Handbike configurations and the prevalence of experienced sitting and riding-related problems in recreational handcyclists training for the HandbikeBattle.

Implications for rehabilitationA large variety in handbike configurations is seen in recreationally-active handcyclists.Although the majority of the recreationally-active handcyclists seemed to be satisfied with their handbike configurations, 31-50% of them thought that their handbike configuration could be improved.Evidence-based guidelines for handbike fitting should be developed in the future.

Changes in body satisfaction during and after a 5-month handcycle training period and associations with physical capacity and body composition in individuals with a physical impairment.

PURPOSE: To investigate: (1) changes in body satisfaction during five months of handcycle training and one year after the training period; (2) whether longitudinal changes are dependent on sex, waist circumference and severity of the physical impairment; (3) associations between changes in physical capacity or body composition, and body satisfaction. MATERIALS AND METHODS: Individuals (N = 143) with health conditions such as spinal cord injury filled out the Adult Body Satisfaction Questionnaire: at the start of the training (T1), directly after the training period (T2); and four months (T3) and one year after the training period (T4). At T1 and T2, physical capacity was determined with an upper-body graded exercise test, and waist circumference was measured. Handcycling classification was used as a proxy for the severity of impairment. RESULTS: Multilevel regression analyses showed that body satisfaction significantly increased during the training period and significantly decreased back to pre-training levels at follow-up. Individuals with more severe impairments showed a larger decrease at T4. Improvements in physical capacity and waist circumference were significantly associated with improvements in body satisfaction. CONCLUSIONS: Body satisfaction significantly increased during the training period, but significantly decreased during follow-up. Additional efforts might be necessary to keep individuals engaged in long-term exercise.

Body image disturbances are frequently described in individuals with a physical impairment.An increase in body image can be achieved by improvements in physical capacity and waist circumference as a consequence of training.It is important to keep individuals engaged in exercise, as body satisfaction decreases after termination of the training period.For individuals with severe physical impairments additional efforts are necessary to keep them engaged in exercise.

External and Internal Work Load During a Mountain Time Trial in Trained Handcyclists Versus a World-Class Handcyclist and Determinants of Performance.

OBJECTIVES: The aims of the study were to evaluate the external and internal work load of trained handcyclists during a mountain time trial, to compare the results with a world-class handcyclist, and to identify time trial performance determinants. DESIGN: Ten trained and one world-class handcyclists performed a graded exercise test to determine power output and heart rate at the (first and second) ventilatory thresholds and exhaustion. Power output and heart rate were continuously measured during the race. RESULTS: The mean absolute power output during the race (119 ± 21 vs. 203 W, P < 0.001) was lower in the trained handcyclists compared with the world-class handcyclist. The absolute and relative heart rate during the race (86 ± 7% vs. 88%, P = 0.40) and relative power output during the race (66 ± 10% vs. 62%, P = 0.24) were similar. Trained handcyclists cycled significantly less time at a power output between first and second ventilatory thresholds (48% vs. 64%, P = 0.02) and more at a power output greater than second ventilatory threshold (34% vs. 11%, P = 0.005). Power output at the second ventilatory threshold showed the strongest correlation with finish time ( r = -0.78) and peak power output with mean power output of the race ( r = 0.90). CONCLUSIONS: The laboratory outcome peak power output and power output at the second ventilatory threshold are important performance determinants for longer time trials in handcyclists, and it is, therefore, important to improve these outcomes with training. Because the trained handcyclists cycled most of the race in intensity zones 2 and 3, it is recommended to incorporate these zones also in the training.

Effect of Training for an Athletic Challenge on Illness Cognition in Individuals with Chronic Disability: A Prospective Cohort Study.

Illness cognitions (IC) influence how a patient adapts to a chronic disease. The aim was (1) to determine if training for a handcycling mountain time trial (HandbikeBattle) improves IC and (2) to identify factors associated with IC change scores. Persons with a chronic disability (N = 220; including N = 151 with spinal cord disorder) trained 5 months and participated in the time trial. The IC Questionnaire measured helplessness, acceptance, perceived benefits and was assessed before training (T1), after training (T2), and four months after the event (T3). Age, sex, body mass index (BMI), time since injury (TSI), disability characteristics, self-efficacy, mental health (MH) and musculoskeletal pain were obtained at T1. Multilevel regression analyses showed that helplessness decreased (from 11.96 to 11.28, p < 0.01) and perceived benefits increased (from 16.91 to 17.58, p < 0.01) from T1 to T2. For helplessness this decrease persisted during follow-up (11.16 at T3). Changes in helplessness were associated with self-efficacy (p = 0.02), MH (p = 0.02) and lesion completeness (p = 0.02), and were independent of disability type (p = 0.66), lesion level (p = 0.30) and demographics such as sex (p = 0.29) and age (p = 0.67). Training with peers may improve helplessness and perceived benefits in individuals with a chronic disability. Especially individuals with MH problems might benefit from training for an athletic challenge with peers to improve illness cognitions, and ultimately, quality of life.

Low drop-out rates in the HandbikeBattle free-living training study: understanding the reasons for dropping out.

STUDY DESIGN: Longitudinal observational study. OBJECTIVES: During the five-month free-living training period for the HandbikeBattle event several participants dropped out. The aim of this study was to clarify the numbers and reasons for drop out, and to characterize the differences between study participants who did (dropouts) and did not (competitors) drop out during the training period for the HandbikeBattle event. SETTING: Former participants of the HandbikeBattle, a handcycling race on an Austrian mountain. METHODS: Participants (N = 313 (N = 209 (67%) with spinal cord injury or spina bifida)) enrolled between 2013-2018. Drop out and reasons for drop out were registered. Competitors and dropouts were compared regarding personal, disability, physical, and psychological factors, which were measured at the start of the training period. RESULTS: Forty-five participants (14%) dropped out during the training period with medical complications (49%) and motivational problems (29%) as main reasons. The only differences were that competitors participated more in sports before the study (p = 0.01) and achieved a higher peak power output (p = 0.04) compared to dropouts. CONCLUSIONS: The drop-out rate of the HandbikeBattle study was low compared to previous exercise intervention studies, which might be related to the less strictly imposed free-living training. Persons with less experience in sport and a lower fitness level might need more attention during a training intervention to prevent them from dropping out.

Training for the HandbikeBattle: an explorative analysis of training load and handcycling physical capacity in recreationally active wheelchair users.

PURPOSE: (1) to analyze training characteristics of recreationally active wheelchair users during handcycle training, and (2) to examine the associations between training load and change in physical capacity. METHODS: Former rehabilitation patients (N = 60) with health conditions such as spinal cord injury or amputation were included. Participants trained for five months. A handcycling/arm crank graded exercise test was performed before and after the training period. Outcomes: peak power output per kg (POpeak/kg) and peak oxygen uptake per kg (VO2peak/kg). Training load was defined as Training Impulse (TRIMP), which is rating of perceived exertion (sRPE) multiplied by duration of the session, in arbitrary units (AU). Training intensity distribution (TID) was also determined (time in zone 1, RPE ≤4; zone 2, RPE 5-6; zone 3, RPE ≥7). RESULTS: Multilevel regression analyses showed that TRIMPsRPE was not significantly associated with change in physical capacity. Time in zone 2 (RPE 5-6) was significantly associated with ΔVO2peak, %ΔVO2peak, ΔVO2peak/kg and %ΔVO2peak/kg. CONCLUSION: Training at RPE 5-6 was the only determinant that was significantly associated with improvement in physical capacity. Additional controlled studies are necessary to demonstrate causality and gather more information about its usefulness, and optimal handcycle training regimes for recreationally active wheelchair users.IMPLICATIONS FOR REHABILITATIONMonitoring of handcycle training load is important to structure the training effort and intensity over time and to eventually optimize performance capacity. This is especially important for relatively untrained wheelchair users, who have a low physical capacity and a high risk of overuse injuries and shoulder pain.Training load can be easily calculated by multiplying the intensity of the training (RPE 0-10) with the duration of the training in minutes.Results on handcycle training at RPE 5-6 intensity in recreationally active wheelchair users suggests to be promising and should be further investigated with controlled studies.

Biophysical aspects of handcycling performance in rehabilitation, daily life and recreational sports; a narrative review.

AIM: In this narrative review the potential and importance of handcycling are evaluated. Four conceptual models form the framework for this review; (1) the International Classification of Functioning, Disability and Health; (2) the Stress-Strain-Capacity model; (3) the Human-Activity-Assistive Technology model; and (4) the power balance model for cyclic exercise. METHODS: Based on international handcycle experience in (scientific) research and practice, evidence-based benefits of handcycling and optimization of handcycle settings are presented and discussed for rehabilitation, daily life and recreational sports. RESULTS: As the load can be distributed over the full 360° cycle in handcycling, peak stresses in the shoulder joint and upper body muscles reduce. Moreover, by handcycling regularly, the physical capacity can be improved. The potential of handcycling as an exercise mode for a healthy lifestyle should be recognized and advocated much more widely in rehabilitation and adapted sports practice.The interface between handcycle and its user should be optimized by choosing a suitable person-specific handcycle, but mainly by optimizing the handcycle dimensions to one's needs and desires. These dimensions can influence efficient handcycle use and potentially improve both endurance and speed of handcycling. CONCLUSION: To optimize performance in rehabilitation, daily life and recreational sports, continued and more systematic research is required.Implications for rehabilitationHandcycling allows users to travel farther distances at higher speeds and to train outdoors. It should be recognized as an alternative exercise modality for daily outdoor use, also already in early rehabilitation, while it contributes to a healthy lifestyle.To individualize handcycle performance, the user-handcycle (assistive device) interface as well as the vehicle mechanics should be optimized to minimize external power and reduce friction, so that the upper body capacity can be efficiently used.To optimize handcycling individual performance, both the physiological and biomechanical aspects of handcycling should be considered when monitoring or testing handcycle exercise.

Good association between sprint power and aerobic peak power during asynchronuous arm-crank exercise in people with spinal cord injury.

PURPOSE: To (1) investigate the association between sprint power and aerobic power output (POpeakGXT) during a graded peak exercise test (GXT); and (2) validate the prediction models of POpeakGXT based on sprint power and personal and lesion characteristics. MATERIALS AND METHODS: Wheelchair users with tetraplegia (N = 35) and paraplegia (N = 58) performed a 30 s-Wingate test and GXT on an asynchronous arm-crank ergometer. Data were split into samples to develop and validate the model. Sprint power (POmeanWingate and POpeakWingate, respectively) and POpeakGXT were determined. Regression analyses were performed to develop POpeakGXT prediction models. Candidate independent variables included POmeanWingate or POpeakWingate, age (years), sex, body mass (kg) or BMI (kg/m2), time since injury (TSI, years) and lesion level (tetraplegia/paraplegia). The best model was validated by comparing the predicted POpeakGXT with measured POpeakGXT. RESULTS: The best model (R2 = 0.76) to predict POpeakGXT included POmeanWingate, BMI and all other independent variables. No significant difference was found between measured (68 ± 35 W) and predicted POpeakGXT (68 ± 30 W, p = 0.97). The ICC was excellent (0.89 with 95% confidence intervals: 0.75-0.95). The 95% limits of agreement for the Bland-Altman plots were wide (-30 to 31 W). CONCLUSIONS: Strong associations were found between POmeanWingate and POpeakGXT. Although relative agreement was excellent, absolute agreement was low. Implications for rehabilitation There is a strong relationship between peak aerobic power output and sprint power output, both tested on an arm-crank ergometer, in people with spinal cord injury. A prediction model for peak aerobic power output, based on sprint power output and personal and lesion characteristics, showed a high explained variance. The predictive model can give a guideline for choosing the right graded exercise test protocol but should be used with caution.

The Course of Physical Capacity in Wheelchair Users During Training for the HandbikeBattle and at 1-Yr Follow-up.

OBJECTIVE: The aims of this study were (1) to compare physical capacity at 1-yr follow-up with physical capacity before and after the training period for the HandbikeBattle event and (2) to identify determinants of the course of physical capacity during follow-up. DESIGN: This was a prospective observational study. Former rehabilitation patients (N = 33) with health conditions such as spinal cord injury or amputation were included. A handcycling/arm crank graded exercise test was performed before (January, T1) and after the training period (June, T2) and at 1-yr follow-up (June, T4). Outcomes were peak power output (W) and peak oxygen uptake (L/min). Determinants were sex (male/female); age (years); classification; physical capacity, musculoskeletal pain, exercise stage of change, and exercise self-efficacy at T1; and HandbikeBattle participation at T4. RESULTS: Multilevel regression analyses showed that peak power output and peak oxygen uptake increased during the training period and did not significantly change during follow-up (T1: 112 ± 37 W, 1.70 ± 0.48 L/min; T2: 130 ± 40 W, 2.07 ± 0.59 L/min; T4: 126 ± 42 W, 2.00 ± 0.57 L/min). Participants who competed again in the HandbikeBattle showed slight improvement in physical capacity during follow-up, whereas participants who did not compete again showed a decrease. CONCLUSION: Physical capacity showed an increase during the training period and remained stable after 1-yr follow-up. Being (repeatedly) committed to a challenge might facilitate long-term exercise maintenance.

Sport participation after the HandbikeBattle: benefits, barriers, facilitators from the event-a follow-up survey.

OBJECTIVES: To investigate sports participation among individuals in the HandbikeBattle project 1.5-5.5 years after the event, the barriers and facilitators to sport participation and benefits of participating in the event. SETTING: Former participants of the HandbikeBattle, a handcycling race on an Austrian mountain. METHODS: Handcyclists who took part in one or more HandbikeBattle events in 2013-2017 were invited to complete a survey in December 2018. Questions were asked on benefits of participating in this event, current sport participation, and experienced barriers and facilitators regarding current sport participation. RESULTS: Respondents (N = 96 (N = 59 with spinal cord injury (SCI) or Spina Bifida (SB)), response rate = 47%) reported benefits from this event regarding their fitness level (90%), personal development (81%), daily life activities (66%), and health (64%). Median current sport participation was 5 h/week (IQR: 3-8). Most frequently indicated personal barriers for sports participation were: lack of time (31%), disability (17%), and pain (15%). Most frequently mentioned environmental barriers were: transportation time to sport accommodation (19%), and lack of peers to do sports with (16%). Most important facilitators were motivation to improve health and/or fitness (92%), fun and/or relaxation (85%). The results for the subgroup with SCI were comparable with the results of the total group. CONCLUSIONS: Results highlight the role sports challenges can have in establishing a sustainable active life lifestyle among people with disabilities.

Changes in Quality of Life During Training for the HandbikeBattle and Associations With Cardiorespiratory Fitness.

OBJECTIVE: To investigate (1) changes in life satisfaction and mental health during 5 months of training for the HandbikeBattle and 4 months of follow-up; (2) associations between changes in handcycling cardiorespiratory fitness and changes in life satisfaction and mental health during the training period. DESIGN: This is a multicenter prospective cohort study with the following measurements: the start of the training (T1), after the 5-month training period, before the event (T2), and after 4 months of follow-up (T3). At T1, T2, and T3, questionnaires were filled out. At T1 and T2, a graded exercise test was performed to measure cardiorespiratory fitness (peak oxygen consumption [Vo2peak] and peak power output [POpeak]). SETTING: Ten Dutch rehabilitation centers training for the HandbikeBattle event. PARTICIPANTS: Patients with a rehabilitation history (N=136) and health conditions such as spinal cord injury, amputation, or multiple trauma history. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Life satisfaction as the sum score of 2 questions (range, 2-13) and the Mental Health subscale of the 36-item Short Form Health Survey (range, 0-100). RESULTS: Multilevel regression analyses showed that life satisfaction increased during the training period and did not significantly change during follow-up (mean ± SD, T1: 8.2±2.2; T2: 8.6±2.3; T3: 8.5±2.4). Mental health showed no change over time (T1: 77.7±14.5; T2: 77.8±14.5; T3: 75.7±16.5). An improvement in cardiorespiratory fitness was associated with an increase in life satisfaction (POpeak, ß=0.014, P=.046; Vo2peak, ß=1.068, P=.04). There were no associations between improvement in cardiorespiratory fitness and an increase in mental health (POpeak, P=.66; Vo2peak, P=.33). CONCLUSIONS: This study shows a positive course of life satisfaction during training for the HandbikeBattle. An improvement in cardiorespiratory fitness was longitudinally associated with an increase in life satisfaction. Mental health showed no changes over time.

Determinants of physical activity in wheelchair users with spinal cord injury or lower limb amputation: perspectives of rehabilitation professionals and wheelchair users.

Purpose: To gain insight into determinants of physical activity in wheelchair users with spinal cord injury or lower limb amputation, from the perspective of both wheelchair users and rehabilitation professionals.Methods: Seven focus groups were conducted: five with wheelchair users (n = 25) and two with rehabilitation professionals (n = 11). The transcripts were analysed using a sequential coding strategy, in which the reported determinants of physical activity were categorized using the Physical Activity for people with a Disability (PAD) model.Results: Reported personal determinants of physical activity were age, general health status, stage of life, demotivation due to difficulty burning calories, available time and energy, balance in daily life, attitude, and history of a physically active lifestyle. Reported environmental determinants were professional guidance, inconvenient exercise times, accessibility of facilities, costs, transportation difficulties, equipment difficulties, and social support.Conclusions: Important, changeable determinants of physical activity that might be influenced in future lifestyle interventions for wheelchair users are: balance in daily life leading to more time and energy to exercise, attitude towards physical activity, professional guidance, accessibility of facilities (providing information on how and where to find accessible facilities), and social support (learning how to get this).Implications for rehabilitationA physically active lifestyle improves everyday functioning, and decreases disability and the risk of secondary health problems in wheelchair users with spinal cord injury or lower limb amputation.After inpatient rehabilitation, it is difficult for wheelchair users to maintain or further enhance their physical activity, a lifestyle intervention can help them in this.To be effective, lifestyle interventions should address important, changeable determinants of physical activity.Important, changeable determinants of physical activity reported by wheelchair users and rehabilitation professionals are: balance in daily life leading to more time and energy to exercise, attitude towards physical activity, professional guidance, accessibility of facilities, and social support.

Peak power output in handcycling of individuals with a chronic spinal cord injury: predictive modeling, validation and reference values.

Purpose: To develop and validate predictive models for peak power output to provide guidelines for individualized handcycling graded exercise test protocols for people with spinal cord injury (SCI); and to define reference values.Materials and methods: Power output was measured in 128 handcyclists with SCI during a synchronous handcycling exercise test. Eighty percent of the data was used to develop four linear regression models: two theoretical and two statistical models with peak power output (in W and W/kg) as dependent variable. The other 20% of the data was used to determine agreement between predicted versus measured power output. Reference values were based on percentiles for the whole group.Results: Lesion level, handcycling training hours and sex or body mass index were significant determinants of peak power output. Theoretical models (R2 = 42%) were superior to statistical models (R2=39% for power output in W, R2 = 30% for power output in W/kg). The intraclass correlation coefficients varied between 0.35 and 0.60, depending on the model. Absolute agreement was low.Conclusions: Both models and reference values provide insight in physical capacity of people with SCI in handcycling. However, due to the large part of unexplained variance and low absolute agreement, they should be used with caution. Implications for rehabilitationIndividualization of the graded exercise test protocol is very important to attain the true peak physical capacity in individuals with spinal cord injury.The main determinants to predict peak power output during a handcycling graded exercise test for individuals with a spinal cord injury are lesion level, handcycling training hours and sex or body mass index.The predictive models for peak power output should be used with caution and should not replace a graded exercise test.

The influence of protocol design on the identification of ventilatory thresholds and the attainment of peak physiological responses during synchronous arm crank ergometry in able-bodied participants.

PURPOSE: To examine the effects of stage duration on power output (PO), oxygen uptake (VO2), and heart rate (HR) at peak level and ventilatory thresholds during synchronous arm crank ergometry. METHODS: Nineteen healthy participants completed a ramp, 1-min stepwise, and 3-min stepwise graded arm crank exercise test. PO, VO2, and HR at the first and second ventilatory threshold (VT1, VT2) and peak level were compared among the protocols: a repeated measures analysis of variance was performed to test for systematic differences, while intraclass correlation coefficients (ICC) and Bland-Altman plots were calculated to determine relative and absolute agreement. RESULTS: Systematic differences among the protocols were found for PO at VT1, VT2, and peak level. At peak level, PO differed significantly among all protocols (ramp: 115 ± 37 W; 1-min stepwise: 108 ± 34 W; 3-min stepwise: 94 ± 31 W, p ≤ 0.01). No systematic differences for HR or VO2 were found among the protocols. VT1 and VT2 were identified at 52% and 74% of VO2peak, respectively. The relative agreement among protocols varied (ICC 0.02-0.97), while absolute agreement was low with small-to-large systematic error and large random error. CONCLUSIONS: PO at VTs and peak level was significantly higher in short-stage protocols compared with the 3-min stepwise protocol, whereas HR and VO2 showed no differences. Therefore, training zones based on PO determined in short-stage protocols might give an overestimation. Moreover, due to large random error in HR at VTs between the protocols, it is recommended that different protocols should not be used interchangeably within individuals.

Interrater and intrarater reliability of ventilatory thresholds determined in individuals with spinal cord injury.

STUDY DESIGN: Cross-sectional. OBJECTIVES: Individualized training regimes are often based on ventilatory thresholds (VTs). The objectives were to study: (1) whether VTs during arm ergometry could be determined in individuals with spinal cord injury (SCI), (2) the intrarater and interrater reliability of VT determination. SETTING: University research laboratory. METHODS: Thirty graded arm crank ergometry exercise tests with 1-min increments of recreationally active individuals (tetraplegia (N = 11), paraplegia (N = 19)) were assessed. Two sports physicians assessed all tests blinded, randomly, in two sessions, for VT1 and VT2, resulting in 240 possible VTs. Power output (PO), heart rate (HR), and oxygen uptake (VO2) at each VT were compared between sessions or raters using paired samples t-tests, Wilcoxon signed-rank tests, intraclass correlation coefficients (ICC, relative agreement), and Bland-Altman plots (random error, absolute agreement). RESULTS: Of the 240 VTs, 217 (90%) could be determined. Of the 23 undetermined VTs, 2 (9%) were VT1 and 21 (91%) were VT2; 7 (30%) among individuals with paraplegia, and 16 (70%) among individuals with tetraplegia. For the successfully determined VTs, there were no systematic differences between sessions or raters. Intrarater and interrater ICCs for PO, HR, and VO2 at each VT were high to very high (0.82-1.00). Random error was small to large within raters, and large between raters. CONCLUSIONS: For VTs that could be determined, relative agreement was high to very high, absolute agreement varied. For some individuals, often with tetraplegia, VT determination was not possible, thus other methods should be considered to prescribe exercise intensity.

Effect of self-guided training for the HandbikeBattle on body composition in people with spinal cord injury.

STUDY DESIGN: Single-group pre-test post-test study. OBJECTIVES: Examine the change in (1) fitness and body composition due to self-guided training in preparation for the HandbikeBattle in people with spinal cord injury (SCI); and (2) whether these possible body composition changes are associated with changes in fitness. SETTING: Handcycling teams of Dutch rehabilitation centers training for the HandbikeBattle, a handcycling race on an Austrian mountain. METHODS: Fitness (peak power output (POpeak) determined during a graded handcycling exercise test) and body composition (body mass, body mass index (BMI), waist circumference (WC), %fat determined with skinfolds and fat and fat free mass (% and kg) assessed by bio-impedance analysis (BIA)) of 18 persons with SCI were evaluated before and after 4 months of training for the HandbikeBattle. The effects of training were evaluated with repeated measures ANOVA. Associations among changes in POpeak and changes in body composition were calculated with Pearson correlation coefficients. RESULTS: Training for the HandbikeBattle led to significant improvements in POpeak, fat mass measured by BIA (19.6 ± 9.6 kg to 18.5 ± 8.3 kg, p = 0.02), %fat measured by skinfolds (28.4 ± 7.8% to 27.2 ± 7.2%, p = 0.02), while body mass and WC approached significance (p = 0.06). Association among changes in body composition and changes in POpeak ranged from trivial (e.g., for %fat BIA r = -0.023) to moderate (e.g., for WC, r = -0.32). CONCLUSIONS: Self-guided training for the HandbikeBattle led to a large increase in fitness but had a small effect on body composition, e.g., nutrition may play a more important role than exercise.

Relationships between internal and external handcycle training load in people with spinal cord injury training for the handbikebattle.

OBJECTIVE: To establish the relationship between internal and external handcycling training load for monitoring training in people with paraplegia. DESIGN: Observational study. SUBJECTS: Ten people with paraplegia. METHODS: All participants performed a graded peak exercise test. Power output and heart rate (HR) were measured and the session rating of perceived exertion (sRPE) was determined during a 12-week training period. Training Stress Score (TSS) was calculated from power output data, and TRaining IMPuls (TRIMP) was determined, based on HR, HRzones and sRPE. Partial correlations (for all training sessions of all participants) and Pearson's correlations (for all training sessions of an individual participant) were performed to determine the relationship between external (TSS) and internal (TRIMPHR, TRIMPHRzones and TRIMPsRPE) training loads. RESULTS: Partial correlations between measures of internal and external loads (r = 0.81-0.85) and correlations between TRIMPsRPE and TRIMP scores based on HR (r = 0.77-0.78) were very large. At the individual level, Pearson's correlations varied from moderate (r=0.48) to nearly perfect (r = 0.99). CONCLUSION: TRIMPsRPE and TRIMPHR showed very large correlations with external training load, and thus appear appropriate for use in monitoring handcycling training load in people with paraplegia. How-ever, it is recommended that both measures are used in combination, when possible, since some individuals showed weaker relationships.

A behavioral intervention promoting physical activity in people with subacute spinal cord injury: secondary effects on health, social participation and quality of life.

OBJECTIVE: To assess, for people with subacute spinal cord injury, if rehabilitation that is reinforced with the addition of a behavioral intervention to promote physical activity leads to a better health, participation and quality of life. DESIGN: Randomized controlled trial. SETTING: Rehabilitation centers. PARTICIPANTS: A total of 39 participants analyzed (45 included), with subacute spinal cord injury in inpatient rehabilitation, dependent on a manual wheelchair (33% tetraplegia, 62% motor complete, 150 ±74 days postinjury). INTERVENTION: A behavioral intervention promoting physical activity after discharge, involving 13 individual sessions delivered by a coach trained in motivational interviewing, beginning two months before and ending six months after discharge from inpatient rehabilitation. MAIN MEASURES: Physical capacity as determined during a maximal exercise test, body mass index, blood pressure, fasting lipid profile, and social participation (IMPACT-S) and quality of life (SF-36) were determined using questionnaires. Measurements were performed two months before discharge, at discharge, and six and 12 months after discharge from inpatient rehabilitation. B represents the between-group difference. RESULTS: Twelve months after discharge, significant intervention effects were found for diastolic blood pressure (B = -11.35 mmHg, 95% CI = -19.98 to -2.71), total cholesterol (B = -0.89 mmol/L, 95% CI = -1.59 to -0.20), low-density lipoprotein cholesterol (B = -0.63 mmol/L, 95% CI = -1.25 to -0.00) and participation (B = 9.91, 95% CI = 3.34 to 16.48). CONCLUSIONS: A behavioral intervention promoting physical activity after discharge from inpatient rehabilitation improves social participation and seems to reduce risk factors for cardiovascular disease in people with subacute spinal cord injury.

Effects of four-month handbike training under free-living conditions on physical fitness and health in wheelchair users.

PURPOSE: Recognizing the encouraging effect of challenging events, the HandbikeBattle (HBB) was created to promote exercise among wheelchair users. The purpose of this study was to reveal the effects on physical fitness and health outcomes of four-month handbike training under free-living conditions in preparation for the event. METHODS: In this prospective cohort study, 59 relatively inexperienced handyclists participated in the HBB of 2013 or 2014. Incremental exercise tests were conducted, respiratory function was tested and anthropometrics were measured before and after the preparation period. Main outcome measures were peak power output (POpeak), peak oxygen uptake (VO2peak) and waist circumference, of which the changes were tested using repeated measures ANOVA. To detect possible determinants of changes in physical fitness, a linear regression analysis was conducted with personal characteristics, executed training volume and upper-extremity complaints during the training period as independent variables. RESULTS: POpeak, VO2peak and waist circumference improved significantly with 17%, 7% and 4.1%, respectively. None of the included variables were significant determinants for the changes in POpeak found as a result of the training. CONCLUSION: A challenging event such as the HBB provokes training regimes among participants of sufficient load to realize substantial improvements in physical fitness and health outcomes. Implications for Rehabilitation Due to the often impaired muscle function in the lower-limbs and an inactive lifestyle, wheelchair users generally show considerably lower levels of fitness compared to able-bodied individuals. This prospective cohort study showed that four months of handbike training under free-living conditions in preparation for this event resulted in substantial improvements in physical fitness and health outcomes in wheelchair users. The creation of a challenging event such as the HandbikeBattle as part of a follow-up rehabilitation practice can therefore be a useful tool to help wheelchair users initiate or keep training to improve their physical fitness and health.

An Incremental Shuttle Wheel Test for Wheelchair Tennis Players.

PURPOSE: To determine the relationship between outcomes of the shuttle wheel test (SWT) and peak oxygen uptake (VO2peak) during that test and whether SWT and VO2peak can discriminate between different skill levels of wheelchair tennis players. METHODS: Fifteen wheelchair tennis players performed an SWT on a tennis court while VO2 was measured continuously. Outcome measures were VO2peak and achieved stage. Relations between outcomes and Dutch wheelchair tennis ranking were calculated with Spearman correlation. Independent t tests were used to test for differences between national and international players. RESULTS: Moderate correlations were found between VO2peak and SWT outcome (r = .40-.47). The tennis ranking correlated weakly with VO2peak (r = -.35) and strongly with SWT outcome (r = -.80). A significant difference was found between national and international players for achieved stage (P = .027) and VO2peak (P = .027). CONCLUSIONS: The SWT outcome only explained a small part of the variance in VO2peak among players, so it cannot be considered a valid test for aerobic capacity. However, SWT outcomes are related to the skill level of the player and give a good indication of the overall peak wheelchair performance.