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Kouwijzer I, de Groot S, van Leeuwen CMC, Valent LJM, Stolwijk-Swüste JM, van der Woude LHV, Post MWM. Changes in body satisfaction during and after a 5-month handcycle training period and associations with physical capacity and body composition in individuals with a physical impairment. Disabil Rehabil 2024; 46:2839-2846. [PMID: 37431151 DOI: 10.1080/09638288.2023.2232732] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 06/29/2023] [Indexed: 07/12/2023]
Abstract
PURPOSE To investigate: (1) changes in body satisfaction during five months of handcycle training and one year after the training period; (2) whether longitudinal changes are dependent on sex, waist circumference and severity of the physical impairment; (3) associations between changes in physical capacity or body composition, and body satisfaction. MATERIALS AND METHODS Individuals (N = 143) with health conditions such as spinal cord injury filled out the Adult Body Satisfaction Questionnaire: at the start of the training (T1), directly after the training period (T2); and four months (T3) and one year after the training period (T4). At T1 and T2, physical capacity was determined with an upper-body graded exercise test, and waist circumference was measured. Handcycling classification was used as a proxy for the severity of impairment. RESULTS Multilevel regression analyses showed that body satisfaction significantly increased during the training period and significantly decreased back to pre-training levels at follow-up. Individuals with more severe impairments showed a larger decrease at T4. Improvements in physical capacity and waist circumference were significantly associated with improvements in body satisfaction. CONCLUSIONS Body satisfaction significantly increased during the training period, but significantly decreased during follow-up. Additional efforts might be necessary to keep individuals engaged in long-term exercise.
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Affiliation(s)
- Ingrid Kouwijzer
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands
- Amsterdam Rehabilitation Research Center I Reade, Amsterdam, The Netherlands
| | - Sonja de Groot
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands
- Amsterdam Rehabilitation Research Center I Reade, Amsterdam, The Netherlands
| | - Christel M C van Leeuwen
- Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Linda J M Valent
- Research and Development, Heliomare Rehabilitation Center, Amsterdam, The Netherlands
| | - Janneke M Stolwijk-Swüste
- Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Lucas H V van der Woude
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marcel W M Post
- Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Hodgkiss DD, Bhangu GS, Lunny C, Jutzeler CR, Chiou SY, Walter M, Lucas SJE, Krassioukov AV, Nightingale TE. Exercise and aerobic capacity in individuals with spinal cord injury: A systematic review with meta-analysis and meta-regression. PLoS Med 2023; 20:e1004082. [PMID: 38011304 PMCID: PMC10712898 DOI: 10.1371/journal.pmed.1004082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/11/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND A low level of cardiorespiratory fitness [CRF; defined as peak oxygen uptake ([Formula: see text]O2peak) or peak power output (PPO)] is a widely reported consequence of spinal cord injury (SCI) and a major risk factor associated with chronic disease. However, CRF can be modified by exercise. This systematic review with meta-analysis and meta-regression aimed to assess whether certain SCI characteristics and/or specific exercise considerations are moderators of changes in CRF. METHODS AND FINDINGS Databases (MEDLINE, EMBASE, CENTRAL, and Web of Science) were searched from inception to March 2023. A primary meta-analysis was conducted including randomised controlled trials (RCTs; exercise interventions lasting >2 weeks relative to control groups). A secondary meta-analysis pooled independent exercise interventions >2 weeks from longitudinal pre-post and RCT studies to explore whether subgroup differences in injury characteristics and/or exercise intervention parameters explained CRF changes. Further analyses included cohort, cross-sectional, and observational study designs. Outcome measures of interest were absolute (A[Formula: see text]O2peak) or relative [Formula: see text]O2peak (R[Formula: see text]O2peak), and/or PPO. Bias/quality was assessed via The Cochrane Risk of Bias 2 and the National Institute of Health Quality Assessment Tools. Certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Random effects models were used in all meta-analyses and meta-regressions. Of 21,020 identified records, 120 studies comprising 29 RCTs, 67 pre-post studies, 11 cohort, 7 cross-sectional, and 6 observational studies were included. The primary meta-analysis revealed significant improvements in A[Formula: see text]O2peak [0.16 (0.07, 0.25) L/min], R[Formula: see text]O2peak [2.9 (1.8, 3.9) mL/kg/min], and PPO [9 (5, 14) W] with exercise, relative to controls (p < 0.001). Ninety-six studies (117 independent exercise interventions comprising 1,331 adults with SCI) were included in the secondary, pooled meta-analysis which demonstrated significant increases in A[Formula: see text]O2peak [0.22 (0.17, 0.26) L/min], R[Formula: see text]O2peak [2.8 (2.2, 3.3) mL/kg/min], and PPO [11 (9, 13) W] (p < 0.001) following exercise interventions. There were subgroup differences for R[Formula: see text]O2peak based on exercise modality (p = 0.002) and intervention length (p = 0.01), but there were no differences for A[Formula: see text]O2peak. There were subgroup differences (p ≤ 0.018) for PPO based on time since injury, neurological level of injury, exercise modality, and frequency. The meta-regression found that studies with a higher mean age of participants were associated with smaller changes in A[Formula: see text]O2peak and R[Formula: see text]O2peak (p < 0.10). GRADE indicated a moderate level of certainty in the estimated effect for R[Formula: see text]O2peak, but low levels for A[Formula: see text]O2peak and PPO. This review may be limited by the small number of RCTs, which prevented a subgroup analysis within this specific study design. CONCLUSIONS Our primary meta-analysis confirms that performing exercise >2 weeks results in significant improvements to A[Formula: see text]O2peak, R[Formula: see text]O2peak, and PPO in individuals with SCI. The pooled meta-analysis subgroup comparisons identified that exercise interventions lasting up to 12 weeks yield the greatest change in R[Formula: see text]O2peak. Upper-body aerobic exercise and resistance training also appear the most effective at improving R[Formula: see text]O2peak and PPO. Furthermore, acutely injured, individuals with paraplegia, exercising for ≥3 sessions/week will likely experience the greatest change in PPO. Ageing seemingly diminishes the adaptive CRF responses to exercise training in individuals with SCI. REGISTRATION PROSPERO: CRD42018104342.
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Affiliation(s)
- Daniel D. Hodgkiss
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Gurjeet S. Bhangu
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- MD Undergraduate Program, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Carole Lunny
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, and University of British Columbia, Vancouver, Canada
| | - Catherine R. Jutzeler
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Schulthess Clinic, Zurich, Switzerland
| | - Shin-Yi Chiou
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, United Kingdom
- Centre for Trauma Science Research, University of Birmingham, Birmingham, United Kingdom
| | - Matthias Walter
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Samuel J. E. Lucas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
| | - Andrei V. Krassioukov
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, Canada
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada
| | - Tom E. Nightingale
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- Centre for Trauma Science Research, University of Birmingham, Birmingham, United Kingdom
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Amatachaya S, Khamnon N, Wattanapan P, Wiyanad A, Thaweewannakij T, Namwong W. Reference Values and Cutoff Scores of the Spinal Cord Independence Measure III to Determine Independence for Wheelchair Users and Ambulatory Individuals With Spinal Cord Injury. Arch Phys Med Rehabil 2023; 104:83-89. [PMID: 36228763 DOI: 10.1016/j.apmr.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/13/2022] [Accepted: 09/07/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To establish the reference values and optimal cutoff scores of the Spinal Cord Independence Measure Version III (SCIM III) to indicate independence of wheelchair users (WU) and ambulatory (AM) individuals with spinal cord injury (SCI). DESIGN A cross-sectional study. SETTING Tertiary rehabilitation center and communities. PARTICIPANTS A total of 309 (168 WU and 141 AM) participants with SCI. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) SCIM III scores. RESULTS Participants with greater levels of independence had significantly higher SCIM III scores, both total and subitem scores (P<.05). The SCIM III scores of ≥55 and ≥75 were optimal indicators of modified independence in WU and AM individuals, respectively (sensitivity and specificity >93%, AUC>.95). In addition, scores of 90 were proved to be excellent indicators for independence of AM individuals (sensitivity 94%, specificity 100%, AUC=.99). CONCLUSIONS The present findings provide the reference values of SCIM III scores covering WU and AM individuals with SCI at various levels of independence as well as optimal cutoff scores to indicate independence of these individuals. These data can be used as standard criteria for data comparison with patients' ability, and target functional values for individuals with SCI in clinical-, community-, and home-based settings.
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Affiliation(s)
- Sugalya Amatachaya
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand; Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand.
| | - Narongsak Khamnon
- Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand; School of Integrative Medicine, Mae Fah Luang University, Chiang Rai, Thailand
| | - Pattra Wattanapan
- Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand; Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Arpassanan Wiyanad
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand; Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Thiwabhorn Thaweewannakij
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand; Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Wilairat Namwong
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand; Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen, Thailand
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Valentino SE, Hutchinson MJ, Goosey-Tolfrey VL, MacDonald MJ. The effects of perceptually regulated exercise training on cardiorespiratory fitness and peak power output in adults with spinal cord injury: a systematic review and meta-analysis. Arch Phys Med Rehabil 2022; 103:1398-1409. [DOI: 10.1016/j.apmr.2022.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/22/2022] [Accepted: 03/08/2022] [Indexed: 11/16/2022]
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Kraaijenbrink C, Vegter RJK, Ostertag N, Janssens L, Vanlandewijck Y, van der Woude LHV, Wagner H. Steering Does Affect Biophysical Responses in Asynchronous, but Not Synchronous Submaximal Handcycle Ergometry in Able-Bodied Men. Front Sports Act Living 2021; 3:741258. [PMID: 34761216 PMCID: PMC8572844 DOI: 10.3389/fspor.2021.741258] [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: 07/14/2021] [Accepted: 09/27/2021] [Indexed: 11/30/2022] Open
Abstract
Real-life daily handcycling requires combined propulsion and steering to control the front wheel. Today, the handcycle cranks are mostly mounted synchronously unlike the early handcycle generations. Alternatively, arm cycle ergometers do not require steering and the cranks are mostly positioned asynchronously. The current study aims to evaluate the effects of combining propulsion and steering requirements on synchronous and asynchronous submaximal handcycle ergometry. We hypothesize that asynchronous handcycling with steering results in the mechanically least efficient condition, due to compensation for unwanted rotations that are not seen in synchronous handcycling, regardless of steering. Sixteen able-bodied male novices volunteered in this lab-based experiment. The set-up consisted of a handcycle ergometer with 3D force sensors at each crank that also allows “natural” steering. Four submaximal steady-state (60 rpm, ~35 W) exercise conditions were presented in a counterbalanced order: synchronous with a fixed steering axis, synchronous with steering, asynchronous with a fixed axis and asynchronous with steering. All participants practiced 3 × 4 mins with 30 mins rest in between every condition. Finally, they did handcycle for 4 mins in each of the four conditions, interspaced with 10 mins rest, while metabolic outcomes, kinetics and kinematics of the ergometer were recorded. The additional steering component did not influence velocity, torque and power production during synchronous handcycling and therefore resulted in an equal metabolically efficient handcycling configuration compared to the fixed condition. Contrarily, asynchronous handcycling with steering requirements showed a reduced mechanical efficiency, as velocity around the steering axis increased and torque and power production were less effective. Based on the torque production around the crank and steering axes, neuromuscular compensation strategies seem necessary to prevent steering movements in the asynchronous mode. To practice or test real-life daily synchronous handcycling, a synchronous crank set-up of the ergometer is advised, as exercise performance in terms of mechanical efficiency, metabolic strain, and torque production is independent of steering requirements in that mode. Asynchronous handcycling or arm ergometry demands a different handcycle technique in terms of torque production and results in higher metabolic responses than synchronous handcycling, making it unsuitable for testing.
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Affiliation(s)
- Cassandra Kraaijenbrink
- Department of Movement Science, Institute for Sport and Exercise Sciences, University of Münster, Münster, Germany.,Department of Human Movement Sciences, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Riemer J K Vegter
- Department of Human Movement Sciences, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands.,Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health, Loughborough University, Loughborough, United Kingdom
| | - Nils Ostertag
- Department of Movement Science, Institute for Sport and Exercise Sciences, University of Münster, Münster, Germany
| | - Luc Janssens
- Electrical Engineering (ESAT) TC, Campus Group T Leuven, KULeuven, Leuven, Belgium.,Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, KULeuven, Leuven, Belgium
| | - Yves Vanlandewijck
- Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, KULeuven, Leuven, Belgium.,Department of Physiology, Nutrition and Biomechanics, The Swedish School of Sport and Health Sciences (GIH), Stockholm, Sweden
| | - Lucas H V van der Woude
- Department of Human Movement Sciences, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands.,Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health, Loughborough University, Loughborough, United Kingdom.,Department of Rehabilitation Medicine, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Heiko Wagner
- Department of Movement Science, Institute for Sport and Exercise Sciences, University of Münster, Münster, Germany
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Kouwijzer I, Valent LJ, Post MW, Wilders LM, Grootoonk A, van der Woude LH, de Groot S. The Course of Physical Capacity in Wheelchair Users During Training for the HandbikeBattle and at 1-Yr Follow-up. Am J Phys Med Rehabil 2021; 100:858-865. [PMID: 33278130 PMCID: PMC8360672 DOI: 10.1097/phm.0000000000001658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aims of this study were (1) to compare physical capacity at 1-yr follow-up with physical capacity before and after the training period for the HandbikeBattle event and (2) to identify determinants of the course of physical capacity during follow-up. DESIGN This was a prospective observational study. Former rehabilitation patients (N = 33) with health conditions such as spinal cord injury or amputation were included. A handcycling/arm crank graded exercise test was performed before (January, T1) and after the training period (June, T2) and at 1-yr follow-up (June, T4). Outcomes were peak power output (W) and peak oxygen uptake (L/min). Determinants were sex (male/female); age (years); classification; physical capacity, musculoskeletal pain, exercise stage of change, and exercise self-efficacy at T1; and HandbikeBattle participation at T4. RESULTS Multilevel regression analyses showed that peak power output and peak oxygen uptake increased during the training period and did not significantly change during follow-up (T1: 112 ± 37 W, 1.70 ± 0.48 L/min; T2: 130 ± 40 W, 2.07 ± 0.59 L/min; T4: 126 ± 42 W, 2.00 ± 0.57 L/min). Participants who competed again in the HandbikeBattle showed slight improvement in physical capacity during follow-up, whereas participants who did not compete again showed a decrease. CONCLUSION Physical capacity showed an increase during the training period and remained stable after 1-yr follow-up. Being (repeatedly) committed to a challenge might facilitate long-term exercise maintenance.
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Abonie US, Albada T, Morrien F, van der Woude L, Hettinga F. Effects of 7-week Resistance Training on Handcycle Performance in Able-bodied Males. Int J Sports Med 2021; 43:46-54. [PMID: 34380150 DOI: 10.1055/a-1373-6033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The effect of an upper body resistance training program on maximal and submaximal handcycling performance in able-bodied males was explored. Eighteen able-bodied men were randomly assigned to a training group (TG: n=10) and a control group (CG: n=8). TG received 7 weeks of upper body resistance training (60% of 1 repetition maximum (1RM), 3×10 repetitions, 6 exercise stations, 2 times per week). CG received no training. Peak values for oxygen uptake (V˙O2peak), power output (POpeak), heart rate (HRpeak), minute ventilation (V˙OEpeak) and respiratory exchange ratio (RERpeak), submaximal values (HR, V˙O2, RER, PO, and gross mechanical efficiency (GE)), and time to exhaustion (TTE) were determined in an incremental test pre- and post-training. Maximal isokinetic arm strength and 1RM tests were conducted. Ratings of perceived exertion (RPE) were assessed. A two-way repeated measures ANOVA and post-hoc comparisons were performed to examine the effect of time, group and its interaction (p<0.05). TG improved on POpeak (8.55%), TTE (10.73%), and 1RM (12.28-38.98%). RPE at the same stage during pre- and post-test was lower during the post-test (8.17%). Despite no improvements in V˙O2peak, training improved POpeak, muscular strength, and TTE. Upper body resistance training has the potential to improve handcycling performance.
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Affiliation(s)
- Ulric Sena Abonie
- Department of Physiotherapy and Rehabilitation Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Tryntje Albada
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Floor Morrien
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Lucas van der Woude
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Florentina Hettinga
- Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
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8
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Kouwijzer I, Valent LJM, van Bennekom CAM, Post MWM, van der Woude LHV, de Groot S. Training for the HandbikeBattle: an explorative analysis of training load and handcycling physical capacity in recreationally active wheelchair users. Disabil Rehabil 2020; 44:2723-2732. [PMID: 33147423 DOI: 10.1080/09638288.2020.1839974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE (1) to analyze training characteristics of recreationally active wheelchair users during handcycle training, and (2) to examine the associations between training load and change in physical capacity. METHODS Former rehabilitation patients (N = 60) with health conditions such as spinal cord injury or amputation were included. Participants trained for five months. A handcycling/arm crank graded exercise test was performed before and after the training period. Outcomes: peak power output per kg (POpeak/kg) and peak oxygen uptake per kg (VO2peak/kg). Training load was defined as Training Impulse (TRIMP), which is rating of perceived exertion (sRPE) multiplied by duration of the session, in arbitrary units (AU). Training intensity distribution (TID) was also determined (time in zone 1, RPE ≤4; zone 2, RPE 5-6; zone 3, RPE ≥7). RESULTS Multilevel regression analyses showed that TRIMPsRPE was not significantly associated with change in physical capacity. Time in zone 2 (RPE 5-6) was significantly associated with ΔVO2peak, %ΔVO2peak, ΔVO2peak/kg and %ΔVO2peak/kg. CONCLUSION Training at RPE 5-6 was the only determinant that was significantly associated with improvement in physical capacity. Additional controlled studies are necessary to demonstrate causality and gather more information about its usefulness, and optimal handcycle training regimes for recreationally active wheelchair users.IMPLICATIONS FOR REHABILITATIONMonitoring of handcycle training load is important to structure the training effort and intensity over time and to eventually optimize performance capacity. This is especially important for relatively untrained wheelchair users, who have a low physical capacity and a high risk of overuse injuries and shoulder pain.Training load can be easily calculated by multiplying the intensity of the training (RPE 0-10) with the duration of the training in minutes.Results on handcycle training at RPE 5-6 intensity in recreationally active wheelchair users suggests to be promising and should be further investigated with controlled studies.
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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
| | - Linda J M Valent
- Research and Development, Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands
| | - Coen A M van Bennekom
- Research and Development, Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands.,Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | | | - Marcel W M Post
- Center of Excellence for Rehabilitation Medicine, UMCU Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, 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.,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, The Netherlands
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Stephenson BT, Stone B, Mason BS, Goosey‐Tolfrey VL. Physiology of handcycling: A current sports perspective. Scand J Med Sci Sports 2020; 31:4-20. [DOI: 10.1111/sms.13835] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/28/2020] [Accepted: 09/15/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Ben T. Stephenson
- Peter Harrison Centre for Disability Sport School of Sport, Exercise and Health Sciences Loughborough University Loughborough UK
- English Institute of Sport Performance Centre Loughborough University Loughborough UK
| | - Benjamin Stone
- Peter Harrison Centre for Disability Sport School of Sport, Exercise and Health Sciences Loughborough University Loughborough UK
| | - Barry S. Mason
- Peter Harrison Centre for Disability Sport School of Sport, Exercise and Health Sciences Loughborough University Loughborough UK
| | - Victoria L. Goosey‐Tolfrey
- Peter Harrison Centre for Disability Sport School of Sport, Exercise and Health Sciences Loughborough University Loughborough UK
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10
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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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Changes in Quality of Life During Training for the HandbikeBattle and Associations With Cardiorespiratory Fitness. Arch Phys Med Rehabil 2020; 101:1017-1024. [DOI: 10.1016/j.apmr.2019.12.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/18/2019] [Accepted: 12/24/2019] [Indexed: 11/23/2022]
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12
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Stone B, Mason BS, Stephenson BT, Goosey-Tolfrey VL. Physiological responses during simulated 16 km recumbent handcycling time trial and determinants of performance in trained handcyclists. Eur J Appl Physiol 2020; 120:1621-1628. [PMID: 32435985 PMCID: PMC7295712 DOI: 10.1007/s00421-020-04390-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/06/2020] [Indexed: 11/28/2022]
Abstract
Purpose To characterise the physiological profiles of trained handcyclists, during recumbent handcycling, to describe the physiological responses during a 16 km time trial (TT) and to identify the determinants of this TT performance. Methods Eleven male handcyclists performed a sub-maximal and maximal incremental exercise test in their recumbent handbike, attached to a Cyclus II ergometer. A physiological profile, including peak aerobic power output (POPeak), peak rate of oxygen uptake (\documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}$$\end{document}V˙O2Peak), aerobic lactate threshold (AeLT) and PO at 4 mmol L−1 (PO4), were determined. Participants also completed a 16 km simulated TT using the same experimental set-up. Determinants of TT performance were identified using stepwise multiple linear regression analysis. Results Mean values of POPeak = 252 ± 9 W, \documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}$$\end{document}V˙O2Peak = 3.30 ± 0.36 L min−1 (47.0 ± 6.8 mL kg−1 min−1), AeLT = 87 ± 13 W and PO4 = 154 ± 14 W were recorded. The TT was completed in 29:21 ± 0:59 min:s at an intensity equivalent to 69 ± 4% POPeak and 87 ± 5% \documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}$$\end{document}V˙O2Peak. POPeak (r = − 0.77, P = 0.006), PO4 (r = − 0.77, P = 0.006) and AeLT (r = − 0.68, P = 0.022) were significantly correlated with TT performance. PO4 and POPeak were identified as the best predictors of TT performance (r = 0.89, P < 0.001). Conclusion POPeak, PO4 and AeLT are important physiological TT performance determinants in trained handcyclists, differentiating between superior and inferior performance, whereas \documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}$$\end{document}V˙O2peak was not. The TT took place at an intensity corresponding to 69% POPeak and 87% \documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}$$\end{document}V˙O2peak.
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Affiliation(s)
- Benjamin Stone
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, NCSEM 1.26, Loughborough University Campus, Loughborough, LE11 3TU, UK
| | - Barry S Mason
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, NCSEM 1.26, Loughborough University Campus, Loughborough, LE11 3TU, UK
| | - Ben T Stephenson
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, NCSEM 1.26, Loughborough University Campus, Loughborough, LE11 3TU, UK.,English Institute of Sport, Performance Centre, Loughborough University, Loughborough, UK
| | - Vicky L Goosey-Tolfrey
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, NCSEM 1.26, Loughborough University Campus, Loughborough, LE11 3TU, UK.
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Bernardi M, Guerra E, Rodio A, Dante D, Castellano V, Peluso I, Schena F, Bhambhani Y. Assessment of Exercise Stroke Volume and Its Prediction From Oxygen Pulse in Paralympic Athletes With Locomotor Impairments: Cardiac Long-Term Adaptations Are Possible. Front Physiol 2020; 10:1451. [PMID: 32218739 PMCID: PMC7079670 DOI: 10.3389/fphys.2019.01451] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 11/08/2019] [Indexed: 12/17/2022] Open
Abstract
The determinants of cardiac output (CO) during exercise, i.e., stroke volume (SV) and heart rate (HR), could differ in Paralympic athletes (PAthl) with spinal cord injury (SCI) with respect to PAthl with locomotor impairments caused by different health conditions (HCs). The purposes of the present study were the comparisons of two groups of PAthl, one with SCI and the other with either amputation (AMP) or post poliomyelitis syndrome (PM), assessing the (1) peak cardiorespiratory responses and determinants (SV and HR) of CO during maximal and submaximal arm cranking exercise (ACE), respectively; (2) correlations between peak oxygen uptake (VO2peak) and the highest SV obtained during submaximal exercise; and (3) correlations between oxygen pulse (O2 pulse, ratio between VO2 and HR) and both SV and O2 arterio-venous difference [(a-v)O2diff]. Each athlete (19 PAthl with SCI, 9 with AMP, and 5 with PM) completed a continuous incremental cardiopulmonary ACE test to volitional fatigue to assess peak responses. In a different session, CO was indirectly measured through carbon dioxide (CO2) rebreathing method at sub-maximal exercise intensities approximating 30, 50, and 70% of the VO2peak. There were no significant differences between the PAthl groups in age, anthropometry, and VO2peak. However, peak HR was significantly lower, and peak O2 pulse was significantly higher in PAthl with AMP/PM compared to those with SCI. During sub-maximal exercise, PAthl with AMP/PM displayed significantly higher SV values (154.8 ± 17.60 ml) than PAthl with SCI (117.1 ± 24.66 ml). SV correlated significantly with VO2peak in both PAthl with SCI (R 2 = 0.796) and AMP/PM (R 2 = 0.824). O2 pulse correlated significantly with SV in both PAthl with SCI (R 2 = 0.888) and AMP/PM (R 2 = 0.932) and in the overall sample (R 2 = 0.896). No significant correlations were observed between O2 pulse and (a-v)O2diff. It was concluded that in PAthl with different HCs: (1) significant differences, as a consequence of the different HC, exist in the determinants of CO at maximal and submaximal ACE; (2) SV is a significant determinant of VO2peak, suggesting cardiac adaptations possible also in PAthl with SCI; and (3) SV can be predicted from O2 pulse measurements during submaximal exercise in both groups of PAthl.
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Affiliation(s)
- Marco Bernardi
- Department of Physiology and Pharmacology, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Rome, Italy.,Italian Paralympic Committee, Rome, Italy
| | - Emanuele Guerra
- Sports Medicine Service, Local Health Unit of Modena, Modena, Italy
| | - Angelo Rodio
- Department of Human, Social and Health Sciences, University of Cassino, Cassino, Italy
| | - Donatella Dante
- Department of Physiology and Pharmacology, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Ilaria Peluso
- Research Centre for Food and Nutrition, Council for Agricultural Research and Economics (CREA-AN), Rome, Italy
| | - Federico Schena
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Yagesh Bhambhani
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
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14
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Crank fore-aft position alters the distribution of work over the push and pull phase during synchronous recumbent handcycling of able-bodied participants. PLoS One 2019; 14:e0220943. [PMID: 31425557 PMCID: PMC6699671 DOI: 10.1371/journal.pone.0220943] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 07/27/2019] [Indexed: 11/30/2022] Open
Abstract
Objective The objective of the current study was to investigate the effect of four different crank fore-aft positions on elbow flexion and shoulder protraction, the consequent propulsion kinetics and the physiological responses during handcycling. Methods Twelve able-bodied male participants volunteered in this study. Crank fore-aft positions were standardised at 94%, 97%, 100% and 103% of the participants’ arm length. Two submaximal 3 min trials were performed at a fixed cadence (70 rpm), in a recumbent handcyle attached to an ergometer at two fixed power outputs (30W and 60W). Elbow flexion, shoulder protraction, propulsion kinetics and physiological responses of the participants were continuously measured. Results As crank fore-aft distance increased, a decrease in elbow flexion (42±4, 37±3, 33±3, 29±3°) and an increase shoulder protraction was observed (29±5, 31±5, 34±5, 36±5°). The percentage of work done in the pull phase increased as well (62±7, 65±7, 67±6, 69±8%, at 60W), which was in line with an increased peak torque during the pull phase (8.8±1.6, 9.0±1.4, 9.4±1.5, 9.7±1.4Nm, at 60W) and reduced peak torque during the push phase (6.0±0.9, 5.6±0.9,5.6±0.9, 5.4±1.0Nm, in 60W condition). Despite these changes in work distribution, there were no significant changes in gross mechanical efficiency (15.7±0.8, 16.2±1.1, 15.8±0.9, 15.6±1.0%, at 60W). The same patterns were observed in the 30W condition. Conclusions From a biomechanical perspective the crank position closest to the trunk (94%) seems to be advantageous, because it evens the load over the push and pull phase, which reduces speed fluctuations, without causing an increase in whole body energy expenditure and hence a decrease of gross mechanical efficiency. These findings may help handcyclists to optimize their recumbent handcycle configuration.
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de Groot S, Kouwijzer I, Valent LJM, van der Woude LHV, Nash MS, Cowan RE. Good association between sprint power and aerobic peak power during asynchronuous arm-crank exercise in people with spinal cord injury. Disabil Rehabil 2019; 43:378-385. [PMID: 31184928 DOI: 10.1080/09638288.2019.1625978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To (1) investigate the association between sprint power and aerobic power output (POpeakGXT) during a graded peak exercise test (GXT); and (2) validate the prediction models of POpeakGXT based on sprint power and personal and lesion characteristics. MATERIALS AND METHODS Wheelchair users with tetraplegia (N = 35) and paraplegia (N = 58) performed a 30 s-Wingate test and GXT on an asynchronous arm-crank ergometer. Data were split into samples to develop and validate the model. Sprint power (POmeanWingate and POpeakWingate, respectively) and POpeakGXT were determined. Regression analyses were performed to develop POpeakGXT prediction models. Candidate independent variables included POmeanWingate or POpeakWingate, age (years), sex, body mass (kg) or BMI (kg/m2), time since injury (TSI, years) and lesion level (tetraplegia/paraplegia). The best model was validated by comparing the predicted POpeakGXT with measured POpeakGXT. RESULTS The best model (R 2 = 0.76) to predict POpeakGXT included POmeanWingate, BMI and all other independent variables. No significant difference was found between measured (68 ± 35 W) and predicted POpeakGXT (68 ± 30 W, p = 0.97). The ICC was excellent (0.89 with 95% confidence intervals: 0.75-0.95). The 95% limits of agreement for the Bland-Altman plots were wide (-30 to 31 W). CONCLUSIONS Strong associations were found between POmeanWingate and POpeakGXT. Although relative agreement was excellent, absolute agreement was low. Implications for rehabilitation There is a strong relationship between peak aerobic power output and sprint power output, both tested on an arm-crank ergometer, in people with spinal cord injury. A prediction model for peak aerobic power output, based on sprint power output and personal and lesion characteristics, showed a high explained variance. The predictive model can give a guideline for choosing the right graded exercise test protocol but should be used with caution.
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Affiliation(s)
- Sonja de Groot
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands.,University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - Ingrid Kouwijzer
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands.,University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands.,Department of Research and Development, Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands
| | - Linda J M Valent
- Department of 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.,Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mark S Nash
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida.,The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, Florida
| | - Rachel E Cowan
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida.,The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, Florida
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16
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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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