The basic principles of exercise testing and exercise prescription stated in ACSM's Guidelines for Exercise Testing and Prescription (2006) and ACSM's Exercise Management of Persons with Chronic Diseases and Disabilities (1997) provide the foundation for this section. Special needs and situations created by amputation will be addressed.

Excellent resources which describe balance, agility, coordination, endurance, stretching, and strengthening exercises for LE amputees are found in the following texts: Strengthening and Stretching for Lower Extremity Amputees (Gailey & Gailey, 1994); Balance. Agility. Coordination and Endurance for Lower Extremity Amputees (Gailey & Gailey, 1994); and Home Exercise Guide for Lower Extremity Amputees (Gailey, Gailey & Sendelback, 1995.)

Another excellent resource for training LE amputees for sport or health is the publication by the Department of Veterans Affairs, Physical Fitness: A Guide for Individuals with Lower Limb Loss (Burgess and Rappoport, 1991). The publication represents a guide for prescribing exercises that will improve all aspects of physical fitness, including cardiovascular, flexibility, muscle strength and endurance and motor skills.

Research has established the benefits of exercise for LE amputees. In 1973, James reported that for healthy (i.e., non-vascular) unilateral above-knee amputees, one-legged (i.e., non-involved leg) bicycle ergometry training improved cardiovascular fitness and walking efficiency. Additionally, the asymmetry of the prosthetic gait was decreased. In 1987, it was reported (Pitetti et al., 1987) that when a combination of unilateral below-and above-knee, and bilateral below-and above-knee amputees trained on a Schwinn Air-Dyne ergometer (an apparatus that involves both upper- and lower-body musculature), they improved their cardiovascular fitness and walking efficiency. Following a treadmill training program, a 63-year-old bilateral below-knee amputee with cardiac status of Class IV and restrictive-obstructive pulmonary disease improved cardiovascular fitness, improved cardiac status from Class IV to Class II, and therapeutically improved from Class E (bed rest) to Class C (moderate exercise restriction). These studies established that LE amputees, whether healthy or suffering from secondary disabilities, can improve their fitness levels, but more importantly, can improve their quality of life by increasing their ability to perform activities of daily living.

It is important that a LE amputee has a comfortable prosthetic limb(s) that is suited for the activity or exercise of choice. Activities and exercises such as treadmill walking, bicycling, rowing, StairMaster, Body Trec and other aerobic machines do not require special adaptations to a standard artificial limb. Such activities and exercises as running, sprinting, and swimming do require special adaptations. It is recommended that the amputee work with a prosthetist in obtaining needed adaptations for prosthetic limbs.

Skin breakdown (i.e., blisters) or hair follicle infections can significantly affect the activity level of any amputee. Practicing proper hygiene will help prevent skin problems. It is important for the amputee to determine the right size of stump socks and the correct number of stump socks to be worn, to change stump socks daily and when they are damp or wet (e.g., following exercise). This is essential to help prevent skin irritations and blisters.

UE amputees, because of their healthy lower extremities, are not as limited in their modes of exercise as LE amputees. All activities and exercises involving the lower extremities that can be performed by non-disabled individuals are applicable to UE amputees. However, when performing upper-extremity exercises (i.e., weight training), the position of the UE amputee's feet and legs are paramount in order to obtain balance and stability. Therefore, UE amputees should perform upper-extremity exercises while standing and, if sitting, they should allow their feet to be in contact with the floor.