Influence of traumatic lower-limb amputation on physical activity, body composition and cardiometabolic risks: A descriptive preliminary study

Peter Ladlow, Thomas E Nightingale, M Polly McGuigan, Alexander N Bennett, Francoise Koumanov, Rhodri Phillip, James L J Bilzon

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2 Citations (SciVal)


Background: Following traumatic lower-limb amputation (LLA), humans are predisposed to numerous unfavorable changes in health, including the development of secondary chronic health conditions such as metabolic disorders and cardiovascular disease. Objective: To determine within and between group differences in cardiometabolic component risks, body composition, and physical activity (PA) in individuals with traumatic unilateral and bilateral LLA, compared to noninjured controls. Design: Prospective observational cohort study. Setting: A military complex trauma rehabilitation center. Participants: Sixteen males with traumatic LLA (8 unilateral, mean age 30 ± 5 years and 8 bilateral, mean age 29 ± 3 years). Thirteen active age-matched males with no LLA (28 ± 5 years) acted as controls and performed habitual activities of daily living. Intervention: Participants with LLA attended two 4-week periods of inpatient rehabilitation, separated by two 6-week periods of home-based recovery. Main Outcome Measures: Venous blood samples were taken prior to and following a 75 g oral glucose load, for determination of biomarkers, including insulin and glucose, at baseline and 20 weeks. Body composition (dual X-ray absorptiometry) was measured at baseline, 10 weeks, and 20 weeks. Daily PA was recorded using a triaxial accelerometer for 7 days during inpatient rehabilitation and while at home. Energy expenditure was estimated using population-specific equations. Results: Individuals with bilateral LLA demonstrated more unfavorable mean body composition values, lower PA, and increased cardiometabolic health risk compared to controls. Cardiometabolic syndrome was identified in 63% of individuals with bilateral LLA. No statistically significant differences in cardiometabolic component risk factors, body composition, and estimated daily PA were reported between unilateral LLA and control groups (p >.05). While at home, mean PA −1 reduced by 17% (p =.018) and 42% (p =.001) in the unilateral and bilateral LLA groups, respectively. Conclusions: Despite extensive inpatient rehabilitation, cardiometabolic component risks are elevated in individuals with bilateral LLA but are comparable between unilateral LLA and active noninjured control groups. Innovative strategies that improve/support the long-term PA and cardiometabolic health of severely injured individuals with bilateral LLA are warranted.

Original languageEnglish
Pages (from-to)413-425
Number of pages13
JournalPM & R : the journal of injury, function, and rehabilitation
Issue number4
Early online date19 Jan 2023
Publication statusPublished - 30 Apr 2023

Bibliographical note

The authors would like to thank all staff and participants from the Complex Trauma Department at the Defence Medical Rehabilitation Centre (DMRC) for their individual and joint efforts supporting this research program


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