Oxygen uptake and heart rate responses to 4 weeks of RPE-guided handcycle training.

PURPOSE: To investigate the efficacy of using Ratings of Perceived Exertion (RPE) to prescribe and regulate a 4-week handcycle training intervention. METHODS: Thirty active adults, untrained in upper body endurance exercise, were divided into three groups to complete a 4-week intervention: (i) RPE-guided training (n = 10; 2 female), (ii) power output (PO)-guided (n = 10; 2 female) training, or (iii) non-training control (n = 10; 4 female). Training groups performed three sessions of handcycling each week. Oxygen uptake ([Formula: see text]), heart rate (HR), and Feeling Scale (FS) rating were collected during training sessions. RPE-guided training was performed at RPE 13. PO-guided training was matched for percentage of peak PO per session, based upon that achieved by the RPE-guided training group. RESULTS: There were no differences in percentage of peak [Formula: see text] (66 ± 13% vs 61 ± 9%, p = 0.22), peak HR (75 ± 8% vs 71 ± 6%, p = 0.11) or FS rating (1.2 ± 1.9 vs 0.8 ± 1.6, p = 0.48) between RPE- and PO-guided training, respectively. The average coefficient of variation in percentage of peak HR between consecutive training sessions was 2.8% during RPE-guided training, and 3.4% during PO-guided training. CONCLUSION: Moderate-vigorous intensity handcycling exercise can be prescribed effectively using RPE across a chronic training intervention, suggesting utility for practitioners in a variety of rehabilitation settings.

Ice Slurry Ingestion Lowers Thermoregulatory Strain in Wheelchair Tennis Players During Repeated Sprint Intervals in the Heat.

PURPOSE: To examine the efficacy of per-cooling via ice slurry ingestion (ICE) in wheelchair tennis players exercising in the heat. METHOD: Eight wheelchair tennis players undertook sprints (4 sets of 10 × 5 s over 40 min) in a hot environment (∼32 °C), interspersed by 3 boluses of 2.67 g·kg (6.8 g·kg total) ICE or drinking temperate water (control condition). Athletes performed an on-court test of repeated sprint ability (20 × 20 m) in temperate conditions immediately before and 20 minutes after the heat exposure, and time to complete each sprint as well as intermediate times were recorded. Gastrointestinal and weighted mean skin and forehead temperatures were collected throughout the heat exposure, as were thermal sensation, heart rate, and blood lactate concentration. Sweat rate was calculated from body mass changes and fluid/ice intakes. RESULTS: Compared with the control condition, ICE resulted in a significantly lower gastrointestinal temperature (95% CI, 0.11-0.17 °C; P < .001), forehead temperature (0.58-1.06 °C; P < .001), thermal sensation (0.07-0.50 units; P = .017), and sweat rate (0.06-0.46 L·h-1; P = .017). Skin temperature, heart rate, and blood lactate concentration were not significantly different between conditions (P ≥ .598). There was no overall change preheating to postheating (P ≥ .114) or an effect of condition (P ≥ .251) on repeated sprint times. CONCLUSIONS: ICE is effective at lowering objective and subjective thermal strain when consumed between sets of repeated wheelchair sprints in the heat. However, ICE has no effect on on-court repeated 20-m sprint performance.

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.

OBJECTIVE: To analyze and summarize the effect of regulating exercise training interventions with subjective measures of intensity on cardiorespiratory fitness, measured by peak oxygen uptake (V̇O2peak) and peak power output (POpeak) in adults with spinal cord injury (SCI). DATA SOURCES: Four databases (MEDLINE, Embase, PsycINFO, SPORTDiscus) were searched from inception up until September 1, 2020, and updated November 18, 2021. STUDY SELECTION: Searches combined keywords relating to the topics: SCI, subjective measures of exercise intensity, and exercise. DATA EXTRACTION: Two reviewers independently conducted eligibility screening, data extraction, and assessed the risk of bias. Nine studies were included in the systematic review and meta-analysis, resulting in the inclusion of data from 95 adults with SCI representing both sexes and a diverse range of age, time since injury, lesion level, and lesion completeness classifications. DATA SYNTHESIS: Data were extracted and added to summary tables with 3 outcomes: V̇O2peak, POpeak, and Other. Mean and SD values for V̇O2peak and POpeak were extracted from pre- and post-perceptually regulated exercise training. CONCLUSIONS: All studies used ratings of perceived exertion scale to prescribe exercise intensity. Seven of 8 studies concluded an improvement in V̇O2peak, and 5 studies of 7 concluded an improvement in POpeak. In the outcome Other, 5 studies concluded an improvement, and 3 studies concluded no change. There was evidence for an improvement in cardiorespiratory fitness, measured by V̇O2peak and POpeak after perceptually regulated exercise training in adults with SCI (Grading of Recommendations, Assessment, Development, and Evaluation ratings: Low) (mean difference [MD], 2.92mL/kg/min; 95% confidence interval [CI], 1.30-4.54; P=.0004 and MD, 9.8W; 95% CI, 5.5-14.3; P<.0001, respectively). This review provides critically appraised, cumulative evidence on the use of perceptually regulated exercise training in individuals with SCI.

Rethinking aerobic exercise intensity prescription in adults with spinal cord injury: time to end the use of "moderate to vigorous" intensity?

STUDY DESIGN: Cohort study. OBJECTIVES: To investigate and critique different methods for aerobic exercise intensity prescription in adults with spinal cord injury (SCI). SETTING: University laboratory in Loughborough, UK. METHODS: Trained athletes were split into those with paraplegia (PARA; n = 47), tetraplegia (TETRA; n = 20) or alternate health condition (NON-SCI; n = 67). Participants completed a submaximal step test with 3 min stages, followed by graded exercise test to exhaustion. Handcycling, arm crank ergometry or wheelchair propulsion were performed depending on the sport of the participant. Oxygen uptake (V̇O2), heart rate (HR), blood lactate concentration ([BLa]) and ratings of perceived exertion (RPE) on Borg's RPE scale were measured throughout. Lactate thresholds were identified according to log-V̇O2 plotted against log-[BLa] (LT1) and 1.5 mmol L-1 greater than LT1 (LT2). These were used to demarcate moderate (LT1, < LT2) and severe (>LT2) exercise intensity domains. RESULTS: Associations between percentage of peak V̇O2 (%V̇O2peak) and HR (%HRpeak) with RPE differed between PARA and TETRA. At LT1 and LT2, %V̇O2peak and %HRpeak were significantly greater in TETRA compared to PARA and NON-SCI (P < 0.05). The variation in %V̇O2peak and %HRpeak at lactate thresholds resulted in large variability in the domain distribution at fixed %V̇O2peak and %HRpeak. CONCLUSIONS: Fixed %V̇O2peak and %HRpeak should not be used for aerobic exercise intensity prescription in adults with SCI as the method does not lead to uniform exercise intensity domain distribution.

Comparison of two Borg exertion scales for monitoring exercise intensity in able-bodied participants, and those with paraplegia and tetraplegia.

STUDY DESIGN: Cross-sectional cohort study. OBJECTIVES: To compare ratings of perceived exertion (RPE) on Borg's 6-20 RPE scale and Category Ratio 10 (CR10) in able-bodied (AB) participants during upper and lower body exercise, and recreationally active participants with paraplegia (PARA) and athletes with tetraplegia (TETRA) during upper body exercise only. SETTING: University and rehabilitation centre-based laboratories in UK and Netherlands. METHODS: Twenty-four participants were equally split between AB, PARA, and TETRA. AB performed maximal tests using cycle (AB-CYC) and handcycle (AB-HC) ergometry. PARA and TETRA performed maximal handcycle and wheelchair propulsion tests, respectively. Oxygen uptake (V̇O2) and blood lactate concentration were monitored throughout. RPE was rated each stage on Borg's RPE scale and CR10. Thresholds were identified according to log-V̇O2 plotted against log-blood lactate (LT1), and 1.5 mmol L-1 greater than LT1 (LT2). RESULTS: RPE from both scales were best fit against each other using a quadratic model, with high goodness of fit between scales that was independent of exercise mode and participant group (range R2: 0.965-0.970, P < 0.005). Though percentage peak V̇O2 was significantly greater in TETRA (P < 0.005), there was no difference in RPE at LT1 or LT2 between groups on Borg's RPE scale or CR10. CONCLUSION: Strong association between Borg's RPE scale and CR10 suggests they can be used interchangeably. RPE at lactate thresholds were independent of mode of exercise and level of spinal cord injury. However, inter-individual variation precludes from making firm recommendations about using RPE for prescribing homogenous exercise intensity.

Optimising classification of proximal arm strength impairment in wheelchair rugby: A proof of concept study.

This study examined the relationship between proximal arm strength and mobility performance in wheelchair rugby (WR) athletes and examined whether a valid structure for classifying proximal arm strength impairment could be determined. Fifty-seven trained WR athletes with strength impaired arms and no trunk function performed six upper body isometric strength tests and three 10 m sprints in their rugby wheelchair. All strength measures correlated with 2 m and 10 m sprint times (r ≥ -0.43; p ≤ 0.0005) and were entered into k-means cluster analyses with 4-clusters (to mirror the current International Wheelchair Rugby Federation [IWRF] system) and 3-clusters. The 3-cluster structure provided a more valid structure than both the 4-cluster and existing IWRF system, as evidenced by clearer differences in strength (Effect sizes [ES] ≥ 1.0) and performance (ES ≥ 1.1) between adjacent clusters and stronger mean silhouette coefficient (0.64). Subsequently, the 3-cluster structure for classifying proximal arm strength impairment would result in less overlap between athletes from adjacent classes and reduce the likelihood of athletes being disadvantaged due to their impairment. This study demonstrated that the current battery of isometric strength tests and cluster analyses could facilitate the evidence-based development of classifying proximal arm strength impairment in WR.

Measures of impairment applicable to the classification of Paralympic athletes competing in wheelchair sports: A systematic review of validity, reliability and associations with performance.

A fundamental aspect of classification systems in Paralympic sport is having valid and reliable measures of impairment. However, minimal consensus exists for assessing impaired strength, coordination and range of motion. This review aimed to systematically identify measures of upper body strength, coordination and range of motion impairments that meet the requirements for use in evidence-based classification systems in wheelchair sports. Three electronic databases were searched from 2003 until 31 August 2019 for studies that assessed upper body function of participants and used a measurement tool that assessed strength, coordination or range of motion. The body of evidence for each identified measure was appraised using the Grading of Recommendations Assessment, Development and Evaluation framework. Twenty-three studies were included: ten measured strength and coordination, and six measured range of motion. There was "moderate" confidence in using isometric strength for assessing strength impairment. Tapping tasks for the assessment of coordination impairment received a "low" confidence rating. All other identified measures of coordination and range of motion impairment received a "very low" confidence rating. Several potential measures were identified for assessing upper body strength, coordination and range of motion impairments. Further research is warranted to investigate their use for classification in Paralympic wheelchair sports.

Division, result and score margin alter the physical and technical performance of elite wheelchair tennis players.

This study determined the physical and technical demands of elite wheelchair tennis (WT) match-play, how the demands differed between divisions (Men, Women, Quad) and the effect that set result and score margin had on these demands. Seventeen WT players were monitored during a singles competition. Physical measures of performance were analysed using an indoor tracking system and inertial measurement units. Technical measures of performance were examined using video analysis. Physical measures of performance differed by division (Men > Women > Quad) for most parameters. Rallies were longer during Men's (P = 0.027) and Women's (P = 0.004) matches compared to Quad's and fewer shots were hit off 2 bounces in Men's matches compared to Women's and Quad's (P ≤ 0.026). High-speed activity (HSA) increased during losing sets (P = 0.043). Most physical measures of performance increased by moderate to large effects during sets with a small score margin (≤3 games differential). Mean speed and HSA were similar during losing sets, regardless of margin, but decreased (large effects) when winning by a large margin. This study demonstrated the physical and technical demands that elite WT players need to be prepared for and how situational factors can influence these demands.

Validity and reliability of isometric tests for the evidence-based assessment of arm strength impairment in wheelchair rugby classification.

OBJECTIVES: The purpose of this study was to examine the validity and test-retest reliability of a battery of single-joint isometric strength tests, to establish whether the tests could be used for evidence-based classification in wheelchair rugby (WR). DESIGN: Cross-sectional. METHODS: Twenty male WR athletes with impaired arm strength and thirty able-bodied (AB) participants (15 male, 15 female) performed four isometric strength tests. Each test required three 5-s efforts and examined maximal isometric force for flexion and extension around the shoulder and elbow joint. Test validity was established by comparing differences (Cohen's effect sizes [d]) in strength between WR athletes and AB participants. Differences were also explored between male and female AB participants. Twenty AB participants returned for a second visit to establish the test-retest reliability of the test battery. RESULTS: Significantly lower force values were observed for all isometric strength measures in WR athletes compared to AB participants (p≤0.0005; d≥2.14). Female AB participants also produced significantly less force than male AB participants for all joint actions (p≤0.0005; d≥1.93). No significant differences were identified between trials for any measure of strength, with acceptable levels of test-retest reliability reported (ICCs≥0.97, SEM≤19.3N and CV≤8.4%). CONCLUSIONS: The current results demonstrated the validity of a battery of isometric strength tests, suggesting they can be used to reliably infer strength impairment in WR athletes, which is a pre-requisite when working towards evidence-based classification in Paralympic sport.

Perceived exertion responses to wheelchair propulsion differ between novice able-bodied and trained wheelchair sportspeople.

OBJECTIVES: To investigate peripheral (RPEP) and central (RPEC) Ratings of Perceived Exertion during wheelchair propulsion in untrained able-bodied (AB) participants, and trained wheelchair rugby athletes with and without cervical spinal cord injury (CSCI). DESIGN: Cross-sectional study. METHODS: 38 participants (AB: n=20; wheelchair rugby athletes with CSCI: n=9; without CSCI: n=9) completed an incremental wheelchair propulsion test to exhaustion on a motorised treadmill. Gas exchange measures and heart rate (HR) were collected throughout. RPEP and RPEC on the Category Ratio-10 were verbally recorded each minute. Blood lactate concentration ([BLa]) was determined post-test. RESULTS: Between 50-100% peak oxygen uptake (V̇O2peak), RPEP was greater than RPEC in AB (p<0.05), but not in athletes with (p=0.07) or without (p=0.16) CSCI. RPEP was greater in AB compared to players with CSCI (Effect sizes: 1.24-1.62), as were respiratory exchange ratio (1.02±0.10 vs 0.82±0.11, p<0.05) and [BLa]peak (7.98±2.53 vs 4.66±1.57mmol·L-1). RPEC was greater in athletes without CSCI compared to those with CSCI (Effect sizes: 0.70-1.38), as were HR (166±20 vs 104±15 beats·min-1, p<0.05) and ventilation (59.2±28.8 vs 35.1±16.6L·min-1, p=0.01). CONCLUSIONS: RPEP was dominant over RPEC during wheelchair propulsion for untrained AB participants. For athletes with CSCI, lower RPEP and RPEC were reported at the same %V̇O2peak compared to those without CSCI. The mechanism for this remains to be fully elucidated.

The impact of impairment on kinematic and kinetic variables in Va'a paddling: Towards a sport-specific evidence-based classification system for Para Va'a.

Para Va'a is a new Paralympic sport in which athletes with trunk and/or leg impairment compete over 200 m. The purpose of this study was to examine the impact of impairment on kinematic and kinetic variables during Va'a ergometer paddling. Ten able-bodied and 44 Para Va'a athletes with impairments affecting: trunk and legs (TL), legs bilaterally (BL) or leg unilaterally (UL) participated. Differences in stroke frequency, mean paddling force, and joint angles and correlation of the joint angles with paddling force were examined. Able-bodied demonstrated significantly greater paddling force as well as knee and ankle flexion ranges of movement (ROM) on the top hand paddling side compared to TL, BL and UL. Able-bodied, BL and UL demonstrated greater paddling force and trunk flexion compared to TL, and UL demonstrated larger bottom hand paddling side knee and ankle flexion ROM compared to BL. Significant positive correlations were observed for both male and female athletes between paddling force and all trunk flexion angles and ROM in the trunk and pelvis rotation and bottom hand paddling side hip, knee and ankle flexion. The results of this study are important for creating an evidence-based classification system for Para Va'a.

The Effect of Small-Sided Game Formats on Physical and Technical Performance in Wheelchair Basketball.

PURPOSE: To examine the effects of different small-sided games (SSGs) on physical and technical aspects of performance in wheelchair basketball (WB) players. DESIGN: Observational cohort study. METHODS: Fifteen highly trained WB players participated in a single 5v5 (24-s shot clock) match and three 3v3 SSGs (18-s shot clock) on a (1) full court, (2) half-court, and (3) modified-length court. During all formats, players' activity profiles were monitored using an indoor tracking system and inertial measurement units. Physiological responses were monitored via heart rate and rating of perceived exertion. Technical performance, that is, ball handling, was monitored using video analysis. Repeated-measures analysis of variance and effect sizes (ESs) were calculated to determine the statistical significance and magnitude of any differences between game formats. RESULTS: Players covered less distance and reached lower peak speeds during half-court (P ≤ .0005; ES ≥ very large) compared with all other formats. Greater distances were covered, and more time was spent performing moderate- and high-speed activity (P ≤ .008; ES ≥ moderate) during full court compared with all other formats. Game format had little bearing on physiological responses, and the only differences in technical performance observed were in relation to 5v5. Players spent more time in possession, took more shots, and performed more rebounds in all 3v3 formats compared with 5v5 (P ≤ .028; ES ≥ moderate). CONCLUSIONS: Court dimensions affect the activity profiles of WB players during 3v3 SSGs yet had little bearing on technical performance when time pressures (shot clocks) were constant. These findings have important implications for coaches to understand which SSG format may be most suitable for physically and technically preparing WB players.

Reliability and Validity of Subjective Measures of Aerobic Intensity in Adults With Spinal Cord Injury: A Systematic Review.

OBJECTIVE: To systematically synthesize and appraise research regarding test-retest reliability or criterion validity of subjective measures for assessing aerobic exercise intensity in adults with spinal cord injury (SCI). DATA SOURCES: Electronic databases (Pubmed, PsychINFO, SPORTDiscus, EMBASE, and CINAHL) were searched from inception to January 1, 2016. STUDY SELECTION: Studies involving at least 50% of participants with SCI who performed an aerobic exercise test that included measurement of subjective and objective intensity based on test-retest reliability or criterion validity protocols. DATA EXTRACTION: Characteristics were extracted on study design, measures, participants, protocols, and results. Each study was evaluated for risk of bias based on strength of the study design and a quality checklist score (COnsensus-based Standards for the selection of health Measurement INstruments [COSMIN]). DATA SYNTHESIS: The 7 eligible studies (1 for reliability, 6 for validity) evaluated overall, peripheral and/or central ratings of perceived exertion (RPE) on a scale of 6-20 (RPE 6-20). No eligible studies were identified for other subjective intensity measures. The evidence for reliability and validity were synthesized separately for each measure and were assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Overall, very low GRADE confidence ratings were established for reliability and validity evidence generalizable to the entire population with SCI and various upper-body and lower-body modalities. There was low confidence for the evidence showing that overall RPE 6-20 has acceptable validity for adults with SCI and high fitness levels performing moderate to vigorous-intensity upper-body aerobic exercise. CONCLUSIONS: Health care professionals and scientists need to be aware of the very low to low confidence in the evidence, which currently prohibits a strong clinical recommendation for the use of subjective measures for assessing aerobic exercise intensity in adults with SCI. However, a tentative, conditional recommendation regarding overall RPE 6-20 seems applicable, depending on participants' fitness level as well as the exercise intensity and modality used. LEVEL OF EVIDENCE: NA.

Assessment of peak oxygen uptake during handcycling: Test-retest reliability and comparison of a ramp-incremented and perceptually-regulated exercise test.

PURPOSE: To examine the reliability of a perceptually-regulated maximal exercise test (PRETmax) to measure peak oxygen uptake ([Formula: see text]) during handcycle exercise and to compare peak responses to those derived from a ramp-incremented protocol (RAMP). METHODS: Twenty recreationally active individuals (14 male, 6 female) completed four trials across a 2-week period, using a randomised, counterbalanced design. Participants completed two RAMP protocols (20 W·min-1) in week 1, followed by two PRETmax in week 2, or vice versa. The PRETmax comprised five, 2-min stages clamped at Ratings of Perceived Exertion (RPE) 11, 13, 15, 17 and 20. Participants changed power output (PO) as often as required to maintain target RPE. Gas exchange variables (oxygen uptake, carbon dioxide production, minute ventilation), heart rate (HR) and PO were collected throughout. Differentiated RPE were collected at the end of each stage throughout trials. RESULTS: For relative [Formula: see text], coefficient of variation (CV) was equal to 4.1% and 4.8%, with ICC(3,1) of 0.92 and 0.85 for repeated measures from PRETmax and RAMP, respectively. Measurement error was 0.15 L·min-1 and 2.11 ml·kg-1·min-1 in PRETmax and 0.16 L·min-1 and 2.29 ml·kg-1·min-1 during RAMP for determining absolute and relative [Formula: see text], respectively. The difference in [Formula: see text] between PRETmax and RAMP was tending towards statistical significance (26.2 ± 5.1 versus 24.3 ± 4.0 ml·kg-1·min-1, P = 0.055). The 95% LoA were -1.9 ± 4.1 (-9.9 to 6.2) ml·kg-1·min-1. CONCLUSION: The PRETmax can be used as a reliable test to measure [Formula: see text] during handcycle exercise in recreationally active participants. Whilst PRETmax tended towards significantly greater [Formula: see text] values than RAMP, the difference is smaller than measurement error of determining [Formula: see text] from PRETmax and RAMP.

Factors contributing to the temperature beneath plaster or fiberglass cast material.

BACKGROUND: Most cast materials mature and harden via an exothermic reaction. Although rare, thermal injuries secondary to casting can occur. The purpose of this study was to evaluate factors that contribute to the elevated temperature beneath a cast and, more specifically, evaluate the differences of modern casting materials including fiberglass and prefabricated splints. METHODS: The temperature beneath various types (plaster, fiberglass, and fiberglass splints), brands, and thickness of cast material were measured after they were applied over thermometer which was on the surface of a single diameter and thickness PVC tube. A single layer of cotton stockinette with variable layers and types of cast padding were placed prior to application of the cast. Serial temperature measurements were made as the cast matured and reached peak temperature. Time to peak, duration of peak, and peak temperature were noted. Additional tests included varying the dip water temperature and assessing external insulating factors. Ambient temperature, ambient humidity and dip water freshness were controlled. RESULTS: Outcomes revealed that material type, cast thickness, and dip water temperature played key roles regarding the temperature beneath the cast. Faster setting plasters achieved peak temperature quicker and at a higher level than slower setting plasters. Thicker fiberglass and plaster casts led to greater peak temperature levels. Likewise increasing dip-water temperature led to elevated temperatures. The thickness and type of cast padding had less of an effect for all materials. With a definition of thermal injury risk of skin injury being greater than 49 degrees Celsius, we found that thick casts of extra fast setting plaster consistently approached dangerous levels (greater than 49 degrees for an extended period). Indeed a cast of extra-fast setting plaster, 20 layers thick, placed on a pillow during maturation maintained temperatures over 50 degrees of Celsius for over 20 minutes. CONCLUSION: Clinicians should be cautious when applying thick casts with warm dip water. Fast setting plasters have increased risk of thermal injury while brand does not appear to play a significant role. Prefabricated fiberglass splints appear to be safer than circumferential casts. The greatest risk of thermal injury occurs when thick casts are allowed to mature while resting on pillow.