Physical activity, ambulation, and comorbidities in people with diabetes and lower-limb amputation

Abstract

We characterized physical activity (PA) and its relation to physical function and number of comorbidities in people with diabetes and transtibial amputation (AMP), people with diabetes without AMP, and nondisabled adults without diabetes or AMP. Twenty-two individuals with type 2 diabetes mellitus (DM) and transtibial amputation (DM+AMP), 11 people with DM, and 13 nondisabled participants were recruited for this cross-sectional cohort study. Measures included PA volume and intensity, a Timed Up and Go test, a 2-min walk test, and number of comorbidities. The nondisabled group performed greater amounts of PA than the DM group, who performed greater amounts of PA than the DM+AMP group. PA was related to physical function in the DM group and in the DM+AMP group, whereas no such relationship existed in the nondisabled group. PA was not related to number of comorbidities in any group. These findings suggest the ability to walk may affect overall performance of PA. Alternately, PA may alleviate walking problems. This possibility is of interest because issues with walking may be modifiable by improved levels and intensity of PA. PA’s lack of relation to number of comorbidities suggests that factors beyond multiple morbidities account for group differences in PA.

Physical Function and Pre‐Amputation Characteristics Explain Daily Step Count after Dysvascular Amputation

“…The significance of pre‐amputation characteristics (ie, presence of cardiovascular disease, low walking time) in daily step count after dysvascular LLA is a novel finding. Prior research has identified that vascular etiology, greater age, and comorbidity burden are associated with lower levels of physical activity after LLA . The broad scope of characteristics that define dysvascular LLA and clinical practice guidelines for rehabilitation after LLA provide little guidance for what pre‐amputation factors should be considered when targeting improved daily step count .…”

“…Prior research has identified that vascular etiology, greater age, and comorbidity burden are associated with lower levels of physical activity after LLA. [15][16][17]19 The broad scope of characteristics that define dysvascular LLA and clinical practice guidelines for rehabilitation after LLA provide little guidance for what pre-amputation factors should be considered when targeting improved daily step count. 65 Although cardiovascular disease and low pre-amputation walking time are not modifiable following dysvascular LLA, personal factors associated with these variables (eg, self-efficacy, motivation) may be particularly important for interventions to improve physical activity.…”

“…Despite the known benefits of physical activity, people with dysvascular LLA are remarkably inactive, with data showing average step counts as low as 1721 steps/day . Current rehabilitation practices after dysvascular LLA emphasize improvement in physical function, yet minimal change in daily step count is observed .…”

“…13,14 Despite the known benefits of physical activity, people with dysvascular LLA are remarkably inactive, with data showing average step counts as low as 1721 steps/day. 15 Current rehabilitation practices after dysvascular LLA emphasize improvement in physical function, yet minimal change in daily step count is observed. 7 Unchanged daily step count after rehabilitation indicates that factors beyond physical function should be intentionally targeted to improve physical activity after dysvascular LLA.…”

Relationships Among Perceived Functional Capacity, Self‐Efficacy, and Disability After Dysvascular Amputation

“…Our findings suggest that self‐efficacy of chronic disease management may be a target of intervention to improve chronic disability with Veterans and non‐Veterans. In addition to complex medical histories, people with dysvascular TTA commonly have poor health behaviors, including history of smoking [28], nonadherence with diabetes management recommendations [29], and low levels of physical activity [8]. Behavior‐based interventions targeting improved self‐efficacy have been developed to increase physical activity behavior with people who have PAD or DM [16,30] and improve health outcomes for those specifically with DM [31].…”