Physical activity barriers and enablers in older Veterans with lower-limb amputation

Abstract

Abstract-Little is known about the types of physical activities that older individuals with lower-limb loss perform, correlates of regular physical activity (PA), and barriers and facilitators to PA. We conducted an exploratory study in 158 older Veterans from the Pacific Northwest with a partial foot (35%), below-knee (39%), and above-knee (26%) amputation. Ninety-eight percent of survey respondents were male, on average 65 yr of age and 15 yr postamputation; 36% of amputations were trauma-related. The most commonly reported physical activities were walking/ wheeling (65%), muscle strengthening (42%), exercise prescribed by a physical or occupational therapist (32%), and gardening (31%). Forty-three percent were classified as physically active based on weekly moderate-and vigorous-intensity PA. History of vigorous preamputation PA was positively associated with being active, while low wealth and watching 5 h/d or more of television/videos were inversely associated. While pain-and resource-related barriers to PA were most frequently reported, only knowledge-related and interest/motivation-related barriers were inversely associated with being active. Family support and financial assistance to join a gym were the most commonly reported factors that would facilitate PA. To increase PA in the older amputee population, interventions should address motivational issues, knowledge gaps, and television watching; reduce financial barriers to exercising; and consider involving family members.

Weight loss intention, dietary behaviors, and barriers to dietary change in veterans with lower extremity amputations

“…Physical activity barriers have been reported elsewhere. 35 In addition to younger age and greater LLA-BMI, those with better physical and mental health scores were more likely to report trying to lose weight. Prior studies have determined that healthrelated quality of life (HRQOL) plays a role in an individual's decision to try to lose weight.…”

Targeted Muscle Reinnervation: Outcomes in Treating Chronic Pain Secondary to Extremity Amputation and Phantom Limb Syndrome

“…In a study of 158 older veterans with a variety of lower extremity amputations, pain was the second greatest barrier to physical activity second only to having the appropriate resources to be physically active. 6 Even in a younger trauma population with high prosthesis compliance rates, 16.7% reported extreme or very bothersome pain associated with prosthesis wear. Additionally, 72% of this population reported phantom limb pain, which was negatively associated with prosthetic ease of use and satisfaction.…”

“…44 Combined with the LEAP (Lower Extremity Assessment Project) study data indicating that 50% of typically young and previously healthy trauma patients who undergo amputation are unable to return to work and 77% have chronic pain, 45 young patients may represent a particular category likely to see success from TMR as well as quality-of-life gains. By examining markers of resilience in studies looking at return to physical activity after amputation, 6 those patients with healthier lifestyles at baseline, higher levels of education, and higher levels of preamputation exercise are all more likely to return to a level of activity that could benefit from TMR, potentially at the index amputation, to maintain baseline function and independence.…”

“…5 Overall, up to three-quarters of lower extremity amputees will develop chronic residual limb pain or phantom pain, the sensation of pain in the absent limb. 1 This pain can preclude prosthetic fit, 6 decrease ambulation, impact quality of life, 7 and, in combination, can increase mortality. 8 The 5-year mortality following a below-knee amputation is significant at 65 to 77% 9,10 and worse for above-knee amputations at 77.5%.…”

Cross-Sectional Assessment of Factors Related to Pain Intensity and Pain Interference in Lower Limb Prosthesis Users

“…14 Similarly, 54% of older veterans with LLA reported that pain-related concerns are a barrier to engagement in physical activity. 15 Another study found that back pain, RLP, and PLP all contribute to pain-related disability. 16 In addition, risk for depression increases in those with chronic back, contralateral, phantom, and residual limb pain.…”