Perceptions of High-Intensity Interval Training Among People With Spinal Cord Injury: A Mixed-Methods Analysis.

This mixed-method project investigated how people with spinal cord injury perceive high-intensity interval training (HIIT). Using a recumbent hand cycle, 11 active men and 9 active women with spinal cord injury or related disease participated in a single HIIT and moderate-intensity continuous training (MICT) session. Following exercise, participants completed surveys assessing enjoyment, self-efficacy, and outcome expectations. Ten participants were randomly selected to participate in a semistructured interview to assess perceptions toward HIIT. Quantitative survey data revealed that participants trended toward enjoying HIIT over MICT (p = .06) with similar levels of self-efficacy and outcome expectations toward HIIT and MICT (p > .05). Qualitative data revealed that participants believed HIIT would enhance long-term physical and self-evaluative outcomes; several barriers emerged that could prevent widespread adoption among the general population with spinal cord injury. Results support HIIT as a viable exercise option, although research should begin exploring ways to remove HIIT-related barriers that people with spinal cord injury may encounter.

The effectiveness of vigorous training on cardiorespiratory fitness in persons with spinal cord injury: a systematic review and meta-analysis.

DESIGN: Systematic review and meta-analysis. BACKGROUND AND PURPOSE: Traditional forms of upper-body moderate intensity exercise consistently provide little cardiovascular benefits for persons with spinal cord injury (PwSCI). Explorations of new training methods are vital to improve cardiovascular fitness among PwSCI. This study sought to evaluate the effectiveness of vigorous training on cardiorespiratory fitness in PwSCI. METHODS: Database search through PubMed, Web of Science, Scopus, SportDiscus, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) was conducted from the databases' inception to November 2020 to identify relevant exercise studies with PwSCI. Two independent reviewers screened articles for inclusion. Data were extracted from included studies and methodological quality evaluated. RESULTS: Sixteen trials (eight pre-post trials and eight controlled trials [CTs]) with a total of 145 participants were analyzed. Results from pre-post studies revealed significant improvements in cardiorespiratory fitness following high-intensity interval training (HIIT) (Peak Oxygen Uptake [VO2peak], standardized mean difference [SMD] = 0.81; 95% CI 0.23-1.39; P < 0.01 and Peak Power Output [PPO], SMD = 0.91; 95% CI 0.32-1.5; P < 0.01) and circuit resistance training (CRT) (VO2peak, MD = 0.38; 95% CI 0.19-0.57; P < 0.01 and PPO, MD = 20.17; 95% CI 8.26-32.08; P < 0.01). Meta-analysis of CTs did not demonstrate significant improvements in cardiorespiratory fitness following vigorous training interventions in comparison to lower intensity training interventions. CONCLUSION: Evidence from HIIT and CRT interventions suggest benefits for cardiovascular functions; however, vigorous training was not more beneficial than other forms of endurance training. More CTs are needed to better understand the effectiveness of vigorous training on cardiorespiratory fitness in PwSCI.

Exploring the Influence of Wheelchair-User Interface and Personal Characteristics on Ischial Tuberosity Peak Pressure Index and Gradient in Elite Wheelchair Basketball Players.

This pilot study investigated the relationship between personal and wheelchair factors on skin pressures at the ischial tuberosity in wheelchair basketball players. Seventeen wheelchair basketball players (7 male and 10 female) were evaluated during static and dynamic propulsive conditions while peak pressure index and peak pressure gradient were recorded with an interface pressure mat. The results showed that greater seat dump angles and backrest heights were negatively associated with the peak pressure index. Therapeutic cushion use was moderately associated with a reduced peak pressure gradient. Higher-class players used chair configurations associated with augmented pressure; however, classification status alone was not associated with pressure magnitude. Body mass index was negatively correlated with the static peak pressure gradient at levels approaching significance (p < .10). In conclusion, greater seat dump angles and backrest heights may provide pressure relief, whereas greater body mass index and therapeutic cushion use may reduce pressure gradients.

Effects of Daily Physical Activity Level on Manual Wheelchair Propulsion Technique in Full-Time Manual Wheelchair Users During Steady-State Treadmill Propulsion.

OBJECTIVE: To examine whether differences in propulsion technique as a function of intraindividual variability occur as a result of shoulder pain and physical activity (PA) level in full-time manual wheelchair users (MWUs). DESIGN: Observational study. SETTING: Research laboratory. PARTICIPANTS: Adults (N=14) with spinal cord injury (mean age: 30.64±11.08) who used a wheelchair for >80% of daily ambulation and were free of any condition that could be worsened by PA. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: PA level was measured using the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD), and shoulder pain was measured using the Wheelchair User's Shoulder Pain Index (WUSPI) survey. Mean and intraindividual variability propulsion metrics were measured for propulsion analysis. RESULTS: WUSPI scores indicated participants experienced low levels of shoulder pain. The results of the Spearman rank-order correlation revealed that PASIPD scores were significantly related to mean contact angle (rs=-.57) and stroke frequency (rs=.60) as well as to coefficient of variation of peak force (rs=.63), peak torque (rs=.59), contact angle (rs=.73), and stroke frequency (rs=.60). WUSPI scores were significantly correlated with only mean peak force (P=.02). No significant correlations were observed between PASIPD, WUSPI, and body mass index scores. CONCLUSIONS: Differences in propulsion technique were observed on the basis of PA levels. Participants with higher PASIPD scores used a more injurious stroke technique when propelling at higher speeds. This may indicate that active individuals who use injurious stroke mechanics may be at higher risk of injury. A strong relation was found between peak propulsion forces and shoulder pain. Rehabilitation professionals should emphasize the use of a protective stroke technique in both inactive and active MWUs during exercise and faster propulsion.

Promoting Physical Activity Through a Manual Wheelchair Propulsion Intervention in Persons With Multiple Sclerosis.

OBJECTIVE: To examine the efficacy and feasibility of a multifactorial intervention to increase lifestyle physical activity in nonambulatory persons with multiple sclerosis (MS) based on wheelchair optimization, propulsion skill/technique training, and behavioral strategies based on social cognitive theory. DESIGN: Randomized controlled trial, 3-month postintervention follow-up. SETTING: Home and general community, and university research laboratory. PARTICIPANTS: Nonambulatory individuals with MS (N=14; mean age ± SD, 53.6±8.7y) were randomly assigned to an intervention group (IG) or a control group (CG). INTERVENTIONS: After baseline testing, the IG participants received custom-fit, ultralightweight manual wheelchairs with propulsion/skills training, followed by 3 months of at-home use with the custom ultralightweight wheelchair and weekly phone calls to deliver support through a multifactorial intervention. The CG participants received no training and used their own wheelchairs at home during this time. MAIN OUTCOME MEASURES: All subjects were assessed at baseline and 3 months later for fatigue (Fatigue Severity Scale), upper extremity strength (digital handheld dynamometer), and propulsion technique (on a treadmill [0.5m/s] with instrumented wheels). Two 1-week bouts of physical activity were measured in both groups from home with wrist-worn accelerometry at the beginning (IG and CG in own wheelchairs) and end (IG in study wheelchair, CG in own) of the 3-month period of home use. RESULTS: The intervention was well tolerated, and no adverse events were reported. The IG demonstrated increased strength (P=.008) and a trend toward less fatigue (P=.068), both with large effect sizes (d>0.8), as well as reduced application of braking torque during propulsion (P=.003) with a moderate/large effect size (d=.73), compared with the CG. CONCLUSIONS: Findings suggest a 3-month physical activity intervention based on manual wheelchair propulsion and training is safe and feasible for some wheelchair users living with MS and may produce secondary benefits in strength, fatigue, and propulsion technique.

Relationship between shoulder pain and kinetic and temporal-spatial variability in wheelchair users.

OBJECTIVE: To examine intra-individual variability of kinetic and temporal-spatial parameters of wheelchair propulsion as a function of shoulder pain in manual wheelchair users (MWUs). DESIGN: Cohort. SETTING: University research laboratory. PARTICIPANTS: Adults with physical disabilities (N=26) who use a manual wheelchair for mobility full time (>80% ambulation). INTERVENTIONS: Participants propelled their own wheelchairs with force-sensing wheels at a steady-state pace on a dynamometer at 3 speeds (self-selected, 0.7m/s, 1.1m/s) for 3 minutes. Temporal-spatial and kinetic data were recorded unilaterally at the hand rim. MAIN OUTCOME MEASURES: Shoulder pain was quantified with the Wheelchair Users Shoulder Pain Index. Intra-individual mean, SD, and coefficient of variation (CV=mean/SD) with kinetic and temporal-spatial metrics were determined at the handrim. RESULTS: There were no differences in mean kinetic and temporal-spatial metrics as a function of pain group (P values >.016). However, individuals with pain displayed less relative variability (CV) in peak resultant force and push time than pain-free individuals (P<.016). CONCLUSIONS: Shoulder pain had no influence on mean kinetic and temporal-spatial propulsion variables at the handrim; however, group differences were found in relative variability. These results suggest that intra-individual variability analysis is sensitive to pain. We propose that variability analysis may offer an approach for earlier identification of MWUs at risk for developing shoulder pain.

Handrim wheelchair propulsion training effect on overground propulsion using biomechanical real-time visual feedback.

OBJECTIVE: To compare the effects of 2 manual wheelchair propulsion training programs on handrim kinetics, contact angle, and stroke frequency collected during overground propulsion. DESIGN: Randomized controlled trial comparing handrim kinetics between 3 groups: a control group that received no training, an instruction-only group that reviewed a multimedia presentation, and a feedback group that reviewed the multimedia presentation and real-time visual feedback. SETTING: Research laboratory. PARTICIPANTS: Full-time manual wheelchair users (N=27) with spinal cord injury living in the Pittsburgh area. INTERVENTIONS: Propulsion training was given 3 times over 3 weeks, and data were collected at baseline, immediately after training, and at 3 months. MAIN OUTCOME MEASURES: Contact angle, stroke frequency, peak resultant force, and peak rate of rise of resultant force. RESULTS: Both feedback and instruction-only groups improved their propulsion biomechanics across all surfaces (carpet, tile, and ramp) at both target and self-selected speeds compared with the control group. While controlling for velocity, both intervention groups showed long-term reductions in the peak rate or rise of resultant force, stroke frequency, and increased contact angle. CONCLUSIONS: Long-term wheelchair users in both intervention groups significantly improved many aspects of their propulsion technique immediately after training and 3 months from baseline. Furthermore, training with a low-cost instructional video and slide presentation was an effective training tool alone.

Use of bone morphogenetic protein-2 (rh-BMP-2) in treatment of wrist and hand nonunion with comparison to historical control groups.

The purpose of this study is to report the percentage of patients achieving union, time to union, and complications with the use of bone morphogenetic protein-2 (rh-BMP-2) in surgical repair of established nonunion in the hand and wrist. Twenty-seven patients with nonunion of the hand and wrist were treated between 2005 and 2011 with surgical repair and augmentation using 4.2 mg of rh-BMP-2. Sites of nonunion included the phalanx (seven), carpus (nine), distal radius (five), and distal ulna (six). Radiographic union and complications were the primary and secondary outcomes, respectively. Eighty-nine percent (24/27) of patients achieved union within an average of 4.3 ± 2.8 months of surgery. There were no direct complications from administration of rh-BMP-2. Radiographic union was consistent with published rates for nonunion repair of scaphoid, phalanx, and distal radius fractures. Rh-BMP-2 did not produce superior rates of union in the patients with wrist and hand nonunion.

Cardiorespiratory Responses to an Acute Bout of High Intensity Interval Training and Moderate Intensity Continuous Training on a Recumbent Handcycle in People With Spinal Cord Injury: A Within-Subject Design.

Objectives: To compare acute cardiorespiratory responses during high intensity interval training (HIIT) and moderate intensity continuous training (MICT) on a recumbent handcycle in persons with spinal cord injury (PwSCI). Methods: Eleven males and nine females with chronic SCI (T3 - L5), aged 23 (9) years, participated in this within-subject design. Based off peak power outputs from an incremental test to exhaustion, participants engaged in a HIIT and MICT session at matched workloads on a recumbent handcycle. Workloads (Joules), time, oxygen uptake (VO2), metabolic equivalent of task (MET), heart rate (HR), and energy expenditure (kcal) were recorded during HIIT and MICT. Results: Total workload was similar across HIIT (87820 ± 24021 Joules) and MICT sessions (89044 ± 23696 Joules; p > .05). HIIT (20.00 [.03] minutes) was shorter in duration than MICT (23.20 [2.56]; p < .01). Average VO2 (20.96 ± 4.84 vs. 129.38 ± 19.13 mL/kg/min O2), MET (7.54 ± 2.00 vs. 6.21 ± 1.25), and HR (146.26 ± 13.80 vs. 129.38 ± 19.13 beats per minute) responses were significantly greater during HIIT than MICT (p < .01). Participants burned significantly more kilocalories during HIIT (128.08 ± 35.65) than MICT (118.93 ± 29.58; p < .01) and at a faster rate (6.40 ± 1.78 [HIIT] vs. 5.09 ± 1.14 [MICT] kcal/min; p < .01). Conclusion: HIIT elicits greater increases in oxygen uptake and HR than MICT in PwSCI. In significantly less time, HIIT also burned more calories than MICT.

Propulsion kinetics of recumbent handcycling during high and moderate intensity exercise.

People with spinal cord injuries (PwSCI) are at high risk of developing cardiovascular disease (CVD). While regular exercise can reduce risk of CVD, PwSCI face various barriers to exercise, including high rates of upper limb injuries, especially in the shoulder. Handcycling high intensity interval training (HIIT), which consists of periods of high intensity exercise followed by rest, is a potential exercise solution, but the musculoskeletal safety of HIIT is still unknown. In this study, we characterized three-dimensional continuous applied forces at the handle during handcycling HIIT and moderate intensity continuous training (MICT). These applied forces can give an early indication of joint loading, and therefore injury risk, at the shoulder. In all three directions (tangential, radial, and lateral), the maximum applied forces during HIIT were larger than those in MICT at all timepoints, which may indicate higher contact forces and loads on the shoulder during HIIT compared to MICT. The tangential and radial forces peaked twice in a propulsion cycle, while the lateral forces peaked once. Throughout the exercises, the location of tangential peak 2 and radial peak 1 was later in HIIT compared to MICT. This difference in maximum force location could indicate either altered kinematics or muscular fatigue at the end of the exercise protocol. These changes in kinematics should be more closely examined using motion capture or other modeling techniques. If we combine this kinetic data with kinematic data during propulsion, we can create musculoskeletal models that more accurately predict contact forces and injury risk during handcycling HIIT in PwSCI.

The influence of gender on shoulder kinematics and head-hip technique during non-level transfers in full-time wheelchair users.

BACKGROUND: Non-level transfers are some of the most demanding tasks for manual wheelchair users. Safely performing these transfer tasks may be needed for maintaining long-term upper limb health. This cross-sectional study aimed to examine the influence of gender on the head-hip technique and lead arm kinematics during multi-height transfers in manual wheelchair users. METHODS: Motion analysis was used to obtain lead-arm shoulder kinematics (flexion/extension and abduction/adduction) and trunk flexion during level, uphill, and floor-to-table transfers in full-time manual wheelchair users. FINDINGS: Twelve male (N = 12) and fifteen female (N = 15) manual wheelchair users with a mean age of 23 ± 5 years and no signs of shoulder pain participated in the study. Lead-arm shoulder flexion and abduction increased as vertical displacement requirements increased during the various transfer tasks (p < 0.01). Women displaced greater trunk flexion during level transfers at approaching significant levels (p = 0.07). During uphill transfers, women displayed significantly greater trunk flexion than men (p < 0.05). INTERPRETATION: Manual wheelchair users use unique kinematic requirements when using the head-hip during level and non-level transfers. Women may be at decreased risk of chronic shoulder pain due to a greater use of the head-hip technique during non-level transfers. Nonetheless, more research that integrates kinetics and strength assessments during non-level transfer biomechanical analyses is needed to better understand technical requirements of non-level transfers in manual wheelchair users.

Moving forward: A review of continuous kinetics and kinematics during handcycling propulsion.

Wheelchair users (WCUs) face high rates of shoulder overuse injuries. As exercise is recommended to reduce cardiovascular disease prevalent among WCUs, it is becoming increasingly important to understand the mechanisms behind shoulder soft-tissue injury in WCUs. Understanding the kinetics and kinematics during upper-limb propulsion is the first step toward evaluating soft-tissue injury risk in WCUs. This paper examines continuous kinetic and kinematic data available in the literature. Attach-unit and recumbent handcycling are examined and compared. Athletic modes of propulsion such as recumbent handcycling are important considering the higher contact forces, speed, and power outputs experienced during these activities that could put users at increased risk of injury. Understanding the underlying kinetics and kinematics during various propulsion modes can lend insight into shoulder loading, and therefore injury risk, during these activities and inform future exercise guidelines for WCUs.

Comparison between overground and dynamometer manual wheelchair propulsion.

Laboratory-based simulators afford many advantages for studying physiology and biomechanics; however, they may not perfectly mimic wheelchair propulsion over natural surfaces. The goal of this study was to compare kinetic and temporal parameters between propulsion overground on a tile surface and on a dynamometer. Twenty-four experienced manual wheelchair users propelled at a self-selected speed on smooth, level tile and a dynamometer while kinetic data were collected using an instrumented wheel. A Pearson correlation test was used to examine the relationship between propulsion variables obtained on the dynamometer and the overground condition. Ensemble resultant force and moment curves were compared using cross-correlation and qualitative analysis of curve shape. User biomechanics were correlated (R ranging from 0.41 to 0.83) between surfaces. Overall, findings suggest that although the dynamometer does not perfectly emulate overground propulsion, wheelchair users were consistent with the direction and amount of force applied, the time peak force was reached, push angle, and their stroke frequency between conditions.

The influence of shoulder pain and fear of falling on level and non-level transfer technique.

BACKGROUND: Level and non-level transfers are essential tasks of daily living for wheelchair users. Minimal research has examined the role of shoulder pain and fear of falling on transfer quality. The purpose of this study is to (1) examine the association between shoulder pain, fear of falling (FoF) and transfer quality and (2) explore the feasibility of assessing non-level transfers to-and-from the floor. METHODS: Cross-sectional design was used to explore shoulder pain, FoF, and transfer quality in 30 manual wheelchair users (aged 18-42; 15 males). Participant demographic information (age, sex, race, disability, and years using wheelchair), Spinal Cord Injury-Fall Concern Scale (SCI-FCS), and Wheelchair User Shoulder Pain Index (WUSPI) was collected. Three types of transfers: (1) level, (2) uphill, and (3) floor-to-table were graded by a trained researcher using the Transfer Assessment Instrument (TAI) 3.0. Kruskal-Wallis test was used to determine differences in transfer quality based on condition. Spearman correlation was used to determine associations between demographic data, WUSPI, SCI-FCS, and transfer quality scores. RESULTS: All participants safely completed the uphill non-level transfer; 27 safely completed the floor-to-table non-level transfer. Statistical analysis revealed no difference in TAI score across transfer conditions. Spearman correlation revealed a significant correlation between WUSPI and SCI-FCS scores (r = .68, P = .01) and WUSPI and uphill TAI scores (r = -.45, P = .01). CONCLUSION: Increases in shoulder pain are related to decreased uphill transfer quality and increased FoF. Non-level transfers to-and-from the floor are feasible within clinical or laboratory settings.

Push-Rate Threshold for Physical Activity Intensity in Persons Who Use Manual Wheelchairs.

ABSTRACT: There is evidence that manual wheelchair users are among the least physically active in society. However, the current cut points for quantifying physical activity intensity based on steps per minute have been developed for ambulatory adults from the general population and other clinical populations and may not be appropriate or applicable for manual wheelchair users. This study examined the association between push rate (an analog of step rate) and energy expenditure across three speeds of treadmill wheelchair propulsion among manual wheelchair users and further generated a push-rate cut point for quantifying moderate-to-vigorous physical activity. Persons who used manual wheelchairs (N = 17) performed three, 6-min bouts of manual wheelchair propulsion on a motor-driven treadmill at speeds of 0.7, 1.3, and 2.0 m/sec. Push rate per trial was measured using SMARTwheels, and the rate of oxygen consumption per trial was measured using a portable metabolic system. The mean (SD) R2 value for the relationship between push rate and energy expenditure was 0.78 (0.14). The mean (SD) push-rate cut point for quantifying moderate-to-vigorous physical activity was 55.05 (26.06) pushes/min. This preliminary study provides the first push-rate cut point for quantifying moderate-to-vigorous physical activity among a heterogeneous sample of manual wheelchair users. This threshold may be important for public health promotion and individual-level monitoring and prescription of free-living physical activity behavior among manual wheelchair users.

Hand rim wheelchair propulsion training using biomechanical real-time visual feedback based on motor learning theory principles.

BACKGROUND/OBJECTIVE: As considerable progress has been made in laboratory-based assessment of manual wheelchair propulsion biomechanics, the necessity to translate this knowledge into new clinical tools and treatment programs becomes imperative. The objective of this study was to describe the development of a manual wheelchair propulsion training program aimed to promote the development of an efficient propulsion technique among long-term manual wheelchair users. METHODS: Motor learning theory principles were applied to the design of biomechanical feedback-based learning software, which allows for random discontinuous real-time visual presentation of key spatiotemporal and kinetic parameters. This software was used to train a long-term wheelchair user on a dynamometer during 3 low-intensity wheelchair propulsion training sessions over a 3-week period. Biomechanical measures were recorded with a SmartWheel during over ground propulsion on a 50-m level tile surface at baseline and 3 months after baseline. RESULTS: Training software was refined and administered to a participant who was able to improve his propulsion technique by increasing contact angle while simultaneously reducing stroke cadence, mean resultant force, peak and mean moment out of plane, and peak rate of rise of force applied to the pushrim after training. CONCLUSIONS: The proposed propulsion training protocol may lead to favorable changes in manual wheelchair propulsion technique. These changes could limit or prevent upper limb injuries among manual wheelchair users. In addition, many of the motor learning theory-based techniques examined in this study could be applied to training individuals in various stages of rehabilitation to optimize propulsion early on.

The short-term influence of rear wheel axle position and training on manual wheelchair propulsion technique in novice able-bodied participants during steady-state treadmill propulsion, a pilot study.

Purpose: To examine if wheelchair fit influenced the effectiveness of video-based propulsion technique training.Method: Based on a cross sectional design, able-bodied participants (n = 21) received an optimally configured wheelchair (OCW; n = 11) or a nonoptimally configured wheelchair (NOCW; n = 10) to determine if propulsion technique was influenced by configuration before and after training. Outcome variables collected during steady-state treadmill propulsion at 1.1 m/s included peak resultant force (peak Fr; N), peak torque (N), contact angle (CA; degrees), stroke frequency (SF; strokes/s), power output (PO; W), and braking torque (BT; N m). Results: Significant group by time interactions were observed for PO (p = 0.05) and peak torque (p = 0.01), while CA, SF, and BT were significant by time (p < 0.05).Conclusion: Results suggest similar benefits from training regardless of rear axle position except for PO and peak torque where configuration was influential. Results suggest the combined effects of optimal configuration with training were most effective; however, those receiving training in a nonoptimal configuration can still improve. Although findings are preliminary, clinicians and end users should be alert to the interplay of configuration andtraining when attempting to modify technique.

Influence of wheelchair user interface and personal characteristics on static and dynamic pretibial skin pressures in elite wheelchair racers, a pilot study.

Context/objective: To examine personal (athletic classification, age, sex, body mass index, duration of disability, tactile sensation of lower extremities) and wheelchair (kneeling plate angle) factors associated with increased pretibial skin pressures in elite wheelchair racers.Design: Cross-sectional study.Setting: University-based laboratory in Champaign, USA.Participants: A convenience sample of elite wheelchair races with traumatic spinal cord injury and spinal disease were recruited for participation.Interventions: Interface pressure mapping was used to examine athletes' average and peak pretibial skin pressures in their own racing wheelchairs during static and dynamic (propulsive) conditions on a dynamometer.Outcome measures: The study examined associations between personal and wheelchair factors and pressure, differences in pressure between static and dynamic conditions, and the influence of athletic classification (T53 vs. T54) on kneeling plate angle preference and skin pressure magnitudes.Results: Increased kneeling plate angle was moderately associated with dynamic pressures. T53 athletes utilized more vertical kneeling angles and experienced larger average and peak pressures during propulsion. Duration of disability was negatively associated with all measures of pressure. Overall, mean dynamic peak pressure was significantly greater than mean static peak pressure.Conclusion: This pilot study represents a first step in understanding the influence of user interface on potentially injurious skin pressures in wheelchair racers. Vertical kneeling plate configurations were associated with increased pressures while increased years with disability was associated with lower pretibial pressures. In addition, T53 athletes with less trunk function may be at a greater risk for experiencing larger interface pressures than T54 athletes.

Nutritional strategies in an elite wheelchair marathoner at 3900 m altitude: a case report.

BACKGROUND: Altitude training is a common practice among middle-distance and marathon runners. During acclimatization, sympathetic drive may increase resting metabolic rate (RMR), therefore implementation of targeted nutritional interventions based on training demands and environmental conditions becomes paramount. This single case study represents the first nutritional intervention performed under hypobaric hypoxic conditions (3900 m) in Paralympic sport. These results may elucidate the unique nutritional requirements of upper body endurance athletes training at altitude. CASE PRESENTATION: This case study examined the effects of a nutritional intervention on the body mass of a 36-year-old professional wheelchair athlete (silver medalist at the Paralympic Games and 106 victories in assorted road events) during a five-week altitude training camp, divided into pre-altitude at sea level (BN), acclimatization to altitude (Puno, 3860 m) (BH), specific training (W1,2,3,4) and return to sea level (Post) phases. Energy intake (kcal) and body mass (kg) were recorded daily. Results demonstrated significant decrease in body mass between BN and BH (52.6 ± 0.4 vs 50.7 ± 0.5 kg, P < 0.001) which returned to pre-altitude values, upon returning to sea level at Post (52.1 ± 0.5 kg). A greater daily intake was observed during BH (2899 ± 670 kcal) and W1,2,3 (3037 ± 490; 3116 ± 170; 3101 ± 385 kcal) compared to BN (2397 ± 242 kcal, P < 0.01) and Post (2411 ± 137 kcal, P < 0.01). No differences were reported between W4 (2786 ± 375 kcal), BN and Post. The amount of carbohydrates ingested (g · kg- 1) was greater in W1,2,3, (9.6 ± 2.1; 9.9 ± 1.2; 9.6 ± 1.2) than in BN (7.1 ± 1.2) and Post (6.3 ± 0.8, P < 0.001). Effect sizes (Cohen's d) for all variables relative to BN (all time points) exceed a large effect (d > 0.80). CONCLUSIONS: These results suggest an elite wheelchair marathoner training at 3860 m required increased nutrient requirements as well as the systematic control needed to re-adapt a nutritional program. Moreover, our findings highlight training and nutritional prescription optimization of elite wheelchair athletes, under challenging environmental conditions.

Influence of Training Load on Mood Disturbance at Sea Level and 3900 m Altitude: A Case Study of a Wheelchair Athlete.

The purpose of this case study was to investigate the influence of a training load (TL), oxygen saturation (SO2) and blood pressure (BP) on mood states in a wheelchair marathoner during (7 weeks at sea level (SL), 5 weeks at 3860 m altitude, 1 week returning to SL). TL was obtained with Foster's equation while mood states were obtained with the Profile of Mood States Questionnaire (POMS). Furthermore, SO2 and BP were assessed upon wakening. SO2 (%) decreased at altitude, compared to SL (88.31 ± 2.46 vs. 98.52 ± 0.11) and increased until the last week at altitude (92.64 ± 1.12). Systolic pressure (SP) increased at altitude compared to pre-altitude (126.0 ± 5.1 vs. 107.6 ± 4.4 mmhg), and was not different from the last week at altitude. Controlling for SO2 and SP, differences were also observed in fatigue (97.66 ± 18.92 vs. 17.39 ± 13.71) and vigor (73.23 ± 8.62 vs. 26.48 ± 11.89) as a function of altitude. Upon return to SL, fatigue, vigor, SO2 and SP returned to pre values. This case study demonstrated the POMS was sensitive to worsening patterns in fatigue and vigor at altitude through a practical survey approach combined with daily physiological assessment.