title: This is your new normal: A qualitative study of barriers and facilitators to physical activity in Veterans with lower extremity loss.
abstract: BACKGROUND
  Regular physical activity (PA) is essential for aging well with a disability, preventing the onset or worsening of chronic conditions, functional loss, and maintaining or improving quality of life, yet PA levels are low in those with disabilities, including those with a lower extremity amputation (LEA).
  
  
  OBJECTIVE
  To determine methods for promoting PA in this population, our objective was to better understand the barriers and facilitators to PA that persons with LEA face.
  
  
  METHODS
  Semi-structured interviews were conducted with male Veterans with a LEA. Two raters analyzed interview transcripts using a qualitative descriptive approach, involving both a priori and emergent themes.
  
  
  RESULTS
  Among the 27 male Veterans (mean age = 54 years) interviewed, facilitators to PA included acceptance of their limb loss, confidence (to try new activities or adapt activities), creating a daily routine involving PA, resources, supportive others, perceived benefit, and having a history of being physically active. Barriers to PA were illnesses/injuries, poorly-fitting prostheses, low self-efficacy, insufficient resources, unsupportive others, and hassle.
  
  
  CONCLUSIONS
  Our study builds upon the literature indicating that individual, interpersonal, and environmental factors should be addressed to increase adoption and maintenance of PA, including making PA a regular, low-hassle activity, increasing access to resources that facilitate PA, and training health care providers, family and friends on how to best to support those with LEA to be more physically active. Addressing prosthetic socket issues that affect fit and stability and promoting acceptance and self-efficacy will also be instrumental.
authors.affiliation: Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, United States; Department of Epidemiology, University of Washington, Seattle, WA, United States. Electronic address: alyson.littman@va.gov.
authors.forename: Alyson J
authors.initials: AJ
authors.lastname: Littman
authors.affiliation: Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, United States.
authors.forename: Erin D
authors.initials: ED
authors.lastname: Bouldin
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, WA, United States; Multiple Sclerosis Center of Excellence West, VA Puget Sound Health Care System, Seattle, WA, United States; Department of Rehabilitation, University of Washington, Seattle, WA, United States.
authors.forename: Jodie K
authors.initials: JK
authors.lastname: Haselkorn
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000523:psychology; D000674:Amputees / Q000523:psychology; D001290:Attitude; D006233:Persons with Disabilities; D015444:Exercise; D005260:Female; D006801:Humans; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants / Q000592:standards; D036301:Qualitative Research; D011788:Quality of Life; D020377:Self Efficacy; D012944:Social Support; D011795:Surveys and Questionnaires; D014728:Veterans / Q000523:psychology; D055815:Young Adult
keywords: Lower limb amputation; Physical activity; Qualitative research