Physical Activity in Adults With an Amputation as Assessed With a Self‐Reported Exercise Vital Sign

Abstract

Background Physical activity (PA) is important for the prevention and treatment of numerous chronic medical conditions. Individuals with a limb amputation face unique challenges for staying physically active. There are few studies evaluating PA of civilians with amputation in the United States. Objective To evaluate self‐reported PA in persons with an amputation in the outpatient setting using a standardized exercise vital sign (EVS) and correlate PA with demographic information, amputation characteristics, and disease burden. Design Cross‐sectional observational study. Setting Outpatient rehabilitation clinic at a tertiary care institution. Interventions N/A. Participants Two hundred twenty‐nine patients with limb amputation. Main Outcome Measurements EVS (self‐reported weekly participation in moderate to vigorous intensity exercise), disease burden using a modified Charlson Comorbidity Index (CCI), possession of a prosthetic limb, amputation level, time from amputation, body mass index (BMI), gender, race, and age. Results A total of 28.8% of patients with limb amputation self‐reported exercising at or above 150 min/wk as recommended by the United States Department of Health and Human Services (HHS); 31.8% of patients with transfemoral amputations, 27.8% with transtibial amputations, and 36% with upper extremity amputations reported exercising the recommended amount. Those with a prosthesis exercised 0.91 h/wk more than those without a prosthesis (95% CI 0.01, 1.8, P = .047), and female patients exercised 1.09 h/wk less than male patients (95% confidence interval [CI] 1.69‐0.49, P < .001). Increasing age (P = .045), CCI (P = .006), and BMI (P = .005) all had a small but significant correlation with lower EVS. There was no statistically significant correlation between EVS and amputation level, race, or time from amputation. Conclusions Less than one‐third of patients with an amputation meet HHS recommendations for aerobic exercise. Male patients, those with a prosthesis, lower CCI, lower BMI, and younger age reported higher PA rates. Assessing EVS can help clinicians to identify patients with amputation that are not sufficiently active and may benefit from PA counseling and prescription.

Implementation of a Physical Activity Vital Sign in Primary Care: Associations Between Physical Activity, Demographic Characteristics, and Chronic Disease Burden

“…Those blanks were transformed into CCI = 0. We additionally evaluated the age distribution by CCI group, which was consistent with the literature in which patients with 0 comorbidities or low CCI values (eg, 1 or 2) were younger and had fewer comorbidities (11,14).…”

“…f Score was calculated by using the International Classification of Diseases, Tenth Revision, Clinical Modification codes (13) for 17 health conditions from the 3 years before the first clinic visit with PAVS recorded. A higher Charlson Comorbidity Index score is generally associated with increased age, comorbidities, and allcause mortality (11)(12)(13) b Patients reporting 0 minutes per week of physical activity consistently in all clinic visits were classified as consistently inactive; patients reporting ≥150 minutes per week of physical activity in all visits were classified as consistently active; patients who reported physical activity rates that did not fit the above 2 categories consistently for all visits were classified as inconsistently active (<150 min/wk). c χ 2 test for independence of variables.…”

“…f Score was calculated by using the International Classification of Diseases, Tenth Revision, Clinical Modification codes (13) for 17 health conditions from the 3 years before the first clinic visit with PAVS recorded. A higher Charlson Comorbidity Index score is generally associated with increased age, comorbidities, and allcause mortality (11)(12)(13).…”

Implementing physical activity vital sign as a self‐reported measure of physical activity in patients with multiple sclerosis in a clinical setting

“…Since some patients had more than one visit in which a physical activity vital sign was recorded, the following final categorization of the physical activity vital sign was used: “consistently inactive” if 0 min/week was reported in all visits; “consistently active” if ≥150 min/week was reported in all visits; and “inconsistently active” if between 1 and 149 min/week was reported or if activity level fluctuated between categories during repeat visits. This same categorization has been used in published studies on the physical activity vital sign in different patient populations 14 …”

“…10,11 It is widely used in the literature and is already implemented in multiple large healthcare systems, including Kaiser Permanente and Intermountain Healthcare. 12 It has also been validated against accelerometry data 11 and used in ethnically diverse populations, 13 in patients with limb amputation, 14 as well as in primary care clinics and specialty care settings. 15 The physical activity vital sign has not yet been implemented in MS specialty clinics.…”