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Ashton JS, Roberts JW, Wakefield CJ, MacLaren DPM, Marwood S, Malone JJ. Medium chain triglycerides with a C8:C10 ratio of 30:70 enhances cognitive performance and mitigates the cognitive decline associated with prolonged exercise in young and healthy adults. Physiol Behav 2023; 269:114284. [PMID: 37394051 DOI: 10.1016/j.physbeh.2023.114284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 06/09/2023] [Accepted: 06/27/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION Prolonged exercise has been linked to a decline in cognitive function due to a variety of factors, such as a drop in oxygen in the prefrontal cortex and an increase in stress hormones and neurotransmitters. Medium chain triglycerides (MCTs) may possibly offset this decline as they provide energy for the brain via both direct and indirect pathways, alongside promoting chronic physiological adaptations within the brain. METHODS Participants were divided into two groups; MCT (n = 9) and Placebo (n = 10). The MCT gels contained 6 g of MCT with a C8:C10 ratio of 30:70, whereas the placebo gels contained carbohydrates of similar calorific value to the MCT gels. Participants visited the laboratory on three occasions (familiarisation/fitness test, pre-supplementation, post-supplementation), during which they performed a battery of cognitive tasks assessing domains such as processing speed, working memory, selective attention, decision making and coordination, before and after a prolonged bout of exercise (60 mins at 90% gas exchange threshold (GET). A 2-week supplementation period between visits 2 and 3 involved the ingestion of 2 gels per day. RESULTS Exercise resulted in detriments in most cognitive tasks pre-supplementation for both groups, and post-supplementation for the Placebo group (main effect ps< 0.05). Post-supplementation, the effect of exercise was mediated in the MCT group for all cognitive tasks (main effect ps< 0.05), except for the Digit and Spatial Span Backwards test phases (main effect ps> 0.05). Furthermore, MCT supplementation enhanced before-exercise cognitive performance and in some measures, such as working memory, this was maintained after-exercise (interaction effect ps> 0.05). CONCLUSIONS Chronic MCT supplementation enhanced before-exercise cognitive performance and offset the cognitive decline caused by a prolonged bout of exercise. In some cases, improvements in before-exercise cognitive performance were maintained after-exercise.
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Affiliation(s)
- Jake S Ashton
- School of Health and Sport Sciences, Liverpool Hope University, Liverpool, UK.
| | - James W Roberts
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | | | - Don P M MacLaren
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Simon Marwood
- School of Health and Sport Sciences, Liverpool Hope University, Liverpool, UK
| | - James J Malone
- School of Health and Sport Sciences, Liverpool Hope University, Liverpool, UK
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Gures A, Colakoglu M, Ozkaya O, As H, Balci GA. Cardiovascular responses of exercises performed within the extreme exercise domain. Physiol Res 2023; 72:319-327. [PMID: 37449745 PMCID: PMC10668999 DOI: 10.33549/physiolres.935068] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/03/2023] [Indexed: 08/26/2023] Open
Abstract
Stroke volume (SV), heart rate (HR) and arterio-venous O2 difference (a-vO2diff) responses to heavy and severe-intensity exercise have been well documented; however, there is a lack of information on the SV, HR and a v-O2diff responses of work rates within extreme exercise domain. The aim of this study was, therefore, to focus on central and peripheral components of VO2 responses to exercises performed within the heavy, severe and extreme exercise domain. Eight well-trained male cyclists participated in this study. Maximal O2 consumption (VO2max) and corresponding work rate (P@VO2max) were determined by multisession constant work rate exercises. Cardiovascular responses to exercises were evaluated by nitrous-oxide rebreathing method with work rates from 40 % to 160 % of P@VO2max, VO2max corresponded to 324+/-39.4 W; however, maximal SV responses occurred at 205+/-54.3 W (p<0.01). Maximal cardiac output (Q), HR, and a vO2diff responses were revealed by the P@VO2max. VO2 response to exercise significantly decreased from severe-intense exercises to the first work rate of extreme exercise domain due to significant decreases in Q, SV, and HR responses (p<0.05), except a v-O2diff (p>0.05). Moreover, non-significant decreases in Q, SV, and a v-O2diff were evaluated as response to increase in work rate belonging to extreme work rates (p>0.05), except the HR (p<0.05). Work rates within the lower district of the extreme exercise domain have an important potential to improve peripheral component of VO2, while the P@VO2max seems the most appropriate intensity for aerobic endurance development as it maximizes the central component of VO2max.
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Affiliation(s)
- A Gures
- Department of Coaching Education, Faculty of Sports Sciences, Adnan Menderes University, Aydin, Republic of Türkiye, Department of Coaching Education, Faculty of Sports Sciences, Ege University, Izmir, Republic of Türkiye.
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Janssen RJF, de Groot S, Van der Woude LHV, Houdijk H, Vegter RJK. Toward a Standardized and Individualized Laboratory-Based Protocol for Wheelchair-Specific Exercise Capacity Testing in Wheelchair Athletes: A Scoping Review. Am J Phys Med Rehabil 2023; 102:261-269. [PMID: 34930864 PMCID: PMC9940834 DOI: 10.1097/phm.0000000000001941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Previous studies on handrim wheelchair-specific (an)aerobic exercise capacity in wheelchair athletes have used a diversity of participants, equipment, and protocols. Therefore, test results are difficult to compare among studies. The first aim of this scoping review is to provide an overview of the populations studied, the equipment and protocols used, and the reported outcomes from all laboratory-based studies on wheelchair-specific exercise capacity in wheelchair athletes. The second aim is to synthesize these findings into a standardized, yet individualized protocol. A scoping literature search resulted in 10 anaerobic and 38 aerobic protocols. A large variety in equipment, protocol design, and reported outcomes was found. Studies that systematically investigated the influence of protocol features are lacking, which makes it difficult to interpret and compare test outcomes among the heterogeneous group of wheelchair athletes. Protocol design was often dependent on a priori participant knowledge. However, specific guidelines for individualization were missing. However, the common protocol features of the different studies were united into guidelines that could be followed when performing standardized and individualized wheelchair-specific exercise capacity tests in wheelchair athletes. Together with guidelines regarding reporting of participant characteristics, used equipment, and outcome measures, we hope to work toward more international agreement in future testing.
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Janssen RJF, Vegter RJK, Houdijk H, Van der Woude LHV, de Groot S. Evaluation of a standardized test protocol to measure wheelchair-specific anaerobic and aerobic exercise capacity in healthy novices on an instrumented roller ergometer. PLoS One 2022; 17:e0274255. [PMID: 36067184 PMCID: PMC9447903 DOI: 10.1371/journal.pone.0274255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/25/2022] [Indexed: 11/19/2022] Open
Abstract
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 (P30est), from which an effective individual WAnT resistance was derived. The subsequently measured WAnT outcome (P30meas) was used to estimate the GXT outcome (POpeakest) 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. P30est did not significantly differ from P30meas, while one participant did not have a valid WanT, as maximal velocity exceeded 3 m·s-1. POpeakest was 10% higher than POpeakmeas, 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.
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Affiliation(s)
- Rowie J. F. Janssen
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- * E-mail:
| | - Riemer J. K. Vegter
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Peter Harrison Centre for Disability Sports, School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Han Houdijk
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lucas H. V. Van der Woude
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Peter Harrison Centre for Disability Sports, School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
- Center for Rehabilitation, University Medical Center Groningen, Groningen, The Netherlands
| | - Sonja de Groot
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Rehabilitation Research Center Reade, Amsterdam, The Netherlands
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As H, Cabuk R, Norouzi M, Balci G, Ozkaya O. Comparison of the critical power estimated by the best fit method and the maximal lactate steady state. Sci Sports 2022. [DOI: 10.1016/j.scispo.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Riboli A, Rampichini S, Cè E, Limonta E, Borrelli M, Coratella G, Esposito F. Training status affects between-protocols differences in the assessment of maximal aerobic velocity. Eur J Appl Physiol 2021; 121:3083-3093. [PMID: 34319445 PMCID: PMC8505335 DOI: 10.1007/s00421-021-04763-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/02/2021] [Indexed: 11/26/2022]
Abstract
Purpose Continuous incremental protocols (CP) may misestimate the maximum aerobic velocity (Vmax) due to increases in running speed faster than cardiorespiratory/metabolic adjustments. A higher aerobic capacity may mitigate this issue due to faster pulmonary oxygen uptake (\documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}$$\end{document}V˙O2) kinetics. Therefore, this study aimed to compare three different protocols to assess Vmax in athletes with higher or lower training status. Methods Sixteen well-trained runners were classified according to higher (HI) or lower (LO) \documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}$$\end{document}V˙O2max\documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}$$\end{document}V˙O2-kinetics was calculated across four 5-min running bouts at 10 km·h−1. Two CPs [1 km·h−1 per min (CP1) and 1 km·h−1 every 2-min (CP2)] were performed to determine Vmax\documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}$$\end{document}V˙O2max, lactate-threshold and submaximal \documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}$$\end{document}V˙O2/velocity relationship. Results were compared to the discontinuous incremental protocol (DP). Results Vmax, \documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}$$\end{document}V˙O2max, \documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}$$\end{document}V˙CO2 and VE were higher [(P < 0.05,(ES:0.22/2.59)] in HI than in LO. \documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}$$\end{document}V˙O2-kinetics was faster [P < 0.05,(ES:-2.74/ − 1.76)] in HI than in LO. \documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}$$\end{document}V˙O2/velocity slope was lower in HI than in LO [(P < 0.05,(ES:-1.63/ − 0.18)]. Vmax and \documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}$$\end{document}V˙O2/velocity slope were CP1 > CP2 = DP for HI and CP1 > CP2 > DP for LO. A lower [P < 0.05,(ES:0.53/0.75)] Vmax-difference for both CP1 and CP2 vs DP was found in HI than in LO. Vmax-differences in CP1 vs DP showed a large inverse correlation with Vmax, \documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}$$\end{document}V˙O2max and lactate-threshold and a very large correlation with \documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}$$\end{document}V˙O2-kinetics. Conclusions Higher aerobic training status witnessed by faster \documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}$$\end{document}V˙O2 kinetics led to lower between-protocol Vmax differences, particularly between CP2 vs DP. Faster kinetics may minimize the mismatch issues between metabolic and mechanical power that may occur in CP. This should be considered for exercise prescription at different percentages of Vmax.
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Affiliation(s)
- Andrea Riboli
- Department of Biomedical Sciences for Health (SCIBIS), University of Milan, Via G. Colombo 71, 20133, Milan, Italy.
| | - Susanna Rampichini
- Department of Biomedical Sciences for Health (SCIBIS), University of Milan, Via G. Colombo 71, 20133, Milan, Italy
| | - Emiliano Cè
- Department of Biomedical Sciences for Health (SCIBIS), University of Milan, Via G. Colombo 71, 20133, Milan, Italy
| | - Eloisa Limonta
- Department of Biomedical Sciences for Health (SCIBIS), University of Milan, Via G. Colombo 71, 20133, Milan, Italy
| | - Marta Borrelli
- Department of Biomedical Sciences for Health (SCIBIS), University of Milan, Via G. Colombo 71, 20133, Milan, Italy
| | - Giuseppe Coratella
- Department of Biomedical Sciences for Health (SCIBIS), University of Milan, Via G. Colombo 71, 20133, Milan, Italy
| | - Fabio Esposito
- Department of Biomedical Sciences for Health (SCIBIS), University of Milan, Via G. Colombo 71, 20133, Milan, Italy
- IRCCS, Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161, Milan, Italy
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Ozkaya O, Balci GA, As H, Yildiztepe E. A new technique to analyse threshold-intensities based on time dependent change-points in the ratio of minute ventilation and end-tidal partial pressure of carbon-dioxide production. Respir Physiol Neurobiol 2021; 294:103735. [PMID: 34229064 DOI: 10.1016/j.resp.2021.103735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/18/2021] [Accepted: 07/01/2021] [Indexed: 11/19/2022]
Abstract
The aim of this study was to test the utility and effectiveness of an alternative computational approach to threshold-intensities based on time dependent change-points in minute ventilation divided by end-tidal partial pressure of CO2 (VE/PETCO2) to reveal whether respiratory compensation point (RCP) is a third ventilatory threshold, or not. Ten recreationally active young adults and ten well-trained athletes volunteered to take part in this study. Following incremental ramp tests, gas exchange threshold (GET) and respiratory compensation point (RCP) were respectively evaluated by the slopes of VCO2-VO2 and VE-VCO2 using the Innocor system automatically. Respiratory threshold (RT) was analysed based on time dependent change-points in the VE/PETCO2 using binary segmentation algorithm. Additionally, those intersections were analysed independently by two experienced investigators using a visual identification technique in a double-blind design. According to the results, in the recreationally active group, there were the first (GET1) and the second (GET2) gas exchange thresholds which were identical with the RT1 (139 W; 1.9 L⋅min-1 of VO2; 1.73 L⋅min-1 of VCO2; 49.9 L⋅min-1 of VE versus 139 W; 1.88 L⋅min-1; 1.7 L⋅min-1; 49 L⋅min-1, respectively) and RT2 (186 W; 2.39 L⋅min-1 of VO2; 2.44 L⋅min-1 of VCO2; 66 L⋅min-1 of VE versus 187 W; 2.41 L⋅min-1; 2.49 L⋅min-1; 65.7 L⋅min-1, respectively). However, there were three threshold intensities which were determined by GET1, GET2, and RCP in well-trained athletes. Additionally, RT1, RT2, and RT3 were determined as valid surrogates of the GET1 (194 W; 2.56 L⋅min-1 of VO2; 1.99 L⋅min-1 of VCO2; 57.5 L⋅min-1 of VE versus 192 W; 2.61 L⋅min-1; 1.99 Lmin-1; 57.7 L⋅min-1, respectively), GET2 (267 W; 3.6 L⋅min-1 of VO2; 3.29 L⋅min-1 of VCO2; 94.5 L⋅min-1 of VE versus 266 W; 3.58 L⋅min-1; 3.26 L⋅min-1; 93.4 L⋅min-1, respectively), and RCP (324 W; 4.05 L⋅min-1 of VO2; 4.13 L⋅min-1 of VCO2; 124 L⋅min-1 of VE versus 322 W; 4.02 L⋅min-1; 4.07 L⋅min-1; 122 L⋅min-1, respectively) in well-trained athletes. There were high levels of agreements between the power outputs determined by traditional techniques and newly proposed change-points in RT. All markers were strongly correlated (p < 0.001). It was shown that RT technique can provide an accurate threshold determination. Furthermore, the RCP was observed as a third threshold-intensity for well-trained athletes but not for recreationally active young adults.
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Affiliation(s)
- Ozgur Ozkaya
- Department of Coaching Education, Faculty of Sport Sciences, Ege University, 35050, Bornova, Izmir, Turkey.
| | - Gorkem A Balci
- Department of Coaching Education, Faculty of Sport Sciences, Ege University, 35050, Bornova, Izmir, Turkey
| | - Hakan As
- Department of Sports and Health Sciences, Institution of Health Sciences, Ege University, 35050, Bornova, Izmir, Turkey
| | - Engin Yildiztepe
- Department of Statistics, Faculty of Science, Dokuz Eylul University, 35390, Buca, Izmir, Turkey
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Vegter RJK, van den Brink S, Mouton LJ, Sibeijn-Kuiper A, van der Woude LHV, Jeneson JAL. Magnetic Resonance-Compatible Arm-Crank Ergometry: A New Platform Linking Whole-Body Calorimetry to Upper-Extremity Biomechanics and Arm Muscle Metabolism. Front Physiol 2021; 12:599514. [PMID: 33679429 PMCID: PMC7933461 DOI: 10.3389/fphys.2021.599514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/27/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Evaluation of the effect of human upper-body training regimens may benefit from knowledge of local energy expenditure in arm muscles. To that end, we developed a novel arm-crank ergometry platform for use in a clinical magnetic resonance (MR) scanner with 31P spectroscopy capability to study arm muscle energetics. Complementary datasets on heart-rate, whole-body oxygen consumption, proximal arm-muscle electrical activity and power output, were obtained in a mock-up scanner. The utility of the platform was tested by a preliminary study over 4 weeks of skill practice on the efficiency of execution of a dynamic arm-cranking task in healthy subjects. RESULTS The new platform successfully recorded the first ever in vivo 31P MR spectra from the human biceps brachii (BB) muscle during dynamic exercise in five healthy subjects. Changes in BB energy- and pH balance varied considerably between individuals. Surface electromyography and mechanical force recordings revealed that individuals employed different arm muscle recruitment strategies, using either predominantly elbow flexor muscles (pull strategy; two subjects), elbow extensor muscles (push strategy; one subject) or a combination of both (two subjects). The magnitude of observed changes in BB energy- and pH balance during ACT execution correlated closely with each strategy. Skill practice improved muscle coordination but did not alter individual strategies. Mechanical efficiency on group level seemed to increase as a result of practice, but the outcomes generated by the new platform showed the additional caution necessary for the interpretation that total energy cost was actually reduced at the same workload. CONCLUSION The presented platform integrates dynamic in vivo 31P MRS recordings from proximal arm muscles with whole-body calorimetry, surface electromyography and biomechanical measurements. This new methodology enables evaluation of cyclic motor performance and outcomes of upper-body training regimens in healthy novices. It may be equally useful for investigations of exercise physiology in lower-limb impaired athletes and wheelchair users as well as frail patients including patients with debilitating muscle disease and the elderly.
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Affiliation(s)
- Riemer J. K. Vegter
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Sebastiaan van den Brink
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Leonora J. Mouton
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Anita Sibeijn-Kuiper
- Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, University Medical Center Groningen, Groningen, Netherlands
| | - Lucas H. V. van der Woude
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Center for Rehabilitation, University Medical Center Groningen, Groningen, Netherlands
| | - Jeroen A. L. Jeneson
- Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, University Medical Center Groningen, Groningen, Netherlands
- Center for Child Development and Exercise, Wilhelmina’s Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands
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Kraaijenbrink C, Vegter R, de Groot S, Arnet U, Valent L, Verellen J, van Breukelen K, Hettinga F, Perret C, Abel T, Goosey-Tolfrey V, van der Woude L. Biophysical aspects of handcycling performance in rehabilitation, daily life and recreational sports; a narrative review. Disabil Rehabil 2020; 43:3461-3475. [DOI: 10.1080/09638288.2020.1815872] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Cassandra Kraaijenbrink
- Center for Human Movement Sciences Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Movement Science, Institute for Sport Science, University of Münster, Münster, Germany
| | - Riemer Vegter
- Center for Human Movement Sciences Groningen, University Medical Center Groningen, Groningen, The Netherlands
- European Research Group in Disability Sport (ERGiDS)
| | - Sonja de Groot
- Center for Human Movement Sciences Groningen, University Medical Center Groningen, Groningen, The Netherlands
- European Research Group in Disability Sport (ERGiDS)
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands
| | | | - Linda Valent
- Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands
| | | | - Kees van Breukelen
- Handcycling Ergonomic Advisor (Sport)Wheelchair and Handbike Shop RD Mobility, Rijswijk, The Netherlands
- International Classifier for Handcycling, Wheelchairrugby, Wheelchairbasketball, Wheelchairhandball and PowerChair Hockey
| | | | - Claudio Perret
- European Research Group in Disability Sport (ERGiDS)
- Swiss Paraplegic Centre, Institute of Sports Medicine, Nottwil, Switzerland
| | - Thomas Abel
- European Research Group in Disability Sport (ERGiDS)
- Sports Sciences Center, University of Cologne, Cologne, Germany
| | - Victoria Goosey-Tolfrey
- European Research Group in Disability Sport (ERGiDS)
- School of Sports, Exercise and Health Sciences, Peter Harrison Center for Disability Sports, Loughborough University, Loughborough, UK
| | - Lucas van der Woude
- Center for Human Movement Sciences Groningen, University Medical Center Groningen, Groningen, The Netherlands
- European Research Group in Disability Sport (ERGiDS)
- Center for Rehabilitation, Groningen, The Netherlands
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