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Amputee

Open the conversation

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Would you be happy to spend a few minutes talking about something that can make a big difference to your future health and wellbeing?

Insight

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Spending a moment to set the scene and asking permission can open a constructive person-centred conversation around behaviour change. This keeps the individual actively engaged in the conversation and decision making.

Did you know?

The metabolic cost of walking with a lower limb prosthesis increases with increasing amputation level

At least 150 minutes moderate intensity activity per week is recommended for substantial health gains

An infographic has been developed to highlight the physical activity recommendations for disabled adults

Real impact

‘If only other amputees would give it ago. I’m not talking about being an ‘athlete’. But if they went for a walk every day for half an hour it’ll really impact their well-being. It affects mine.’

‘If I keep my body in a good condition …then I can walk for a full day on my prosthesis. Thus, if I’m more active, I can use my prosthesis better.’

‘If only other amputees would give it ago. I’m not talking about being an ‘athlete’. But if they went for a walk every day for half an hour it’ll really impact their well-being. It affects mine.’

Assess impact of the condition

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How has your condition affected your physical activity levels and the things you enjoy?

Insight

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Living life with a long term condition commonly affects an individual’s physical activity beliefs and behaviours. Focusing on this can be a useful way to introduce the topic.
Most people are ambivalent about, rather than resistant to, increasing their physical activity levels. Your challenge is to help an individual to consider and share their own ‘pros’ for increasing their physical activity levels and help them to develop these ideas into a workable plan that fits into their life.
Try to understand their perspective, agenda and priorities and do not assume they:

  • ought to change
  • want to change
  • are primarily motivated by their health
  • either ARE or ARE NOT motivated to increase their activity levels
  • will respond well to a tough approach from you
  • must (or will) follow your advice

Learning skills like motivational interviewing can help you avoid common pitfalls that sometimes make conversations about behaviour change unrewarding and ineffective. Visit our education section to learn more.

Did you know?

The metabolic cost of walking with a lower limb prosthesis increases with increasing amputation level

At least 150 minutes moderate intensity activity per week is recommended for substantial health gains

An infographic has been developed to highlight the physical activity recommendations for disabled adults

Real impact

‘If only other amputees would give it ago. I’m not talking about being an ‘athlete’. But if they went for a walk every day for half an hour it’ll really impact their well-being. It affects mine.’

‘If I keep my body in a good condition …then I can walk for a full day on my prosthesis. Thus, if I’m more active, I can use my prosthesis better.’

‘If only other amputees would give it ago. I’m not talking about being an ‘athlete’. But if they went for a walk every day for half an hour it’ll really impact their well-being. It affects mine.’

Explore current activity

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How much physical activity do you manage to get done in a regular day?

Consider calculating their physical activity vital sign

Q1 On average, how many days each week do you do moderate or greater physical activity (like a brisk walk) ?

Q2 On those days, on average how many minutes do you do this physical activity for?

Results

Inactive. Only small increases in physical activity across the week can have large health benefits. Explain that just 30 minutes physical activity in one week can make a huge difference to their health.

Insufficiently active. A good start, but there is still a lot to be gained by increasing physical activity levels.

Active. Well done. Maintaining this level of activity is really important.

Insight

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Evaluating how active a person is, as part of a conversation to help them move more in the future, is recognised as being an important aspect of assessment. The way in which this is done, however, remains a cause for debate.

Gathering data about physical activity levels on a system wide basis can be a powerful way of integrating physical activity contacts into patient pathways, for instance through electronic medical records systems. They can also provide important data for demonstrating change and therefore the impact of an intervention, which can in turn drive changes in patient care and support commissioning of physical activity services.

However, recent evidence shows that any activity is better than none, and that there is no simple cut off or ‘threshold’ for health which applies to everyone. Identifying a cut off point introduces a concept of success or failure and can be detrimental to having a person-centred conversation based on individual values. In practice this can be the difference between a judgemental / diagnostic approach such as ‘you’re not doing enough and need to do more’ to a values based one such as ‘why might you want to become more active, personally?’ which can make them more likely to change their own behaviour.

Assessment tools can be used for screening and are particularly useful in systems. Whilst this can support systems delivery, it’s important to recognise that whilst those who say they are inactive generally are, many people who report being sufficiently active are not when compared with objective measures. This lead to many people who would benefit from a physical activity intervention being excluded on the false assumption they are sufficiently active.

Therefore we recommend that if you are going to assess physical activity levels, it can be helpful to approach it in one of two ways:

  1. Include the physical activity vital sign in the assessment phase of a healthcare contact, for instance alongside height, weight and blood pressure measurements.
  2. As part of a more focussed physical activity conversation, it might be preferable to explore current levels of activity as part of their daily/ weekly routine as a more informal way of ‘assessing’ physical activity behaviours, and resist the temptation to get too hung up on the numbers. This will facilitate a more patient -centred conversation which can then be developed to explore how they feel about becoming more active in the future and how they might go about it. It then provides an opportunity to share information about physical activity guidelines if appropriate, but try to avoid any statements such as ‘you are/ are not doing enough’.

Did you know?

The metabolic cost of walking with a lower limb prosthesis increases with increasing amputation level

At least 150 minutes moderate intensity activity per week is recommended for substantial health gains

An infographic has been developed to highlight the physical activity recommendations for disabled adults

Real impact

‘If only other amputees would give it ago. I’m not talking about being an ‘athlete’. But if they went for a walk every day for half an hour it’ll really impact their well-being. It affects mine.’

‘If I keep my body in a good condition …then I can walk for a full day on my prosthesis. Thus, if I’m more active, I can use my prosthesis better.’

‘If only other amputees would give it ago. I’m not talking about being an ‘athlete’. But if they went for a walk every day for half an hour it’ll really impact their well-being. It affects mine.’

Find out what they already know

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What do you know about the benefits of physical activity in people with lower limb amputations?

Insight

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As an individual is more likely to change if they can personally identify with the ‘pros’ for change, help them to identify how they might benefit from being more active. Find out what they know first so that you can add to their existing understanding by sharing some of the wide-ranging benefits of being more active.

Did you know?

It is important that measures to increase physical activity in lower limb amputees do not compromise social interaction

Personalised interventions, access to appropriate equipment/facilities and support from family, professionals and peers can motivate lower limb amputees to be more active

With modern prostheses and advanced rehabilitation, the metabolic cost of walking for unilateral transtibial amputees is similar to able bodied individuals

Real impact

‘If I keep my body in a good condition …then I can walk for a full day on my prosthesis. Thus, if I’m more active, I can use my prosthesis better.’

‘When I looked down now, I see my legs. I’m in charge of my legs. My legs are not in charge of me. But I can only do that by trying to be as active as a possibly can.’

‘This is your new normal, that’s what you have to learn. It doesn’t mean it’s going to be worse, it’s just new.’

Share benefits

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Can I share some other things people find beneficial to see what you make of them.

Insight

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Based on your discussion so far, choose to share the benefits you judge will be most relevant and important to them. Some benefits are quite generic and others will be condition specific.

Remember the conversation won’t work if you take away their control. Ask permission and keep this a conversation not a lecture.

Did you know?

It is important that measures to increase physical activity in lower limb amputees do not compromise social interaction

Personalised interventions, access to appropriate equipment/facilities and support from family, professionals and peers can motivate lower limb amputees to be more active

With modern prostheses and advanced rehabilitation, the metabolic cost of walking for unilateral transtibial amputees is similar to able bodied individuals

Real impact

‘If I keep my body in a good condition …then I can walk for a full day on my prosthesis. Thus, if I’m more active, I can use my prosthesis better.’

‘When I looked down now, I see my legs. I’m in charge of my legs. My legs are not in charge of me. But I can only do that by trying to be as active as a possibly can.’

‘This is your new normal, that’s what you have to learn. It doesn’t mean it’s going to be worse, it’s just new.’

Encourage reflection

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What do you make of what I have just said?

Insight

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Allow some space for people to talk and explore the information rather than asking ‘do you understand?’ which can shut things down. Ask if they need anything clarifying and what concerns they might have about how the information applies to them.

Listen and reflect their concerns: ‘you’re worried about X’. Help them to address these issues by sharing the experience of other people: ‘other people I’ve worked with have had those concerns, but what typically happens when they get started is…’ or ‘whilst there is a small risk of X when you get started, this is outweighed by the risk reduction you experience once you have started moving more’. Ask what they think about what you have said.

Did you know?

It is important that measures to increase physical activity in lower limb amputees do not compromise social interaction

Personalised interventions, access to appropriate equipment/facilities and support from family, professionals and peers can motivate lower limb amputees to be more active

With modern prostheses and advanced rehabilitation, the metabolic cost of walking for unilateral transtibial amputees is similar to able bodied individuals

Real impact

‘If I keep my body in a good condition …then I can walk for a full day on my prosthesis. Thus, if I’m more active, I can use my prosthesis better.’

‘When I looked down now, I see my legs. I’m in charge of my legs. My legs are not in charge of me. But I can only do that by trying to be as active as a possibly can.’

‘This is your new normal, that’s what you have to learn. It doesn’t mean it’s going to be worse, it’s just new.’

Explore how they think activity may help

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What do you understand about how physical activity might help you?

Readiness Cycle

Using your judgement, offer to share the most relevant and important problem commonly reported by people with lower limb amputations then ask what they make of it.

is

  • More physical activity
  • Better strength, balance and fitness
  • Ability to do more for yourself
  • More independence
  • Higher self – esteem
  • More physical activity
  • Less physical activity
  • Reduced physical ability
  • Inability to do as much for yourself
  • Greater dependence on others
  • Lower self – esteem
  • Less physical activity
  • More physical activity
  • Greater control and independence
  • More able to engage in social opportunities and interactions
  • Improved mood and self-esteem
  • More comfortable with your body and abilities
  • More physical activity
  • Less physical activity
  • Greater dependency on others
  • Risk of social isolation
  • Lower mood, confidence and self-esteem
  • Feeling ‘stuck in a rut’
  • Less physical activity
  • More physical activity
  • Stronger muscles and improved balance
  • Reduced risk and fear of falling
  • Everyday tasks become easier
  • Greater confidence
  • Greater motivation and desire to do more
  • More physical activity
  • Less physical activity
  • Weaker muscles and reduced balance
  • Greater risk and fear of falling
  • Everyday tasks seem more difficult
  • Lower confidence
  • More afraid and avoidant of activity
  • Less physical activity
  • More physical activity
  • Better core strength and stronger limb muscles
  • Greater support for the spine
  • Reduced back pain
  • More confidence with moving
  • More physical activity
  • Less physical activity
  • Reduced strength and control in core and limb muscles
  • Reduced support for the spine
  • More back pain
  • Less confidence with moving
  • Less physical activity
  • More physical activity
  • Increased release of endorphins
  • More positive feelings and more energy
  • Improved mood
  • Desire and motivation to do more
  • More physical activity
  • Less physical activity
  • Lower levels of endorphins
  • More fatigue and fewer positive feelings
  • Low mood
  • Lack of desire and motivation to be active
  • Less physical activity

Insight

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The symptoms and challenges experienced by people with long term conditions are a real and frequently debilitating part of everyday life. Understanding how physical activity can make a difference to their day-to-day life can help strengthen their resolve and confidence to become more active.

Did you know?

Those who are currently physically inactive should start gently and build up slowly, enabling their body to gradually adapt to the higher levels of activity  

The least active individuals stand to gain the most from a small increase in physical activity

<40% of lower limb amputees are sufficiently active and 33% are considered sedentary

Real impact

‘If I keep my body in a good condition …then I can walk for a full day on my prosthesis. Thus, if I’m more active, I can use my prosthesis better.’

‘I can’t live my life thinking what others will think. It’s my life and this is how I want to live my life. And I’m going to live my life. Regardless, if I’ve got two prostheses or not’

‘When I looked down now, I see my legs. I’m in charge of my legs. My legs are not in charge of me. But I can only do that by trying to be as active as a possibly can.’

Respond to concerns

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What concerns might you have about becoming more active, if you decided to?

Insight

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Many people with health problems – and those without – have reasonable concerns about becoming more active. When you ask them about this, saying “if you decided to” reminds them that they are the decision maker, not you, keeping the discussion open and active, focusing your supportive role.

Find a way to reflect that you understand – ‘Yes, that is a common concern’ or ‘you’re concerned that being more active may make your pain worse’ (said as a statement, not a question).

Allow some space for people to talk about and explore new information, asking ‘what do you think about what I’ve just said?’ rather than asking ‘do you understand?’ which can shut things down. Ask if they need anything clarifying and what concerns they might have about how the information applies to them.

Did you know?

Those who are currently physically inactive should start gently and build up slowly, enabling their body to gradually adapt to the higher levels of activity  

The least active individuals stand to gain the most from a small increase in physical activity

<40% of lower limb amputees are sufficiently active and 33% are considered sedentary

Real impact

‘If I keep my body in a good condition …then I can walk for a full day on my prosthesis. Thus, if I’m more active, I can use my prosthesis better.’

‘I can’t live my life thinking what others will think. It’s my life and this is how I want to live my life. And I’m going to live my life. Regardless, if I’ve got two prostheses or not’

‘When I looked down now, I see my legs. I’m in charge of my legs. My legs are not in charge of me. But I can only do that by trying to be as active as a possibly can.’

Make it personal

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What would be the top 2-3 reasons for you personally becoming more active, if you decided to?

In addition to the personal benefits that being active can have, living an active life can reduce the risk of many common medical conditions by up to 50%

Offer to share some of this evidence if you feel they might be interested in finding out out more about the impact of physical activity on disease prevention.

Insight

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Help them to generate and articulate their own reasons, which may or may not be health-related and recognise they might not be interested in long term disease prevention.

Saying ‘if you decided to’ reminds them that they are the decision maker, not you. This helps keep the discussion open and active, focusing your role on providing support.

Did you know?

In order to benefit health, research has shown that activities need to be of at least moderate intensity. For most people, this will mean experiencing an increased heart rate and breathing rate during the activity

The least active individuals stand to gain the most from a small increase in physical activity

<40% of lower limb amputees are sufficiently active and 33% are considered sedentary

Real impact

‘When I looked down now, I see my legs. I’m in charge of my legs. My legs are not in charge of me. But I can only do that by trying to be as active as a possibly can.’

‘If only other amputees would give it ago. I’m not talking about being an ‘athlete’. But if they went for a walk every day for half an hour it’ll really impact their well-being. It affects mine.’

‘Physical activity helps with my pain; it stretches me out and helps my circulation’

Look forwards

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Let’s imagine that you did decide to live a more active lifestyle and were able to keep it up for six months or so, what differences do you think you might notice?

Insight

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Personal motivation may be strengthened by having people look further into the future – since the benefits of a more active lifestyle may be cumulative. Certain benefits may only materialise several weeks or months into the future. Getting people to talk about a potentially better future helps to ‘develop discrepancy’ – highlighting the gap between where a person is and where they want to be.

Did you know?

In order to benefit health, research has shown that activities need to be of at least moderate intensity. For most people, this will mean experiencing an increased heart rate and breathing rate during the activity

The least active individuals stand to gain the most from a small increase in physical activity

<40% of lower limb amputees are sufficiently active and 33% are considered sedentary

Real impact

‘When I looked down now, I see my legs. I’m in charge of my legs. My legs are not in charge of me. But I can only do that by trying to be as active as a possibly can.’

‘If only other amputees would give it ago. I’m not talking about being an ‘athlete’. But if they went for a walk every day for half an hour it’ll really impact their well-being. It affects mine.’

‘Physical activity helps with my pain; it stretches me out and helps my circulation’

Help them build confidence

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What are the reasons you feel you could become more active if you decided to?

Or consider an alternative approach using a confidence ruler

“On a scale of 0-10, how confident are you that, if you did decide to become more active, you would be able to keep up an active lifestyle for, say, 6 months, where 0 is not at all confident and 10 is extremely confident?”

Explore “What makes you say x and not a lower number?”what makes you feel you could do this if you tried?”

Ask “What would help you become more confident?”

Insight

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These questions aim to get people talking about why they could be more active, if they tried, as this can help to increase their confidence, or self-efficacy. It also helps people to think about the concrete steps that they would need to take, which can help the change seem more achievable. Listen to and explore what they say: ‘are there any other reasons why you think you might be able to keep up an active lifestyle, if you decided this was what you wanted to do?’

Your focus is on encouraging them to think through what would help them to become more confident. This helps to strengthen their ideas about what else they might need to do. These questions can sometimes prompt individuals to create a personalised behaviour change plan. Continue to explore their ideas (before you share yours). Ask ‘and what else might help you become and stay more active?’

Did you know?

In order to benefit health, research has shown that activities need to be of at least moderate intensity. For most people, this will mean experiencing an increased heart rate and breathing rate during the activity

The least active individuals stand to gain the most from a small increase in physical activity

<40% of lower limb amputees are sufficiently active and 33% are considered sedentary

Real impact

‘When I looked down now, I see my legs. I’m in charge of my legs. My legs are not in charge of me. But I can only do that by trying to be as active as a possibly can.’

‘If only other amputees would give it ago. I’m not talking about being an ‘athlete’. But if they went for a walk every day for half an hour it’ll really impact their well-being. It affects mine.’

‘Physical activity helps with my pain; it stretches me out and helps my circulation’

Summarise without adding anything

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Can I summarise what I think you have said?

Don’t be tempted to impose your own plan at this stage – they may agree with you just to end the conversation. Summarise the main points of the conversation and find out what they are thinking

This may sound something like: ‘so some of the benefits of physical activity for someone like you with X include A and B and C. The most important reasons for you personally would be P and W’.

Using a summary can be a good way to demonstrate and express empathy, that you can see the world from their perspective. Empathy contributes to outcomes in a range of settings.

Insight

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Don’t be tempted to impose your own plan at this stage – they may agree with you just to end the conversation. Summarise the main points of the conversation and find out what they are thinking

This may sound something like: ‘so some of the benefits of physical activity for someone like you with X include A and B and C. The most important reasons for you personally would be P and W’.

Using a summary can be a good way to demonstrate and express empathy, that you can see the world from their perspective. Empathy contributes to outcomes in a range of settings.

Did you know?

Strength and balance activities should be performed on at least two days per week

Those who are currently physically inactive should start gently and build up slowly, enabling their body to gradually adapt to the higher levels of activity  

Evidence has demonstrated that unsupervised physical activity at an appropriate intensity is safe for disabled adults

Real impact

‘This is your new normal, that’s what you have to learn. It doesn’t mean it’s going to be worse, it’s just new.’

‘If only other amputees would give it ago. I’m not talking about being an ‘athlete’. But if they went for a walk every day for half an hour it’ll really impact their well-being. It affects mine.’

‘If I keep my body in a good condition …then I can walk for a full day on my prosthesis. Thus, if I’m more active, I can use my prosthesis better.’

Ask the key question

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So, what do you think you will do?

If they decide that they are NOT ready:

Thank them for taking the time to talk with you about physical activity and offer an opportunity to review the conversation. Reassure them that help is available when they feel ready to change.

If they decide to become more active:

THEN move on to planning. Continue to keep the focus on them generating their own ideas for change, rather than telling and instructing. People are much more likely to make successful changes if they develop their own plans.

Insight

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The individual has heard about the benefits of physical activity for someone like them and has had the chance to consider the benefits they would most like to experience. They have heard their ideas spoken back to them, which can help to reinforce them. Now it’s decision time. Asking an open question ‘what do you think you will do?’ rather than a closed question ‘so, are you going to do physical activity?’ helps remind them that they – not you – are the decision maker. If they are not ready to change now this can be challenging for you, but they might have good reasons to keep things the same for now. Encouraging further reflection can be an important part of the process of helping people to make successful changes over time. Offer an opportunity to follow up on this conversation to review their thoughts about making changes.

Did you know?

Strength and balance activities should be performed on at least two days per week

Those who are currently physically inactive should start gently and build up slowly, enabling their body to gradually adapt to the higher levels of activity  

Evidence has demonstrated that unsupervised physical activity at an appropriate intensity is safe for disabled adults

Real impact

‘This is your new normal, that’s what you have to learn. It doesn’t mean it’s going to be worse, it’s just new.’

‘If only other amputees would give it ago. I’m not talking about being an ‘athlete’. But if they went for a walk every day for half an hour it’ll really impact their well-being. It affects mine.’

‘If I keep my body in a good condition …then I can walk for a full day on my prosthesis. Thus, if I’m more active, I can use my prosthesis better.’

Explore opportunities in daily routine

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How do you think you might get started?

Build activity into everyday life
Gardening
Carrying shopping bags
MM-Icons-Home Exercise Videos Stand during advert breaks
Housework – doing the hoovering
Bicycle
mm-icons-amputee walking Walk
Public Transport
Walking up stairs
mm-icons-amputee standing desk Standing desk
Standing to talk on a telephone
MM-Icons-Worksheet Active meeting
MM-Icons-Pool based activities Pool based activity – swimming or aqua class
Yoga/Pilates
mm-icons-Amputee – active play Throwing ball in park
Exercise class
mm-icons-Armchair Chair based exercises
Walking the dog
mm-icons-Disability – dancing Dance
MM-Icons-Home Exercise Videos Online exercise videos

Signpost the activity finder to explore local opportunities

Insight

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Useful questions to ask may include:

  • What easy or enjoyable ways can you think of fitting opportunities to move more into your daily life?
  • What’s the easiest thing you might do?
  • What kind of help might you need?
  • How often do you see yourself doing that?
  • Who might you do that with?

You may need to give some information here – about starting slow and building up, stopping if they notice any particular symptoms, etc.

Reflect back and expand on relevant points from your earlier discussion.

Did you know?

At least 150 minutes moderate intensity activity per week is recommended for substantial health gains

Dysvascular amputees are significantly less active than those who have undergone a lower limb amputation for other indications

With modern prostheses and advanced rehabilitation, the metabolic cost of walking for unilateral transtibial amputees is similar to able bodied individuals

Real impact

‘When I looked down now, I see my legs. I’m in charge of my legs. My legs are not in charge of me. But I can only do that by trying to be as active as a possibly can.’

‘I can’t live my life thinking what others will think. It’s my life and this is how I want to live my life. And I’m going to live my life. Regardless, if I’ve got two prostheses or not’

‘This is your new normal, that’s what you have to learn. It doesn’t mean it’s going to be worse, it’s just new.’

Agree a plan

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Can I share with you some things people find helpful when making a plan?

If they agree, ask them which of these might suit them

Share the relevant resource from the list below with your patient

Increase walking

This simple and progressive 12 week walking programme, developed by the ‘PACE-UP’ trial team is proven to help increase walking and health in the long term

Set some goals

Use our active lifestyles workbook to help those who are interested in building resilience and setting structured goals to create a roadmap for behaviour change

Use a diary

Creating a personalised monthly schedule helps work out where, when and how someone can start to fit opportunities to become more active into their own life

Use an app

iPrescribe Exercise is a NHS approved app, which provides a personalised 12 week physical activity plan with tailored support for people with long term health conditions. It is free to use, just add the code ‘moving’ when logging on

Insight

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Aim to keep the focus on the individual generating their own ideas about change, rather than telling and instructing. People are much more likely to make successful changes if they develop their own plans.

Did you know?

At least 150 minutes moderate intensity activity per week is recommended for substantial health gains

Dysvascular amputees are significantly less active than those who have undergone a lower limb amputation for other indications

With modern prostheses and advanced rehabilitation, the metabolic cost of walking for unilateral transtibial amputees is similar to able bodied individuals

Real impact

‘When I looked down now, I see my legs. I’m in charge of my legs. My legs are not in charge of me. But I can only do that by trying to be as active as a possibly can.’

‘I can’t live my life thinking what others will think. It’s my life and this is how I want to live my life. And I’m going to live my life. Regardless, if I’ve got two prostheses or not’

‘This is your new normal, that’s what you have to learn. It doesn’t mean it’s going to be worse, it’s just new.’

Troubleshoot

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What might get in the way of your plan?

Get some detail

When people come up with some ideas it’s good to get some detail, so ask them how they might find a way round that and who might help them get there.

Insight

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The pathway to successful behaviour change is seldom straightforward and people have often tried before. It is important to recognise, anticipate and prepare for setbacks and identify the individuals in someone’s life who will be able to support them through difficult periods. There is always more than one path to each destination and it is important to get support along the journey.Encouraging people to think of possible obstacles to success and ways around them can be helpful during the planning phase.

Did you know?

At least 150 minutes moderate intensity activity per week is recommended for substantial health gains

Dysvascular amputees are significantly less active than those who have undergone a lower limb amputation for other indications

With modern prostheses and advanced rehabilitation, the metabolic cost of walking for unilateral transtibial amputees is similar to able bodied individuals

Real impact

‘When I looked down now, I see my legs. I’m in charge of my legs. My legs are not in charge of me. But I can only do that by trying to be as active as a possibly can.’

‘I can’t live my life thinking what others will think. It’s my life and this is how I want to live my life. And I’m going to live my life. Regardless, if I’ve got two prostheses or not’

‘This is your new normal, that’s what you have to learn. It doesn’t mean it’s going to be worse, it’s just new.’

Arrange follow up

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What would be helpful for me to arrange for you to follow up on this conversation?

Ongoing support is a key factor of successful behavioural change and clinical services exist to support people through their own journey with their lower limb amputation.

Useful things to organise for people with lower limb amputations may include:

  • A follow up appointment with you or a colleague
  • Referral to a multidisciplinary pain programme
  • Referral to a walking for health or exercise referral programme

Signpost the patient information section, which contains links to physical activity opportunities.

Insight

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Asking this as an open question helps make it clear that what is important is their own personal agenda, not yours. It can be appropriate to follow up by asking permission to share follow up options they may not know about, such as:

  • Exercise on referral schemes are widely available throughout the UK, but their referral criteria and programmes vary. Check the local council’s website or contact the council’s physical activity lead to find out more information.
  • Referral to a multidisciplinary pain programme may be particularly important for people who are fearful of activity, have co-existing mental health problems and have been previously been unsuccessful in becoming more active.

The arrangement of a follow up appointment would also be appropriate for those people deciding not to become more active yet, but who want to ‘think about it some more’ The follow up appointment could be face to face but could also be via telephone or text.

Did you know?

Dysvascular amputees are significantly less active than those who have undergone a lower limb amputation for other indications

It is important that measures to increase physical activity in lower limb amputees do not compromise social interaction

The least active individuals stand to gain the most from a small increase in physical activity

Real impact

‘Just because I’ve got one left leg and no toes, that’s not going to stop me from keep living my life, you know’

‘When I looked down now, I see my legs. I’m in charge of my legs. My legs are not in charge of me. But I can only do that by trying to be as active as a possibly can.’

‘If only other amputees would give it ago. I’m not talking about being an ‘athlete’. But if they went for a walk every day for half an hour it’ll really impact their well-being. It affects mine.’

Signpost support organisations

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There are some great, free resources available here and on other websites by people who understand what it’s like living with your condition if you’d be interested to have a look

Support organisations

It can be helpful to share the patient information and other leaflets and links to the following organisations:

Activity Alliance

Activity Alliance work to make active lives possible by enabling organisations to support disabled individuals to be and stay active. Their work is centred on research and insight with disabled people as well as engagement with organisations from various sectors.

Limb Power

LimbPower work to engage amputees and individuals with limb impairments in physical activity, sport and the arts to improve quality of life and aid lifelong rehabilitation.

The Limbless Association

The Limbless Association are a leading charity for the limb-loss community, providing a wealth of information and support to their members. They provide assistance regarding legal advice and welfare benefits and co-ordinate a volunteer group of established amputees who offer support and advice to anyone who has had, or is having, an amputation.

Insight

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People may or may not be interested in accessing information and support groups, but they can offer unique support for people contemplating physical activity behavioural change with their condition. Particularly given the range and reliability of information on the internet, trusted resources are important to highlight.

Did you know?

Dysvascular amputees are significantly less active than those who have undergone a lower limb amputation for other indications

It is important that measures to increase physical activity in lower limb amputees do not compromise social interaction

The least active individuals stand to gain the most from a small increase in physical activity

Real impact

‘Just because I’ve got one left leg and no toes, that’s not going to stop me from keep living my life, you know’

‘When I looked down now, I see my legs. I’m in charge of my legs. My legs are not in charge of me. But I can only do that by trying to be as active as a possibly can.’

‘If only other amputees would give it ago. I’m not talking about being an ‘athlete’. But if they went for a walk every day for half an hour it’ll really impact their well-being. It affects mine.’