Anthropometry, Body Composition, and Performance in Sport-Specific Field Test in Female Wheelchair Basketball Players

Evaluation of the relationship between body composition and dietary habits of physically active people with disabilities

Physical activity offers numerous physical and mental health benefits for individuals with disabilities, while nutrition plays a crucial role in maintaining bodily homeostasis. This study aimed to assess the relationship between body composition and dietary habits among physically active people with disabilities. Fifty-five participants aged 16 to 61, including 28 with disabilities and 27 without, were included in the study. The FFQ-6 questionnaire, Tanita body composition analyzer, and Stadiometer were utilized. No significant differences in BMI were observed between the two groups. However, individuals with disabilities showed higher body fat, metabolic age, or pulse values, whereas the control group exhibited higher muscle mass, muscle quality, body type, or bone mass. Participants with disabilities were more likely to consume vegetables (p = 0.004) and animal fats (p = 0.027), while those without disabilities were more inclined to consume fast food, instant products (p = 0.006), sweetened beverages (p < 0.001), and alcohol (p < 0.001). People with disabilities often have a higher percentage of body fat, cautioning against the consumption of processed fruits, dried fruits, fast food, and red meat. Conversely, in non-disabled individuals, frequent consumption of eggs, animal fats, sugar, and sweets is not recommended due to the potential for increased body fat, visceral fat, and higher BMI.

Initial Maximum Push-Rim Propulsion and Sprint Performance in Elite Men's Wheelchair Basketball

OBJECTIVES

This study sought to report the reliability (intrasession) values of initial maximum push-rim propulsion (IMPRP) and sprint performance in elite wheelchair basketball (WB) players and to assess the involvement of strength in sprint capacity.

METHODS

Fifteen Spanish international WB male players participated in this study. The maximum single wheelchair push from a stationary position (IMPRP) and the sprint performance (ie, 3, 5, and 12 m) of WB players were measured in this study.

RESULTS

IMPRP mechanical outputs V, Vmax, P, Rel. P, F, and Rel. F variables presented high reliability values (intraclass correlation coefficient [ICC] ≥ .92; coefficient of variation [CV] ≤ 8.04 ± 7.37; standard error of measurement [SEM] ≤ 29.92), but the maximum strength variables Pmax, Rel. Pmax, Fmax, and Rel. Fmax (ICC ≥ .63; CV ≤ 13.19 ± 16.63; SEM ≤ 203.76) showed lower ICC values and by contrast higher CV and SEM values. The most substantial correlations were identified between maximum IMPRP values (ie, V, Vmax, P, Rel. P, F, and Rel. F) and sprint performance in 3 m (r ± confidence limits ≥ -0.74 ± 0.22, very large; R2 ≥ .55), 5 m (r ± confidence limits ≥ -0.72 ± 0.24, very large; R2 ≥ .51), and 12 m (r ± confidence limits ≥ -0.67 ± 0.27, large; R2 ≥ .44).

CONCLUSIONS

The IMPRP test and sprint tests (3, 5, and 12 m) are practical and reliable for measuring strength and speed in WB players. In addition, there were large to very large associations among strength variables (ie, P, Rel. P, F, and Rel. F) and all sprint variables. This could indicate a need to implement specific strength exercises in WB players to improve sprint capacity.

Evaluating field-goal shooting effectiveness in wheelchair basketball players across a competitive season: a preliminary study

Background

Information about non-elite wheelchair basketball (WB) players across national competitive seasons are still missing. This study aimed at identifying which situational-related variables were associated with shooting effectiveness in non-elite WB players.

Methods

All the matches played by one WB team across one national competitive season were video-recorded and analysed; 333 shooting attempts from high-point players and several situational-related variables were considered.

Results

Pearson's Chi-square test showed that increased shooting effectiveness under the following conditions: playing on home ground, during won matches, while taking shots with the wheelchair in motion, and when no opposing player raised their arm in defence. Results of the multivariable logistic regression analysis showed a statistically significant influence of match location (p-value = 0.001), shot-clock remaining (p-value = 0.015) and modality of press (p-value < 0.001). The highest attack effectiveness was achieved when teams played at home (odds ratio [OR] = 2.49), while the shooting effectiveness decreased when the shot occurred during the last seconds of the action (OR = 0.36), or the opponents defended with the arm raised (OR = 0.19). These results suggest that coaches should include exercises aimed at shooting under conditions of increased pressure in their programmes in order to create specific situations during the training sessions to prepare their high-point athletes for shots under specific match constraints.

Predictors of Ball Velocity in the Sitting Volleyball Serve: A Causal Analysis

This study explored the performance of the Sitting Volleyball serve by investigating the causal factors associated with ball velocity. Thirty-seven athletes underwent anthropometry and strength assessment and performed ten successful maximal effort serves. Ball velocity was measured using a sports radar gun. The hip, shoulder, elbow and wrist angles at the instant of ball impact as well as the height of ball impact were estimated through two-dimensional motion analysis. The causal relationships between variables were described through a linear Structural Equation Model and a Directed Acyclic Graph. Results showed that a smaller hip angle determines a greater shoulder angle, which in turn causes a greater elbow angle. A more open elbow angle together with a greater vertical reach allowed for a greater height of ball impact. Finally, increased height of ball impact along with greater abdominal strength are beneficial for higher ball velocity. These results underlined that the Sitting Volleyball serve is a multifactorial stroke involving anthropometric, technical and strength factors and suggest that athletes should improve their abdominal strength and master the technique necessary to perform the serve with the shoulder and the elbow joints fully extended in order to produce the greatest possible impact on the ball.

Evaluation of hand functions and distal radioulnar joint instability in elite wheelchair basketball athletes: a cross-sectional pilot study

BACKGROUND

Wrist injury affects wheelchair basketball players' performance; however, the relationship between distal radioulnar joint (DRUJ) instability and hand functions is unclear. This cross-sectional pilot study investigated DRUJ instability in elite female wheelchair basketball athletes using force-monitor ultrasonography.

METHODS

Nine elite female wheelchair basketball athletes (18 wrists) were included in the study. A triangular fibrocartilage complex (TFCC) injury was confirmed using magnetic resonance imaging (MRI). Hand functions were evaluated based on the range of motion (ROM) of wrist palmar flexion, dorsiflexion, radial deviation, and ulnar deviation; grip strength; arm circumference; forearm circumference; and DRUJ instability or pain using the ballottement test. The Mann-Whitney U test was used to compare parameters between the TFCC-injured and intact wrists. Radioulnar displacement was measured using force-monitor ultrasonography and pressure data, and the displacement-to-force ratio was used as an indicator of DRUJ instability. The correlation between the DRUJ displacement-to-force ratio and each hand function assessment was evaluated using Pearson correlation coefficient for the TFCC-injured and intact wrists. A generalized linear mixed model (GLMM) was used to estimate the relationship between hand functions and DRUJ instability.

RESULTS

TFCC injuries in seven wrists were confirmed using MRI findings (38.9%). The ulnar deviation ROM values of the TFCC-injured wrist (n = 7) and intact (n = 11) groups were 38.6 ± 8.0° and 48.6 ± 7.8°, respectively. The ulnar deviation ROM was significantly smaller in the TFCC-injured wrists (p = 0.02, r = - 0.54). In the TFCC-injured wrists, no correlation was observed between the displacement-to-force ratio and the hand function assessment. In contrast, the displacement-to-force ratio negatively correlated with grip strength, arm circumference, and forearm circumference in the intact wrists (Pearson correlation coefficient r = - 0.78, - 0.61, and - 0.74, respectively). The GLMM showed that the displacement-to-force ratio significantly affected grip strength, arm circumference, and forearm circumference in the intact group.

CONCLUSIONS

In intact wrists, correlations were observed between hand functions such as upper arm/forearm strength and DRUJ stability evaluated using ultrasound. Maintaining and strengthening grip strength, forearm circumference, and arm circumference are associated with DRUJ stability and may be related to TFCC injury prevention in wheelchair basketball athletes.

TRIAL REGISTRATION

The protocol was registered with the UMIN Clinical Trials Registry (UMIN000043343) [Date of first registration: 16/02/2021].

Physical fitness assessment in wheelchair basketball: A mini-review

Introduction

Wheelchair basketball (WB) is a Paralympic sport ideated for people with motor disabilities, and the research on this topic still requires attention. It is fundamental to evaluate physical fitness characteristics with appropriate tests and standardized routines to plan and monitor the training. Considering that a standard operating procedure is a document that makes the test battery replicable, the objective of the present study was to review the literature on physical fitness assessment in WB players and to create a standard operating procedure.

Methods

Studies were collected from different databases, and after a screening process, data were discussed narratively.

Results

Only 18 articles met the eligibility criteria. The test batteries presented similarities in different studies.

Conclusion

The suggested standard operating procedure consists of 10-min warm-up followed by handgrip evaluation (only if the instrument is available), 20-m sprint test, maximal pass, modified push-up, back scratch test, and the Yo-Yo intermittent recovery test adapted test Version 1.

Wheelchair skill tests in wheelchair Basketball: A systematic review

OBJECTIVES

The aim of this study was to identify, describe and synthesize the skill tests used in wheelchair basketball.

METHOD

A systematic review was carried out in the databases: PubMed/Medline, ScienceDirect, Scopus, Web of science and Google Scholar from inception to January 2021 with up to date in January 2022. the eligibility criteria used were Inclusion: (i) evaluation of wheelchair basketball athletes; (ii) using skill tests (defined as agility, speed, ball maneuverability, slalom, etc.) and (iii) papers needed to be written in English and published in peer-reviewed journals. Exclusion: (i) papers with poor description of the test methodology, (ii) participants not classified as wheelchair basketball athletes (less than one year of practice) and (iii) Participants were not people without disabilities.

RESULTS

Our main findings were: a) the most explored skills were pass and speed, and the most frequent test was the pass tests and sprint tests, b) Strong associations were found between sports classes and performance in field tests, c) The most used tests for each skill were: pass = pass accuracy and maximum pass; speed = 20m sprint test with and without the ball; agility = slalom test; dribbling = obstacle dribbling tests and throw = free throw and spot shot.

CONCLUSION

The most explored skills were passing and speed, and to evaluate these skills we highlight the two-handed chest pass test, 20m sprint test with ball and the WMP test. The use of specific tests can facilitate the creation of reference standards and possible comparison of athletes and, thus, enable better training conditions, aiming to meet the specific demands of each athlete and team.

Physique and performance in male sitting volleyball players: implications for classification and training

Background

This study assessed whether anthropometry, physical fitness and sport-specific sprint performance vary across the three groups of sitting volleyball (SV) athletes (athletes with a disability (VS1), athletes with a minimal disability (VS2) and able-bodied SV athletes (AB)) in order to explore the validity of the current system of classification. This study also investigated how the anthropometric and physical fitness characteristics of athletes relate to their sprint performance.

Methods

Thirty-five SV male athletes aged 37.4 ± 10.8 years and practicing SV at a national/international level volunteered for this study. Testing consisted in the evaluation of linear anthropometry, physical fitness (body composition by-means of dual-energy X-ray absorptiometry and upper-body strength) and sprint performance (5-meter sprint tests, agility test and speed and endurance test).

Results

Athletes in the three groups differed in fat mass percentage (%FM) which was higher in VS1 versus AB at the sub-total level (+9%), in the arms (+15%) and in the non-impaired leg (+8%) regions. Greater hand span, greater length of the impaired lower leg, lower %FM at both the sub-total and regional level and a higher level of strength in the upper body are all associated with better performances in the considered sprint tests (P < 0.05 for all). These results do not confirm the validity of the current system of classification of athletes adopted in SV. Professionals dealing with SV athletes should include specific exercises aimed at improving whole-body and regional body composition and the strength of the trunk and upper limbs in their training programs.

Analysis of wheelchair falls in team sports at the Paralympic Games: video-based descriptive comparison between the Rio 2016 and Tokyo 2020 games

OBJECTIVES

To identify the fall characteristics of athletes in wheelchair rugby and wheelchair basketball during the Tokyo 2020 Paralympic Games and descriptively compare these with those of the Rio 2016 Paralympic Games.

DESIGN

Cross-sectional analysis.

PRIMARY AND SECONDARY OUTCOME MEASURES

We obtained video footage from the International Paralympic Committee of the Tokyo 2020 Paralympic Games that included 8 teams from each of the 18 wheelchair rugby and 10 wheelchair basketball games (men and women). The data were analysed to evaluate the number of falls, class difference (low or high pointer), time of play during the fall, phase of play, contact with other athletes, fall direction, fall location and the body part that first contacted the floor during the fall. These data from the Rio 2016 and Tokyo 2020 games were compared.

RESULTS

Overall, 430 falls (rugby, 104; men's basketball, 230 and women's basketball, 96) occurred (average per game ±SD: 5.8±3.1, 23.0±5.4 and 9.6±5.0, respectively). Significant differences in class, direction, fall location and body part point of contact between the three sports were observed. In wheelchair rugby, falls occurred mainly in high pointers and tended to be more lateral due to contact. In wheelchair basketball, falls occurred more in female high-pointers and in male low pointers, with more forward falls due to forward contact. Unlike in the Rio 2016 games, no difference between the events based on the presence or absence of contact was observed in the Tokyo 2020 games.

CONCLUSIONS

The number of falls increased in Tokyo 2020 compared with Rio 2016, with no significant difference in the characteristics of falls between the Rio 2016 and Tokyo 2020 games. Only in men's wheelchair basketball, the number of falls in low pointers significantly increased in the Tokyo 2020 games when compared with that in the Rio 2016 games.

Forced Sedentariness and Sports Activity as Factors Differentiating Anthropometric Characteristics, Indices, and Body Composition in People with Disabilities

Simple Summary

People with disabilities, especially those with musculoskeletal disabilities, are prone to leading forced sedentary lifestyles due to their limitations. Inactivity or reduced physical activity affect their body composition and physique. There are also athletes among people with disabilities. The sports they practice can compensate for physical inactivity in everyday life. The aim of our study was to demonstrate that forced sedentariness and varied sports activity are factors differentiating between anthropometric characteristics, indices, and body composition of individuals with disabilities, including Polish Para athletes (track and field athletes, sitting volleyball players, and wheelchair rugby players). It was found that non-athletes had the highest levels of obesity indices compared to Para athletes. Furthermore, in the group of Polish Para athletes, sitting volleyball players had the highest values of obesity indices. The results of the present study indicate that forced sedentariness and sports activity among individuals with disabilities differentiate body structure and physique.

Abstract

Introduction: Although the assessment of physique and body composition poses methodological, technical, and interpretative difficulties, it is of great importance for the health of people with disabilities. The aim of the study was to demonstrate that sedentariness and sports activity are factors differentiating anthropometric characteristics, indices, and body composition in people with physical disabilities. Materials and methods: Fifty-eight people were examined: 48 elite Polish Para athletes, including Paralympic track and field athletes (PTF, n = 8), sitting volleyball players (SV, n = 15), wheelchair rugby players (WR, n = 25), and individuals with cervical spinal cord injury (CSCI, n = 10). Body mass (BM), body height (BH), body length (BL), waist circumference (WC), hip circumference (HC), body fat percentage (%FT), and visceral fat rating (VFR) were measured. Furthermore, BMI, BMIcorrected, and body adiposity index (BAI) were evaluated. Results: The highest WC, BAI, %FT, and VFR were found for the CSCI group. The type of sport significantly differentiated between anthropometric features, indices, and body composition of the athletes. Sitting volleyball players achieved the highest mean BM (83.9), WC (92.9), HC (103.7), BMI (24.5), BAI (23.4), and VFR (12.6). The highest %FT (28.9) was found in wheelchair rugby players. Conclusions: The results of the present study indicate that forced sedentariness and sports activity among individuals with disabilities differentiate body structure and physique.

Initial Maximum Push-Rim Propulsion and Sprint Performance in Elite Women's Wheelchair Basketball: Differences Between Players' Functional Classification

The aim of the present study was to determine, for the first time in elite women's wheelchair basketball, the differences in the initial maximum push-rim propulsion (IMPRP), mechanical outputs, and sprint performance between A category (≤2.5 class) and B category (≥3 class) players. A secondary aim was to assess the association between IMPRP mechanical outputs and sprint performance to determine the influence of specific strength in the latter. Sixteen Spanish women's wheelchair basketball players participated in this study: A category (n = 9, International Wheelchair Basketball Federation [IWBF] classification range: 1-2.5 points) and B category (n = 7, IWBF classification range: 3-4.5 points). All the players undertook 2 tests: the IMPRP test to measure the strength variables and the 3-, 5-, and 12-m sprint test. B category players reported significantly better performance values in almost all the IMPRP variables and all the sprint distances than A category players. Large to very large significant correlations were observed among IMPRP absolute mechanical outputs (excepting mean power) and sprint performance (3, 5, and 12 m) for all the participants. When the group was divided according to categories A and B, the significant differences observed in the whole group decreased in both groups, although some relationships were large or very large. The IMPRP test and sprint test (3, 5, and 12 m) seemed to be sensitive to differentiate the level between the 2 functional categories. In addition, there was a high association between strength and sprint variables, which shows that greater strength could improve sprint capacity.

Anthropometry, body composition, and athletic performance in specific field tests in Paralympic athletes with different disabilities

Purpose

The structural appearance of each disabled athlete or the shape of their body, as determined by their individual genotype and influenced by the environment, considerably affects their technical and physical performance. This study sought to examine the morphological characteristics of elite track and field athletes with different disabilities, including their possible effects on physical and physiological performance.

Methods

A total of 66 male elite athletes with cerebral palsy (n = 12), upper arm amputation (n = 12), short stature (n = 20), or intellectual disability (n = 22) were included. For each athlete, height, weight, sitting height, arm span and four skin folds were assessed; ape index, body mass index, body fat percentage, fat mass, fat mass index and fat-free mass values were calculated; and vertical jump, drop jump, countermovement jump, squat jump, repeated sprint ability and Yo-Yo Intermittent Recovery Level 1 tests were performed.

Results

Significant differences were noticed between short stature and the other groups concerning morphological characteristics, however, the best motor performance was observed in amputees and, to a lesser degree, in short stature. In the top performing athletes, physical performance was significantly correlated with body mass index and fat mass index for amputees, and with arm span, ape index, body fat percentage and fat mass index for short stature. Regression analysis revealed that regardless of disability type, physical and physiological performance (except maximum heart rate) were significantly influenced primarily by adipose tissue-specific variables. A significant effect of height, weight, fat free mass, arm span, sitting height, and ape index on drop jump performance with left leg, maximal oxygen consumption, and maximum heart rate was also noticed. The type of disability affects performance in the squat jump and vertical jump tests, and to a lesser extent in the countermovement jump test.

Correlations Between Medicine Ball Throw With Wheelchair Mobility and Isokinetic Tests in Basketball Para-Athletes

CONTEXT

A detailed analysis of wheelchair basketball skills in beginner wheelchair basketball players (WBP) can provide practitioners with important indications regarding the selection and prospective development of potential sports talents. A comprehensive WBP evaluation can be very time consuming, mainly during the initial phases of the training processes, which could be a barrier in clinical and practical settings. Moreover, the large number and the turnover of beginner WBP attending rehabilitation centers make the applicability of field and strength tests unfeasible.

OBJECTIVE

To verify the relationships between the medicine ball throw (MBT) and wheelchair basketball mobility performance field tests and the shoulder and trunk peak torque in male and female beginner WBP.

DESIGN

Cross-sectional study.

SETTING

Rehabilitation Hospital Network, Paralympic Program.

PARTICIPANTS

Thirty-seven female and male beginner WBP.

MAIN OUTCOMES MEASURES

Participants performed wheelchair basketball field tests (speed, agility, strength, and power tests) and the maximum strength test in the isokinetic dynamometer. The outcomes were correlated with the MBT results.

RESULTS

The MBT presented significantly very high and perfect correlations with all wheelchair basketball field tests assessed (5-m sprint, 20-m sprint, and zig-zag agility test with and without a ball), and peak torque (R2 ranging from .810 to .995; P ≤ .05) for male and female athletes.

CONCLUSIONS

The MBT, a simple and feasible test, can be used for estimating and determining the wheelchair mobility performance of female and male beginner WBP. It is suggested to measure the distance of a 5-kg medicine ball thrown by athletes during training and testing routines to follow the players' progression.

Body composition and bone mineral density in athletes with a physical impairment

Background

The impact of the type and the severity of disability on whole-body and regional body composition (BC), and bone mineral density (BMD) must be considered for dietary advice in athletes with a physical impairment (PI). This study aimed to investigate the impact of the type and the severity of disability on BC, the pattern of distribution of fat mass at the regional level, and BMD in athletes with a PI.

Methods

Forty-two male athletes with spinal cord injury (SCI, n = 24; age = 40.04 ± 9.95 years, Body Mass Index [BMI] = 23.07 ± 4.01 kg/m²) or unilateral lower limb amputation (AMP, n = 18; age = 34.39 ± 9.19 years, BMI = 22.81 ± 2.63 kg/m²) underwent a Dual-Energy X-Ray Absorptiometry scan. Each athlete with a PI was matched by age with an able-bodied athlete (AB, n = 42; age = 37.81 ± 10.31 years, BMI = 23.94 ± 1.8 kg/m²).

Results

One-Way Analysis of Variance showed significant differences between the SCI, AMP and AB groups for percentage fat mass (%FM) (P < 0.001, eta squared = 0.440). Post-hoc analysis with Bonferroni’s correction showed that athletes with SCI had significantly higher %FM vs. the AMP and AB groups (25.45 ± 5.99%, 21.45 ± 4.21% and 16.69 ± 2.56%, respectively; P = 0.008 vs. AMP and P < 0.001 vs. AB). The %FM was also significantly higher in the AMP vs. the AB group (P < 0.001). Whole-body BMD was negatively affected in SCI athletes, with about half of them showing osteopenia or osteoporosis. In fact, the mean BMD and T-score values in the SCI group (1.07 ± 0.09 g/cm² and −1.25 ± 0.85, respectively) were significantly lower in comparison with the AB group (P = 0.001 for both) as well as the AMP group (P = 0.008 for both). The type of disability affected BC and BMD in the trunk, android, gynoid and leg regions in SCI athletes and the impaired leg only in AMP athletes.

Conclusions

In conclusion, the type of disability and, partly, the severity of PI impact on BC and BMD in athletes with a PI. Nutritionists, sports medicine doctors, clinicians, coaches and physical conditioners should consider athletes with SCI or AMP separately. Athletes with a PI would benefit from specific nutrition and training programs taking into account the type of their disability.

Anthropometric Prediction of DXA-Measured Percentage of Fat Mass in Athletes With Unilateral Lower Limb Amputation

To date there is no anthropometric equation specific to athletes with unilateral lower limb amputation to estimate the percentage of fat mass (%FM). This study investigated the accuracy of a set of anthropometric equations validated on able-bodied populations to predict the %FM assessed by-means of dual-energy x-ray absorptiometry (DXA) in athletes with unilateral lower limb amputation. Furthermore, a predictive anthropometric equation specific to athletes with unilateral lower limb amputation was developed from skinfold thickness measurements using DXA as the reference method for the estimation of the %FM. Twenty-nine white male athletes with unilateral lower limb amputation underwent a DXA scan and an anthropometric assessment on the same day. The %FM, calculated through several existing anthropometric equations validated upon able-bodied populations, was compared with the DXA-measured %FM (%FM_DXA). Accuracy and agreement between the two methods was computed with two-tailed paired-sample t-test, concordance correlation coefficient, reduced major axis regression and Bland-Altman analysis. A stepwise multiple regression analysis with the %FM_DXA as the dependent variable and age and nine skinfold thicknesses as potential predictors was carried out and validated using a repeated 10-fold cross-validation. A linear regression analysis with the sum of nine skinfolds as the independent variable was also carried out and validated using a repeated 10-fold cross-validation. The results showed that the anthropometric equations validated on able-bodied populations are inaccurate in the estimation of %FM_DXA with an average bias ranging from 0.51 to -13.70%. Proportional bias was also found revealing that most of the anthropometric equations considered, tended to underestimate/overestimate the %FM_DXA as body fat increased. Regression analysis produced two statistically significant models (P < 0.001 for both) which were able to predict more than 93% of total variance of %FM_DXA from the values of four skinfold measurements (i.e., thigh, abdominal, subscapular and axillary skinfold measurements) or from the sum of 9 skinfolds. Repeated cross-validation analysis highlighted a good predictive performance of the proposed equations. The predictive equations proposed in this study represent a useful tool for clinicians, nutritionists, and physical conditioners to evaluate the physical and nutritional status of athletes with unilateral lower limb amputation directly in the field.

Diet in neurogenic bowel management: A viewpoint on spinal cord injury

The aim of this review is to offer dietary advice for individuals with spinal cord injury (SCI) and neurogenic bowel dysfunction. With this in mind, we consider health conditions that are dependent on the level of lesion including skeletal muscle atrophy, autonomic dysreflexia and neurogenic bladder. In addition, SCI is often associated with a sedentary lifestyle, which increases risk for osteoporosis and diseases associated with chronic low-grade inflammation, including cardiovascular and chronic kidney diseases. The Mediterranean diet, along with exercise and dietary supplements, has been suggested as an anti-inflammatory intervention in individuals with SCI. However, individuals with chronic SCI have a daily intake of whole fruit, vegetables and whole grains lower than the recommended dietary allowance for the general population. Some studies have reported an increase in neurogenic bowel dysfunction symptoms after high fiber intake; therefore, this finding could explain the low consumption of plant foods. Low consumption of fibre induces dysbiosis, which is associated with both endotoxemia and inflammation. Dysbiosis can be reduced by exercise and diet in individuals with SCI. Therefore, to summarize our viewpoint, we developed a Mediterranean diet-based diet and exercise pyramid to integrate nutritional recommendations and exercise guidelines. Nutritional guidelines come from previously suggested recommendations for military veterans with disabilities and individuals with SCI, chronic kidney diseases, chronic pain and irritable bowel syndrome. We also considered the recent exercise guidelines and position stands for adults with SCI to improve muscle strength, flexibility and cardiorespiratory fitness and to obtain cardiometabolic benefits. Finally, dietary advice for Paralympic athletes is suggested.

Body composition assessment in athletes with physical impairment who have been practicing a wheelchair sport regularly and for a prolonged period

BACKGROUND

Today several important aspects related to the impact of long-term wheelchair sports on whole-body and regional body composition in athletes with a physical impairment are poorly understood.

OBJECTIVE

This cross-sectional study aimed at investigating the impact of the long-term regular practice of wheelchair sports on body composition in male wheelchair athletes (WA) as compared with both non-athletic participants with a physical impairment and non-athletic able-bodied participants.

METHODS

Nine WA were each matched pairwise by age, duration of injury and body mass index (BMI) with a participant with a physical impairment not engaged in any wheelchair sport (N-WA) and by age and BMI with an able-bodied (AB) participant. Whole-body and regional bone mineral content (BMC), fat-free soft tissue mass (FFSTM), fat mass (FM) and percentage FM (%FM) were assessed by means of Dual-Energy X-ray Absorptiometry.

RESULTS

WA had significantly lower FM and %FM vs. N-WA at the whole-body level (P = 0.01 for both) and in the trunk region (P = 0.001 and P = <0.001, respectively). The only difference in body composition variables between WA and AB was found in the legs where WA had significantly higher FM (P = 0.014) along with lower BMC (P = 0.009) and FFSTM (P = 0.005) vs. AB in the legs.

CONCLUSIONS

The results of the present study showed that the regular, long-term practice of wheelchair sport may be associated with beneficial body composition adaptations in athletes with a physical impairment at the whole-body and trunk level.

Body Composition in Swiss Elite Wheelchair Athletes

The aim of this study was to retrospectively interpret body composition in various wheelchair athletes. In total, 69 athletes (mean ± standard deviation; age 33 ± 11 years; body mass 65.1 ± 14.8 kg; height 169.9 ± 14.9 cm and time since injury 19 ± 11 years) from different national teams in wheelchair sports underwent a dual X-ray absorptiometry (DXA) measurement during the yearly medical check-up. The data showed a significant difference between total fat and total fat-free mass between male (fat mass: 15.1 ± 7.6 kg; fat-free mass: 51.8 ± 9.3 kg) and female (fat mass: 19.4 ± 7.8 kg; fat-free mass: 36.8 ± 7.6 kg) athletes (p = 0.032, p < 0.001). In contrast, no significant difference (p = 0.16, p = 0.07) in fat and fat-free mass between paraplegic, tetraplegic and non-SCI athletes was found. Comparing different sports, the lowest fat mass was found in paracycling athletes whereas curling game players showed the highest total fat mass. Basketball game players showed the highest fat-free mass (fat-free mass: 54.8 ± 10.1 kg). In tetraplegic athletes, difference in fat-free mass between left and right arms correlated with the upper extremity motor score. For the interpretation of the data it seems to be crucial, that many different parameters (i.e., gender, motor level of the injury) are taken into consideration in wheelchair athletes.

Investigation of the Female Athlete Triad in Japanese Elite Wheelchair Basketball Players

Background and objectives: Para-sports have become increasingly competitive, necessitating greater physical activity; secondary disorder prevention is therefore crucial. Among secondary disorders, the female athlete triad (FAT) is defined as low energy availability (EA), menstrual dysfunction, and low bone mineral density (BMD); although studied in able-bodied athletes, reports on female para-athletes are scarce. We retrospectively investigated the FAT in wheelchair basketball players in the Japanese national team. Materials and Methods: Thirteen female wheelchair basketball players (mean age: 28.9 ± 8.1 years) were enrolled. The medical history (underlying diseases, gynecological disorders, and stress fractures), athletic and sport-specific parameters (wheelchair basketball classification, and wheelchair usage conditions), hematological status (hemoglobin, iron, estradiol, progesterone, total P1NP, and TRACP-5b levels), nutritional status (total energy, protein, calcium, and iron intake), body composition (BMD and lean body mass (LBM)), and EA were assessed. Results: Two (15.4%) had pertinent gynecological histories and six (46.2%) had menstrual cycle disorders. Three (23.1%) experienced excessive menstrual flow and nine (69.2%) had menstrual pain. No stress fractures were reported. All laboratory data were within normal limits. Total energy and iron intakes based on age-specific requirements were 99.8% and 59.8%, respectively. Iron and hemoglobin levels correlated with menstrual flow (ρ = −0.63, p = 0.019 and ρ = −0.56, p = 0.046, respectively). The mean total BMD was 109.2%, and the mean EA (41.4 kcal/kg LBM) was lower than recommended levels. The leg BMD in spinal disorders was significantly lower than that in skeletal disorders (p = 0.003). The arm LBM was higher (150.6%) than that of age-matched controls. Conclusion: Among female wheelchair basketball players with FAT, the total BMD was comparable to that of age-matched controls; however, leg BMD in spinal disorders was significantly lower than that in skeletal disorders. Players with heavy menstrual flow had lower hemoglobin and iron levels. Further research is needed on the FAT to optimize health and sports performance among para-athletes.