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Amputee – Improves balance and balance confidence

Improves balance and balance confidence

Evidence summary

Balance is known to deteriorate following an amputation [1], and fear of falling is a common barrier to physical activity in amputees [2,3]. One study demonstrated a clinically meaningful improvements in balance and balance confidence following a 6-week supervised exercise programme that incorporated balance exercises, as well as exercises to address flexibility, gait, core strength and lower limb strength [4]. Hip abductor strengthening programmes have been shown to improve balance confidence in those with transfemoral amputations [5]. Poor balance may result in falls, and exercise programmes incorporating balance activities have been shown to reduce the risk of falls in in the short-term [6] and reduce the incidence of falls in the longer-term [7].

Quality of evidence


Strength of recommendation



While there is a paucity of high-quality evidence, lower limb amputees should be encouraged to incorporate balance exercises into their activity routine to improve their balance and balance confidence and reduce their risk of falls. Exercise programmes incorporating exercises to improve balance which are available to amputees during their rehabilitation should be utilised.

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.


  1. van Velzen JM, van Bennekom CAM, Polomski W, et al. Physical capacity and walking ability after lower limb amputation: a systematic review. Clinical Rehabilitation 2006;20(11):999-1016. doi: 10.1177/0269215506070700
  2. Littman AJ, Boyko EJ, Thompson ML, et al. Physical activity barriers and enablers in older Veterans with lower-limb amputation. Journal of Rehabilitation Research and Development 2014;51(6):895-906. doi: 10.1682/jrrd.2013.06.0152
  3. Littman AJ, Bouldin ED, Haselkorn JK. This is your new normal: A qualitative study of barriers and facilitators to physical activity in Veterans with lower extremity loss. Disability and Health Journal 2017;10(4):600-06. doi: 10.1016/j.dhjo.2017.03.004
  4. Miller CA, Williams JE, Durham KL, et al. The effect of a supervised community-based exercise program on balance, balance confidence, and gait in individuals with lower limb amputation. Prosthetics and Orthotics International 2017;41(5):446-54. doi: 10.1177/0309364616683818
  5. Pauley T, Devlin M, Madan-Sharma P. A Single-Blind, Cross-Over Trial of Hip Abductor Strength Training to Improve Timed Up & Go Performance in Patients With Unilateral, Transfemoral Amputation. Journal of Rehabilitation Medicine 2014;46(3):264-70. doi: 10.2340/16501977-1270
  6. Godlwana LL, Stewart A, Musenge E. Mobility during the intermediate stage of rehabilitation after lower limb amputation from an under resourced community: a randomized controlled trial. Physiotherapy 2015;101:e458. doi: 10.1016/
  7. 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