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Lower limb amputations and comorbidities

Those undergoing a lower limb amputation are known to have a high number of co-morbidities. A retrospective study at a regional UK vascular centre looked at those undergoing an above knee amputation and found that 58% of their cohort had diabetes mellitus, 39% had chronic kidney disease, 35% had heart failure and 13% had COPD (Kennedy, 2019).

Amputees spend more time in low-intensity activities than the general population and have high levels of physical inactivity (Desveaux, 2016; Pepin, 2018).

In patients with type 2 diabetes who have undergone a lower limb amputation, the risk of major cardiac events is increased if they are non-concordant with physical activity recommendations, in addition to smoking cessation, anti-platelet therapy and dietary change (Shalaeva, 2017).

Regular physical activity should be recommended to most people following a major lower limb amputation to help reduce their increased risk of mortality and the high number of co-morbidities.

Other benefits of increased physical activity levels in patients with amputation include improved quality of life (Christensen, 2016), physical function and walking performance of prosthetic users (Wong, 2016), reduced rate of falls (Godlwana, 2015; Schafer, 2018) and reduced low back pain (Anaforoglu, 2016).


Anaforoglu B, Erbahceci F, Aksekili MAE. The effectiveness of a back school program in lower limb amputees: a randomized controlled study. Turkish Journal of Medical Sciences 2016;46(4):1122-29. doi: 10.3906/sag-1503-131

Christensen J, Ipsen T, Doherty P, et al. Physical and social factors determining quality of life for veterans with lower-limb amputation(s): a systematic review. Disability and Rehabilitation 2016;38(24-26):2345-53. doi: 10.3109/09638288.2015.1129446

Desveaux L, Goldstein RS, Mathur S, et al. Physical Activity in Adults with Diabetes Following Prosthetic Rehabilitation. Canadian Journal of Diabetes 2016;40(4):336-41. doi: 10.1016/j.jcjd.2016.02.003Kennedy G, McGarry K, Bradley G, et al. All-Cause Mortality Amongst Patients Undergoing Above and Below Knee Amputation in a Regional Vascular Centre within 2014-2015. The Ulster medical journal 2019;88(1):30-35.

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/

Pepin ME, Akers KG, Galen SS. Physical activity in individuals with lower extremity amputations: a narrative review. Physical Therapy Reviews 2018;23(2):77-87. doi: 10.1080/10833196.2017.1412788

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

Shalaeva EV, Saner H, Janabaev BB, et al. Tenfold risk increase of major cardiovascular events after high limb amputation with non-compliance for secondary prevention measures. European Journal of Preventive Cardiology 2017;24(7):708-16. doi: 10.1177/2047487316687103

Wong CK, Ehrlich JE, Ersing JC, et al. Exercise programs to improve gait performance in people with lower limb amputation: A systematic review. Prosthetics and Orthotics International 2016;40(1):8-17. doi: 10.1177/0309364614546926