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2015 HSR&D/QUERI National Conference Abstract

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3114 — "This is your new normal": Barriers and enablers to physical activity and weight management in veterans with lower limb loss: A qualitative study

Littman AJ, Seattle Epidemiologic Research & Information Center, Seattle, WA; Bouldin ED, Seattle-Denver Center of Innovation for Veteran-Centered & Value Driven Care, Seattle, WA;

Objectives:
Obesity, physical inactivity, and sedentary lifestyles are common in people with a lower extremity amputation (LEA) and impair physical functioning and quality of life. We aimed to determine typical physical activity (PA) performed, PA barriers and enablers, and weight management experiences faced by Veterans with LEA to inform the development of a physical activity and weight management program for this population.

Methods:
We purposively sampled Veterans from VA-sponsored sports events, VA clinics, and community organizations with various levels of amputation, adiposity, and PA. Semi-structured interviews were conducted by phone and in person, transcribed and analyzed by 2 researchers using a priori and emergent codes to identify themes.

Results:
Participants (n = 27; mean age = 54) were male and had their amputation 11 years prior on average. Self-reported PA included transportation-related activity (e.g., walking to work, shopping), exercise using home (e.g., stationary bicycle) and VA-issued (e.g., a handcyle) equipment, and group or solo exercise at a community or VA gym. Enablers of PA included a supportive social environment (e.g., encouragement from a spouse or clinician, social interactions with others, serving as a role model, and having physically active role models); desire for autonomy/independence; well-fitting prostheses; desire for and perceived improvements in physical/psychological well-being; and the daily structure and sense of accomplishment provided by PA. Important barriers to PA were pain associated with their prosthesis and low self-efficacy. Enablers of and motivation for weight loss included a diagnosis/health condition, spousal support, and desire for improved physical functioning. Key barriers for weight loss were limited financial resources to afford healthier food and an unsupportive social network.

Implications:
Findings from this study suggest that veterans with LEA may benefit from a PA/weight management program that includes peer and/or spouse support, targets self-efficacy, and reduces financial barriers to PA and healthy food. Enhancing fit of prosthetic devices, teaching pain management, and increasing self-efficacy are also important factors amenable to intervention.

Impacts:
This study provides detailed and rich context to better understand and help Veterans with LEA. Future experimental studies are needed to identify effective methods to address the needs of this high priority VA population.