An amputation does not prevent an individual from taking up or continuing to exercise and keep fit. When it comes to taking part in sport, physical activity and exercise, amputees and individuals with limb impairments have similar options as those without - although some modifications may need to be made to enable participation.
Here, we provide some advice for exercise and fitness for amputees to help you keep fit.
Why is Exercise Good for You After an Amputation?
If you are fitted with a prosthesis, your body will experience a negative force on the muscles and skeleton, which, if left uncontrolled, will eventually cause posture changes. This, in turn, affects how your muscles perform causing the following:
Weakness and a strain on ligaments
Loss of balance
Aches and pains in the joints
Exercise helps you to stay more symmetrical, preventing your amputation side from becoming weak and inactive and forcing other parts of your body to overcompensate and become overused. The fitter you can be following an amputation, the better your body will cope with a prosthesis as you will have more control over your body. This will help to make daily tasks easier to accomplish.
Other benefits of exercising include:
Improved well-being and reduced stress
Lower cholesterol and blood pressure
Reduced risk of obesity, diabetes and heart disease
Weight management
Better breathing
Increased strength and endurance
Improved range of movement and joint mobility
Injury prevention
My Fitness Journey - Jamie Gane
I have always loved sports, but due to my chronic pain condition, which started at the age of nine, I was unable to participate in sport with my peers. When I started looking at amputation as a viable option for my pain, I realised that I would need to be as fit and healthy as possible. I started to look at wheelchair racing, but then I found throwing sports.
Once my amputation was completed and I could walk, I couldn’t stop myself from running, obstacle racing and getting back into Judo, which I had started at a very young age. I began competing on the international stage for Jude and obstacle racing, winning the silver medal at the World Judo Games, which placed me second in the world for my Judo category.
To keep up with Jamie’s progress, take a look at his Instagram here. Visit jamiegane.com.
Barriers to Exercising with an Amputation
As an amputee, you may face a number of barriers to physical activity that can make becoming and staying active a real challenge. Here are a few common barriers and how you can try to overcome them:
“I don’t know where to start”
The most important thing is to find an activity that you enjoy doing so that you will keep doing it. Adding a social element can make exercising much more fun, for instance, joining a friend at the gym, trying an exercise class or heading to the park with your family.
Don’t be afraid to try something new as these can often surprise you and leave you wanting to do more. To help you find a local sports club, visit the Parasport website. Jamie Gane, adaptive athlete, said: “There are lots of websites out there or reach out to other adaptive athletes. The community is extremely welcoming and there’s always someone out there to help you.”
“I don’t have the time”
Many people are busy with work and family commitments; however, not having sufficient time to exercise should be a concern. While there may be difficulties with travel that make a trip to an exercise venue long or expensive, it is important to consider where else you might be able to exercise. For example, a long journey isn’t required if you can do a workout in your local park, or in your home or garden.
As little as 30 minutes of moderate-intensity exercise a day, five times a week is enough to keep you feeling physically and mentally fit.
“I can’t find a local facility with accessibility”
Accessibility is a common issue faced by amputees; however, you do not necessarily need a gym or leisure centre to become more active. There are lots of exercises you can do with minimal equipment in many different environments, such as in your home or at the park. Jamie Gane’s advice on exercising at home is to get yourself into a routine, don’t set off too hard and give yourself little and achievable goals. If possible, find a friend who can help to push/motivate you.
If you do want to join a gym, the Inclusive Fitness Initiative (IFI) awards facilities across the UK with an IFI Mark accreditation of ‘good’, ‘very good’ or ‘excellent’. To find an accredited venue, visit the Activity Alliance website.
If you choose to go to a local leisure centre or gym, and are not offered an induction, make sure to ask for one so you can become familiar with the equipment and environment.
“I feel too tired to exercise”
If tiredness is preventing you from exercising, consider when it is you feel the most tired and try to exercise at a time you feel like you have more energy. Regular exercise can reduce fatigue and help you to sleep better. You should begin to notice improved energy levels after a few weeks of regular physical activity.
“I’ve never been good at exercise or sport”
Staying fit can bring back feelings of PE at school if you disliked it, which can put you off exercising as an adult. However, as an adult, you can choose what type of exercise/sport you do. Finding an activity that you enjoy should help to prolong your involvement. Mark Smith said: “The social side of football for me, personally, has been just as enjoyable as the competitive side of it.
“Keep stepping out of your comfort zone and trying new things, things you may not have tried before your amputation, as there may be a sport out there that you’ll fall in love with.”
Starting Out in Exercise or Sport as an Amputee
If you are new to exercise as an amputee, or returning after a break, you should seek advice from your prosthetic centre or a healthcare professional, such as your GP or physiotherapist. They should be able to provide you with advice regarding how much physical exercise and activity is appropriate for you in the early stages. Be prepared to modify an activity or exercise if you need to, but remember, nothing is off limits.
Amputee and prosthetist Jim Ashworth-Beaumont said: “Previously I was a keen weightlifter, but now I’m focusing on different types of exercise than I did before. Likewise, I’ve now got into adaptive sport. You only have to look at the Paralympic events to see that sport is about ability, never about disability.”
Your prosthetist or physiotherapist should be able to help you create an initial exercise programme based on using and not using your prosthesis to give you a variety of starter activities.
Mark Smith said: “For many people, the hardest part of starting exercising is the aches and pains in the first few weeks, but once you start to see and feel benefits, it becomes addictive - in a good way!”
You will not need a sport-specific prosthetic to exercise as your everyday leg should cope with most activities. Once you are fit and exercising regularly, or taking part in sport more often, you may find that your prosthesis is holding you back, which is when you should speak to your prosthetist.
Jamie Gane said: “One of the hardest parts of keeping fit with an amputation is finding a prosthetic that works for you, as well as the fit. Once you have a good prosthetist and prosthetic, you’re away!”
It is important to remember that keeping fit is a marathon, not a sprint, so if you can only do five minutes at first, don’t worry. The great thing about exercise is that you can work your way up, meaning you can start slow and take into account your current ability level (i.e. strength, stamina and stability). A common mistake many people make when working out is being too aggressive in the early stages and burning out. Listen to your body and if it doesn’t feel right, stop what you’re doing immediately.
My Fitness Journey - Mark Smith
My fitness journey started after losing my leg while serving in the British Army. Wanting to find a purpose and something challenging, I initially wanted to step on a bodybuilding stage, as a way to grow in confidence. If I could stand on stage missing a leg and be critiqued, then I could do anything.
I was very lucky to win several bodybuilding shows, my highlight was sharing a stage with Phil Heath in the States. To test myself further, I then stepped into disabled strongman competitions, winning Britain’s Strongest Disabled Man twice in 2016 and 2017, winning the Arnold Classic twice in 2017 and 2018, and winning England’s Strongest Disabled Man in 2018.
I always wanted to return to my first love of football at some point though, and, in January 2019, I started playing amputee football for Peterborough United Amputees, which was football played on crutches without the prosthetic leg.
It has been life-changing, particularly winning the national league title in my first season. I am now in my third season with Peterborough and I absolutely love it.
To keep up with Mark’s latest updates, take a look at his Instagram here.
What Exercise Should I Do?
To maintain your health and fitness following an amputation, you need an exercise regime that you will enjoy and is convenient for you. Any exercise programme should contain elements that address strength, balance, posture, coordination and cardiovascular fitness.
Jamie Gane said: “Exercising with an amputated limb can be very similar to a biological limb. You find exercises that are tailored to the muscle groups that you do have. Just bear in mind that you may have to lower the weights and really focus on those targeted muscle groups. Once you have settled with an amputation, there’s really no type of exercise that isn’t either accessible or able to be adapted.”
Here, we take a look at some of the common types of exercise used by amputees:
Yoga/Pilates
Try to do the exercises as normal, as prosthetic restrictions will be apparent. You should group together any positions that you may wish to remove your prosthesis to avoid taking it off and putting it on too much.
Be mindful of your posture throughout the exercise - use a mirror perhaps to ensure that you do not twist out of position.
Stretching
Advice suggests you should perform a top-to-toe stretch twice a week, as well as any stretches given to you by your physiotherapist. Stretching helps to realign the skeleton and lengthen your muscles, which keeps you flexible. You may need to modify some stretches to accommodate a prosthesis.
Balance and Coordination
Exercises for balance and coordination should help you to ‘feel’ your prosthesis (i.e. sense where it is and how you are standing on it). Speaking about the differences between exercising with and without a prosthesis, Mark Smith said: “The differences can be balance when it comes to squats and deadlift, but core stability helps a lot.”
Strengthening
There are a number of strengthening exercises that you can carry out in the gym and at home, including:
Upper and lower limb weights
Stair climbing leg over leg
Wall sits
Most gym equipment, such as cycling and step machines, will be fine to use with the exception of hamstring curls and quadricep leg extensions if you’re wearing a leg prosthesis. Mark Smith said: “Anything can be adapted for an amputee to train in the gym, some exercises may require improvising slightly, but on the whole, everything is still possible in the gym”.
Strength sessions should be repeated twice a week.
Cardiovascular
When it comes to cardiovascular fitness, you should aim to increase your heartbeat for about 30 minutes - this could be made up of a mixture of exercises. Swimming, cycling, treadmill walking, walking outdoors with walking poles, stepper machines and rowing are all good forms of cardiovascular exercise for amputees. Running is not the best way to keep fit following an amputation if there is an alternative.
Remember, high-impact exercise can cause trauma to the skin in your socket after a while, such as bruising and blisters, so make sure to monitor your capability.
Cardiovascular exercise should be carried out five times a week, but housework, dancing, shopping, dog walking, gardening and other daily activities could make up part of your routine.
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