Wheelchair Exercise Research Articles

I engage in physical activity while operating a wheelchair.: a systematic review of stroke patients

Introduction: Stroke is a major contributor to mortality rates in numerous nations, resulting in enduring challenges for individuals who have survived the condition in doing routine tasks. The chair-stand exercise was implemented as a distinct intervention, clearly differentiated from a convalescent rehabilitation program. The objective of this study is to gather empirical data on the movement of stroke patients in wheelchairs used by healthcare professionals, given the current lack of clarity in clinical practices. Method: Studies were obtained from PubMed, Embase, Cochrane Library, EBSCO, Web of Science, and CNKI. Only randomized controlled trials were left to evaluate exercises suitable for wheelchair-using stroke patients, and with no restrictions on data or study language. Result: Specifically, six studies utilized interventions such as Trunk Stability, Sit And Stand Independently, Sitting Posture and Trunk Control, Monkey Chair And Band System, Beach Chair Position, and Chair-Stand Exercise. Conclusion: The study's positive outcomes illustrate that engaging in wheelchair exercise can have a beneficial effect and improve the capacities of individuals who have experienced a stroke. Wheelchair users employ many strategies to improve their functioning abilities. Keyword: Sitting Position, Stroke, Wheelchairs, Delivery of Health Care

Feasibility, acceptability, and initial efficacy of a wheelchair exercise training program in persons with multiple sclerosis: study protocol for a parallel group randomized controlled trial

Purpose: This study is a randomized controlled trial (RCT) that examines the feasibility, acceptability, and initial efficacy of a home-based, remotely supported and supervised exercise training program that was developed using a three-step community engaged research process for persons with multiple sclerosis (MS) who are wheelchair users.Materials and Methods: The study design is a parallel group RCT (NCT05888727). We aim to enroll 24 wheelchair users with MS who will be randomly assigned using REDCap randomization module into exercise training or attention/contact wellness control conditions. The conditions will be delivered remotely over 16 weeks and supported using online, one-onone behavioral coaching. The feasibility outcomes of interest include recruitment and retention rates, and safety outcomes collected throughout the study period. The acceptability outcomes include participant satisfaction and perceptions measured using formative surveys and interviews following the 16-week period. Efficacy outcomes include metabolic health, MS symptoms, and exercise behavior measured before and after the 16-week period. The data analysis will follow intent-to-treat principles using 2 group by 2 time mixed factor ANOVA with estimation of Cohen’s d values as effect sizes.Conclusions: The results will guide future research targeting health outcomes using exercise training among wheelchair users with MS who have largely been absent from health promotion research.

Relationship between rolling resistance, preferred speed, and manual wheelchair propulsion mechanics in non-disabled adults

Purpose To characterize the relationship among rolling resistance (RR), preferred speed, and propulsion mechanics. Methods N = 11 non-disabled individuals (mean (SD)); Age 24 years (2), BMI 23.8 kg/m2 (4.3) completed a submaximal graded wheelchair exercise test (GXTsubmax, fixed speed, terminated at Rating of Perceived Effort (RPE)=8 (0-10 scale)) and a single-blind, within-subject repeated measures wheelchair propulsion experiment (RME). RR at RPE = 10 (estimated maximum workload, Maxestimated) was estimated from the GXTsubmax RPE-RR relationship. RME consisted of N = 19 1-minute trials (self-selected speed) each followed by 2-minutes rest. The trials included N = 16 unique RR between 25-100% of Maxestimated. Averages of all pushes in N = 16 unique 1-minute trials were computed for average RR (N), speed (m/s), peak force (Fpeak (N)), force rate of rise (Fror (N/s)), push frequency (PF (pushes/min)), and push length (PL (deg)). Results Repeated measures correlation assessed relationships among outcome variables (α = 0.05). RR was associated with decreased speed (r=–0.81, p < 0.001), increased Fpeak (r = 0.92), Fror (r = 0.26), and PL (r = 0.32) (all p > 0.001), and unrelated to PF (r = 0.02, p = 0.848). Increased speed was associated with increased Fror (r = 0.23, p = 0.003) and PF (r = 0.27, p < 0.001) and decreased Fpeak (r=–0.66, p < 0.001) and PL (r=-0.25, p < 0.001). Conclusion Increasing RR increases Fpeak despite reducing self-selected speed. RR and speed were strongly and moderately related to Fpeak, respectively, but weakly related to other propulsion mechanics. These results suggest that reducing user-system RR may confer dual benefits of improved mobility and decreased upper extremity loading. Further testing among wheelchair users is required. Clinical trial registration number: NCT04987177

Exercise Intensity and Borg’s Scale as Self-Monitoring Tools in Wheelchair Test for Soldiers with Post-traumatic Lower Limb Injury

Background: Soldiers recovering from lower limb injury must maintain their endurance to return to duty. Wheelchair is commonly used for exercising during the recovery process to maintain muscular and cardiorespiratory endurance. Aim of the study is to assess heart rate (HR) or exercise intensity and Borg’s scale as self-monitoring tools in wheelchair exercise for soldiers. Methods: Design of the study is cross-sectional internal comparison study. One hundred and four healthy, well-trained male normal soldiers (NS) performed 12 minutes tests: (1) running, (2) wheeling a sports wheelchair. Fifty injured soldiers (IS) performed 12 minutes wheeling test. HR and distance were measured using a smartwatch. The HR was then used as a measurement for exercise intensity. Borg’s perceived score of effort, dyspnea, and fatigue was obtained by conducting interviews. Result: There is no significant difference in the characteristics of NS and IS, thus the subjects in both groups are comparable. Distance and intensity values were significantly lower in the wheeling test than in the running test (P&lt;0.05). During the running test, all subjects could reach their maximum level of intensity, whereas, during the wheeling test, both NS and IS subjects reached the moderate-vigorous level of intensity. The Borg’s scale showed a significant difference in dyspnea and fatigue scores between running and wheeling (P&lt;0.05). In the NS group, an interesting phenomenon emerged, there was a difference between the onset of dyspnea and fatigue. Dyspnea occured prior to leg fatigue during the running test. On the other hand, when they performed wheeling test, dyspnoe occurs later and is not even felt, instead arm fatigue will appears fist. Conclusion: Counting of HR for exercise intensity, Borg’s scale (dyspnea and fatigue) can be a convenient alternative for self-monitoring wheeling exercise. These two tools are meant to help assessing safety and goals of exercise.

Association between individual wheelchair skills and fitness in community-dwelling manual wheelchair users with spinal cord injuries

Purpose Wheelchair skills are a key component to promotion of community participation among persons with spinal cord injury (SCI). The objective of this secondary analysis was to examine the association between individual wheelchair skills from the Wheelchair Skills Test Questionnaire (WST-Q) and fitness among community-dwelling adults with SCI. Materials and methods Twenty-six adults were recruited to complete the WST-Q and a standard graded aerobic wheelchair exercise test on a motorized treadmill for assessing peak power output (POpeak). Results Spearman Rho rank-order correlation (ρ) analyses indicated statistically significant correlations between POpeak and six basic (ρ = 0.41–0.57), eight intermediate (ρ = 0.44–0.59), and nine advanced (ρ = 0.42–0.80) WST-Q skill scores. After controlling for sex and injury level (Partial Spearman Rho rank order) significant correlations persisted for four advanced skills (i.e., descends high curb, turns in place in wheelie position, descends steep incline in wheelie position, descends high curb in wheelie position; ρ = 0.46–0.59) and one additional skill (i.e., ascends high curb ρ = 0.51). Conclusions More advanced wheelchair skills are significantly associated with fitness in persons with SCI. The directionality of the skills-fitness relationship, specifically whether wheelchair skills facilitate greater fitness or fitness is a prerequisite for certain wheelchair skills needs to be determined in future, larger studies. However, results from this study provide a comprehensive list of wheelchair skills that are associated with fitness that can be directly applied to guide further research and practice promoting community participation among persons with SCI. Implications for Rehabilitation Significant positive associations exist between advanced wheelchair skills (i.e., descends high curb, turns in place in wheelie position, descends steep incline in wheelie position, descends high curb in wheelie position and ascends high curb) and fitness in manual wheelchair users with spinal cord injury (SCI). This study provides a list of skills associated with fitness to guide clinical practice and areas for further rehabilitation research assessing the directionality of the relationship between fitness and wheelchair skills.

Developing a community-engaged wheelchair exercise program for persons with MS: community advisory board formation and feedback

Purpose Exercise is a safe, evidence-based approach for improving symptoms such as mobility impairment, cognitive dysfunction, and fatigue; however, persons with multiple sclerosis (MS) who use wheelchairs for mobility have been excluded from most research. This paper describes our approach for recruiting ten community advisor board (CAB) members and partnering with them on developing a novel home-based exercise training program for wheelchair users with MS. Materials and Methods The exercise training program, which was developed based on initial qualitative research, includes a progressive exercise prescription, equipment, and one-on-one behavioural coaching based on Social Cognitive Theory. The CAB members convened in groups of five people for five meetings online, using virtual conference software. The CAB meetings each lasted approximately 1-hour and notes were transcribed into digital format for data analyses. Results Content analysis identified elements that aligned with meeting foci (i.e., prescription, equipment, coaching, and outcomes). Feedback was divided into categories to refine the program, specifically modifying, adding, or retaining content and/or activities. CAB member feedback was very positive and emphasised potential additions to the materials presented. The research team proposed implementing modifications based on the CAB member feedback such as adding wrist weights to the equipment options for completing resistance training exercises. Conclusions The overall CAB feedback was invaluable for assessing the appropriateness of the proposed exercise training program before initiating feasibility testing. This report provides a model and guidance for researchers who seek community-engaged research approaches in creating products and interventions. Implication for Rehabilitation Community advisory board participation was invaluable in creating and modifying a novel exercise training programmes for wheelchair users with multiple sclerosis (MS). The current study provides a framework for the creation of exercise interventions for subpopulations of persons with MS that may provide substantial rehabilitation benefits such as improved symptoms and quality of life. Health behaviour interventists targeting individuals with disabilities may consider the benefits of recruiting stakeholders from the community in creation of novel programmes.

A Reappraisal of Ventilatory Thresholds in Wheelchair Athletes With a Spinal Cord Injury: Do They Really Exist?

The ventilatory threshold (VT) separates low- from moderate-intensity exercise, the respiratory compensation point (RCP) moderate- from high-intensity exercise. Both concepts assume breakpoints in respiratory data. However, the objective determination of the VT and RCP using breakpoint models during upper-body modality exercise in wheelchair athletes with spinal cord injury (SCI) has received little attention. Therefore, the aim of this study was to compare the fit of breakpoint models (i.e., two linear regression lines) with continuous no-breakpoint models (i.e., exponential curve/second-order polynomial) to respiratory data obtained during a graded wheelchair exercise test to exhaustion. These fits were compared employing adjusted R2, and blocked bootstrapping was used to derive estimates of a median and 95% confidence intervals (CI). V̇O2-V̇CO2 and V̇E/V̇O2-time data were assessed for the determination of the VT, and V̇CO2-V̇E and V̇E/V̇CO2-time data for the determination of the RCP. Data of 9 wheelchair athletes with tetraplegia and 8 with paraplegia were evaluated. On an overall group-level, there was an overlap in the adjusted R2 median ± 95% CI between the breakpoint and the no-breakpoint models for determining the VT (V̇O2-V̇CO2: 0.991 ± 0.003 vs. 0.990 ± 0.003; V̇E/V̇O2-time: 0.792 ± 0.101 vs. 0.782 ± 0.104, respectively) and RCP (V̇E-V̇CO2: 0.984 ± 0.004 vs. 0.984 ± 0.004; V̇E/V̇CO2-time: 0.729 ± 0.064 vs. 0.691 ± 0.063, respectively), indicating similar model fit. We offer two lines of reasoning: (1) breakpoints in these respiratory data exist but are too subtle to result in a significant difference in adjusted R2 between the investigated breakpoint and no-breakpoint models; (2) breakpoints do not exist, as has been argued previously.

Paralympic Medicine: The Road to Rio.

Over the past 10 years, our team has attended numerous Paralympic games and International Paralympic Committee (IPC)-sanctioned events where we have accumulated the largest data set to date from elite athletes with spinal cord injury (SCI). This empirical evidence has allowed us to address critical questions related to health and athletic performance in these incredibly medically complex individuals. Namely, does autonomic function influence performance? Can we account for this with the present sport classification? How can we prevent the doping practice of self-inducing life-threatening episodes of hypertension to improve performance (termed "boosting")? How does extremely high participation in routine upper-body wheelchair exercise impact cardiovascular and cerebrovascular disease risk? Is it possible to improve the sport classification to level the playing field between athletes with and without autonomic dysfunction? Herein, we will narratively address these questions, and provide our perspective on future directions and recommendations moving forward. Our extensive clinical experience and comprehensive dataset suggest preserved autonomic function is critical for elite performance. We will explore how an easy-to-execute test may be able to predict which individuals are most likely to develop autonomic dysfunctions that may negatively affect their health and performance. We also will evaluate the possibility that a level playing field may be even more difficult to establish than once thought, considering the importance of not only voluntary movement to performance, but also autonomic function. Finally, we also will discuss new changes in screening guidelines at Rio to assess the occurrence of boosting, which is a banned practice by the IPC.

Metabolic syndrome in people with a long-standing spinal cord injury: associations with physical activity and capacity.

This study investigated (i) the prevalence of the metabolic syndrome (MetS) in people with a long-standing spinal cord injury (SCI); (ii) whether personal or lesion characteristics are determinants of the MetS; and (iii) the association with physical activity or peak aerobic capacity on the MetS. In a cross-sectional study, persons with SCI (N = 223; time since injury of ≥10 years) were tested. The individual components of the MetS were assessed together with the physical activity measured by the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD), while peak aerobic capacity was tested during a graded wheelchair exercise test on a treadmill. Thirty-nine percent of the participants had MetS. In a multivariate logistic regression analyses and after performing a backward regression analysis, only age and education were significant determinants of the MetS. A 10-year increase in age leads to a 1.5 times more chance to have the MetS. Furthermore, people with a low education will multiply the relative risk of MetS compared with people with high education by almost 2. With and without correcting for confounders, no significant relationship was found between PASIPD or peak aerobic capacity and the MetS. It can be concluded that the prevalence of the MetS is high (39%) in people with a long-standing SCI but is comparable to the general Dutch population. Older people and those with a lower education level are most at risk for the MetS. Physical activity and peak aerobic fitness were not related to the MetS in this group with a long-standing SCI.

Editorial: Wheeled Mobility Biomechanics

Editorial: Wheeled Mobility Biomechanics

Effect of lower limb compression on blood flow and performance in elite wheelchair rugby athletes

Objective: To investigate the effects of compression socks worn during exercise on performance and physiological responses in elite wheelchair rugby athletes.Design: In a non-blinded randomized crossover design, participants completed two exercise trials (4 × 8 min bouts of submaximal exercise, each finishing with a timed maximal sprint) separated by 24 hr, with or without compression socks.Setting: National Sports Training Centre, Queensland, Australia.Participants: Ten national representative male wheelchair rugby athletes with cervical spinal cord injuries volunteered to participate.Interventions: Participants wore medical grade compression socks on both legs during the exercise task (COMP), and during the control trial no compression was worn (CON).Outcome Measures: The efficacy of the compression socks was determined by assessments of limb blood flow, core body temperature, heart rate, and ratings of perceived exertion, perceived thermal strain, and physical performance.Results: While no significant differences between conditions were observed for maximal sprint time, average lap time was better maintained in COMP compared to CON (P<0.05). Lower limb blood flow increased from pre- to post-exercise by the same magnitude in both conditions (COMP: 2.51 ± 2.34; CON: 2.20 ± 1.85 ml.100 ml.−1min−1), whereas there was a greater increase in upper limb blood flow pre- to post-exercise in COMP (10.77 ± 8.24 ml.100 ml.−1min−1) compared to CON (6.21 ± 5.73 ml.100 ml.−1min−1; P < 0.05).Conclusion: These findings indicate that compression socks worn during exercise is an effective intervention for maintaining submaximal performance during wheelchair exercise, and this performance benefit may be associated with an augmentation of upper limb blood flow.

Wheelchair users' perceived exertion during typical mobility activities.

Each participant performed a series of wheelchair exercises equivalent in intensity to minimal functional speed (1 m s(-1)), functional walking speed (1.3 m s(-1)), a relatively challenging speed (1.6 m s(-1)) and a self-selected speed. Each participant also completed a graded exercise test (GXT) to volitional exhaustion (VO2peak). The purpose of this study was (1) to assess the physical capacity of wheelchair users as they undertake typical mobility activities and (2) to investigate how closely the components of a differentiated model of perceived exertion mirror wheelchair users' own perception of exertion. Eleven (eight males and three females) spinal cord-injured or congenitally impaired wheelchair-dependent participants volunteered for the study. Differentiated ratings of perceived exertion (RPE_arm and RPE_respiration) and oxygen uptake (VO2) and heart rate were recorded during each exercise. The mean comfortable speed at which the participants propelled their own wheelchairs on the wheelchair ergometer was 1.1±0.2 m s(-1). Speeds of 1 m s(-1) and 1.3 m s(-1) are typical of everyday functional propulsion. The corresponding RPE_respiration and RPE_arm ranged from 7 to 13 on the Borg scale; the %VO2peak measured in these trials ranged from 37 to 80% VO2peak. For propulsion intensities used in the present study-low, moderate, high and graded exercise intensity-no difference could be observed between RPE_respiration and RPE_arm. There were no significant differences between RPE_arm and RPE_respiration at the termination of the GXT. The current study showed potential for the use of RPE to assess and monitor daily wheelchair propulsion intensity in individuals with paraplegia.

Effects of wheelchair exercise on 3 patients with low back pain and sciatica

Effects of wheelchair exercise on 3 patients with low back pain and sciatica

Longitudinal relationship between wheelchair exercise capacity and life satisfaction in patients with spinal cord injury: A cohort study in the Netherlands

ObjectiveTo examine the relationship between wheelchair exercise capacity and life satisfaction in persons with spinal cord injury from the start of active inpatient rehabilitation up to 5 years after discharge.DesignProspective cohort study.SubjectsPersons with spinal cord injury, aged 18–65 years, and wheelchair dependent at least for long distances.MethodMeasurements at the start of active rehabilitation, after 3 months, at discharge from inpatient rehabilitation, and 1 and 5 years after discharge. A peak wheelchair exercise test was performed to record peak oxygen uptake (VO2peak) and peak power output (POpeak). Life satisfaction was measured as current life satisfaction and change of life satisfaction in comparison with life after spinal cord injury. Relationships between (changes in) exercise capacity and (changes in) life satisfaction were analyzed random coefficient analysis, corrected for possible confounders (age, gender, level of lesion, functional status, secondary impairments, pain, and sports activity) if necessary.ResultsOf 225 persons included, 130 attended two or more peak exercise tests, who were include in the analyses. Mean age at start was 39 years, 75% were male, 73% had paraplegia, and 76% had a traumatic lesion. Mean POpeak increased during the study from 32.9 to 55.9 Watts, mean VO2peak from 1.02 to 1.38 l/minute, and mean life satisfaction from 5.7 to 7.8. An increase of POpeak with 10 W was associated with a 0.3-point increase of life satisfaction (P = 0.01). An increase of VO2peak with 0.1 l/minute was associated with a 0.1-point increase of life satisfaction (P = 0.049).ConclusionHigh(er) wheelchair exercise capacity is related to high(er) life satisfaction in spinal cord injury patients.

Differentiated Perceived Exertion and Self-Regulated Wheelchair Exercise

ObjectiveTo investigate the utility of the differentiated rating of perceived exertion (RPE) for the self-regulation of submaximal wheelchair propulsion in novice users. DesignEach participant completed a submaximal incremental test and a graded test to exhaustion to determine peak oxygen consumption (Vo2peak) on a wheelchair ergometer. On a separate day, two 12-minute intermittent bouts consisting of three 4-minute stages were completed at individualized imposed power outputs equating to light (40% Vo2peak) and moderate (60% Vo2peak) intensity exercise. On a third occasion, participants were assigned to either the overall group or the peripheral group and were required to self-regulate 12-minute intermittent exercise according to either overall RPE or peripheral RPE reported during the corresponding imposed intensity trial. SettingLaboratory facilities at a university. ParticipantsPreliminary population of able-bodied participants with no prior experience of wheelchair propulsion (N=18). InterventionsNot applicable. Main Outcome MeasuresDifferences in oxygen consumption (V˙o2), heart rate, blood lactate concentration, and power output between the imposed and self-regulated exercise trials. ResultsNo difference was found in physiological responses between the moderate-intensity imposed and RPE-regulated trials in the peripheral group, whereas a significant (P<.05) underproduction in V˙o2 (1.76±.31 vs 1.59±.25L/min) and blood lactate concentration (2.8±0.90 vs 2.21±.83mmol/L) was seen in the overall group. In contrast, a significant (P<.05) overproduction was seen in the peripheral group at a light exercise intensity, whereas no difference was found between all variables during the light-intensity imposed and RPE-regulated trials in the overall group. ConclusionsPeripheral RPE enabled a more precise self-regulation during moderate-intensity wheelchair exercise in novice users. In contrast, overall RPE provided a more accurate stimulus when performing light-intensity propulsion.

Patterns of Changes in Wheelchair Exercise Capacity After Spinal Cord Injury

Objectives(1) To identify different patterns of changes in wheelchair exercise capacity in the period between the start of active spinal cord injury (SCI) rehabilitation and 5 years after discharge; (2) to examine the pattern determinants of the change in wheelchair exercise capacity. DesignProspective cohort study. Measurements were recorded at the start of active inpatient rehabilitation, 3 months after the start, at discharge of inpatient rehabilitation, 1 year after discharge, and 5 years after discharge. SettingEight rehabilitation centers. ParticipantsPersons with SCI (N=130; age range, 18–65y), who were wheelchair-dependent, at least for long distances. InterventionsNot applicable. Main Outcome MeasureWheelchair exercise capacity: peak power output (W). ResultsWe found 4 different patterns of the change of peak power output (mean ± SD): (1) a pattern with high and progressive scores (33% of total study group): high progressive scores (start of rehabilitation: 49±15W to 5 years after discharge: 77±17.2W); (2) a pattern of improvement during inpatient rehabilitation and deterioration after inpatient rehabilitation (12%): progressive scores during inpatient rehabilitation with deteriorating scores after discharge (start of rehabilitation: 29±8.7W, to discharge: 60±8.4W, to 5 years after discharge: 39±13.1W); (3) a pattern with low and only slightly progressive scores (52%): low progressive scores (start of rehabilitation: 20±10.1W to 5 years after discharge: 31±15.9W); and (4) a pattern with low scores during inpatient rehabilitation and a sharp rise after discharge (3%): low inpatient scores with strong progressive scores after discharge (start of rehabilitation: 29±15.5W to 5 years after discharge: 82±10.6W). A logistic regression of factors that may distinguish between patterns with high and progressive scores and patterns with low and only slightly progressive scores revealed that older age, being a woman, having a tetraplegic lesion, and low functional status were associated with patterns with low and only slightly progressive scores. The pattern of improvement during inpatient rehabilitation and deterioration after inpatient rehabilitation showed more neuropathic pain and lower sports participation than patterns with high and progressive scores. ConclusionsFor the vast majority of patients, wheelchair exercise capacity after SCI shows a positive trend and can be described in distinct patterns that are dependent on personal, lesion, and functional characteristics.

Are tetraplegic handbikers going to disappear from team relay in para-cycling?

Are tetraplegic handbikers going to disappear from team relay in para-cycling?

Wheelchair exercise capacity in spinal cord injury up to five years after discharge from inpatient rehabilitation

To elucidate the course and determinants of wheelchair exercise capacity in spinal cord injury up to 5 years after discharge from inpatient rehabilitation, and to describe loss to follow-up. Prospective cohort study, with measurements at the start and discharge from inpatient rehabilitation, 1 and 5 years after discharge. A total of 225 wheelchair-dependent persons with spinal cord injury. Random coefficient analysis of the course and determinants of peak aerobic power output (POpeak) and peak oxygen uptake (VO2peak). A total of 162 participants attended 1 or more peak exercise tests and were analysed. Significant changes were found for both VO2peak and POpeak between start and 5 years after discharge, and discharge and 5 years after discharge. No significant changes were found for VO2peak and POpeak between 1 year and 5 years after discharge. Age, gender, level and completeness of lesion were determinants for level of VO2peak and age, gender, and level of lesion for level of POpeak. No significant determinants were found for the course of wheelchair exercise capacity. The 63 participants who were not analysed were older, and showed more persons with a tetraplegia. Wheelchair exercise capacity of persons with spinal cord injury stabilizes at between 1 and 5 years after discharge. The participants appear to be a positive selection of the total study group.

Cardiovascular drift in trained paraplegic and able-bodied individuals during prolonged wheelchair exercise: effect of fluid replacement

The progressive heart rate (HR) increase and stroke volume (SV) decline during prolonged constant-load leg exercise signifies cardiovascular drift (CVdrift); fluid replacement is known to minimize this phenomenon. Like their able-bodied counterparts (AB), paraplegic athletes undergo prolonged exercise during training and competition, which could result in CVdrift. The aim of this study is to address the role of rehydration on preventing CVdrift in spinal cord injured (SCI) paraplegic athletes. Eight SCI athletes with an injury level between C7 and T6 and 9 AB subjects performed 60-min constant-load exercise on a wheelchair ergometer in a thermo-neutral environment. No fluid was taken in 1 trial, whereas 85% of sweat losses were replaced by drinking water in another trial. Cardic output (CO), SV, HR, and oral temperature (Tor) were determined during exercise. Prolonged exercise resulted in similar HR (18 beats·min(-1) for AB and 12 beats·min(-1) for SCI) and Tor (0.63 °C for AB and 0.71 °C for SCI) elevation and SV decline (-8.5 mL·beat(-1) for AB and -5.5 mL·beat(-1) for SCI), whereas CO remained unchanged. Water intake restrained the exercise-induced hyperthermia and resulted in smaller SV decline (-4.0 mL for AB and -3.0 mL for SCI, p < 0.01). In conclusion, CVdrift was similar in SCI and AB subjects during prolonged wheelchair exercise. Likewise, the beneficial effects of hydration in both groups were analogous.

Design of a randomized-controlled trial on low-intensity aerobic wheelchair exercise for inactive persons with chronic spinal cord injury

Purpose: To investigate effects and working mechanisms of low-intensity aerobic wheelchair exercise on fitness, (upper-body) health and active lifestyle in inactive persons with chronic spinal cord injury (SCI). Methods: A multicenter randomized-controlled trial (RCT) in 40 inactive manual wheelchair users (aged 28–65y) with chronic paraplegia or tetraplegia (time since injury >10y). Subjects will be randomly assigned to an intervention or a control group. The intervention will consist of 16 weeks (2 times per week, 30 min per session) of low-intensity aerobic handrim wheelchair exercise (30–40% HRR) on a treadmill. Repeated measurements will be performed before starting the intervention or entrance of the control group, and after week 8, 16 and 42 following the start. The primary outcome will be wheelchair-specific physical fitness. Secondary outcomes will be upper-body pain and discomfort, shoulder load, propulsion technique, wheelchair skill performance and physical activity levels. Conclusions: Results of this first RCT on low-intensity aerobic wheelchair exercise for inactive persons with chronic SCI can improve SCI-specific exercise guidelines and provide an evidence-base for an aftercare program aimed at preserving fitness, health and active lifestyle of persons aging with SCI.Implications for RehabilitationLow-intensity wheelchair aerobic exercise may be effective for improving fitness, (upper-body) health and active lifestyle of inactive persons with chronic SCI, without the high dropout rates that plague exercise programs for this population.Results of this study can 1) improve SCI-specific aerobic exercise guidelines and 2) provide an evidence-base for a long-term aftercare rehabilitation program for persons aging with SCI.As this study is embedded in Dutch rehabilitation practice, chances of knowledge transfer and implementation are high, and strengthen the Dutch SCI rehabilitation network.