Development of physical activity recommendations for adults living with lower limb amputation

To develop evidence-based physical activity recommendations for people living with lower-limb amputation (LLA). The Appraisal of Guideline, Research and Evaluation protocol (AGREE) II tool was used. A panel of clinicians and researchers with expertise in LLA and guideline development, people with LLA, and a nonprofit advocacy organization for people with LLA was formed. The expert panel then met to refine the scope of the guidelines, review the evidence (based on a systematic review), and formulate the guidelines. Feedback was obtained from partners. For benefits in balance and mobility outcomes, adults with a unilateral major LLA of any etiology, living in the community and using a prosthesis, should perform at least 60 min per week of moderate to vigorous aerobic exercise. This aerobic exercise prescription should be combined with strengthening or balance exercises. Strengthening exercises should include at least 3 sets of 10 repetitions of strengthening exercises for the major muscle groups of the lower limbs at least 2 times per week. Balance exercises should include at least 20 min of balance exercises 3 times per week. There was insufficient evidence to make recommendations for other fitness-related outcomes. The AGREE II process led to the development of the first physical activity recommendations for people living with LLA. Current physical activity guidelines for people with disability do not specifically include evidence for adults with lower limb amputation (LLA).This is the first physical activity guideline specifically aimed at adults with lower limb amputation.At least 60 min per week of moderate to vigorous aerobic exercise combined with strengthening or balance exercises can improve balance and mobility.Strengthening exercises should be performed twice a week and target major lower limb muscles, and balance exercises should be performed three times per week for at least 20 min per session.People with LLA, their families and caregivers, healthcare professionals, exercise specialists, and organizations can use these guidelines to develop safe, tailored exercise programs for adults with LLA. Current physical activity guidelines for people with disability do not specifically include evidence for adults with lower limb amputation (LLA). This is the first physical activity guideline specifically aimed at adults with lower limb amputation. At least 60 min per week of moderate to vigorous aerobic exercise combined with strengthening or balance exercises can improve balance and mobility. Strengthening exercises should be performed twice a week and target major lower limb muscles, and balance exercises should be performed three times per week for at least 20 min per session. People with LLA, their families and caregivers, healthcare professionals, exercise specialists, and organizations can use these guidelines to develop safe, tailored exercise programs for adults with LLA.