Prediction of peak oxygen uptake from differentiated ratings of perceived exertion during wheelchair propulsion in trained wheelchair sportspersons

Exoskeletal-Assisted Walking During Acute Inpatient Rehabilitation Enhances Recovery for Persons with Spinal Cord Injury-A Pilot Randomized Controlled Trial

Spinal cord injury (SCI) negatively impacts individuals' functional independence, and motor and sensory function. Intense walking training has been shown to facilitate recovery for individuals with chronic SCI. Powered robotic exoskeletons provide therapists with a tool that allows them to conduct walking training with less therapist effort as compared to conventional walking training. Exoskeletal-assisted walking (EAW) has been studied in the chronic SCI population with preliminary reports showing benefits in mobility, health, and quality-of-life outcomes. However, few reports have studied EAW's benefits in the acute (<90 days post) SCI population at a time when neural plasticity is most dynamic and modifiable. The purpose of the study was to conduct a pilot randomized controlled trial (RCT) to understand the effects of incorporated EAW in acute inpatient rehabilitation (AIR) for individuals with SCI on functional, motor, and sensory recovery. The study outcomes included the Spinal Cord Independence Measure (SCIM) III and International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) motor and sensory scores that were assessed by unblinded assessors. We also recorded EAW session data, including adverse events, walking and up time, step counts, Borg Rating of Perceived Exertion (RPE), and compliance with scheduled EAW training. From August 2019 to July 2022, 16 participants completed the AIR with incorporated EAW, and 12 completed the standard AIR, all with SCI and preserved leg function within 90 days post-injury. During each session, the AIR with incorporated EAW group averaged 34.3 (±9.4) min of up time, 25.4 (±7.7) min of walk time, and 536 (±157) steps. Analysis via two-by-two mixed-effects models showed significant increases in the SCIM total score and ISNCSCI total motor and sensory scores over time for the AIR with incorporated EAW group [SCIM total score: F(1, 26) = 5.59, p = 0.03; total motor score: F(1, 26) = 8.06, p < 0.01; total sensory score: F(1, 19.2) = 5.08, p = 0.04], outperforming the standard AIR group. The AIR with incorporated EAW group showed 13, 14, and 22 points higher changes in the SCIM total score, total motor score, and total sensory score (respectively) by discharge compared with the standard AIR group. Incorporating EAW into AIR may facilitate functional, motor, and sensory recovery for individuals with SCI during AIR better than standard AIR. However, the study had a limited sample size. Further studies are needed to clarify the effects of EAW in AIR.

Confirming the attainment of maximal oxygen uptake within special and clinical groups: A systematic review and meta-analysis of cardiopulmonary exercise test and verification phase protocols

BACKGROUND AND AIM

A plateau in oxygen uptake ([Formula: see text]) during an incremental cardiopulmonary exercise test (CPET) to volitional exhaustion appears less likely to occur in special and clinical populations. Secondary maximal oxygen uptake ([Formula: see text]) criteria have been shown to commonly underestimate the actual [Formula: see text]. The verification phase protocol might determine the occurrence of 'true' [Formula: see text] in these populations. The primary aim of the current study was to systematically review and provide a meta-analysis on the suitability of the verification phase for confirming 'true' [Formula: see text] in special and clinical groups. Secondary aims were to explore the applicability of the verification phase according to specific participant characteristics and investigate which test protocols and procedures minimise the differences between the highest [Formula: see text] values attained in the CPET and verification phase.

METHODS

Electronic databases (PubMed, Web of Science, SPORTDiscus, Scopus, and EMBASE) were searched using specific search strategies and relevant data were extracted from primary studies. Studies meeting inclusion criteria were systematically reviewed. Meta-analysis techniques were applied to quantify weighted mean differences (standard deviations) in peak [Formula: see text] from a CPET and a verification phase within study groups using random-effects models. Subgroup analyses investigated the differences in [Formula: see text] according to individual characteristics and test protocols. The methodological quality of the included primary studies was assessed using a modified Downs and Black checklist to obtain a level of evidence. Participant-level [Formula: see text] data were analysed according to the threshold criteria reported by the studies or the inherent measurement error of the metabolic analysers and displayed as Bland-Altman plots.

RESULTS

Forty-three studies were included in the systematic review, whilst 30 presented quantitative information for meta-analysis. Within the 30 studies, the highest mean [Formula: see text] values attained in the CPET and verification phase protocols were similar (mean difference = -0.00 [95% confidence intervals, CI = -0.03 to 0.03] L·min-1, p = 0.87; level of evidence, LoE: strong). The specific clinical groups with sufficient primary studies to be meta-analysed showed a similar [Formula: see text] between the CPET and verification phase (p > 0.05, LoE: limited to strong). Across all 30 studies, [Formula: see text] was not affected by differences in test protocols (p > 0.05; LoE: moderate to strong). Only 23 (53.5%) of the 43 reviewed studies reported how many participants achieved a lower, equal, or higher [Formula: see text] value in the verification phase versus the CPET or reported or supplied participant-level [Formula: see text] data for this information to be obtained. The percentage of participants that achieved a lower, equal, or higher [Formula: see text] value in the verification phase was highly variable across studies (e.g. the percentage that achieved a higher [Formula: see text] in the verification phase ranged from 0% to 88.9%).

CONCLUSION

Group-level verification phase data appear useful for confirming a specific CPET protocol likely elicited [Formula: see text], or a reproducible [Formula: see text], for a given special or clinical group. Participant-level data might be useful for confirming whether specific participants have likely elicited [Formula: see text], or a reproducible [Formula: see text], however, more research reporting participant-level data is required before evidence-based guidelines can be given.

TRIAL REGISTRATION

PROSPERO (CRD42021247658) https://www.crd.york.ac.uk/prospero.

Predicting Maximum Oxygen Uptake from Non-Exercise and Submaximal Exercise Tests in Paraplegic Men with Spinal Cord Injury

This study aimed to develop prediction equations for maximum oxygen uptake (VO₂max) based on non-exercise (anthropometric) and submaximal exercise (anthropometric and physiological) variables in paraplegic men with a spinal cord injury. All participants were tested on an arm ergometer using a maximal graded exercise test. Anthropometric variables such as age, height, weight, body fat, body mass index, body fat percentage, and arm muscle mass and physiological variables such as VO₂, VCO₂, and heart rate at 3 and 6 min of graded exercise tests were included in the multiple linear regression analysis. The prediction equations revealed the following. Regarding non-exercise variables, VO₂max was correlated with age and weight (equation R = 0.771, R² = 0.595, SEE= 3.187). Regarding submaximal variables, VO₂max was correlated with weight and VO₂ and VCO₂ at 6 min (equation R = 0.892, R² = 0.796, SEE = 2.309). In conclusion, our prediction equations can be used as a cardiopulmonary function evaluation tool to estimate VO₂max simply and conveniently using the anthropometric and physiological characteristics of paraplegic men with spinal cord injuries.

Evaluation of a standardized test protocol to measure wheelchair-specific anaerobic and aerobic exercise capacity in healthy novices on an instrumented roller ergometer

This study aims to evaluate whether a test protocol with standardized and individualized resistance settings leads to valid wheelchair Wingate tests (WAnT) and graded exercise tests (GXT) in healthy novices. Twenty able-bodied individuals (10M/10F, age 23 ± 2 years, body mass 72 ± 11 kg) performed an isometric strength test, sprint test, WAnT and GXT on a wheelchair ergometer. Using a previously developed set of regression equations, individuals’ isometric strength outcome was used to estimate the WAnT result (P30_est), from which an effective individual WAnT resistance was derived. The subsequently measured WAnT outcome (P30_meas) was used to estimate the GXT outcome (POpeak_est) and to scale the individual GXT resistance steps. Estimated and measured outcomes were compared. The WAnT protocol was considered valid when maximal velocity did not exceed 3 m·s^-1; the GXT protocol was considered valid when test duration was 8–12 min. P30_est did not significantly differ from P30_meas, while one participant did not have a valid WanT, as maximal velocity exceeded 3 m·s^-1. POpeak_est was 10% higher than POpeak_meas, and six participants did not reach a valid GXT: five participants had a test duration under 8 min and one participant over 12 min. The isometric strength test can be used to individually scale the WAnT protocol. The WAnT outcome scaled the protocol for the GXT less accurately, resulting in mostly shorter-than-desired test durations. In conclusion, the evaluated standardized and individualized test protocol was valid for the WAnT but less valid for the GXT among a group of novices. Before implementing the standardized individual test protocol on a broader scale, e.g. among paralympic athletes, it should be evaluated among different athletic wheelchair-dependent populations.

Knowledge Gaps in Biophysical Changes After Powered Robotic Exoskeleton Walking by Individuals With Spinal Cord Injury—A Scoping Review

In addition to helping individuals with spinal cord injury (SCI) regain the ability to ambulate, the rapidly evolving capabilities of robotic exoskeletons provide an array of secondary biophysical benefits which can reduce the complications resulting from prolonged immobilization. The proposed benefits of increased life-long over-ground walking capacity include improved upper body muscular fitness, improved circulatory response, improved bowel movement regularity, and reduced pain and spasticity. Beyond the positive changes related to physical and biological function, exoskeletons have been suggested to improve SCI individuals' quality of life (QOL) by allowing increased participation in day-to-day activities. Most of the currently available studies that have reported on the impact of exoskeletons on the QOL and prevention of secondary health complications on individuals with SCI, are of small scale and are heterogeneous in nature. Moreover, few meta-analyses and reviews have attempted to consolidate the dispersed data to reach more definitive conclusions of the effects of exoskeleton use. This scoping review seeks to provide an overview on the known effects of overground exoskeleton use, on the prevention of secondary health complications, changes to the QOL, and their effect on the independence of SCI individuals in the community settings. Moreover, the intent of the review is to identify gaps in the literature currently available, and to make recommendations on focus study areas and methods for future investigations.

The ability of heart rate or perceived exertion to predict oxygen uptake varies across exercise modes in persons with tetraplegia

STUDY DESIGN

Descriptive study.

OBJECTIVES

To examine grouped and intra-individual relationships between 1) exercise intensity and heart rate (EI-HR); 2) EI and oxygen uptake (EI-VO₂); 3) VO₂ and HR (VO₂-HR); and 4) perceived exertion and VO₂ (PE-VO₂) in persons with tetraplegia (C4/5-C8) during different modes of exercise.

SETTING

Community in Winnipeg, Canada.

METHODS

Participants exercised at 3 graded intensities during arm ergometry (ERG), wheeling indoors on cement (MWC), or hand-cycling outdoors (HC). EI (Watts, km/hr) and VO₂, HR and PE were recorded.

RESULTS

22 persons completed ERG, 14/22 also completed MWC and 5/22 completed ERG, MWC and HC. Regression analysis of grouped data showed a significant relationship between EI-VO₂ but not for EI-HR or HR-VO₂. Intra-individual analyses showed a strong correlation (r or ρ > 0.7) for VO₂-HR for 16/22 during ERG. In the participants completing multiple exercise modes, a strong VO₂-HR relationship was present in 12/14 in ERG, but in only 6/14 in MWC. The 5 persons exercising with all 3 modes had a strong HR-VO₂ relationship in 5/5 for ERG, 2/5 in MWC and 1/5 in HC. A strong relationship for PE-VO₂ was observed in a higher proportion of participants (versus HR-VO₂) during MWC (9/14) and HC (2/4).

CONCLUSION

Within the same individual, the HR-VO₂ relationship varies across modes, despite exercising over similar ranges of steady-state VO₂. HR appears less able to predict VO₂ compared to PE. Based on these new findings, systematic investigation of the HR-VO₂ relationship across modes of exercise in tetraplegia is warranted.

Comparison of two Borg exertion scales for monitoring exercise intensity in able-bodied participants, and those with paraplegia and tetraplegia

STUDY DESIGN

Cross-sectional cohort study.

OBJECTIVES

To compare ratings of perceived exertion (RPE) on Borg's 6-20 RPE scale and Category Ratio 10 (CR10) in able-bodied (AB) participants during upper and lower body exercise, and recreationally active participants with paraplegia (PARA) and athletes with tetraplegia (TETRA) during upper body exercise only.

SETTING

University and rehabilitation centre-based laboratories in UK and Netherlands.

METHODS

Twenty-four participants were equally split between AB, PARA, and TETRA. AB performed maximal tests using cycle (AB-CYC) and handcycle (AB-HC) ergometry. PARA and TETRA performed maximal handcycle and wheelchair propulsion tests, respectively. Oxygen uptake (V̇O₂) and blood lactate concentration were monitored throughout. RPE was rated each stage on Borg's RPE scale and CR10. Thresholds were identified according to log-V̇O₂ plotted against log-blood lactate (LT₁), and 1.5 mmol L^-1 greater than LT₁ (LT₂).

RESULTS

RPE from both scales were best fit against each other using a quadratic model, with high goodness of fit between scales that was independent of exercise mode and participant group (range R²: 0.965-0.970, P < 0.005). Though percentage peak V̇O₂ was significantly greater in TETRA (P < 0.005), there was no difference in RPE at LT₁ or LT₂ between groups on Borg's RPE scale or CR10.

CONCLUSION

Strong association between Borg's RPE scale and CR10 suggests they can be used interchangeably. RPE at lactate thresholds were independent of mode of exercise and level of spinal cord injury. However, inter-individual variation precludes from making firm recommendations about using RPE for prescribing homogenous exercise intensity.

Locomotor training in people with spinal cord injury: is this exercise?

Locomotor training holds tremendous appeal to people with spinal cord injury who are wheelchair dependent, as the reacquisition of gait remains one of the most coveted goals in this population. For the last few decades this type of training has remained primarily in the clinical environment, as it requires the use of expensive treadmills with bodyweight support or complex overhead suspension tracks to facilitate overground walking. The development of powered exoskeletons has taken locomotor training out of the clinic, both improving accessibility and providing a potential option for community ambulation in people with lower limb paralysis. A question that has yet to be answered, however, is whether or not locomotor training offers a sufficiently intense stimulus to induce improvements in fitness or health. As inactivity-related secondary health complications are a major source of morbidity and mortality in people with SCI, it would be important to characterize the potential of locomotor training to not only improve functional walking ability, but also improve health-related fitness. This narrative review will summarize the key literature in this area to determine whether locomotor training challenges the cardiovascular, muscular or metabolic systems enough to be considered a viable form of exercise.

Health promotion and cardiovascular risk reduction in people with spinal cord injury: physical activity, healthy diet and maintenance after discharge- protocol for a prospective national cohort study and a preintervention- postintervention study

INTRODUCTION

Spinal cord injury (SCI) predisposes those who suffer from it to physical inactivity and weight gain; consequently, death due to cardiovascular diseases is more frequent among people with SCI than in the general population. The literature documents a consensus about an interdisciplinary multimodal approach for the prevention and treatment of cardiovascular risk factors including overweight and obesity in people with SCI, focusing on diet, physical activity (PA) and behavioural interventions. This study will investigate implementation of recommendations from a recent clinical practice guideline for identification and management of cardiometabolic risk after SCI through multimodal patient education in a subacute clinical setting.

METHODS AND ANALYSIS

All patients who are aged 18 years or older with an SCI within the previous 12 months and admitted to highly specialised rehabilitation are included, regardless of SCI aetiology or neurological level. A primary study designed as a controlled, pragmatic, preintervention- postintervention study with 6-month follow-up evaluates the effect of the clinical intervention; a prospective national cohort study on body mass index (BMI) serves as a historical control. The intervention consists of a standardised approach to patient education about cardiovascular risk factors, PA and a healthy diet that begins at the outset of primary SCI rehabilitation and is integrated into existing settings and workflows. Outcome measures are collected at admission, discharge and 6 months after discharge and include peak oxygen uptake (VO2peak) (primary outcome), BMI, body composition, metabolic profile, neurological status, level of functioning, depression, quality of life, objective PA (accelerometry), self-reported PA, self-assessed PA ability, shared decision making, and dietary habits. Test-retest reliability of four VO2peak test protocols are investigated, as is test-retest reliability of a multisensor accelerometer in a rehabilitation setting.

ETHICS AND DISSEMINATION

The project is approved by the Committees on Health Research Ethics in the Capital Region of Denmark on 10 July 2018 (Journal-nr.: H-18018325). The principal investigator obtains informed consent from all participants. The interventions in the project are closely related to existing rehabilitation care, and the risk of pain and discomfort is considered modest. Any unintended events related to the elements of the intervention are reported, according to existing regional procedures. Data are stored in a secure web-based database (Redcap). The primary study and prospective cohort study are registered at Clinicaltrials.gov. Positive and negative results will be submitted to relevant scientific journals related to SCI for publication. Important protocol modifications are reported to the Committees on Health Research Ethics in the Capital Region of Denmark.

TRIAL REGISTRATION NUMBERS

NCT03689023 and NCT03369080.

Intensity of physical activity as a percentage of peak oxygen uptake, heart rate and Borg RPE in motor-complete para- and tetraplegia

Objective

The aims were to describe VO_2peak, explore the potential influence of anthropometrics, demographics and level of physical activity within each cohort; b) to define common, standardized activities as percentages of VO_2peak and categorize these as light, moderate and vigorous intensity levels according to present classification systems, and c) to explore how clinically accessible methods such as heart-rate monitoring and Borg rating of perceived exertion (RPE) correlate or can describe light, moderate and vigorous intensity levels.

Design

Cross sectional.

Setting

Rehabilitation facility and laboratory environment.

Subjects

Sixty-three individuals, thirty-seven (10 women) with motor-complete paraplegia (MCP), T7-T12, and twenty-six (7 women) with motor-complete tetraplegia (MCT), C5-C8.

Interventions

VO_2peak was obtained during a graded peak test until exhaustion, and oxygen uptake during eleven different activities was assessed and categorized using indirect calorimetry.

Main outcome measures

VO_2peak, Absolute and relative oxygen consumption, Borg RPE.

Results

Absolute VO_2peak was significantly higher in men than in women for both groups, with fairly small differences in relative VO_2peak. For MCP sex, weight and time spent in vigorous-intensity activity explained 63% of VO_2peak variance. For MCT sex and time in vigorous-intensity activity explained 55% of the variance. Moderate intensity corresponds to 61–72% HR_peak and RPE 10–13 for MCP vs. 71–79% HR_peak, RPE 13–14 for MCT.

Conclusion

Using current classification systems, eleven commonly performed activities were categorized in relative intensity terms, (light, moderate and vigorous) based on percent of VO_2peak, HR_peak and Borg RPE. This categorization enables clinicians to better guide persons with SCI to meet required physical activity levels.

The influence of operator and wheelchair factors on wheelchair propulsion effort

Purpose: The goal of this study was to evaluate the relative influence of operator and wheelchair factors on propulsion effort during over-ground wheelchair manoeuvres.Method: This observational study included 23 full-time manual wheelchair users and 13 able-bodied subjects. The operator factors included shoulder position, aerobic capacity and propulsion strength. The wheelchair factors included system mass, weight distribution, and frictional loss in straight and turning trajectories. The performance of over-ground manoeuvres was defined as the propulsion effort measured by VO₂ as operators propelled along a modified figure-8 course on tile and carpet surfaces.Results: According to our regression model, shoulder position was the only significant contributor within operator factors, whereas weight distribution was the only significant contributor within wheelchair factors in influencing propulsion efforts. When combining operator and mechanical factors in the regression model, weight distribution became the only significant contributor to influence propulsion effort.Conclusion: Weight distribution and shoulder position had a significant influence on propulsion effort. These variables are related to the operator's relationship to the drive wheels. However, system mass and muscle strength had the least influence on wheelchair manoeuvres. Our finding can help clinicians to improve wheelchair configurations and manufacturers to improve wheelchair design by understanding the importance of shoulder position and weight distribution.Implication for rehabilitationStudying wheelchair manoeuvers by considering both wheelchair and operator factors might provide a unique insight to address the complex interactions among wheelchair designs and users.Propulsion effort decreases as percentage weight is increased on the drive wheels and the shoulder becomes more aligned with the axle position, which highlights the need to optimize wheelchair axle position.Wheelchair configuration, as represented by weight distribution, had a more significant influence on everyday manoeuvre than wheelchair mass does.It is essential for wheelchair users to choose a wheelchair that can match their daily needs and anthropometric measurements for saving propulsion efforts.

Peak oxygen uptake measured during a perceptually-regulated exercise test is reliable in community-based manual wheelchair users

This study compares test-retest reliability and peak exercise responses from ramp-incremented (RAMP) and maximal perceptually-regulated (PRET_max) exercise tests during arm crank exercise in individuals reliant on manual wheelchair propulsion (MWP). Ten untrained participants completed four trials over 2-weeks (two RAMP (0-40 W + 5-10 W · min^-1) trials and two PRET_max. PRET_max consisted of five, 2-min stages performed at Ratings of Perceived Exertion (RPE) 11, 13, 15, 17 and 20). Participants freely changed the power output to match the required RPE. Gas exchange variables, heart rate, power output, RPE and affect were determined throughout trials. The V̇O_2peak from RAMP (14.8 ± 5.5 ml · kg^-1 · min^-1) and PRET_max (13.9 ± 5.2 ml · kg^-1 · min^-1) trials were not different (P = 0.08). Measurement error was 1.7 and 2.2 ml · kg^-1 · min^-1 and coefficient of variation 5.9% and 8.1% for measuring V̇O_2peak from RAMP and PRET_max, respectively. Affect was more positive at RPE 13 (P = 0.02), 15 (P = 0.01) and 17 (P = 0.01) during PRET_max. Findings suggest that PRET_max can be used to measure V̇O_2peak in participants reliant on MWP and leads to a more positive affective response compared to RAMP.

Peak oxygen uptake in Paralympic sitting sports: A systematic literature review, meta- and pooled-data analysis

Background

Peak oxygen uptake (VO_2peak) in Paralympic sitting sports athletes represents their maximal ability to deliver energy aerobically in an upper-body mode, with values being influenced by sex, disability-related physiological limitations, sport-specific demands, training status and how they are tested.

Objectives

To identify VO_2peak values in Paralympic sitting sports, examine between-sports differences and within-sports variations in VO_2peak and determine the influence of sex, age, body-mass, disability and test-mode on VO_2peak.

Design

Systematic literature review and meta-analysis.

Data sources

PubMed, CINAHL, SPORTDiscus^TM and EMBASE were systematically searched in October 2016 using relevant medical subject headings, keywords and a Boolean.

Eligibility criteria

Studies that assessed VO_2peak values in sitting sports athletes with a disability in a laboratory setting were included.

Data synthesis

Data was extracted and pooled in the different sports disciplines, weighted by the Dersimonian and Laird random effects approach. Quality of the included studies was assessed with a modified version of the Downs and Black checklist by two independent reviewers. Meta-regression and pooled-data multiple regression analyses were performed to assess the influence of sex, age, body-mass, disability, test mode and study quality on VO_2peak.

Results

Of 6542 retrieved articles, 57 studies reporting VO_2peak values in 14 different sitting sports were included in this review. VO_2peak values from 771 athletes were used in the data analysis, of which 30% participated in wheelchair basketball, 27% in wheelchair racing, 15% in wheelchair rugby and the remaining 28% in the 11 other disciplines. Fifty-six percent of the athletes had a spinal cord injury and 87% were men. Sports-discipline-averaged VO_2peak values ranged from 2.9 L∙min^-1 and 45.6 mL∙kg^-1∙min^-1 in Nordic sit skiing to 1.4 L∙min^-1 and 17.3 mL∙kg^-1∙min^-1 in shooting and 1.3 L∙min^-1 and 18.9 mL∙kg^-1∙min^-1 in wheelchair rugby. Large within-sports variation was found in sports with few included studies and corresponding low sample sizes. The meta-regression and pooled-data multiple regression analyses showed that being a man, having an amputation, not being tetraplegic, testing in a wheelchair ergometer and treadmill mode, were found to be favorable for high absolute and body-mass normalized VO_2peak values. Furthermore, high body mass was favourable for high absolute VO_2peak values and low body mass for high body-mass normalized VO_2peak values.

Conclusion

The highest VO_2peak values were found in Nordic sit skiing, an endurance sport with continuously high physical efforts, and the lowest values in shooting, a sport with low levels of displacement, and in wheelchair rugby where mainly athletes with tetraplegia compete. However, VO_2peak values need to be interpreted carefully in sports-disciplines with few included studies and large within-sports variation. Future studies should include detailed information on training status, sex, age, test mode, as well as the type and extent of disability in order to more precisely evaluate the effect of these factors on VO_2peak.

Comparison of Aerobic Performance Testing Protocols in Elite Male Wheelchair Basketball Players

In wheelchair sports, aerobic performance is commonly assessed with the use of an arm crank ergometer (ACE), a wheelchair ergometer (WCE) or a wheelchair treadmill (WCT). There are different protocols to identify peak oxygen uptake in wheelchair sports; however, only a few protocols have been applied to evaluate these conditions in wheelchair basketball players. The purpose of this study was to compare physiological responses during maximal exercise testing with the use of ACE and WCT in wheelchair basketball players. Twelve elite male wheelchair basketball players participated in this study. The research was performed during a training camp of the Polish National Wheelchair Basketball Team. The study participants were divided into two functional categories: A (players with class 1.0 - 2.5) and B (players with class 3.0 - 4.5). Two main maximal exercise tests, i.e. wheelchair treadmill stress test (WCT test) and arm crank ergometer stress test (ACE test) were used to evaluate aerobic performance of the players. There were no statistically significant differences in aerobic tests between the players from both groups. The comparison of results achieved in two aerobic tests performed on WCT and ACE did not reveal any significant differences between the analyzed variables (peak heart rate (HRpeak), peak oxygen uptake (VO2peak), minute ventilation (VE), anaerobic threshold (AT), lactate concentration (LApeak), and a drop in lactate concentration (%LA)). Strong correlations between results achieved in WCT and ACE tests were found for VO2peak, VE and LApeak. The main conclusion of the study is that both WCT and ACE tests may be useful when determining aerobic capacity of wheelchair basketball players. Moreover, both protocols can be used by athletes regardless of their functional capabilities and types of impairment.

Submaximal, Perceptually Regulated Exercise Testing Predicts Maximal Oxygen Uptake: A Meta-Analysis Study

BACKGROUND

Recently, several authors have proposed the use of a submaximal 'perceptually regulated exercise test' (PRET) to predict maximal oxygen uptake ([Formula: see text]). The PRET involves asking the individual to self-regulate a series of short bouts of exercise corresponding to pre-set ratings of perceived exertion (RPE). The individual linear relationship between RPE and oxygen uptake (RPE:[Formula: see text]) is then extrapolated to the [Formula: see text], which corresponds to the theoretical maximal RPE (RPE20). Studies suggest that prediction accuracy from this method may be better improved during a second PRET. Similarly, some authors have recommended an extrapolation to RPE19 rather than RPE20.

OBJECTIVES

The purpose of the meta-analysis was to examine the validity of the method of predicting [Formula: see text] from the RPE:[Formula: see text] during a PRET, and to determine the level of agreement and accuracy of predicting [Formula: see text] from an initial PRET and retest using RPE19 and RPE20.

DATA SOURCES

From a systematic search of the literature, 512 research articles were identified.

STUDY ELIGIBILITY CRITERIA

The eligible manuscripts were those which used the relationship between the RPE≤15 and [Formula: see text], and used only the Borg's RPE scale.

PARTICIPANTS AND INTERVENTIONS

Ten studies (n = 274 individuals) were included.

STUDY APPRAISAL AND SYNTHESIS METHODS

For each study, actual and predicted [Formula: see text] from four subgroup outcomes (RPE19 in the initial test, RPE19 in the retest, RPE20 in the initial test, RPE20 in the retest) were identified, and then compared. The magnitude of the difference regardless of subgroup outcomes was examined to determine if it is better to predict [Formula: see text] from extrapolation to RPE19 or RPE20. The magnitude of differences was examined for the best PRET (test vs retest).

RESULTS

The results revealed that [Formula: see text] may be predicted from RPE:[Formula: see text] during PRET in different populations and in various PRET modalities, regardless of the subgroup outcomes. To obtain greater accuracy of predictions, extrapolation to RPE20 during a retest may be recommended.

LIMITATIONS

The included studies reported poor selection bias and data collection methods.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

The [Formula: see text] may be predicted from RPE:[Formula: see text] during PRET, especially when [Formula: see text] is extrapolated to RPE20 during a second PRET.

Predicting peak oxygen uptake from submaximal exercise after spinal cord injury

The purpose of this study was to determine the validity of the 6-min arm ergometry test (6MAT) in predicting peak oxygen consumption (V̇O2peak) in individuals with chronic spinal cord injury (SCI). Fifty-two individuals with chronic SCI (age, 38 ± 10 years; American Spinal Injury Association Impairment Scale (AIS), A-D; neurological level of injury (NLI), C1-L2; years post-injury (YPI), 13 ± 10 years) completed an incremental arm ergometry V̇O2peak test and a submaximal 6MAT. Oxygen consumption (V̇O2) data from both tests were used to create a predictive equation with regression analysis. Subsequently, a cross-validation group comprising an additional 10 individuals with SCI (age, 39 ± 13 years; AIS, A-D; NLI, C3-L3; YPI, 9 ± 9 years) were used to determine the predictive power of the equation. All participants were able to complete both the V̇O2peak and 6MAT assessments. Regression analysis yielded the following equation to predict V̇O2peak from end-stage 6MAT V̇O2: V̇O2peak (mL·kg(-1)·min(-1)) = 1.501(6MAT V̇O2) - 0.940. Correlation between measured and predicted V̇O2peak was excellent (r = 0.89). No significant difference was found between measured (17.41 ± 7.44 mL·kg(-1)·min(-1)) and predicted (17.42 ± 6.61 mL·kg(-1)·min(-1)) V̇O2peak (p = 0.97). When cross-validated with a sample of 10 individuals with SCI, correlation between measured and predicted V̇O2peak remained high (r = 0.89), with no differences between measured (18.81 ± 8.35 mL·kg(-1)·min(-1)) and predicted (18.73 ± 7.27 mL·kg(-1)·min(-1)) V̇O2peak (p = 0.75). Results suggest that 6MAT V̇O2 can be used to predict V̇O2peak among individuals with chronic SCI. The 6MAT should be used as a clinical tool for assessing aerobic capacity when peak exercise testing is not feasible.