Reviews

Juntendo Medical Journal 2020. 66(Suppl 1), 88-100 Physical Fitness Measurement Items and Methods for Amputee Soccer Outfield Players

HIROFUMI MAEHANA＊1) 2),HIDETADA KISHI＊3),KOYA SUZUKI＊3)

＊1)Department ofPsychological Counseling, Faculty ofHuman Sciences, Mejiro University, Tokyo, , ＊2)Department ofHealth Science, Juntendo University Faculty ofHealth and Science, Chiba, Japan, ＊3)Graduate School ofHealth and Sports Science, Juntendo University, Chiba, Japan

Objective: The aim of this study was to (1) review the research on physical fitness tests conducted as a field test for amputee soccer players, (2) organize measurement items and methods of physical fitness tests adapted to amputee soccer outfield players based on previous studies. Methods: The following key words were used to identify proper articles: amputee soccer/, lower limb amputation, amputeeʼs physical fitness, amputeeʼs field-based fitness test, and amputeeʼs fitness-test battery. A comprehensive search was conducted until November 2019 using electronic databases (MEDLINE, SPORTdiscus, CINAHL, Web ofScience, Scopus, EMBASE, Cochrane, and Google Scholar). Results: The original search netted 29 studies and after the removal of duplicates and screening, 17 studies remained. Based on previous studies, the following measurement items were selected as physical fitness tests adapted to amputee soccer outfield players and the measurement methods were organized. Anthropometric measurements included body height, body weight, and body composition. Muscular performance included balance, flexibility, muscular endurance and muscular strength. Anaerobic performance included sprint, agility, and jump. Several studies have evaluated the aerobic performance of outfield players by using aerobic tests developed for healthy individuals; however, the test has not been standardized. Conclusion: This pilot study reviewed and organized the physical fitness tests of amputee soccer players. Key words: amputee soccer/football, lower limb amputation, amputeeʼs physical fitness, amputeeʼs field- based fitness test, amputeeʼs fitness-test battery

Introduction has established a classification system aimed at ensuring fair opportunities and fair playing fields. Amputees are categorized as disability groups The Paralympic Games are basically defined by a with the partial or complete lack ofextremities ( i.e., classification system that determines which com- upper limbs: shoulder, elbow, arm, and wrist; lower petitors are eligible to participate in the competition limbs: hip, thigh, knee, lower leg, and ankle). and groups them into classes 1). In other Differences in leg length at birth and shortening of words, classification minimizes the impact of one leg bone due to trauma (e.g., bone cancer) are disability-class and allows athletic performance and also incorporated into limb deficiency. Amputee excellence in the sport to be determinants. athletes are eligible to compete in The Paralympic Amputee soccer is one ofthe types ofsoccer Games. However, the degree ofdisability can lead to designed for the disabled, especially those who have an unbalanced competitive environment for ampu- undergone amputations as well as those with tee athletes. Therefore, The Paralympic Movement extremity dysfunction 2). The criteria for participation

Corresponding author: Hirofumi Maehana Department ofPsychological Counseling, Faculty ofHuman Sciences, Mejiro University 4-31-1 Nakaochiai, Shinjuku-ku, Tokyo 161-8539, Japan TEL: +81-3-3813-3111 E-mail: [email protected] 〔Received Dec. 12, 2019〕〔Accepted Jan. 20, 2020〕

Copyright © 2020 The Juntendo Medical Society. This is an open access article distributed under the terms ofCreative Commons Attribution Li- cense (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original source is properly credited. doi: 10.14789/jmj.2020.66.JMJ19-P09

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in the game are a one-sided amputation or approximately 60 meters and the width is 40 congenital malformation of the lower limb A2 (i.e., meters, which is the standard for international unilateral above the knee lower limb amputations)/ competitions. A4 (i.e., unilateral below the knee lower limb Notably, amputee soccer was played by 11 amputations) for outfield players and a unilateral players on both sides under a standard size pitch amputation ofthe upper limb A6 ( i.e., unilateral until 1987 6). Amputee soccer originated in the above the elbow upper limb amputations)/A8 (i.e., ofAmerica (USA). The name ofthe unilateral below the elbow upper limb amputations) association is“American Amputee Soccer Associa- for goalkeepers 3). As of2019, amputee soccer can tion.”As it is written as“Soccer”instead of also be played by individuals from the“Les Autres” “Football,”this study uses amputee“soccer.” group, those with other locomotor disabilities (e.g., Amputee soccer was invented by Don Bennett, who with underdeveloped limbs) 4). Outfield players are first attempted to introduce soccer among people prohibited from wearing prosthetic legs. Therefore, with amputation in . Initially, amputee soccer the players use lofstrand crutches to move on the was used as a form of training that helped skiers pitch and play mainly with one leg. The intentional with disabilities from the USA National Team to touching ofthe ball with lofstrandcrutches is maintain proper endurance and fitness levels considered an offense. In this way, amputee soccer during the summer 4). In countries involved in has its own specially designed rules; hence, we will military conflicts, it can be said that there were refer to the most important rules based on several wounded soldiers after the war, which was Yazicioğlu 5). The rules are as follows: (1) The one ofthe opportunities forthe spreading of goalkeeper must have a one-sided amputation in amputee soccer. The World the upper limb; however, there should be no Federation (WAFF) standardized the rules ofthe disability in the lower limbs. Therefore, the game. The WAFF sponsors its own World Cup goalkeeper cannot compete outside the penalty Tournament. As a result, amputee soccer has area. (2) There is a limit on the number of“playersʼ gained popularity in the disability community all substitution”that can be changed once; however, over the world, and the number ofplayers there is no limit on the number ofplayers that can increased. Thus, amputee soccer has exponentially be changed. Additionally, players who have once grown with the WAFF and now includes more than gone out ofthe pitch can return to the pitch and 46 national associations in five continents 7).Onthe play again. (3) One-minute“time-outs”can be other hand, the International Paralympic Commit- taken in both the firstand second halfofa match. tee has confirmed that the Paris 2024 Paralympic (4) The off-side rule does not apply in amputee Games sports program will remain the same as the soccer. (5) The kick-in is applied instead ofthe Tokyo 2020 Paralympics program with 22 sports throw-in. In amputee soccer, the standard in included. Unfortunately, amputee soccer was not international competitions is 7-a-side game (Each included in the Paris 2024 Paralympic Games sports team consists of7 players: one goalkeeper and six program. In deciding the final sports for inclusion, outfield players). The aim of the 7-a-side amputee the Board assessed all applications and committed soccer game is to score more goals than your to the Paralympic Movementʼs desire to pursue opponent in a playing time frame of 50 minutes. The gender parity, safeguard the involvement of ath- match is split up into two halves of25 minutes each. letes with high support needs, and ensure that a After the first 25 minutes, players will take a 10- diverse range ofnations could take part 8). In fact, it minute rest period called halftime. The second 25- has been mentioned that the continental qualifying minute period will resume and any time deemed fit for every five continents has not been enriched in to be added on by the referee (additional time) will the amputee soccer community so far. However, be added accordingly. The pitch dimensions vary continental qualifying is also being prepared in the depending on the ground; however, the length is Asian region currently. In addition, women have

This manuscript was submitted for the Special Issue “Tokyo 2020 Olympic and Paralympic Games, and Sportology”, prior to the decision to postpone the Tokyo 2020 Summer Olympics to 2021.

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been playing amputee soccer on the same pitch fitness test. Additionally, it is necessary to organize with men since the first day of the game in 1982 7).In the test items and methods in consideration ofthe particular, the first Womenʼs Amputee Soccer reproducibility ofadditional tests and experiments Tournament will be held in Miami and Florida in by a third party. In particular, amputee soccer is January 2020. This sport will further develop played under the rule that the disability-class is womenʼsʼ games. We also expect to gain a strong mixed; however, reports that specifically focus on position for inclusion in the future Paralympic the disability-class and gender differences are Games sports program. lacking. The Los Angeles 2028 Paralympic Games is In amputee soccer games, the total distance scheduled to be played in the USA, where amputee moved by the outfield player is about 3 km. soccer originated. In order for amputee soccer to be Additionally, the specific movement pattern of selected for the Paralympic Games sports program, moves with only one leg and lofstrand crutches it is necessary to ensure the fairness of the competi- exerts a high exercise load. In addition to the long tion by presenting clear evidence on disability-class standing and walking times during the match, it has and gender differences as well as the rise of the been reported that high-intensity running is also an competition. intermittent exercise pattern, similar to soccer 9). Therefore, the purpose of this study was to The activities required for amputee soccer include (1) review the research on physical fitness tests standing/static balance, jogging, running, sprinting, conducted as a field test for amputee soccer players, acceleration, deceleration, change ofdirection, (2) organizing measurement items and methods of jumping, and dynamic balance. In addition, basic physical fitness test adapted to amputee soccer football skills such as ball-control, skills for receiv- outfield players based on previous studies. ing balls such as traps, skills for transporting balls such as dribbling, and skills for outputting balls Methods such as passes and shoots are required. When performing any activity, the body movement skills 1. Design corresponding to the demands ofclutch operation Studies that conducted field tests on amputee skills are required in addition to the physical soccer players were eligible for inclusion in the performance. Therefore, in order to compare and review. The following key words were used to examine the physical characteristics ofamputee identify proper articles: amputee soccer/football, soccer players, it is necessary to elucidate the lower limb amputation, amputeeʼs physical fitness, physical performance using the physical fitness amputeeʼs field-based fitness test, and amputeeʼs tests used in the previous studies and the specific fitness-test battery. A comprehensive search was physical fitness test. It is also important to conducted until November 2019 using electronic continuously acquire information on the disability- databases (MEDLINE, SPORTdiscus, CINAHL, class and gender differences in amputee soccer Web ofScience, Scopus, EMBASE, Cochrane, and players. So far, amputee soccer players have been Google Scholar). surveyed in fields related to balance, flexibility, and muscular endurance as evaluations ofmuscle 2. Selection of Studies performance, and anaerobic performance have been After the elimination of duplicates, two research- measured in fields related to sprint, agility, and ers screened the search results individually against jump. For the evaluation ofaerobic performance, eligibility criteria. Researchers were not masked to Yo-Yo Intermittent Recovery Test Level 1, 1-Mile the title or authors ofthe publications. Disagree- Run Test, and Cooper Test are mainly conducted as ments were resolved by discussions or third-party field tests mainly on aerobic power. Previous researchers. Disagreements in the selection of studies have also quantitatively evaluated and literature for review were resolved by discussion or examined the physical performance that can be third-party researchers. Additionally, the following used to present the profiles of amputee soccer article inclusion criteria were applied; (1) original players. However, there are several unclear points scientific paper, (2) paper published in a peer- in the measurement conditions in the physical reviewed journal, (3) annual meeting abstracts in a

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peer-reviewed conference, and (4) paper published (3) Measurements must not be conducted after in the English language. meals or immediately after strenuous exercise unless it is the primary purpose. 3. Data Extraction References were organized for each item related 3. Anthropometric measurements to the physical measurement. Additionally, two 1) Body height researchers conducted excerpts ofthe relevant The Body height is measured using tape meas- content described in the text as material used for ure, height scale, electronic height scale, and Martin measurements and specific form and surface, anthropometer. As a measuring method, the respectively. prosthetic leg is removed and the patient is barefoot. The unilateral healthy leg is opened at 4. Organizing measurement items and methods about 60°, and the heel, buttocks, and back is put on Researchers selected the test items that are the support column and an upright posture is taken. highly versatile and expected to accumulate more The vertical distance from the horizontal evidence data, and organized the measurement floor/reference plane to the top of the head is taken. methods. While measuring the upper limb length, a standing posture is taken, the upper limb is dropped at the Results side ofthe body, and the long axis ofthe upper limb is matched with the long axis ofthe hand. The linear 1. Selection of studies distance is measured from the shoulder peak point The original search netted 29 studies. After the to the fingertip point. The lower limb is measured removal ofduplicates and screening, 17 studies from the femur greater trochanter to the floor. The remained. Based on the references, Table-1 shows measurement is performed in such a manner that the contents ofanthropometric measurements, the instrument is vertical when viewed from the Table-2 shows the contents ofmuscular perform- floor. ance, Table-3 shows the contents ofanaerobic performance, and Table-4 shows the contents of 2) Body weight aerobic performance. For the measuring ofbody weight, it is practical to use a body scale or an electronic body weight 2. Measurement prerequisites and precautions scale. After urination and defecation are completed Throughout this section, the prerequisites and in advance, at the time ofthe measurement the precautions are as follows. Prerequisites; (1) The prosthetic leg is removed and the measurement is description ofeach measurement shows the general performed while maintaining balance in a barefoot equipment used for the measurement; however, it state. can be changed to a similar equipment ifnecessary. (2) The instrument used for each measurement is 3) Body composition calibrated. (3) When performing each measure- The formula for Body Mass Index (BMI) was ment, the prosthetic leg is to be removed, only the devised in the 1830s by Belgian mathematician remaining limbs and healthy leg are to be kept, and Adolphe Quetelet and is universally used in body light clothing is to be worn. (4) The material and weight (kg) / body height2(m2). As a method for length of the lofstrand crutches are greatly affected measuring the body fat percentage, there is a by the measurement results; hence, the criteria measurement using the Skinfold Caliper method. must be clarified. Precautions; (1) The loftstrand However, the level ofexperience ofthe examiner crutches may or may not be used depending on the has a significant effect on the readings and is not field test; therefore, care must be taken. (2) The suitable for obtaining continuous and significantly conditions such as measurement time, number of accurate readings. Therefore, it is desirable for a measurements, and measurement environment lower limb amputee to measure from both palm must be taken care ofin order to obtain continuous measurements using a bioelectrical impedance and more accurate measurement values. device. The bioelectrical impedance method applies

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Table-1 Physical fitness test in anthropometric measurements Anthropometric Measurements Measurement items References Material used for measurements Specific form and surface Body Height Guchan et al., 2017 10) Non described. Non described. Ilkim et al., 2018 11) FB 721 brand Body Analyzer was used for height Bare feet and flat ground. measurement. Kalinowski et al., 2018 3) The height ofthe body was determined by the The subject was standing 0064istance ofthe Vertex-Basis points using the upright, propped up with Holtain (UK). Canadian crutches. Kayihan, 2014 12) Height (to the nearest 0.01 mm) were measured Without shoes and pros- for each participant using a portable stadiometer theses. (Holtain, UK). Miyamoto et al., 2018 13) Non described. Non described. Miyamoto et al., 2019 14) Body height was measured using an analog height Participants wearing an stadiometer. artificial leg. Özkan et al., 2012 15) The body height ofthe soccer players was Non described. measured by a stadiometer with an accuracy of± 1 cm (SECA, Germany). Simim et al., 2013 16) Non described. Non described. Body Weight Guchan et al., 2017 10) Non described. Non described. Ilkim et al., 2018 11) The body weight measurement was made with the Barefoot and onto the Seca 727 electronic measuring instrument. meter without clothes to weigh on them. Kalinowski et al., 2018 3) The electronic weight (Wagi Wielkopolska, ) Non described. was used to measure body weight with precision to 0.1 kg. Kayihan, 2014 12) Weight (to the nearest 0.1 kg) were measured Without shoes and pros- physicianʼs scale (Tanita TBF 401 A, Japan). theses. Miyamoto et al., 2018 13) Non described. Non described. Miyamoto et al., 2019 14) Body mass was measured using an electronic Participants wearing an platform scale (HBF-215F, OMRON HEALTH- artificial leg. CARE Co., Ltd., Japan). Özkan et al., 2012 15) An electronic scale (SECA, Germany) with an Non described. accuracy of± 0.1 kg was used to measure body mass. Simim et al., 2013 16) Body mass was measured using an electronic scale Non described. platform (Filizola®), with 0.1 kg precision and height obtained with a stadiometer with 0.1 cm accuracy. Body mass index Guchan et al., 2017 10) Non described. Not required. Ilkim et al., 2018 11) It is defined by dividing the kilogram to square of Not required. the height (kg/m2). Kayihan, 2014 12) Body mass index (BMI) was calculated using the Not required. formula: weight (kg) divided by height (m) squared. Simim et al., 2013 16) Non described. Not required. Body fat percentage Guchan et al., 2017 10) Lange Skinfold caliper (Cambridge Scientific indus- Not required. tries, cambridge, Md, USA) was used to determine the percentage ofbody fat.Jackson-pollock method, a commonly used method for calculating body fat percentage, was used. Ilkim et al., 2018 11) A skinfold caliper is used to measure subcutaneous Not required. fat thickness. Özkan et al., 2012 15) Skinfold thickness was measured with a Holtain Not required. skinfold caliper (Hotain, UK) which applied a pressure of10 g/mm 2 with an accuracy of± 2 mm. body fat was determined by the Jackson and Pollock formula (1978). Simim et al., 2013 16) A single trained examiner recorded measurements Not required. using a caliper scientific (Sanny®). The relative body fat pacentage was estimated using the following formula: (Faulkner, 1968).

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Table-2 Physical fitness test in muscular performance Muscular Performance Specific form, Measurement items References Material used for measurements extent and surface Balance Balance test Aytar et al., 2012 17) The Kinesthetic Ability Trainer (SportKAT Static balance was eval- 3000®) (LLC, Vista, Calif) device was used to uated without prosthesis assess static balance. standing on non ampu- tated limb. Guchan et al., 2017 10) The Berg Balance Scale, which consists of14 Non described. items that are scored on a scale of0 to 4, was used to assess balance. Yazicioglu et al., 2007 18) Balance ofthe subjects was evaluated with the The one-leg static bal- KAT balance system (Kinesthetic Ability ance test was performed Trainer; Breg, Vista, CA). with the person standing on the nonamputee leg; the dynamic balance test was performed with the subject standing on both legs using his prosthesis. Flexibility Flexibility test Guchan et al., 2017 10) A modified Thomas test was used to determine Non described. the flexibility of hip flexor muscles. Muscular endurance Sit-ups isotonic test Guchan et al., 2017 10) The maximal repetitions and the duration ofthe Non described. movement was recorded. Push-ups isotonic test Guchan et al., 2017 10) The maximal repetitions and the duration ofthe Non described. movement was recorded. Push up test Miyamoto et al., 2018 13) The number ofpush-ups accomplished in 60 Non described. seconds was recorded. Simim et al., 2017 19) The maximum number ofrepetitions completed Non described. in 60 s with perfect form was used as the criteria measure. Subsequently, these values were div- ided by body mass to include a relative measure. Simim et al., 2018 20) The maximum number ofrepetitions completed Non described. in 60 s with perfect form was used as the criteria measure. Subsequently, these values were div- ided by body mass to include a relative measure. Back extensors Guchan et al., 2017 10) The subjects were then asked to cross their arms Non described. isometric test in front of their shoulders and raise their trunk while the assessor was fixing their legs. Duration that the subjects could sustain this position was recorded. Trunk flexors test Guchan et al., 2017 10) The subjects were asked to position their arms Non described. straight toward their knees, raise their head, neck and shoulders and stay in this position. duration that the subjects could sustain this position was recorded. Muscular strength 3 kg Medicine ball Simim et al., 2017 19) All throws were measured to the nearest 0.1 cm. Non described. throw Simim et al., 2018 20) All throws were measured to the nearest 0.1 cm. Non described. Hand grip strength Wieczorek et al., 2015 2) Non described. Non described.

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Table-3 Physical fitness test in anaerobic performance Anaerobic Performance Measurement items References Material used for measurements Specific form, extent and surface Sprint 25 m Sprint test Tatar et al., 2018 21) Run at their fastest pace on a 25- Sprint patterns: movement patterns meters track, videos were recorded were executed as swing-through gait. (Sony, TRV900E). Lofstrand crutches type: non described. Shoes: non described. Surface: track. 30 m Sprint test Maehana et al., 2018 A 9) Sprint times were recorded using Sprint patterns: non described. electronic timing gates (Fusion Sport Lofstrand crutches type: non described. Smart Speed, Brisbane, Australia) Shoes: non described. located at the start and finish lines. In Surface: artificial turf pitch. addition, 10-m and 20-m sprint times were recorded. Mine et al., 2014 22) Automated timers, cone, and tape Sprint patterns: non described. measure for distance were used. Tim- Lofstrand crutches type: non described. ing ofall repetitions was measured by Shoes: all players wore rubber-soled an electronic timing system. track shoes. Surface: non described. Miyamoto et al., 2018 13) The durations of30 m sprint test and Subjects ran with two crutches ando- the transit time every 10 m were neleg; they did not wear an artificial calculated using images captured by a leg. video camera (30 fps) located at the Sprint patterns: non described. side ofthe lane. Lofstrand crutches type: non described. Shoes: non described. Surface: non described. Miyamoto et al., 2019 14) The 30-m sprint test time and times Participants ran with two crutches and taken for each 10 m interval were natural/unaffected leg (i.e., they did recorded using electronic timing gates not wear an artificial leg). (TC Timing System, Brower Timing Sprint patterns: non described. Systems, USA) located every 10 m Lofstrand crutches type: non described. between the start and finish lines. Shoes: non described. Surface: non described. Özkan et al., 2012 15) Sprint times were measured with light Wearing a prosthetic device was not gates combined to the timing system allowed during the sprint. (Prosport, Tumer Electronics, Ankara, Sprint patterns: non described. ). Lofstrand crutches type: non described. Shoes: non described. Surface: indoor court. Wieczorek et al., 2015 2) With regard to the running times in Sprint patterns: non described. particular sections, a Fusion Smart Lofstrand crutches type: non described. Speed System (Fusion Sport, Coopers Shoes: non described. Plains, QLD, Australia) was applied. Surface: non described. Simim et al., 2013 16) A stopwatch was used to measure Sprint patterns: non described. time. Lofstrand crutches type: non described. Shoes: non described. Surface: field with natural grass. Agility T-square test Simim et al., 2013 16) Agility was determined by the T- Lofstrand crutches type: non described. square test that consists in a squared Shoes: non described. area limitedfby fourcones with 4 m Surface: field with natural grass. inside. Jump Vertical jump test Guchan et al., 2017 10) Subjects were asked to stand up, fix Non described. their amputated limb next to a wall, and extend their arm above. The end of the longest finger was marked. Then, subjects were asked to jump vertically and the finger was marked again. The distance between two marked heights was recorded in centimeters.

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Countermovement Özkan et al., 2012 15) All jumps were performed using a The subjects did not use bilateral Jump Test force plate (Sport Expert TM, MPS- crutches (wearing a prosthetic device 501 multi purpose measurement sys- was not allowed during jumping). tem, Tumer Electronic LDT, Turkey). Miyamoto et al., 2018 13) The CMJ test measured jump height Subjects performed jumps using only with a Digital jump meter (T. K. K. the healthy leg; they did not wear an 5406). artificial leg or use crutches. Simim et al., 2017 19) Players jump height (cm) and power Non described. production (absolute and relative) were measured using an accelerometer (Myotest®, Sion, Switzerland) that had been previously validated. Simim et al., 2018 20) Jump height (centimeters) and power Non described. production (absolute and relative) were measured using an accelerometer (Myotest®, Sion, Switzerland). Squat jump Özkan et al., 2012 15) All jumps were performed using a The subjects did not use bilateral force plate (Sport Expert TM, MPS- crutches (wearing a prosthetic device 501 multi purpose measurement sys- was not allowed during jumping). tem, Tumer Electronic LDT, Turkey).

Table-4 Physical fitness test in aerobic performance Aerobic performance Measurement items References Material used for measurements Specific form, extent and surface Aerobic power Yo-Yo intermittent Simim et al., 2013 16) Yo-Yo intermittent recovery test Lofstrand crutches type: non described. recovery level 1 performance was considered Shoes: non described. test level 1 at 20 m as the total distance covered by the Surface: field with natural grass. subject when they drop out. Yo-Yo intermittent Maehana et al., 2018 B 23) Running performances data such as Lofstrand crutches type: non described. recovery movement speed, acceleration, and Shoes: non described. test level 1 at 20 m deceleration were collected using a Surface: non described. global positioning systems technol- ogy. Yo-Yo intermittent Maehana et al., 2018 B 23) Running performances data such as Lofstrand crutches type: non described. recovery movement speed, acceleration, and Shoes: non described. test level 1 at 15 m deceleration were collected using a Surface: non described. global positioning systems technol- ogy. Yo-Yo intermittent Maehana et al., 2018 B 23) Running performances data such as Lofstrand crutches type: non described. recovery movement speed, acceleration, and Shoes: non described. test level 1 at 10 m deceleration were collected using a Surface: non described. global positioning systems technol- ogy. 1-Mile Run Test Kayihan, 2014 12) The test result was reported by the The amputee football players with distance. bilateral crutches (without prostheses). Lofstrand crutches type: non described. Shoes: non described. Surface: track. Cooper Test Kayihan, 2014 12) The test result was reported by the The amputee football players with distance. bilateral crutches (without prostheses). Lofstrand crutches type: non described. Shoes: non described. Surface: track.

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a weak current to estimate the percentage offat contact with the supporting leg 27) 28). In this test, the and other tissues. However, the physical burden is prosthetic leg is used as the supporting leg, the miniscule. The prosthetic leg is removed for basic number ofattempts is 3 times, and it is measurement and the unilateral healthy leg is possible to measure with the eyes closed. opened at approximately 60° and a standing posture is maintained. The left and right grip 2) Flexibility electrodes are held with the palm. Measurements The Sit-and-Reach Test, described by Wells and are made while the elbow is not bent and the arm is Dillon in the 1950s is widely used in many fitness kept parallel to the body at 90°24). batteries to measure lower back and hamstring flexibility. The basic outline of The Sit-and-Reach 4. Muscular performance Test is described below. Measurements are per- 1) Balance formed using a testing box, measuring board, and Recently, technological advances have provided electronic ruler. Participants must sit on the floor the scientific community with a force platform with the prosthetic leg removed, the trunk is bent system for the quantitative assessment of static to the maximum, the knee is kept flat on the floor, balance. These systems quantitatively assess the and the ankle is kept at 90°. The participant holds functional balance through the analysis of posture the state for approximately 1 to 2 seconds with the swing. The displacement ofthe center offoot hand extended to the maximum 29). The measured pressure is recorded using a strain gauge sensor value is recorded in units of0.1 cm and the basic built into the platform structure. However, the number ofattempts is approximately 3 times. space and cost requirements associated with static balance measuring devices are not suitable for field 3) Muscular endurance testing; therefore, an alternative is presented. Muscular endurance includes fitness components (1) The Stork Stand Balance Test: the participant with several things in common. This section removes the prosthetic leg, becomes barefoot, describes the general measurement methods for maintains a standing posture, and places both hands the Push/Press-up Test and Sit-up Test that are on the waist. During the measurement, it is widely used in many fitness batteries. (1) The necessary to maintain a state where the heel ofthe Push/Press-up Test: In this test, the participants supporting leg is raised. When the heel leaves the remove their prosthetic leg, become barefoot, and floor, the measurement is started using a stopwatch. wait on the floor mat. The push-up is performed on The stopwatch is stopped ifany ofthe followoccur: a flat, stable surface, hands placed slightly wider (A) the hands come off the hips, (B) the than shoulder-width apart, and fingers pointed supporting leg swivels or moves or hops in any forward. Hands and toes the floor and keep direction, or (C) the heel ofthe supporting leg the body and healthy leg straight. Keeping the back touches the floor 25) 26). In this test, the basic number and knees straight, the participant lowers the body ofattempts is 3 times, and it is possible to measure to a pre-determined point, to touch the ground or with the eyes closed. (2) One-Leg Balance Test: some other object, or until there is a 90°angle at the This test is similar to the Stork Stand Balance Test. elbows, then returns back to the starting position The participant performs the measurement while with the arms extended 30). (2) The Sit-up Test: In wearing the prosthetic leg. In this test, the this test, the participant performs the measurement participant raises both arms in a parallel manner barefoot while wearing a prosthetic leg. The and stands on one leg, and the non-supporting leg participant lays supine on the floor with 90°flexion maintains the state raised to about 30°forward. The in the knee joints, hands at the side oftheir head, test lasts 30 seconds, and the stopwatch starts the and with elbows pointing straight forward. To measurement with the non-supporting leg raised. perform an accurate sit-up execution, the elbows The stopwatch is stopped ifany ofthe followoccur: should touch the knees and then go back for the (A) the parallelism ofboth arms is lost, (B) the shoulders to touch the floor. The participantʼs feet supporting leg swivels or moves or hops in any and knees are supported by the test leader 31) 32). direction, or (C) the non-supporting leg comes into These actions are repeated without rest until the

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target push-up or sit-up count is achieved or the acquired in units of0.1 kg and each measurement time limit is reached. The measurement time is site is measured twice. measured with a stopwatch and the general time setting is 30 to 60 seconds. 5. Anaerobic performance 1) Sprint and Agility 4) Muscular strength In team sports in the field, sprint and agility are Muscular strength is the ability ofa muscle or closely related to the competition performance. This muscle group to generate maximal force. There are section describes common measurement methods many ways to measure muscular strength, often for both sprint and agility. Considering the reality with a focus on a specific group of muscles. The and reproducibility ofmeasurement, spiked shoes medicine ball throw is the most widely known and are worn and measurement is carried out on indirect test used to evaluate the power ofthe artificial grass to unify the surface. The participant upper limbs in team sports. The measurement uses removes the prosthesis and performs measure- a 2 to 4 kg medicine ball and a chair with adjustable ments using lofstrand crutches with specified height. The participant removes their prosthetic leg material and length. The general running method before participating in the measurement. Partici- using lofstrand crutches is the swing-through gait. pants keep their backs upright in a sitting position, The ratio oflofstrandcrutches to one leg ground bend their knee at 90°, and place their feet on the contact during the running cycle is 1:2 for maxi- ground or floor. At the height of the participantʼs mum speed 38). Measurements using electronic central chest, a stretch strap is attached around the timing gates are standard. However, since the torso and secured to the seat to increase stability single beam type may react to the clutches before and minimize trunk movement. The medicine ball is the participantʼs torso passes, dual beam type held at the chest level with both hands and thrown electronic timing gates can be used for measure- forward without moving the trunk 33) 34). The ment most accurately. The height ofthe transmis- distance is measured from the starting point of the sion and reception port for the timing gates is 80 to throw to the first point on the floor or ground where 110 cm and distance between the paired timing the medicine ball fell. The throw distance is gates is 1.5 to 2 m 39) 40). The timing gates are measured to the nearest 0.1 m using a tape installed on the start line, measurement point line, measure. The measurement should be performed and goal line. The starting method is as follows: A 3 times. standing posture is maintained and the lofstrand The hand and foot grip strength measurements crutch is grounded slightly behind the starting line. are used to assess the integrity in the upper and The leg is grounded at a point 1 m behind the lower extremity function. The measurement uses a starting line. The measurement can be started at dynamometer and a chair with adjustable height. any timing ofthe participant. The measurement The participant removes their prosthetic leg and record is valid up to the first decimal place and the participates in measurement. Participants keep measurement is performed twice. their backs upright in a sitting position, bend their knee at 90°, and place their feet on the ground or 2) Jump floor. The participant grips the dynamometer with Jumping is a multi-joint movement that requires maximum force without touching the rest of the complex motor coordination and several jumping body or chair. (1) Hand grip strength test: The tests have been used as field tests. It is desirable for participant sits in a chair with their shoulder the participant to remove the prosthetic leg and adducted and neutrally rotated, elbow flexed at 90°, wear shoe suitable for measurement. In the forearm and wrist in the neutral position 35) 36). measurement, a standing posture with one leg is (2) Foot grip strength test: The participant sits maintained and an attempt is made according to the with the trunk upright, puts the hip and knee joints conditions specified for each test. (1) Standing at 90°, and keeps the ankle joint in a neutral Broad/Long Jump Test: the participant stands on position. The dynamometer handle is set at the first the starting line with one leg and jumps as far metatarsophalangeal joint 37). The dynamometer is forward as possible using the swing of both arms.

97 Maehana H, et al: Physical fitness measurement items and methods for amputee soccer outfield players

Afterjumping, ifa part ofthe body touches the research, we expect that the aerobic tests adapted ground with backward contact, it becomes to outfield players of amputee soccer will be invalid 41). The distance is measured from the standardized and provided a step-by-step guide starting line to the landing point at the heel contact based on clear evidence. Furthermore, the fitness point in units of 0.1 m. For recording, it is effective tests are not just to check for the evidence of to set a tape measure or use a mat in advance. In the disability-classes and gender differences. There is a following jump test, measurements using an need to attempt to implement a field test battery electronic mat computer program system is stand- aimed at improving the profiling of playersʼ physical ard. (2) Vertical Jump Test: The participant is and physiological abilities. made to jump vertically using a counter-movement with arm swing, the knee angle during jumping Conclusions should remain 180°, and ground contact must be initiated on the toe 42) 43). (3) Squat Jump Test: The This study was a pilot study that attempted to subject flexes the knee at 90°and performs the review the physical fitness test in amputee soccer. maximum vertical jump while actively swinging In the future, additional evidence will be accumu- the arm, or places both hands on the waist to limit lated using the physical fitness test shown in this the recoil ofthe upper limb and performsthe study. maximum vertical jump. The knee angle during jumping should remain 180°and ground contact Conflict of interests must be initiated on the toe 42)-44). (4) Counter Movement Jump Test: In the same way as the The authors declare that there are no conflicts of squat jump, after the ground contact, a quick interest. vertical jump is performed repeatedly. This cycle is repeated according to the required number of Funding consecutive times 44) 45). (5) Drop Jump Test: The participant fell on the mat from the step of 40 to 45 This work was supported by JSPS KAKENHI cm high with hands on the waist. Additionally, as Grant Number JP19K19982 & Institute ofHealth soon as the foot touches the ground, the participant and Sports Science & Medicine, Juntendo Univer- jumps upward in an 120°halfsquat as high as they sity. can. The knee angle during jumping should remain 180°and ground contact must be initiated on the Reference toe 43) 44). For safety and balance, the Drop Jump Tests may allow arm swings. All tests are 1) International Paralympic Committee: Explanatory performed twice and the first decimal place is used guide to Paralympic classification Paralympic summer sports. https://www.paralympic.org/sites/default/files/ as a significant figure. document/150915170806821_2015_09_15+Explanatory+ guide+Classification_summer+FINAL+_5.pdf (Last 6. Future Directions accessed Jan. 31, 2020) Kayihan 12) stated that amputee football which 2) Wieczorek M, Wiliński W, Struzik A, Rokita A: Hand grip strength vs. Sprint effectiveness in amputee soccer includes various explosive movements is an aerobic- players. J Hum Kinet, 2015; 48: 133-139. based anaerobic sport. As far as we know, aerobic 3) Kalinowski P, Bugaj O, Konarski MJ, et al: Characteris- tests adapted to the outfield players of amputee tics ofthe competitive loads ofpolish national amputee soccer based on clear evidence have not been football team. Pilot studies. Journal of Education, Health and Sport, 2018; 8: 737-750. developed by previous studies. Several studies have 4) Kasińska Z and Tasiemaki T: Amputee football in attempted to evaluate the outfield playerʼs aerobic practice and research. Advances in Rehabilitation, 2016; power using aerobic tests developed for healthy 30: 55-66. individuals; however, the test has not been 5) Yazicioğlu K: The Rules ofAmputee Football. In: Centre ofExcellence DefenceAgainst Terrorism, standardized 12) 16). Therefore, in this study, it was Ankara, Turkey, ed. NATO Science for Peace and not possible to select the measurement items and Security Series - E: Human and Societal Dynamics, methods related to the aerobic power. In future 2007; 31: 94-100.

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