# Walking Exercise Sustainability Through Telehealth for Veterans with Lower-LimbAmputation

> **NIH VA I01** · VA EASTERN COLORADO HEALTH CARE SYSTEM · 2022 · —

## Abstract

Veterans living with lower-limb amputation have poor physical health outcomes, multiple chronic comorbidities,
high medical service utilization, and high levels of disability. Self-reported disability for people living with lower-
limb amputation is greater than 95% of the general population. One way to reduce disability for Veterans with
lower-limb amputation is for them to participate in life-long sustained walking exercise. Regular exercise
improves functional independence and mental well-being, and reduces adverse effects of common
comorbidities associated with lower-limb amputation, such as diabetes and peripheral artery disease.
However, most Veterans with lower-limb amputation do not regularly exercise. Only 50% of people with lower-
limb amputation achieve levels of walking activity that support participation in their local community, creating a
critical need to improve physical exercise participation after lower-limb amputation. Evidence suggests that
clinician-supported exercise in a person’s home living environment that includes evidence-based promotion of
patient self-management has promise for interrupting the cycle of elevated sedentary behavior and poor health
outcomes. Therefore, the primary aim of this randomized controlled superiority trial is to determine if a
telerehabilitation walking exercise self-management program produces clinically meaningful walking exercise
sustainability compared to attention-control education. This novel, low-cost intervention includes a novel
combination of piloted behavior-change methods and clinical resources, including VA multidisciplinary
telehealth sessions, individual exercise self-management training, and VA Whole Health peer-group sessions.
In addition, the intervention is integrated within an established VA Regional Amputation Center, using
established VA clinical telerehabilitation and technology. Exercise and physical activity will be monitored as a
continuous daily outcome, with secondary outcomes assessed at a baseline test and then after 6 and 18
months of intervention participation. The primary outcome will be accelerometer-assessed daily walking step
count monitored continuously each day across the 18-month study period. Secondary outcomes are designed
to assess the potential to assess how to best translate the walking exercise intervention into conventional VA
amputation rehabilitation. These secondary outcomes include measures of intervention reach, intervention
efficacy, likelihood of clinical adoption, potential for clinical implementation, and ability of participants to
maintain long-term exercise behavior. The unique rehabilitation paradigm used in this study addresses the
problem of chronic sedentary lifestyles following lower-limb amputation with a home-based exercise model of
life-long exercise support from clinicians and peers. The trial results will advance rehabilitation knowledge and
provide the necessary evidence for larger clinical translation of self-management interv...

## Key facts

- **NIH application ID:** 10534859
- **Project number:** 1I01RX003917-01A1
- **Recipient organization:** VA EASTERN COLORADO HEALTH CARE SYSTEM
- **Principal Investigator:** Cory L Christiansen
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2022-11-01 → 2026-10-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10534859

## Citation

> US National Institutes of Health, RePORTER application 10534859, Walking Exercise Sustainability Through Telehealth for Veterans with Lower-LimbAmputation (1I01RX003917-01A1). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10534859. Licensed CC0.

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