitation program improves postural control and quality of life in people with unilateral transtibial amputation (TTA). Twenty middle-aged men (48.4±3.8 y) with lower limb amputation, in a randomized-controlled longitudinal design, volunteered to participate in the study and were divided into experimental (EXP, n=10) and control (CON, n=10) groups. Before and after 8 weeks of the exercise training program, postural control performance, using one-leg standing (OLS) and Y-balance tests, was measured. The quality of life was also assessed before and after 8 weeks training period using standard questionnaires. Group x time interactions were observed for the EXP group in OLS and Y-balance tests and quality of life scores in comparison to pre- training values and the CON group (p<0.05). People with unilateral TTA who received exercise-based amputee rehabilitation program demonstrated significant improvement in balance performance with significant effects on quality of life.

Keywords: balance • rehabilitation • exercise training • amputation.


Ahmed, M., Ambalavanan, C., Ramar, S., & Waleed, A. B. (2010). Quantitative assessment of postural stability and balance between persons with lower limb amputation and normal subjects by using dynamic posturography. Open Access Macedonian Journal of Medical Sciences, 15(3), 138-143.

Arazi, H., & Asadi, A. (2011). The effect of aquatic and land plyometric training on strength, sprint, and balance in young basketball players. Journal of Human Sport and Exercise, 6, 101-111.

Asadi, A., Saez de Villarreal, E., & Arazi, H. (2015). The effects of plyometric type neuromuscular training on postural control performance of male team basketball players. The Journal of Strength & Conditioning Research, 29, 1870-1875.

Barthuly, A. M., Bohannon, R. W., & Gorack, W. (2012). Gait speed is a responsive measure of physical performance for patients undergoing short-term rehabilitation. Gait & Posture, 36, 61–64.

Burke-Doe, A., Hudson, A., Werth, H., & Riordan, D. G. (2008). Knowledge of osteoporosis risk factors and prevalence of risk factors for osteoporosis, falls, and fracture in functionally independent older adults. Journal of Geriatric Physical Therapy, 31, 11–17.

Caballero, F. F., Miret, M., Power, M., Chatterji, S., Tobiasz-Adamczyk, B., Koskinen, S., Leonardi, M., Olaya, B., Haro, J. M., & Ayuso-Mateos, J. L. (2013). Validation of an instrument to evaluate quality of life in the aging population: WHOQOL-AGE. Health and Quality of Life Outcomes, 11, 177.

Charkhkar, H., Christie, B. P., & Triolo, R. J. (2020). Sensory neuroprosthesis improves postural stability during sensory organization test in lower-limb amputees. Scientific Reports – Nature, 10, 6984.

Chaudhry, H., Bukiet, B., Ji, Z., & Findley, T. (2011). Measurement of balance in computer posturography: Comparison of methods–A briefreview. Journal of Bodywork and Movement Therapies, 15, 82–91.

Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences. Hillsdale: Lawrence Erlbaum.

Gabbard, C. P. (2008). Lifelong Motor Development (5th ed). San Francisco, CA: Pearson Benjamin Cummings.

Gailey, R., Gaunaurd, I., Raya, M., Kirk-Sanchez, N., Prirto-Sanchez, L., & Roach, K. (2020). Effectiveness of an evidence-based amputee rehabilitation program: A pilot randomized controlled trial. Physical Therapy, 100, 773-787.

Gribble, P. A., & Hertel, J. (2003). Considerations for normalizing measures of the star excursion balance test. Measurement in Physical Education and Exercise Science, 7, 89-100.

Lephart, S. M., & Henry, T. J. (1996). The physiological basis for open and closed kinetic chain rehabilitation for the upper extremity. Journal of Sport Rehabilitation, 5, 71–87.

Marigold, D. S., & Patla, A. E. (2002). Strategies for dynamic stability during locomotion on a slippery surface: Effects of prior experience and knowledge. Journal of Neurophysiology, 88, 339-353.

McGuine, T. A., Greene, J. J., Best, T., & Leverson, G. (2000). Balance as a predictor of ankle injuries in high school basketball players. Clinical Journal of Sport Medicine, 10, 239-244.

Miller, W. C., Speechley, M., & Deathe, B. (2001). The prevalence and risk factors of falling and fear of falling among lower extremity amputees. Archives of Physical Medicine and Rehabilitation, 82, 1031–1037.

Nagy, E., Toth, K., Janositz, G., Kovacs, G., Feher-Kiss, A., Angyan, L., & Horvath, G. (2004). Postural control in athletes participating in an ironman triathlon. European Journal of Applied Physiology, 92, 407-413.

Pauley, T., Devlin, M., & Madan-Sharma, P. A. (2014). Single-blind, cross-over trial of the hip abductor strength training to improve timed Up & Go performance in patients with unilateral, transfemoral amputation. Journal of Rehabilitation Medicine, 46:264-270.

Ramirez-Campillo, R., Alvarez, C., Garcia-Hermoso, A., Celis-Morales, C., Ramirez-Velez, R., Gentil, P., & Izquierdo, M. (2018). High-speed resistance training in elderly women: Effects of cluster training sets on functional performance and quality of life. Experimental Gerontology, 110, 216–222.

Ries, J. D., & Vaughan, V. G. (2007). Rehabilitation of persons with recent transtibial amputation. In M. M. Lusardi and C. C. Nielsen (Eds.), Orthotics and prosthetics in rehabilitation. 2nd ed. (pp. 711–744). St. Louis, MO: Saunders/Elsevier.

Sherk, V. D., Bemben, M. G., & Bemben, D. A. (2010). Interlimb muscle and fat comparisons in persons with lower-limb amputation. Archives of Physical Medicine and Rehabilitation, 91, 1077–1081.

Studenski, S., Perera, S., & Wallace, D. (2003). Physical performance measures in the clinical setting. Journal of the American Geriatrics Society, 51, 314–322.

Thorpe, J. L., & Ebersole, K. T. (2008). Unilateral balance performance in female collegiate soccer athletes. The Journal of Strength & Conditioning Research, 22, 1429-1433.

Van Velzen, J. M., Van Bennekom, C. A. M., & Polomski, W. (2006). Physical capacity and walking ability after lower limb amputation: A systematic review. Clinical Rehabilitation, 20, 999–1016.

Wasser, J. G., Herman, D. C., Horodyski, M., Zaremski, J. L., Tripp, B., Page, P., Vincent, K. R., & Vincent, H.K. (2017). Exercise intervention for unilateral amputees with low back pain: study protocol for a randomized, controlled trial. Trials, 18, 630.

Wilkerson, G. B., Colston, M. A., Short, N. I., Neal, K. L., Hoewischer, P. E., & Pixley, J. J. (2004). Neuromuscular changes in female collegiate athletes resulting from a plyometric jump training program. Journal of Athletic Training, 39, 17–23.

Wong, C. K., Ehrlich, J. E., Ersing, J. C., Maroldi, N. J., Stevenson, C. E., & Varca, M. J. (2016). Exercise programs to improve gait performance in people with lower limb amputation: A systematic review. Prosthetics and Orthotics International, 40(1), 8–17.

Ziegler-Graham, K., MacKenzie, E. J., Ephraim, P. L., Travison, T. G., & Brookmeyer, R. (2008). Estimating the prevalence of limb loss in the United States: 2005 to 2050. Archives of Physical Medicine and Rehabilitation, 89(3), 422-429.