Physical Fitness Measurement Items and Methods for Amputee Soccer Outfield Players

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/football, 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 of Science, 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.


Introduction
Amputees are categorized as disability groups with the partial or complete lack of extremities (i.e., upper limbs: shoulder, elbow, arm, and wrist; lower limbs: hip, thigh, knee, lower leg, and ankle). Differences in leg length at birth and shortening of one leg bone due to trauma (e.g., bone cancer) are also incorporated into limb deficiency. Amputee athletes are eligible to compete in The Paralympic Games. However, the degree of disability can lead to an unbalanced competitive environment for amputee athletes. Therefore, The Paralympic Movement has established a classification system aimed at ensuring fair opportunities and fair playing fields. The Paralympic Games are basically defined by a classification system that determines which competitors are eligible to participate in the competition and groups them into sport classes 1) . In other words, classification minimizes the impact of disability-class and allows athletic performance and excellence in the sport to be determinants.
Amputee soccer is one of the types of soccer designed for the disabled, especially those who have undergone amputations as well as those with extremity dysfunction 2) . The criteria for participation in the game are a one-sided amputation or congenital malformation of the lower limb A2 (i.e., unilateral above the knee lower limb amputations)/ A4 (i.e., unilateral below the knee lower limb amputations) for outfield players and a unilateral amputation of the upper limb A6 (i.e., unilateral above the elbow upper limb amputations)/A8 (i.e., unilateral below the elbow upper limb amputations) for goalkeepers 3) . As of 2019, amputee soccer can also be played by individuals from the"Les Autres" group, those with other locomotor disabilities (e.g., with underdeveloped limbs) 4) . Outfield players are prohibited from wearing prosthetic legs. Therefore, the players use lofstrand crutches to move on the pitch and play mainly with one leg. The intentional touching of the ball with lofstrand crutches is considered an offense. In this way, amputee soccer has its own specially designed rules; hence, we will refer to the most important rules based on Yazicioğlu 5) . The rules are as follows: (1) The goalkeeper must have a one-sided amputation in the upper limb; however, there should be no disability in the lower limbs. Therefore, the goalkeeper cannot compete outside the penalty area. (2) There is a limit on the number of"playersʼ substitution"that can be changed once; however, there is no limit on the number of players that can be changed. Additionally, players who have once gone out of the pitch can return to the pitch and play again. (3) One-minute"time-outs"can be taken in both the first and second half of a match. (4) The off-side rule does not apply in amputee soccer. (5) The kick-in is applied instead of the throw-in. In amputee soccer, the standard in international competitions is 7-a-side game (Each team consists of 7 players: one goalkeeper and six outfield players). The aim of the 7-a-side amputee soccer game is to score more goals than your opponent in a playing time frame of 50 minutes. The match is split up into two halves of 25 minutes each. After the first 25 minutes, players will take a 10minute rest period called half time. The second 25minute period will resume and any time deemed fit to be added on by the referee (additional time) will be added accordingly. The pitch dimensions vary depending on the ground; however, the length is approximately 60 meters and the width is 40 meters, which is the standard for international competitions.
Notably, amputee soccer was played by 11 players on both sides under a standard size pitch until 1987 6) . Amputee soccer originated in the United States of America (USA). The name of the association is"American Amputee Soccer Association."As it is written as"Soccer"instead of "Football,"this study uses amputee"soccer." Amputee soccer was invented by Don Bennett, who first attempted to introduce soccer among people with amputation in Seattle. Initially, amputee soccer was used as a form of training that helped skiers with disabilities from the USA National Team to maintain proper endurance and fitness levels during the summer 4) . In countries involved in military conflicts, it can be said that there were several wounded soldiers after the war, which was one of the opportunities for the spreading of amputee soccer. The World Amputee Football Federation (WAFF) standardized the rules of the game. The WAFF sponsors its own World Cup Tournament. As a result, amputee soccer has gained popularity in the disability community all over the world, and the number of players increased. Thus, amputee soccer has exponentially grown with the WAFF and now includes more than 46 national associations in five continents 7) . On the other hand, the International Paralympic Committee has confirmed that the Paris 2024 Paralympic Games sports program will remain the same as the Tokyo 2020 Paralympics program with 22 sports included. Unfortunately, amputee soccer was not included in the Paris 2024 Paralympic Games sports program. In deciding the final sports for inclusion, the Board assessed all applications and committed to the Paralympic Movementʼs desire to pursue gender parity, safeguard the involvement of athletes with high support needs, and ensure that a diverse range of nations could take part 8) . In fact, it has been mentioned that the continental qualifying for every five continents has not been enriched in the amputee soccer community so far. However, continental qualifying is also being prepared in the 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. been playing amputee soccer on the same pitch with men since the first day of the game in 1982 7) . In particular, the first Womenʼs Amputee Soccer Tournament will be held in Miami and Florida in January 2020. This sport will further develop womenʼsʼ games. We also expect to gain a strong position for inclusion in the future Paralympic Games sports program.
In amputee soccer games, the total distance moved by the outfield player is about 3 km. Additionally, the specific movement pattern of moves with only one leg and lofstrand crutches exerts a high exercise load. In addition to the long standing and walking times during the match, it has been reported that high-intensity running is also an intermittent exercise pattern, similar to soccer 9) . The activities required for amputee soccer include standing/static balance, jogging, running, sprinting, acceleration, deceleration, change of direction, jumping, and dynamic balance. In addition, basic football skills such as ball-control, skills for receiving balls such as traps, skills for transporting balls such as dribbling, and skills for outputting balls such as passes and shoots are required. When performing any activity, the body movement skills corresponding to the demands of clutch operation skills are required in addition to the physical performance. Therefore, in order to compare and examine the physical characteristics of amputee soccer players, it is necessary to elucidate the physical performance using the physical fitness tests used in the previous studies and the specific physical fitness test. It is also important to continuously acquire information on the disabilityclass and gender differences in amputee soccer players. So far, amputee soccer players have been surveyed in fields related to balance, flexibility, and muscular endurance as evaluations of muscle performance, and anaerobic performance have been measured in fields related to sprint, agility, and jump. For the evaluation of aerobic performance, Yo-Yo Intermittent Recovery Test Level 1, 1-Mile Run Test, and Cooper Test are mainly conducted as field tests mainly on aerobic power. Previous studies have also quantitatively evaluated and examined the physical performance that can be used to present the profiles of amputee soccer players. However, there are several unclear points in the measurement conditions in the physical fitness test. Additionally, it is necessary to organize the test items and methods in consideration of the reproducibility of additional tests and experiments by a third party. In particular, amputee soccer is played under the rule that the disability-class is mixed; however, reports that specifically focus on the disability-class and gender differences are lacking. The Los Angeles 2028 Paralympic Games is scheduled to be played in the USA, where amputee soccer originated. In order for amputee soccer to be selected for the Paralympic Games sports program, it is necessary to ensure the fairness of the competition by presenting clear evidence on disability-class and gender differences as well as the rise of the competition.
Therefore, the purpose of this study was to (1) review the research on physical fitness tests conducted as a field test for amputee soccer players, (2) organizing measurement items and methods of physical fitness test adapted to amputee soccer outfield players based on previous studies.

Design
Studies that conducted field tests on amputee soccer players were eligible for inclusion in the review. The following key words were used to identify proper articles: amputee soccer/football, 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 of Science, Scopus, EMBASE, Cochrane, and Google Scholar).

Selection of Studies
After the elimination of duplicates, two researchers screened the search results individually against eligibility criteria. Researchers were not masked to the title or authors of the publications. Disagreements were resolved by discussions or third-party researchers. Disagreements in the selection of literature for review were resolved by discussion or third-party researchers. Additionally, the following article inclusion criteria were applied; (1) original scientific paper, (2) paper published in a peerreviewed journal, (3) annual meeting abstracts in a peer-reviewed conference, and (4) paper published in the English language.

Data Extraction
References were organized for each item related to the physical measurement. Additionally, two researchers conducted excerpts of the relevant content described in the text as material used for measurements and specific form and surface, respectively.

Organizing measurement items and methods
Researchers selected the test items that are highly versatile and expected to accumulate more evidence data, and organized the measurement methods.

Selection of studies
The original search netted 29 studies. After the removal of duplicates and screening, 17 studies remained. Based on the references, Table-1 shows the contents of anthropometric measurements, Table-2 shows the contents of muscular performance, Table-3 shows the contents of anaerobic  performance, and Table-4 shows the contents of aerobic performance.

Measurement prerequisites and precautions
Throughout this section, the prerequisites and precautions are as follows. Prerequisites; (1) The description of each measurement shows the general equipment used for the measurement; however, it can be changed to a similar equipment if necessary.
(2) The instrument used for each measurement is calibrated. (3) When performing each measurement, the prosthetic leg is to be removed, only the remaining limbs and healthy leg are to be kept, and light clothing is to be worn. (4) The material and length of the lofstrand crutches are greatly affected by the measurement results; hence, the criteria must be clarified. Precautions; (1) The loftstrand crutches may or may not be used depending on the field test; therefore, care must be taken. (2) The conditions such as measurement time, number of measurements, and measurement environment must be taken care of in order to obtain continuous and more accurate measurement values.
(3) Measurements must not be conducted after meals or immediately after strenuous exercise unless it is the primary purpose.

Anthropometric measurements 1) Body height
The Body height is measured using tape measure, height scale, electronic height scale, and Martin anthropometer. As a measuring method, the prosthetic leg is removed and the patient is barefoot. The unilateral healthy leg is opened at about 60°, and the heel, buttocks, and back is put on the support column and an upright posture is taken. The vertical distance from the horizontal floor/reference plane to the top of the head is taken. While measuring the upper limb length, a standing posture is taken, the upper limb is dropped at the side of the body, and the long axis of the upper limb is matched with the long axis of the hand. The linear distance is measured from the shoulder peak point to the fingertip point. The lower limb is measured from the femur greater trochanter to the floor. The measurement is performed in such a manner that the instrument is vertical when viewed from the floor.

2) Body weight
For the measuring of body weight, it is practical to use a body scale or an electronic body weight scale. After urination and defecation are completed in advance, at the time of the measurement the prosthetic leg is removed and the measurement is performed while maintaining balance in a barefoot state.

3) Body composition
The formula for Body Mass Index (BMI) was devised in the 1830s by Belgian mathematician Adolphe Quetelet and is universally used in body weight (kg) / body height 2 (m 2 ). As a method for measuring the body fat percentage, there is a measurement using the Skinfold Caliper method. However, the level of experience of the examiner has a significant effect on the readings and is not suitable for obtaining continuous and significantly accurate readings. Therefore, it is desirable for a lower limb amputee to measure from both palm measurements using a bioelectrical impedance device. The bioelectrical impedance method applies Bare feet and flat ground.
Kalinowski et al., 2018 3) The height of the body was determined by the 0064istance of the Vertex-Basis points using the Holtain (UK).
The subject was standing upright, propped up with Canadian crutches.
Without shoes and prostheses.
Miyamoto et al., 2019 14) Body height was measured using an analog height stadiometer.
Participants wearing an artificial leg.
Özkan et al., 2012 15) The body height of the soccer players was measured by a stadiometer with an accuracy of ± 1 cm (SECA, Germany).
Non described.
Ilkim et al., 2018 11) The body weight measurement was made with the Seca 727 electronic measuring instrument.
Barefoot and onto the meter without clothes to weigh on them.
Kalinowski et al., 2018 3) The electronic weight (Wagi Wielkopolska, Poland) was used to measure body weight with precision to 0.1 kg.
Non described.
Without shoes and prostheses.
Participants wearing an artificial leg.
Özkan et al., 2012 15) An electronic scale (SECA, Germany) with an accuracy of ± 0.1 kg was used to measure body mass.
Non described.
Simim et al., 2013 16) Body mass was measured using an electronic scale platform (Filizola ® ), with 0.1 kg precision and height obtained with a stadiometer with 0.1 cm accuracy.
Non described.  A modified Thomas test was used to determine the flexibility of hip flexor muscles.

Body mass index
Non described.

Muscular endurance
Sit-ups isotonic test Guchan et al., 2017 10) The maximal repetitions and the duration of the movement was recorded.
Non described.
Push-ups isotonic test Guchan et al., 2017 10) The maximal repetitions and the duration of the movement was recorded.
Non described.
Push up test Miyamoto et al., 2018 13) The number of push-ups accomplished in 60 seconds was recorded.
Non described.
Simim et al., 2017 19) The maximum number of repetitions completed in 60 s with perfect form was used as the criteria measure. Subsequently, these values were divided by body mass to include a relative measure.
Non described.
Simim et al., 2018 20) The maximum number of repetitions completed in 60 s with perfect form was used as the criteria measure. Subsequently, these values were divided by body mass to include a relative measure.
Non described.

Back extensors isometric test
Guchan et al., 2017 10) The subjects were then asked to cross their arms 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.
Non described.
Trunk flexors test Guchan et al., 2017 10) The subjects were asked to position their arms 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.
Non described.

kg Medicine ball throw
Simim et al., 2017 19) All throws were measured to the nearest 0.1 cm. Non described.
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. Agility T-square test Simim et al., 2013 16) Agility was determined by the Tsquare test that consists in a squared area limitedf by four cones with 4 m inside.
Lofstrand crutches type: non described. Shoes: non described. Surface: field with natural grass.

Jump
Vertical jump test Guchan et al., 2017 10) Subjects were asked to stand up, fix 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.
Non described. Subjects performed jumps using only the healthy leg; they did not wear an artificial leg or use crutches. Simim et al., 2017 19) Players jump height (cm) and power production (absolute and relative) were measured using an accelerometer (Myotest ® , Sion, Switzerland) that had been previously validated.
Non described.
The subjects did not use bilateral crutches (wearing a prosthetic device was not allowed during jumping).  23) Running performances data such as movement speed, acceleration, and deceleration were collected using a global positioning systems technology.

Measurement items
Lofstrand crutches type: non described. Shoes: non described. Surface: non described.
Yo-Yo intermittent recovery test level 1 at 10 m Maehana et al., 2018 B 23) Running performances data such as movement speed, acceleration, and deceleration were collected using a global positioning systems technology.

1-Mile Run Test
Kayihan, 2014 12) The test result was reported by the distance.
The amputee football players with 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 distance.
The amputee football players with bilateral crutches (without prostheses). Lofstrand crutches type: non described. Shoes: non described. Surface: track. a weak current to estimate the percentage of fat and other tissues. However, the physical burden is miniscule. The prosthetic leg is removed for measurement and the unilateral healthy leg is opened at approximately 60°and a standing posture is maintained. The left and right grip electrodes are held with the palm. Measurements are made while the elbow is not bent and the arm is kept parallel to the body at 90°2 4) .

Muscular performance 1) Balance
Recently, technological advances have provided the scientific community with a force platform system for the quantitative assessment of static balance. These systems quantitatively assess the functional balance through the analysis of posture swing. The displacement of the center of foot pressure is recorded using a strain gauge sensor built into the platform structure. However, the space and cost requirements associated with static balance measuring devices are not suitable for field testing; therefore, an alternative is presented.
(1) The Stork Stand Balance Test: the participant removes the prosthetic leg, becomes barefoot, maintains a standing posture, and places both hands on the waist. During the measurement, it is necessary to maintain a state where the heel of the supporting leg is raised. When the heel leaves the floor, the measurement is started using a stopwatch. The stopwatch is stopped if any of the follow occur: (A) the hands come off the hips, (B) the supporting leg swivels or moves or hops in any direction, or (C) the heel of the supporting leg touches the floor 25) 26) . In this test, the basic number of attempts is 3 times, and it is possible to measure with the eyes closed. (2) One-Leg Balance Test: This test is similar to the Stork Stand Balance Test. The participant performs the measurement while wearing the prosthetic leg. In this test, the participant raises both arms in a parallel manner and stands on one leg, and the non-supporting leg maintains the state raised to about 30°forward. The test lasts 30 seconds, and the stopwatch starts the measurement with the non-supporting leg raised. The stopwatch is stopped if any of the follow occur: (A) the parallelism of both arms is lost, (B) the supporting leg swivels or moves or hops in any direction, or (C) the non-supporting leg comes into contact with the supporting leg 27) 28) . In this test, the prosthetic leg is used as the supporting leg, the basic number of attempts is 3 times, and it is possible to measure with the eyes closed.

2) Flexibility
The Sit-and-Reach Test, described by Wells and Dillon in the 1950s is widely used in many fitness batteries to measure lower back and hamstring flexibility. The basic outline of The Sit-and-Reach Test is described below. Measurements are performed using a testing box, measuring board, and electronic ruler. Participants must sit on the floor with the prosthetic leg removed, the trunk is bent to the maximum, the knee is kept flat on the floor, and the ankle is kept at 90°. The participant holds the state for approximately 1 to 2 seconds with the hand extended to the maximum 29) . The measured value is recorded in units of 0.1 cm and the basic number of attempts is approximately 3 times.

3) Muscular endurance
Muscular endurance includes fitness components with several things in common. This section describes the general measurement methods for the Push/Press-up Test and Sit-up Test that are widely used in many fitness batteries. (1) The Push/Press-up Test: In this test, the participants remove their prosthetic leg, become barefoot, and wait on the floor mat. The push-up is performed on a flat, stable surface, hands placed slightly wider than shoulder-width apart, and fingers pointed forward. Hands and toes touch the floor and keep the body and healthy leg straight. Keeping the back and knees straight, the participant lowers the body to a pre-determined point, to touch the ground or some other object, or until there is a 90°angle at the elbows, then returns back to the starting position with the arms extended 30) . (2) The Sit-up Test: In this test, the participant performs the measurement barefoot while wearing a prosthetic leg. The participant lays supine on the floor with 90°flexion in the knee joints, hands at the side of their head, and with elbows pointing straight forward. To perform an accurate sit-up execution, the elbows should touch the knees and then go back for the shoulders to touch the floor. The participantʼs feet and knees are supported by the test leader 31) 32) . These actions are repeated without rest until the target push-up or sit-up count is achieved or the time limit is reached. The measurement time is measured with a stopwatch and the general time setting is 30 to 60 seconds.

4) Muscular strength
Muscular strength is the ability of a muscle or muscle group to generate maximal force. There are many ways to measure muscular strength, often with a focus on a specific group of muscles. The medicine ball throw is the most widely known and indirect test used to evaluate the power of the upper limbs in team sports. The measurement uses a 2 to 4 kg medicine ball and a chair with adjustable height. The participant removes their prosthetic leg before participating in the measurement. Participants keep their backs upright in a sitting position, bend their knee at 90°, and place their feet on the ground or floor. At the height of the participantʼs central chest, a stretch strap is attached around the torso and secured to the seat to increase stability and minimize trunk movement. The medicine ball is held at the chest level with both hands and thrown forward without moving the trunk 33) 34) . The distance is measured from the starting point of the throw to the first point on the floor or ground where the medicine ball fell. The throw distance is measured to the nearest 0.1 m using a tape measure. The measurement should be performed 3 times.
The hand and foot grip strength measurements are used to assess the integrity in the upper and lower extremity function. The measurement uses a dynamometer and a chair with adjustable height. The participant removes their prosthetic leg and participates in measurement. Participants keep their backs upright in a sitting position, bend their knee at 90°, and place their feet on the ground or floor. The participant grips the dynamometer with maximum force without touching the rest of the body or chair. (1) Hand grip strength test: The participant sits in a chair with their shoulder adducted and neutrally rotated, elbow flexed at 90°, forearm and wrist in the neutral position 35) 36) .
(2) Foot grip strength test: The participant sits with the trunk upright, puts the hip and knee joints at 90°, and keeps the ankle joint in a neutral position. The dynamometer handle is set at the first metatarsophalangeal joint 37) . The dynamometer is acquired in units of 0.1 kg and each measurement site is measured twice.

Anaerobic performance 1) Sprint and Agility
In team sports in the field, sprint and agility are closely related to the competition performance. This section describes common measurement methods for both sprint and agility. Considering the reality and reproducibility of measurement, spiked shoes are worn and measurement is carried out on artificial grass to unify the surface. The participant removes the prosthesis and performs measurements using lofstrand crutches with specified material and length. The general running method using lofstrand crutches is the swing-through gait. The ratio of lofstrand crutches to one leg ground contact during the running cycle is 1: 2 for maximum speed 38) . Measurements using electronic timing gates are standard. However, since the single beam type may react to the clutches before the participantʼs torso passes, dual beam type electronic timing gates can be used for measurement most accurately. The height of the transmission and reception port for the timing gates is 80 to 110 cm and distance between the paired timing gates is 1.5 to 2 m 39) 40) . The timing gates are installed on the start line, measurement point line, and goal line. The starting method is as follows: A standing posture is maintained and the lofstrand crutch is grounded slightly behind the starting line. The leg is grounded at a point 1 m behind the starting line. The measurement can be started at any timing of the participant. The measurement record is valid up to the first decimal place and the measurement is performed twice.

2) Jump
Jumping is a multi-joint movement that requires complex motor coordination and several jumping tests have been used as field tests. It is desirable for the participant to remove the prosthetic leg and wear shoe suitable for measurement. In the measurement, a standing posture with one leg is maintained and an attempt is made according to the conditions specified for each test. (1) Standing Broad/Long Jump Test: the participant stands on the starting line with one leg and jumps as far forward as possible using the swing of both arms.
After jumping, if a part of the body touches the ground with backward contact, it becomes invalid 41) . The distance is measured from the starting line to the landing point at the heel contact point in units of 0.1 m. For recording, it is effective to set a tape measure or use a mat in advance. In the following jump test, measurements using an electronic mat computer program system is standard. (2) Vertical Jump Test: The participant is made to jump vertically using a counter-movement with arm swing, the knee angle during jumping should remain 180°, and ground contact must be initiated on the toe 42) 43) . (3) Squat Jump Test: The subject flexes the knee at 90°and performs the maximum vertical jump while actively swinging the arm, or places both hands on the waist to limit the recoil of the upper limb and performs the maximum vertical jump. The knee angle during jumping should remain 180°and ground contact must be initiated on the toe 42)-44) . (4) Counter Movement Jump Test: In the same way as the squat jump, after the ground contact, a quick vertical jump is performed repeatedly. This cycle is repeated according to the required number of consecutive times 44) 45) . (5) Drop Jump Test: The participant fell on the mat from the step of 40 to 45 cm high with hands on the waist. Additionally, as soon as the foot touches the ground, the participant jumps upward in an 120°half squat as high as they can. The knee angle during jumping should remain 180°and ground contact must be initiated on the toe 43) 44) . For safety and balance, the Drop Jump Tests may allow arm swings. All tests are performed twice and the first decimal place is used as a significant figure. Kayihan 12) stated that amputee football which includes various explosive movements is an aerobicbased anaerobic sport. As far as we know, aerobic tests adapted to the outfield players of amputee soccer based on clear evidence have not been developed by previous studies. Several studies have attempted to evaluate the outfield playerʼs aerobic power using aerobic tests developed for healthy individuals; however, the test has not been standardized 12) 16) . Therefore, in this study, it was not possible to select the measurement items and methods related to the aerobic power. In future research, we expect that the aerobic tests adapted to outfield players of amputee soccer will be standardized and provided a step-by-step guide based on clear evidence. Furthermore, the fitness tests are not just to check for the evidence of disability-classes and gender differences. There is a need to attempt to implement a field test battery aimed at improving the profiling of playersʼ physical and physiological abilities.

Conclusions
This study was a pilot study that attempted to review the physical fitness test in amputee soccer. In the future, additional evidence will be accumulated using the physical fitness test shown in this study.