The Hip and Core for Gait Project

Project Summary

Lower limb amputation is associated with reduced mobility, altered gait, loss of autonomy, increased fall risk, and psychological difficulties. Despite the well-established importance of physical activity for this population, only one-third of individuals with lower limb loss are sufficiently active, and relatively little research has examined the effects of exercise programs in clinical settings.

This project evaluated the effects of a structured 6-week exercise program targeting the activation, stabilization, and strengthening of the hip and trunk musculature in persons with lower limb loss. The program was assessed using a single case experimental design with multiple baseline measures.

Objectives

The program was designed to evaluate the effects of hip and core targeted exercise on:

• Gait parameters (velocity, symmetry)
• Functional abilities (balance, mobility, fall risk)
• Psychological well-being (quality of life, balance confidence)
• Physical activity levels (accelerometer-based)
• Acceptability of the program

Methods

A single case experimental design with a multiple baseline framework was used (Krasny-Pacini & Evans, 2018; Tate et al., 2016). Gait measurements were collected using StepScan Technologies pressure-sensing walkway systems. Outcome measures included the Amputee Mobility Predictor (AMP), Berg Balance Scale, Activities-specific Balance Confidence (ABC) Scale, SF-36 quality of life questionnaire, Prosthesis Evaluation Questionnaire, six-minute walk test, handheld dynamometry, and accelerometry.

Each session included a warm-up, flexibility work, muscle activation, progressive strengthening, functional application, and reactive balance training.

Results

Participants demonstrated notable improvements across several outcome measures following the intervention, including gait velocity, fall risk scores (AMP, Berg Balance Scale), and balance confidence. Accelerometer data revealed changes in physical activity levels across inactivity, light, moderate, and vigorous activity thresholds over the course of the intervention.

Qualitative findings revealed five major themes related to participants’ experience of the program:

• Enjoyment and satisfaction — Participants consistently rated their experience positively, highlighting the instructor, exercise variety, session duration, and frequency.
• Physical progress — Improvements in gait, physical function, and mobility were reported by most participants.
• Cognitive progress — Increased confidence, motivation, and knowledge about exercise were noted.
• External limitations — Time constraints, commuting distance, lack of home equipment, and limited exercise knowledge were barriers identified.
• Program difficulty — Some participants noted challenges related to pain, weakness, or their current physical condition.

Participant testimonials highlighted the value of the program:

“I’m really really glad I did it… Sébastien was just excellent, he pushed me at certain things, but there was also a limit he didn’t want me to get hurt, can’t say enough about it.” — P3

“I have found that after this series of training exercises I’m a little more confident with balance, I find that I have taken a few more steps around the house without the walker.” — P4

“Overall I give it a 9 out of 10.” — P5

Conclusions

This intervention shows promise for improving gait and reducing fall risk in persons with lower limb loss. Major improvements were observed in the AMP and Berg Balance Scale, and participants reported high levels of satisfaction and a desire to continue the program. Key limitations include the fact that the same individual conducted both the measurements and the intervention, and the relatively short 6-week duration of the program.

Team

• Sébastien Hébert — BEAM Lab, École de kinésiologie et de loisir, Université de Moncton; The Eastern Prosthetic Clinic
• Kirsten Simonsen — The Eastern Prosthetic Clinic
• Heather Howe — The Eastern Prosthetic Clinic
• Grant Handrigan — BEAM Lab, École de kinésiologie et de loisir, Université de Moncton