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Itodo OA, Flueck JL, Raguindin PF, Stojic S, Brach M, Perret C, Minder B, Franco OH, Muka T, Stucki G, Stoyanov J, Glisic M. Physical activity and cardiometabolic risk factors in individuals with spinal cord injury: a systematic review and meta-analysis. Eur J Epidemiol 2022; 37:335-365. [PMID: 35391647 PMCID: PMC9187578 DOI: 10.1007/s10654-022-00859-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
Physical inactivity in individuals with spinal cord injury (SCI) has been suggested to be an important determinant of increased cardiometabolic disease (CMD) risk. However, it remains unclear whether physically active SCI individuals as compared to inactive or less active individuals have truly better cardiometabolic risk profile. We aimed to systematically review and quantify the association between engagement in regular physical activity and/or exercise interventions and CMD risk factors in individuals with SCI. Four medical databases were searched and studies were included if they were clinical trials or observational studies conducted in adult individuals with SCI and provided information of interest. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was applied to rate the certainty of evidence. Of 5816 unique citations, 11 randomized clinical trials, 3 non-randomized trial and 32 cross-sectional studies comprising more than 5500 SCI individuals were included in the systematic review. In meta-analysis of RCTs and based on evidence of moderate certainty, physical activity in comparison to control intervention was associated with: (i) better glucose homeostasis profile [WMD of glucose, insulin and Assessment of Insulin Resistance (HOMA-IR) were - 3.26 mg/dl (95% CI - 5.12 to - 1.39), - 3.19 μU/ml (95% CI - 3.96 to - 2.43)] and - 0.47 (95% CI - 0.60 to - 0.35), respectively], and (ii) improved cardiorespiratory fitness [WMD of relative and absolute oxygen uptake relative (VO2) were 4.53 ml/kg/min (95% CI 3.11, 5.96) and 0.26 L/min (95% CI 0.21, 0.32) respectively]. No differences were observed in blood pressure, heart rate and lipids (based on evidence of low/moderate certainty). In meta-analysis of cross-sectional studies and based on the evidence of very low to low certainty, glucose [WMD - 3.25 mg/dl (95% CI - 5.36, - 1.14)], insulin [- 2.12 μU/ml (95% CI - 4.21 to - 0.03)] and total cholesterol [WMD - 6.72 mg/dl (95% CI - 13.09, - 0.34)] were lower and HDL [WMD 3.86 mg/dl (95% CI 0.66, 7.05)] and catalase [0.07 UgHb-1 (95% CI 0.03, 0.11)] were higher in physically active SCI individuals in comparison to reference groups. Based on limited number of cross-sectional studies, better parameters of systolic and diastolic cardiac function and lower carotid intima media thickness were found in physically active groups. Methodologically sound clinical trials and prospective observational studies are required to further elaborate the impact of different physical activity prescriptions alone or in combination with other life-style interventions on CMD risk factors in SCI individuals.
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Affiliation(s)
- Oche Adam Itodo
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland
- Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | | | - Peter Francis Raguindin
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland
- Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Stevan Stojic
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Mirjam Brach
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland
| | - Claudio Perret
- Sports Medicine, Swiss Paraplegic Centre Nottwil, 6207, Nottwil, Switzerland
| | - Beatrice Minder
- Public Health and Primary Care Library, University Library of Bern, University of Bern, Bern, Switzerland
| | - Oscar H Franco
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Gerold Stucki
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland
| | - Jivko Stoyanov
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland
| | - Marija Glisic
- Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland.
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.
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Figoni SF, Dolbow DR, Crawford EC, White ML, Pattanaik S. Does aerobic exercise benefit persons with tetraplegia from spinal cord injury? A systematic review. J Spinal Cord Med 2021; 44:690-703. [PMID: 32043944 PMCID: PMC8477928 DOI: 10.1080/10790268.2020.1722935] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
CONTEXT This review synthesizes the findings of previous research studies on the cardiovascular and metabolic benefits of aerobic exercise for individuals with tetraplegia secondary to spinal cord injury. They are often less active due to muscular paralysis, sensory loss, and sympathetic nervous system dysfunction that result from injury. Consequently, these persons are at higher risk for exercise intolerance and secondary health conditions. OBJECTIVE To evaluate the evidence concerning efficacy of aerobic exercise training for improving health and exercise performance in persons with tetraplegia from cervical injury. METHODS The search engines PubMed and Google Scholar were used to locate published research. The final 75 papers were selected on the basis of inclusion criteria. The studies were then rank-ordered using Physiotherapy Evidence Database. RESULTS Studies combining individuals with tetraplegia and paraplegia show that voluntary arm-crank training can increase mean peak power output by 33%. Functional electrical stimulation leg cycling was shown to induce higher peak cardiac output and stroke volume than arm-crank exercise. A range of peak oxygen uptake (VO2peak) values have been reported (0.57-1.32 L/min). Both VO2peak and cardiac output may be enhanced via increased muscle pump in the legs and venous return to the heart. Hybrid exercise (arm-crank and functional electrical stimulation leg cycling) can result in greater peak oxygen uptake and cardiovascular responses. CONCLUSION Evidence gathered from this systematic review of literature is inconclusive due to the lack of research focusing on those with tetraplegia. Higher power studies (level 1-3) are needed with the focus on those with tetraplegia.
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Affiliation(s)
- Stephen F Figoni
- Spinal Cord Injury/Disorders Healthcare Group (128), Tibor Rubin VA Medical Center, Long Beach, California, USA
| | - David R Dolbow
- Physical Therapy Program, William Carey University, Hattiesburg, Mississippi, USA
| | - Edwin C Crawford
- Physical Therapy Program, William Carey University, Hattiesburg, Mississippi, USA
| | - Margaret L White
- Physical Therapy Program, William Carey University, Hattiesburg, Mississippi, USA
| | - Sambit Pattanaik
- College of Osteopathic Medicine, William Carey University, Hattiesburg, Mississippi, USA
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Vivodtzev I, Taylor JA. Cardiac, Autonomic, and Cardiometabolic Impact of Exercise Training in Spinal Cord Injury: A QUALITATIVE REVIEW. J Cardiopulm Rehabil Prev 2021; 41:6-12. [PMID: 33351539 PMCID: PMC7768813 DOI: 10.1097/hcr.0000000000000564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Direct and indirect effects of spinal cord injury lead to important cardiovascular (CV) complications that are further increased by years of injury and the process of "accelerated aging." The present review examines the current evidence in the literature for the potential cardioprotective effect of exercise training in spinal cord injury. REVIEW METHODS PubMed and Web of Science databases were screened for original studies investigating the effect of exercise-based interventions on aerobic capacity, cardiac structure/function, autonomic function, CV function, and/or cardiometabolic markers. We compared the effects in individuals <40 yr with time since injury <10 yr with those in older individuals (≥40 yr) with longer time since injury (≥10 yr), reasoning that the two can be considered individuals with low versus high CV risk factors. SUMMARY Studies showed similar exercise effects in both groups (n = 31 in low CV risk factors vs n = 15 in high CV risk factors). The evidence does not support any effect of exercise training on autonomic function but does support an increased peripheral blood flow, improved left ventricular mass, higher peak cardiac output, greater lean body mass, better antioxidant capacity, and improved endothelial function. In addition, some evidence suggests that it can result in lower blood lipids, systemic inflammation (interleukin-6, tumor necrosis factor α, and C-reactive protein), and arterial stiffness. Training intensity, volume, and frequency were key factors determining CV gains. Future studies with larger sample sizes, well-matched groups of subjects, and randomized controlled designs will be needed to determine whether high-intensity hybrid forms of training result in greater CV gains.
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Affiliation(s)
- Isabelle Vivodtzev
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts (Drs Vivodtzev and Taylor); Cardiovascular Research Laboratory, Spaulding Rehabilitation Hospital, Cambridge, Massachusetts (Drs Vivodtzev and Taylor); and Sorbonne Université, INSERM, UMRS1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France (Dr Vivodtzev)
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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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van der Woude LHV, Houdijk HJP, Janssen TWJ, Seves B, Schelhaas R, Plaggenmarsch C, Mouton NLJ, Dekker R, van Keeken H, de Groot S, Vegter RJK. Rehabilitation: mobility, exercise & sports; a critical position stand on current and future research perspectives. Disabil Rehabil 2020; 43:3476-3491. [PMID: 32805152 DOI: 10.1080/09638288.2020.1806365] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Human movement, rehabilitation, and allied sciences have embraced their ambitions within the cycle of "RehabMove" congresses over the past 30 years. This combination of disciplines and collaborations in the Netherlands has tried to provide answers to questions in the fields of rehabilitation and adapted sports, while simultaneously generating new questions and challenges. These research questions help us to further deepen our understanding of (impaired) human movement and functioning, with and without supportive technologies, and stress the importance of continued multidisciplinary (inter)national collaboration. METHODS This position stand provides answers that were conceived by the authors in a creative process underlining the preparation of the 6th RehabMove Congress. RESULTS The take-home message of the RehabMove2018 Congress is a plea for continued multidisciplinary research in the fields of rehabilitation and adapted sports. This should be aimed at more individualized notions of human functioning, practice, and training, but also of performance, improved supportive technology, and appropriate "human and technology asset management" at both individual and organization levels and over the lifespan. CONCLUSIONS With this, we anticipate to support the development of rehabilitation sciences and technology and to stimulate the use of rehabilitation notions in general health care. We also hope to help ensure a stronger embodiment of preventive and lifestyle medicine in rehabilitation practice. Indeed, general health care and rehabilitation practice require a healthy and active lifestyle management and research agenda in the context of primary, secondary, and tertiary prevention.IMPLICATIONS FOR REHABILITATIONContinued multidisciplinary (international) collaboration will stimulate the development of rehabilitation and human movement sciences.Notions from "human and technology asset management and ergonomics" are fundamental to rehabilitation practice and research.The rehabilitation concept will further merge into general health care and the quality there-off.
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Affiliation(s)
- Lucas H V van der Woude
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Han J P Houdijk
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Research & Development, Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands
| | - Thomas W J Janssen
- Amsterdam Rehabilitation Research Center, Amsterdam, The Netherlands.,Faculty of Behavioural and Movement Sciences, Department of Human Movement Sciences, Research Institute MOVE, VU University, Amsterdam, The Netherlands
| | - Bregje Seves
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Reslin Schelhaas
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Corien Plaggenmarsch
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Noor L J Mouton
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rienk Dekker
- Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Helco van Keeken
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sonja de Groot
- Amsterdam Rehabilitation Research Center, Amsterdam, The Netherlands.,Faculty of Behavioural and Movement Sciences, Department of Human Movement Sciences, Research Institute MOVE, VU University, Amsterdam, The Netherlands
| | - Riemer J K Vegter
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Kouwijzer I, Cowan RE, Maher JL, Groot FP, Riedstra F, Valent LJM, van der Woude LHV, de Groot S. Interrater and intrarater reliability of ventilatory thresholds determined in individuals with spinal cord injury. Spinal Cord 2019; 57:669-678. [PMID: 30820032 DOI: 10.1038/s41393-019-0262-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/11/2019] [Accepted: 02/11/2019] [Indexed: 12/13/2022]
Abstract
STUDY DESIGN Cross-sectional. OBJECTIVES Individualized training regimes are often based on ventilatory thresholds (VTs). The objectives were to study: (1) whether VTs during arm ergometry could be determined in individuals with spinal cord injury (SCI), (2) the intrarater and interrater reliability of VT determination. SETTING University research laboratory. METHODS Thirty graded arm crank ergometry exercise tests with 1-min increments of recreationally active individuals (tetraplegia (N = 11), paraplegia (N = 19)) were assessed. Two sports physicians assessed all tests blinded, randomly, in two sessions, for VT1 and VT2, resulting in 240 possible VTs. Power output (PO), heart rate (HR), and oxygen uptake (VO2) at each VT were compared between sessions or raters using paired samples t-tests, Wilcoxon signed-rank tests, intraclass correlation coefficients (ICC, relative agreement), and Bland-Altman plots (random error, absolute agreement). RESULTS Of the 240 VTs, 217 (90%) could be determined. Of the 23 undetermined VTs, 2 (9%) were VT1 and 21 (91%) were VT2; 7 (30%) among individuals with paraplegia, and 16 (70%) among individuals with tetraplegia. For the successfully determined VTs, there were no systematic differences between sessions or raters. Intrarater and interrater ICCs for PO, HR, and VO2 at each VT were high to very high (0.82-1.00). Random error was small to large within raters, and large between raters. CONCLUSIONS For VTs that could be determined, relative agreement was high to very high, absolute agreement varied. For some individuals, often with tetraplegia, VT determination was not possible, thus other methods should be considered to prescribe exercise intensity.
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Affiliation(s)
- Ingrid Kouwijzer
- Research and Development, Heliomare Rehabilitation Center, Wijk aan Zee, the Netherlands. .,University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, the Netherlands. .,Amsterdam Rehabilitation Research Center
- Reade, Amsterdam, the Netherlands.
| | - Rachel E Cowan
- Department of Neurological Surgery, Miller School of Medicine & The Miami Project to Cure Paralysis, University of Miami, Miami, FL, USA
| | - Jennifer L Maher
- Department of Neurological Surgery, Miller School of Medicine & The Miami Project to Cure Paralysis, University of Miami, Miami, FL, USA
| | - Floor P Groot
- Heliomare Rehabilitation Center, Wijk aan Zee, the Netherlands.,Sport- en Beweegkliniek, Haarlem, the Netherlands
| | - Feikje Riedstra
- Heliomare Rehabilitation Center, Wijk aan Zee, the Netherlands.,Sport- en Beweegkliniek, Haarlem, the Netherlands
| | - Linda J M Valent
- Research and Development, Heliomare Rehabilitation Center, Wijk aan Zee, the Netherlands
| | - Lucas H V van der Woude
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, the Netherlands
| | - Sonja de Groot
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, the Netherlands.,Amsterdam Rehabilitation Research Center
- Reade, Amsterdam, the Netherlands
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An Experimental Method to Estimate Upper Limbs Inertial Parameters During Handcycling. J Appl Biomech 2018; 34:175-183. [PMID: 29182433 DOI: 10.1123/jab.2017-0136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study proposes an experimental method to estimate personalized inertial parameters of upper limbs during handcycling by using a planar dynamic model. The handle forces are expressed as a product of a matrix describing the kinematics terms and a vector of inertial parameters of arm and forearm. The parameters are estimated by measuring the handle forces during a suitable "passive test" and inverting the mentioned matrix. The data were acquired while an operator actuated the handle and the subject's muscles were relaxed. To validate the estimation procedure, it was applied to a custom-made artificial arm mechanism, and the results were compared with its known parameters. The method was then used to estimate the inertial parameters of 6 human subjects. The estimated parameters were used to compute the exchanged forces and compared with the measured ones obtaining an average error of 14% both for Fx and Fy. These errors are significantly smaller than those obtained using dynamic parameters extracted from the literature to compute the forces, which were 50% for Fx and 19% for Fy. An individual evaluation of inertial parameters better describes interaction forces during handcycling, especially for subjects whose body structures are different from the average population.
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Kraaijenbrink C, Vegter RJK, Hensen AHR, Wagner H, van der Woude LHV. Different cadences and resistances in sub-maximal synchronous handcycling in able-bodied men: Effects on efficiency and force application. PLoS One 2017; 12:e0183502. [PMID: 28841704 PMCID: PMC5571929 DOI: 10.1371/journal.pone.0183502] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 08/04/2017] [Indexed: 11/26/2022] Open
Abstract
Background With the introduction of an add-on handcycle, a crank system that can be placed in front of a wheelchair, handcycling was made widely available for daily life. With it, people go into town more easily, e.g. to do groceries; meet up with friends, etc. They have more independency and can be socially active. Our aim is to explore some settings of the handcycle, so that it can be optimally used as a transportation device. Therefore, the effects of cadence and added resistance on gross mechanical efficiency and force application during sub-maximal synchronous handcycling were investigated. We hypothesized that a cadence of 52 rpm with a higher resistance (35 W) would lead to a higher gross mechanical efficiency and a more tangential force application than a higher cadence of 70 rpm and no extra resistance (15 W). Methods Twelve able-bodied men rode in an instrumented add-on handcycle on a motorized level treadmill at 1.94 m/s. They performed three sessions of three four-minute blocks of steady state exercise. Gear (70, 60 and 52 rpm) was changed in-between the blocks and resistance (rolling resistance +0 W, +10 W, +20 W) was changed across sessions, both in a counterbalanced order. 3D force production, oxygen uptake and heart rate were measured continuously. Gross mechanical efficiency (ME) and fraction of effective force (FEF) were calculated as main outcomes. The effects of cadence and resistance were analyzed using a repeated measures ANOVA (P<0.05) with Bonferroni-corrected post-hoc pairwise comparisons. Results With a decrease in cadence a slight increase in ME (70 rpm: 5.5 (0.2)%, 60 rpm: 5.7 (0.2)%, 52 rpm: 5.8 (0.2)%, P = 0.008, η2p = 0.38), while an increase in FEF (70 rpm: 58.0 (3.2)%, 60 rpm: 66.0 (2.8)%, 52 rpm: 71.3 (2.3)%, P<0.001, η2p = 0.79) is seen simultaneously. Also with an increase in resistance an increase in ME (+0 W: 4.0 (0.2)%, +10 W: 6.0 (0.3)%, +20 W: 7.0 (0.2)%, P<0.001, η2p = 0.92) and FEF (+0 W: 59.0 (2.9)%, +10 W: 66.1 (3.4)%, +20 W: 70.2 (2.4)%, P<0.001, η2p = 0.56) was found. Interpretation A cadence of 52 rpm against a higher resistance of about 35 W leads to a more optimal direction of forces and is more mechanically efficient than propelling at a higher cadence or lower resistance. Therefore, changing gears on a handcycle is important, and it is advised to keep the linear hand velocity relatively low for locomotion purposes.
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Affiliation(s)
- Cassandra Kraaijenbrink
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, Groningen, the Netherlands
- Department of Movement Science, Institute of Sport Sciences, University of Münster, Münster, North Rhine-Westphalia, Germany
- * E-mail:
| | - Riemer J. K. Vegter
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, Groningen, the Netherlands
| | - Alexander H. R. Hensen
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, Groningen, the Netherlands
| | - Heiko Wagner
- Department of Movement Science, Institute of Sport Sciences, University of Münster, Münster, North Rhine-Westphalia, Germany
| | - Lucas H. V. van der Woude
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, Groningen, the Netherlands
- Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, Groningen, the Netherlands
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Eerden S, Dekker R, Hettinga FJ. Maximal and submaximal aerobic tests for wheelchair-dependent persons with spinal cord injury: a systematic review to summarize and identify useful applications for clinical rehabilitation. Disabil Rehabil 2017. [DOI: 10.1080/09638288.2017.1287623] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sophia Eerden
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rienk Dekker
- Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, Groningen, The Netherlands
- Center for Sports Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Florentina J. Hettinga
- School of Biological Sciences, Centre of Sport and Exercise Science, University of Essex, Colchester, UK
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Handcycling: training effects of a specific dose of upper body endurance training in females. Eur J Appl Physiol 2016; 116:1387-94. [PMID: 27222003 DOI: 10.1007/s00421-016-3395-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 05/14/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE This study aims to evaluate a handcycling training protocol based on ACSM guidelines in a well-controlled laboratory setting. Training responses of a specific dose of handcycling training were quantified in a homogeneous female subject population to obtain a more in depth understanding of physiological mechanisms underlying adaptations in upper body training. METHODS 22 female able-bodied participants were randomly divided in a training (T) and control group (C). T received 7-weeks of handcycling training, 3 × 30 min/week at 65 % heart rate reserve (HRR). An incremental handcycling test was used to determine local, exercise-specific adaptations. An incremental cycling test was performed to determine non-exercise-specific central/cardiovascular adaptations. Peak oxygen uptake (peakVO2), heart rate (peakHR) and power output (peakPO) were compared between T and C before and after training. RESULTS T completed the training sessions at 65 ± 3 % HRR, at increasing power output (59.4 ± 8.2 to 69.5 ± 8.9 W) over the training program. T improved on handcycling peakVO2 (+18.1 %), peakPO (+31.9 %), and peakHR (+4.0 %). No improvements were found in cycling parameters. CONCLUSION Handcycling training led to local, exercise-specific improvements in upper body parameters. Results could provide input for the design of effective evidence-based training programs specifically aimed at upper body endurance exercise in females.
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Arnet U, Hinrichs T, Lay V, Bertschy S, Frei H, Brinkhof MWG. Determinants of handbike use in persons with spinal cord injury: results of a community survey in Switzerland. Disabil Rehabil 2015; 38:81-6. [DOI: 10.3109/09638288.2015.1024339] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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13
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Bakkum AJT, de Groot S, Stolwijk-Swüste JM, van Kuppevelt DJ, van der Woude LHV, Janssen TWJ. Effects of hybrid cycling versus handcycling on wheelchair-specific fitness and physical activity in people with long-term spinal cord injury: a 16-week randomized controlled trial. Spinal Cord 2015; 53:395-401. [DOI: 10.1038/sc.2014.237] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 11/25/2014] [Accepted: 11/25/2014] [Indexed: 11/09/2022]
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Kressler J, Burns PA, Betancourt L, Nash MS. Circuit training and protein supplementation in persons with chronic tetraplegia. Med Sci Sports Exerc 2015; 46:1277-84. [PMID: 24389521 DOI: 10.1249/mss.0000000000000250] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
UNLABELLED Circuit resistance training (CRT) performed three times weekly for 40-45 min each session increases muscular strength and both aerobic and anaerobic capacity in untrained individuals with chronic paraplegia. Whether similar CRT is also effective for conditioning of persons with chronic tetraplegia is unknown. In addition, protein supplementation (PS) before and immediately postexercise has been shown to enhance exercise adaptations. PURPOSE This study aimed to investigate whether a modified 40-45 min CRT program will improve fitness attributes in individuals with tetraplegia and whether these changes are enhanced by PS. METHODS Eleven individuals with chronic tetraplegia underwent 6 months of CRT performed three times per week. Six randomly assigned participants received PS (whey protein = 36-37 g) in split doses immediately before and after exercise sessions. Others consumed a matched protein dose 24 h postexercise. Measurements of one-repetition maximum (1-RM) strength for six different resistance exercises, arm peak oxygen consumption (VO2peak), and arm anaerobic power (Wingate) were obtained 3 months before (-3mo), at the beginning (0mo), 3 months into (3mo), and 6 months after (6mo) the beginning of CRT. RESULTS One-repetition maximum increased by 8%-11% ± 6%-12% for each successive 3-month period (P ≤ 0.001-0.012), independent of PS group (P = 0.105). VO2peak increased significantly from 0mo to 6mo with immediate PS (35% ± 29%, P = 0.020) but failed to reach significance for delayed PS (15% ± 8%, P = 0.147). Power drop changes during the Wingate test were also only significant for the immediate PS (median difference 40W, P = 0.028) and not for delayed (10W, P = 0.500). CONCLUSION CRT effectively increased muscular strength, aerobic capacity, and anaerobic fatigue resistance in persons with chronic tetraplegia. The latter two conditioning benefits were further enhanced by timely PS.
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Affiliation(s)
- Jochen Kressler
- 1The Miami Project to Cure Paralysis, Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL; and 2Department of Rehabilitation Medicine, Miller School of Medicine, University of Miami, Miami, FL
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FES-rowing in tetraplegia: a preliminary report. Spinal Cord 2014; 52:880-6. [PMID: 25266698 DOI: 10.1038/sc.2014.159] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 08/01/2014] [Accepted: 08/12/2014] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN A training intervention study using functional electrical stimulation-rowing (FES-R) in a group of eight individuals with tetraplegia. OBJECTIVES To assess the feasibility of a structured progressive FES-R training programme in people with tetraplegia, and to explore the number and type of FES-training sessions required to enable continuous FES-R for 30 min. SETTING A fully integrated sports centre, elite rowing training centre and university sport science department. METHODS Eight participants with chronic complete and incomplete tetraplegia (C4 to C7, American Spinal Injury Association Impairment Scale A, B and C) who had not previously used any form of FES-assisted exercise, participated in the study. Participants completed a progressive FES-assisted training programme building to three continuous 30-min FES-R sessions per week at 60-80% of their predetermined peak power output. Thereafter, rowing performance was monitored for 12 months. MAIN OUTCOME MEASURES number and type of FES-training sessions required before achieving 30-min continuous FES-R, and FES-R average power output (POav) pre and post 12 months training. Participant feedback of perceived benefits was also documented. RESULTS All participants were able to continuously FES-row for 30 min after completing 13±7 FES-R training sessions. Each individual POav during 30 min FES-R increased over 12 months FES-training. FES-R was found safe and well tolerated in this group of individuals with tetraplegia. CONCLUSION Individuals with tetraplegia are able to engage in a progressive programme of FES-R training. Future research examining FES-R training as an adjunctive therapy in people with tetraplegia is warranted.
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Coordinating arms and legs on a hybrid rehabilitation tricycle: the metabolic benefit of asymmetrical compared to symmetrical arm movements. Eur J Appl Physiol 2014; 114:743-50. [PMID: 24384984 DOI: 10.1007/s00421-013-2814-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 12/22/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE The most commonly used propulsion method for handcycling is moving the arms symmetrically. Previous studies indicated that during outdoor handcycling symmetrical arm movements are more efficient. During locomotor movements, however, arm movements are performed asymmetrically in combination with leg movements. We questioned which combination of arm and leg movements is more efficient during combined arm and leg cycling for stationary use. METHODS Twenty-five able-bodied adults performed eight submaximal tests of 6 min on a hybrid handcycle at three incremental gears during four different conditions ('arms only' and 'arms & legs' with arms symmetrical and asymmetrical). Oxygen uptake (VO2), heart rate (HR) and Borg score (Borg) were assessed. RESULTS Increasing workload resulted in significant increases in VO2 (16 W: 13.0 ± 2.4 ml kg(-1) min(-1), 31 W: 14.5 ± 2.9, 49 W: 15.5 ± 2.8; p < 0.001) and Borg (16 W: 7.7 ± 1.7 points, 31 W: 8.6 ± 1.9, 49 W: 9.5 ± 1.9; p < 0.001). During 'arms only', no differences were found in exercise intensity between symmetrical and asymmetrical movements. Contrarily, during 'arms & legs', both VO2 (p < 0.001) and Borg (p = 0.001) were significantly lower for the asymmetrical (VO2: 13.8 ± 2.6 ml kg(-1) min(-1), Borg: 8.1 ± 1.6 points) compared to the symmetrical condition (VO2: 14.9 ± 2.8, Borg: 9.1 ± 2.0). CONCLUSIONS Results indicated that asymmetrical arm movements, especially in combination with leg movements, represented the most efficient condition on a stationary hybrid handcycle. The current results suggest that neural energy costs are lower when moving in the preferred (asymmetrical) coordination when no steering is required. These findings may have implications for stationary arm & leg cycling rehabilitation and tricycle adaptations in patients with spinal cord injury.
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Force Application During Handcycling and Handrim Wheelchair Propulsion: An Initial Comparison. J Appl Biomech 2013; 29:687-95. [DOI: 10.1123/jab.29.6.687] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of the study was to evaluate the external applied forces, the effectiveness of force application and the net shoulder moments of handcycling in comparison with handrim wheelchair propulsion at different inclines. Ten able-bodied men performed standardized exercises on a treadmill at inclines of 1%, 2.5% and 4% with an instrumented handbike and wheelchair that measured three-dimensional propulsion forces. The results showed that during handcycling significantly lower mean forces were applied at inclines of 2.5% (P< .001) and 4% (P< .001) and significantly lower peak forces were applied at all inclines (1%:P= .014, 2.5% and 4%:P< .001). At the 2.5% incline, where power output was the same for both devices, total forces (mean over trial) of 22.8 N and 27.5 N and peak forces of 40.1 N and 106.9 N were measured for handbike and wheelchair propulsion. The force effectiveness did not differ between the devices (P= .757); however, the effectiveness did increase with higher inclines during handcycling whereas it stayed constant over all inclines for wheelchair propulsion. The resulting peak net shoulder moments were lower for handcycling compared with wheelchair propulsion at all inclines (P< .001). These results confirm the assumption that handcycling is physically less straining.
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Hettinga FJ, de Groot S, van Dijk F, Kerkhof F, Woldring F, van der Woude L. Physical strain of handcycling: an evaluation using training guidelines for a healthy lifestyle as defined by the American College of Sports Medicine. J Spinal Cord Med 2013; 36:376-82. [PMID: 23820153 PMCID: PMC3758534 DOI: 10.1179/2045772313y.0000000127] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE Developments in assistive technology such as handcycling provide attractive possibilities to pursue a healthy lifestyle for patients with spinal cord injury. The objective of the study is to evaluate physical stress and strain of handcycling against training guidelines as defined by the American College of Sports Medicine (ACSM). DESIGN Seven able-bodied males conducted an incremental peak exercise handcycling test on a treadmill. In addition, two indoor treadmill (1.3 m/second with an inclination of 0.7% and 1.0 m/second with an inclination of 4.8%) and three outdoor over ground exercise bouts were performed (1.7, 3.3, and 5.0 m/second). One individual handcycled a representative 8-km-distance outdoors. OUTCOME MEASURES Physical stress and strain were described in terms of absolute and relative power output, oxygen uptake (VO2), gross efficiency (GE), and heart rate (HR). Also, local perceived discomfort (LPD) was determined. RESULTS Relative handcycling exercise intensities varied between 23.3 ± 4.2 (below the ACSM lower limit of 46%VO2peak) and 72.5 ± 15.1%VO2peak (well above the ACSM lower limit), with GE ranging from 6.0 ± 1.5% at the lower to 13.0 ± 2.6% at the higher exercise intensities. Exercise intensities were performed at 49.8 ± 4.2 to 80.1 ± 10.5%HRpeak. LPD scores were low to moderate (<27 ± 7). CONCLUSION Handcycling is relatively efficient and exercise intensities > 46%VO2peak were elicited. However, exercise load seems to be underestimated using %HRpeak. LPD was not perceived as limiting. Physiological stress and strain in able-bodied individuals appear to be comparable to individuals with a paraplegia. To understand individualize and optimize upper-body training, different training programs must be evaluated.
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Affiliation(s)
- Florentina J. Hettinga
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, The Netherlands,Correspondence to: Florentina J. Hettinga, Ph.D., Center for Human Movement Sciences, University of Groningen/University Medical Center Groningen, A. Deusinglaan 1, Building, 3215, room 330, 9713 AV Groningen, The Netherlands.
| | - Sonja de Groot
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, The Netherlands; and Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands
| | - Frank van Dijk
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, The Netherlands; and Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Faes Kerkhof
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Ferry Woldring
- Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Luc van der Woude
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, The Netherlands; and Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Springer BA. Ride 2 Recovery's Project HERO: using cycling as part of rehabilitation. Phys Ther Sport 2012; 14:77-86. [PMID: 23257397 DOI: 10.1016/j.ptsp.2012.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 11/09/2012] [Accepted: 11/12/2012] [Indexed: 10/27/2022]
Abstract
Ride 2 Recovery was founded in 2008 by a former world-class cycling competitor and coach to enhance the physical and psychological recovery of our nation's wounded, ill and injured service members and veterans through the sport of cycling. Ride 2 Recovery's most notable endeavor is Project HERO (Healing Exercise Rehabilitation Opportunity) which uses staff members and volunteers to promote cycling as an integral part of rehabilitation at select military facilities to enhance physical, psychological, spiritual and social recovery. Project HERO is directed by a retired military physical therapist that spent the last decade caring for service men and women wounded in Iraq and Afghanistan. This article describes all facets of the Project HERO initiative and highlights the profound impact it has had in the lives of US military members and veterans.
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van der Woude LHV, de Groot S, Postema K, Bussmann JBJ, Janssen TWJ, Post MWM. Active LifestyLe Rehabilitation interventions in aging spinal cord injury (ALLRISC): a multicentre research program. Disabil Rehabil 2012; 35:1097-103. [PMID: 23030594 DOI: 10.3109/09638288.2012.718407] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND With today's specialized medical care, life expectancy of persons with a spinal cord injury (SCI) has considerably improved. With increasing age and time since injury, many individuals with SCI, however, show a serious inactive lifestyle, associated with deconditioning and secondary health conditions (SHCs) (e.g. pressure sores, urinary and respiratory tract infections, osteoporosis, upper-extremity pain, obesity, diabetes, cardiovascular disease) and resulting in reduced participation and quality of life (QoL). Avoiding this downward spiral, is crucial. OBJECTIVES To understand possible deconditioning and SHCs in persons aging with a SCI in the context of active lifestyle, fitness, participation and QoL and to examine interventions that enhance active lifestyle, fitness, participation and QoL and help prevent some of the SHCs. METHODS A multicentre multidisciplinary research program (Active LifestyLe Rehabilitation Interventions in aging Spinal Cord injury, ALLRISC) in the setting of the long-standing Dutch SCI-rehabilitation clinical research network. RESULTS ALLRISC is a four-study research program addressing inactive lifestyle, deconditioning, and SHCs and their associations in people aging with SCI. The program consists of a cross-sectional study (n = 300) and three randomized clinical trials. All studies share a focus on fitness, active lifestyle, SHCs and deconditioning and outcome measures on these and other (participation, QoL) domains. It is hypothesized that a self-management program, low-intensity wheelchair exercise and hybrid functional electrical stimulation-supported leg and handcycling are effective interventions to enhance active life style and fitness, help to prevent some of the important SHCs in chronic SCI and improve participation and QoL. CONCLUSION ALLRISC aims to provide evidence-based preventive components of a rehabilitation aftercare system that preserves functioning in aging persons with SCI.
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Affiliation(s)
- L H V van der Woude
- Centre for Human Movement Sciences, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
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Arnet U, van Drongelen S, Schlüssel M, Lay V, van der Woude LHV, Veeger HEJ. The effect of crank position and backrest inclination on shoulder load and mechanical efficiency during handcycling. Scand J Med Sci Sports 2012; 24:386-94. [PMID: 22989023 DOI: 10.1111/j.1600-0838.2012.01524.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2012] [Indexed: 11/26/2022]
Abstract
Handbikes come in different models and setups, but only limited knowledge is available on the handbike-user interface. The aim of this study was to identify optimal handbike setups, assuming that in such a setup mechanical efficiency is high, while shoulder load is low. Thirteen subjects with a spinal cord injury (paraplegia) performed handcycling with different handbike setups at constant power output: four crank positions (two distances, two heights) and four backrest inclinations. The O2-consumption, kinetics, and kinematics were measured to calculate mechanical efficiency and shoulder load (glenohumeral contact force, net shoulder moments, and rotator cuff force). The analysis showed that more upright backrest positions resulted in lower shoulder load compared with the most reclined position [glenohumeral contact force (260 vs 335 N), supraspinatus (14.4% vs 18.2%), and infraspinatus force (5.4% vs 9.8%)], while there was no difference in efficiency. Except for a reduction in subscapularis force at the distant position, no differences in shoulder load or efficiency were found between crank positions. Recreational handbike users, who want to improve their physical capacity in a shoulder-friendly way, should set up their handbike with a more upright backrest position and a distant crank placement.
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Affiliation(s)
- U Arnet
- Swiss Paraplegic Research, Nottwil, Switzerland; Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
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Arnet U, van Drongelen S, Veeger DH, van der Woude LH. Are the force characteristics of synchronous handcycling affected by speed and the method to impose power? Med Eng Phys 2012; 34:78-84. [DOI: 10.1016/j.medengphy.2011.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Revised: 06/27/2011] [Accepted: 07/04/2011] [Indexed: 11/27/2022]
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van Drongelen S, van den Berg J, Arnet U, Veeger D(H, van der Woude LH. Development and validity of an instrumented handbike: Initial results of propulsion kinetics. Med Eng Phys 2011; 33:1167-73. [DOI: 10.1016/j.medengphy.2011.04.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 03/16/2011] [Accepted: 04/29/2011] [Indexed: 11/28/2022]
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Valent L, Dallmeijer A, Houdijk H, Slootman HJ, Janssen TW, Van Der Woude LHV. Effects of hand cycle training on wheelchair capacity during clinical rehabilitation in persons with a spinal cord injury. Disabil Rehabil 2010; 32:2191-200. [DOI: 10.3109/09638288.2010.509461] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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GOOSEY-TOLFREY VICTORIA, LENTON JOHN, GODDARD JIMMY, OLDFIELD VICTORIA, TOLFREY KEITH, ESTON ROGER. Regulating Intensity Using Perceived Exertion in Spinal Cord-Injured Participants. Med Sci Sports Exerc 2010; 42:608-13. [DOI: 10.1249/mss.0b013e3181b72cbc] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Hettinga F, Valent L, Groen W, van Drongelen S, de Groot S, van der Woude L. Hand-Cycling: An Active Form of Wheeled Mobility, Recreation, and Sports. Phys Med Rehabil Clin N Am 2010; 21:127-40. [DOI: 10.1016/j.pmr.2009.07.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Effects of hand cycle training on physical capacity in individuals with tetraplegia: a clinical trial. Phys Ther 2009; 89:1051-60. [PMID: 19643834 DOI: 10.2522/ptj.20080340] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Regular physical activity is important for people with tetraplegia to maintain fitness but may not always be easily integrated into daily life. In many countries, hand cycling has become a serious option for daily mobility in people with tetraplegia. However, little information exists regarding the suitability of this exercise mode for this population. OBJECTIVE The purpose of this study was to evaluate the effects of a structured hand cycle training program in individuals with chronic tetraplegia. DESIGN Pretraining and posttraining outcome measurements of physical capacity were compared. SETTING Structured hand cycle interval training was conducted at home or in a rehabilitation center in the Netherlands. PARTICIPANTS Twenty-two patients with tetraplegia (American Spinal Injury Association Impairment Scale classification A-D) at least 2 years since injury participated. INTERVENTION The intervention was an 8- to 12-week hand cycle interval training program. MEASURES Primary outcomes of physical capacity were: peak power output (POpeak) and peak oxygen uptake (Vo(2)peak), as determined in hand cycle peak exercise tests on a motor-driven treadmill. Secondary outcome measures were: peak muscle strength (force-generating capacity) of the upper extremities (as assessed by handheld dynamometry), respiratory function (forced vital capacity and peak expiratory flow) and participant-reported shoulder pain. RESULTS Significant improvements following a mean of 19 (SD=3) sessions of hand cycle training were found in POpeak (from 42.5 W [SD=21.9] to 50.8 W [SD=25.4]), Vo(2)peak (from 1.32 L.min(-1) [SD=0.40] to 1.43 L.min(-1) [SD=0.43]), and mechanical efficiency, as reflected by a decrease in submaximal oxygen uptake. Except for shoulder abduction strength, no significant effects were found on the secondary outcomes. LIMITATIONS Common health complications, such as urinary tract infections, bowel problems, and pressure sores, led to dropout and nonadherence. CONCLUSION Patients with tetraplegia were able to improve their physical capacity through regular hand cycle interval training, without participant-reported shoulder-arm pain or discomfort.
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Affiliation(s)
- Harish Hosalkar
- Rady Children's Hospital, UCSD San Diego, San Diego, CA 92123, USA.
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van Drongelen S, Maas JC, Scheel-Sailer A, Van Der Woude LHV. Submaximal arm crank ergometry: Effects of crank axis positioning on mechanical efficiency, physiological strain and perceived discomfort. J Med Eng Technol 2009; 33:151-7. [PMID: 19205993 DOI: 10.1080/13561820802565676] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE To evaluate the effect of the spatial orientation of the crank axis on mechanical efficiency, physiological strain and perceived discomfort in submaximal synchronous arm crank ergometry. METHODS Twelve able-bodied individuals performed 12 submaximal exercise bouts of 3 minutes (women: 20 W/25 W; men: 25 W/35 W). The crank axis position was defined by elbow and shoulder angle. RESULTS The results showed that a crank set-up with an elbow angle of 30 degrees was more efficient than 15 degrees ; oxygen consumption and minute ventilation were significantly lower. No significant effects were seen for shoulder angle. Power output and gender showed obvious effects. DISCUSSION AND CONCLUSION The magnitude of this effect and the absence of any significant shoulder angle effects may be due to the relative low exertion levels that were evaluated. An elbow angle of 30 degrees flexion in arm crank exercise is favourable compared to an elbow angle of 15 degrees in able-bodied untrained subjects.
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Fawcett JW, Curt A. Damage control in the nervous system: rehabilitation in a plastic environment. Nat Med 2009; 15:735-6. [DOI: 10.1038/nm0709-735] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Neville V, Pain MTG, Folland JP. Aerobic power and peak power of elite America’s Cup sailors. Eur J Appl Physiol 2009; 106:149-57. [DOI: 10.1007/s00421-009-1002-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2009] [Indexed: 12/01/2022]
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