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.

Peak and submaximal steady-state metabolic and cardiorespiratory responses during arm-powered and arm-trunk-powered handbike ergometry in able-bodied participants.

The purpose of this study was to compare the peak and submaximal metabolic and cardiorespiratory responses during steady-state arm-powered (AP) and arm-trunk-powered (ATP) handbike ergometry. Twelve male able-bodied participants with no prior experience in handcycling completed a maximal progressive incremental test and a series of 6-minute submaximal tests at 130 W with various cadences in a custom-designed handbike ergometer that allowed a realistic simulation of AP and ATP handcycling. Peak power output, peak oxygen uptake, and peak ventilation were significantly lower, whereas peak blood lactate concentration was significantly higher during AP handcycling. Mean gross mechanical efficiency was significantly higher during AP handcycling (range 16.7 to 20.5%) compared with ATP handcycling (range 15.8 to 17.6%). These results suggest that AP handcycling is advantageous during submaximal steady-state handcycling, whereas ATP handcycling allows for a higher peak power output generation. However, it remains unclear which handbike configuration would be favorable during competition.

Towards evidence-based classification in wheelchair sports: impact of seating position on wheelchair acceleration.

In most Paralympic wheelchair sports, active trunk range of movement is assessed by observing shoulder girdle excursion during active trunk movements and is a key determinant of an athlete's class. However, to date research evaluating the impact of reduced trunk range of movement on wheelchair sports performance has not been conducted. In the present study, 15 non-disabled male participants performed two 20-s sprints on a wheelchair ergometer in each of three seating positions. Positions were typical of those used to enhance sitting stability in wheelchair sport and each impacted available trunk range of movement differently: condition-90 (seated with thighs horizontal; unrestricted range of movement) condition-45 (seated with thighs in 45°), and condition-0 (seated with hips maximally flexed; minimum range of movement). In condition-90, the trunk only actively contributed to the first push; for the remainder of the sprint, the trunk was held almost isometrically at 48.2° to the horizontal (range 42.1-56.4°). Similar patterns were observed for both condition-45 and condition-0. Compared with condition-90, participants in condition-0 had reduced capacity to accelerate of statistical (P < 0.05) and practical significance. These findings are an important initial step towards evidence-based decision making in classification. Future research should evaluate the individual and collective impact of other factors that affect the trunk's contribution to wheelchair sports performance, including strapping, seating position, and impairments of trunk muscle power and coordination.

Trunk strength effect on track wheelchair start: implications for classification.

PURPOSE: The T54 wheelchair racing class comprises athletes with normal arm muscle strength and trunk strength ranging from partial to normal. Paralympic sports classes should comprise athletes who have impairments that cause a comparable degree of activity limitation. On the basis of this criterion, the purpose of this study was to determine whether the T54 class is valid by assessing the strength of association between trunk strength and wheelchair acceleration. METHODS: Participants were 10 male and 3 female international wheelchair track athletes with normal arm strength. Six were clinically assessed as having normal trunk strength, and seven had impaired trunk strength. Measures included isometric arm and trunk strength and distance covered at 1, 2, and 3 s in an explosive start from standstill on a regulation track, as well as on a custom-built ergometer with four times normal rolling resistance. RESULTS: No significant differences were observed between male athletes with and without full trunk strength in distance covered after 1, 2, and 3 s. Correlations between isometric trunk strength and wheelchair track acceleration were nonsignificant and low (0.27-0.32), accounting for only 7%-10% of variance in performance. Correlations between trunk strength and distance pushed under high resistance were also nonsignificant, although values were almost double (r = 0.41-0.54), accounting for 18%-28% of the variance in performance. CONCLUSIONS: These results provide evidence that impairment of trunk strength has minimal effect on wheelchair acceleration and indicate the T54 class is valid. Results do not infer that athletes with no trunk strength should compete with those who have partial or full trunk strength.

The ability of elite table tennis players with intellectual disabilities to adapt their service/return.

In this study the ability of elite table tennis players with intellectual disability (ID) to adapt their service/return to specific ball spin characteristics was investigated. This was done by examining the performance of 39 players with ID and a reference group of 8 players without ID on a standardized table tennis specific test battery. The battery included 16 sets of 15 identical serves that had to be returned to a fixed target, and two additional tests measuring reaction time and upper limb speed. A 2 x 4 ANOVA (with group and type of spin as independent variables) with repeated measurements (15 consecutive returns) supported the hypothesis that elite table tennis players with ID were significantly less proficient than their counterparts without ID, but both groups demonstrated a comparable progression in learning. Spearman correlation coefficients indicated a positive relationship between accuracy of return and upper limb speed (rho = 0.42: p < .05) and reaction time (rho = 0.41: p < .05), showing that these generic factors are useful in partially explaining skill variations in specific sports.

Consistency of within-cycle torque distribution pattern in hand cycling.

This investigation studied the consistency of the within-cycle torque pattern in hand cycling (1) in subsequent cycles, (2) between different individuals, (3) between different power output levels, and (4) with respect to fatigue. Ten nondisabled male participants performed a progressive peak arm crank ergometry test; a number of 5-minute submaximal tests at 10, 20, 30, and 40 W; and one 15-minute submaximal test at 80% to 90% of their peak heart rate. A hand cycle unit attached to a computerized motor allowed for power output adjustments and registered position and torque. Variation coefficients were calculated and averaged for evaluation of the pattern consistency. Values were 2.7% to 3.9% for subsequent cycles, 3.2% to 5.3% between participants, 2.8% between different power output levels, and 3.1% with respect to fatigue. These results indicate a consistent within-cycle torque distribution pattern for subsequent cycles that is minimally influenced by factors such as power output and fatigue.

Cardiorespiratory responses during arm ergometry, functional electrical stimulation cycling, and two hybrid exercise conditions in spinal cord injured.

PURPOSE: The purpose of this study was to compare peak functional aerobic power (VO2 peak) across four different types of exercise: arm crank ergometry (ACE), functional electrical stimulation (FES) cycling, and two hybrid exercise conditions: FES cycling combined with ACE and FES rowing using a newly developed rowing device (ROWSTIM). METHODS: Five participants (C7-T12), four male paraplegics with neurologically complete spinal cord injury (SCI), and one male with neurologically incomplete SCI, underwent a progressive maximal peak oxygen exercise test to ascertain peak physical work capacity during arm cranking, FES cycling, FES cycling combined with arm cranking and FES rowing. ariables were significantly lower for FES cycling versus ACE, FES cycling combined with ACE and FES rowing measures (P < 0.05). However there were no significant differences between ACE, FES cycling combined with ACE and FES rowing. CONCLUSIONS: Preliminary results suggest that the ROWSTIM is as effective an exercise device or training tool for persons with SCI as ACE or combined FES-cycling and ACE, and more effective than FES-cycling. A larger sample size and further technological developments of the ROWSTIM are needed to demonstrate the efficacy of rowing over other hybrid exercise modalities and ACE.

Determinants of shuttle run performance in the prediction of peak VO2 in wheelchair users.

PURPOSE: The purpose of this study was to determine the impact of ergonomic and environmental variations on indoor shuttle run (SR) performance in wheelchair sportsmen. METHODS: Eleven experienced male wheelchair sportsmen performed three 25-m SRs in random order with varying turning capacity (TC) and mechanical resistance (MR): condition NN where participants used their sports wheelchair on a tartan surface, condition RN with increased MR, and condition RD with limited TC. Metabolic data were continuously recorded using a portable K4b(2) system. RESULTS: Friedman ANOVA with Wilcoxon a posteriori testing indicated similar VO(2peak) values in all three tests. SR performance, however, was significantly different across the three test conditions (NN: 536.18 +/-119.09 s; RN: 488.82+/-119.84 s; RD: 404.91+/-88.41 s). SR performance contributed for 28% of the explained variance of the measured VO(2peak). The addition of TC or MR or both increased the explained variance to 32, 38 and 41%, respectively. CONCLUSIONS: These findings demonstrate a significant impact of variations in floor surface and wheelchair-user interface on SR performance. The findings also suggest that strong reservations have to be made regarding the validity of a SR test, as predictor of VO(2peak) in a wheelchair user population.

Influence of crank rate in hand cycling.

PURPOSE: The purpose of this study was to determine gross mechanical efficiency (ME) at different power output (PO) levels of synchronous hand cycling and to evaluate the influence of increasing PO by changing crank rate or resistance in wheelchair users with experience in hand cycling. METHODS: Nine male participants with spinal cord injury randomly performed three maximal incremental hand cycling tests using a computer controlled cycle ergometer. Each test started at a PO level of 50 W with increments of 10 W. In the velocity protocol, PO was increased via crank rate while resistance was constant (VEL). In the resistance protocol PO was increased via resistance while crank rate was constant (RES). In the freely chosen frequency protocol, the participants could freely select their crank rate while resistance was automatically adjusted to obtain the desired PO (FCF). RESULTS: Peak physiological responses were similar in all three tests, whereas PO max was lower in VEL compared with RES and FCF. Similar values for gross ME were found in both RES and FCF protocols, although systematically higher and increasing crank rates were adopted throughout FCF. Nevertheless, differences in gross ME at comparable relative (RES > VEL at 60 and 80% of PO range: 14.09 and 14.40% vs 13.02 and 13.11%, respectively) and absolute (RES, FCF > VEL at 90 W: 14.47, 14.47, and 13.43%, respectively) PO levels were demonstrated. CONCLUSION: These results suggest that during synchronous hand cycling the freely chosen crank rate is not necessarily the most economical, that high crank rates result in a lower ME at a given PO and that freely chosen crank rates increase with increasing PO levels.

The relationship between functional potential and field performance in elite female wheelchair basketball players.

The functional classification system for wheelchair basketball is based on an analysis of the players' functional resources through field-testing and game observation. Under this system, players are assigned a score of 1 to 4.5. The aim of this study was to determine if the wheelchair basketball player classification system reflects the existing differences in performance of elite female players. During the World Championship for Wheelchair Basketball in Sydney 1998, eight teams were videotaped for three 40-min games for a total of 120 min per team. Fifty-nine female players (Class I [1 and 1.5 points] n=12; Class II [2 and 2.5 points] n=20; Class III [3 and 3.5 points] n=13; Class IV [4 and 4.5 points] n=14) were retained for a detailed performance analysis by means of the Comprehensive Basketball Grading System (CBGS). Two-way analysis of variance showed high point players to perform better compared with low point players for the majority of variables determining the quality of game performance. A lack of significant differences between two adjacent classes was explained on the basis of the methodological approach, the class-position relationship in this sample, and the performance level of women's wheelchair basketball. We conclude that the performance of elite female wheelchair basketball players is dependent on functional ability.