Para sport and anti-doping: a study of Swedish Para athletes' experiences and perceptions.

Introduction: A well-functioning anti-doping system relies on being perceived by athletes as effective, fair, and practically feasible to implement. While research has highlighted the views of Olympic athletes on anti-doping over the past decade, the experiences and perceptions of Para athletes have not been extensively explored. The purpose of this study was to examine Swedish elite Para athletes' experiences and perceptions of the policy and practice of the anti-doping system. Methods: A quantitative cross-sectional approach was used, with a web survey elaborated from a survey with Olympic athletes adjusted for Para athletes with physical, visual, and intellectual impairments. The sample consisted of 66 active Para athletes competing at national or international level (response rate 71%). Data were analyzed using descriptive statistics and differences between subgroups were examined Fisher's exact test. Thematic analysis was employed to analyze open-ended questions. Results: Most of the respondents expressed a positive outlook on the anti-doping system, advocating for comprehensive efforts. A significant portion (35%) had not received anti-doping education, with those who did reporting increased confidence in avoiding unintentional doping. Despite their elite status, half of the respondents had not undergone doping control. Mistrust regarding the system's effectiveness and fairness was identified, with over half of the participants emphasizing the need for new technical solutions to enhance procedures specifically tailored for Para athletes. Discussion: The athletes in this study advocate for a Para sports-focused approach in the anti-doping system, emphasizing equal testing opportunities, procedural adjustments for independence and privacy, and increased access to education. The findings illuminate the unique conditions faced by athletes with impairments within the anti-doping system, offering valuable insights for policymaking in the development of anti-doping strategies tailored to Para athletes and their various impairments.

Isometric, Dynamic, and Manual Muscle Strength Measures and Their Association With Cycling Performance in Elite Paracyclists.

OBJECTIVE: Paracycling classification aims to generate fair competition by discriminating between levels of activity limitation. This study investigated the relationship between lower limb manual muscle tests (MMT) with ratio-scaled measures of isometric and dynamic strength and of the ratio-scaled measures with cycling performance. DESIGN: Fifty-six para cyclists (44 males, 12 females) with leg impairments performed isometric and dynamic strength tests: leg push and pull, and an all-out 20-sec sprint. The MMT results were obtained from the classification database ( n = 21) and race speeds from time trials ( n = 54). RESULTS: Regression analyses showed significant associations of MMT with isometric push ( R2 = 0.49), dynamic push ( R2 = 0.35), and dynamic pull ( R2 = 0.28). Isometric strength was significantly correlated with dynamic push (ρ = 0.63) and pull (ρ = 0.54). The isometric and dynamic tests were significantly associated with sprint power and race speed ( R2 = 0.16-0.50). CONCLUSIONS: The modified MMT and ratio-scaled measures were significantly associated. The significant relation of isometric and dynamic strength with sprint power and race speed maps the impact of lower limb impairments on paracycling performance. The MMT and the isometric and dynamic measures show potential for use in paracycling classification.

Kinematic and kinetic performance variables during paddling among para-kayak athletes with unilateral above or below knee amputation.

In para-kayak, athletes with unilateral above knee amputation (AK) and athletes with below knee amputation (BK) compete in the same class. This has been questioned since previous research have shown that the legs are important for paddling performance. The purpose was therefore to examine differences in kinematic and kinetic performance variables between AK and BK para-kayak athletes and the amputated (A) and non-amputated (NA) sides. Eleven AK and six BK athletes on international level participated. 3D kinematic and kinetic data were collected for the body, seat, footrest and paddle during kayak ergometer paddling. There were no significant differences between the groups in main performance variables such as power output or paddle force. Differences between the groups were only seen in the hip joint in flexion range of motion, flexion and extension angular velocity and flexion moment where BK demonstrated larger values. The NA side demonstrated greater values compared to the A side in posterior force at the seat and in hip flexion moment. As there were no significant differences between the groups in the majority of the examined key performance variables, the results suggest that athletes with unilateral AK and BK amputation may be able to compete in the same class.

The relation between sprint power and road time trial performance in elite para-cyclists.

OBJECTIVES: Whilst cycling performance has been studied extensively, very little is known about the performance of para-cyclists. This study assessed the relation between sprint power and road time trial performance in elite para-cyclists, and whether this relation differed based on impairment type and type of bike used. DESIGN: Cross-sectional. METHODS: During international para-cycling events, 168 athletes (88 bicycles, 17 tricycles, 56 recumbent handbikes and 7 kneeling handbikes) performed 20-s sport-specific sprint tests (mean power output (POmean) W), and their road time trial performance (average speed (km/h)) was taken from the official results. Multilevel regression models to assess the relation of sprint with time trial performance were composed for i. leg-cyclists: bicycle and tricycle and ii. arm-cyclists: recumbent- and kneeling handbike, adjusted for identified confounders. Furthermore, impairment type (categorized as i) muscle power/range of motion, ii) limb deficiency/leg length difference, and iii) coordination) and bike type were tested as effect modifiers. RESULTS: POmean ranged from 303 ±â€¯12 W for recumbent handcyclists to 482 ±â€¯156 W for bicyclists. POmean was significantly related to time trial performance, for both leg-cyclists (ß = 0.010, SE = 0.003, p < 0.01) and arm-cyclists (ß = 0.029; SE = 0.005, p < 0.01), and impairment type and bike type were not found to be effect modifiers. CONCLUSIONS: Sprint power was related to road time trial performance in all para-cyclists, with no differences found in this relation based on impairment type nor bike type. For those competing on a bicycle, tricycle, recumbent- or kneeling handbike, sprint tests might therefore be useful to predict or monitor time trial performance.

Abdominal Muscle Activation During Common Modifications of the Trunk Curl-up Exercise.

ABSTRACT: Crommert, ME, Bjerkefors, A, Tarassova, O, and Ekblom, MM. Abdominal muscle activation during common modifications of the trunk curl-up exercise. J Strength Cond Res 35(2): 428-435, 2021-The purpose of this study was to investigate effects of common modifications of trunk curl-up exercise on the involvement of the abdominal muscles, particularly the deepest muscle layer, transversus abdominis (TrA). Ten healthy females performed 5 different variations of the trunk curl-up at a standardized speed, varying the exercise by assuming 3 different arm positions and applying left and right twist. Indwelling fine-wire electromyography (EMG) electrodes were used to record from TrA, obliquus internus (OI), obliquus externus (OE), and rectus abdominis (RA) unilaterally on the right side. Increasing the load by changing the arm position during a straight trunk curl-up increased the EMG of all abdominal muscles. Obliquus internus and TrA showed higher activation during right twist compared with left twist, whereas OE displayed the opposite pattern. Rectus abdominis did not show any change in activation level between twisting directions. The apparent load dependency on the activation level of all muscles, and the twisting direction dependency of all muscles except RA, are in keeping with the fiber orientation of the muscles. Notably, also TrA, with a less obvious mechanical role with regards to fiber orientation, increased activation with load during the straight trunk curl-up. However, the highest activation level of TrA during the trunk curl-up was only 40% of a maximum contraction; thus, it might not be the most suitable strength training exercise for this muscle.

Para-cycling race performance in different sport classes.

PURPOSE: The para-cycling classification system, consisting of five classes (C1-C5) for bicycling (C5 athletes having least impairments), is mostly based on expert-opinion rather than scientific evidence. The aim of this study was to determine the differences in race performance between para-cycling classes. METHODS: From official results of the men's 1 km time trials for classes C1-C5 of seven Union Cycliste Internationale World Championships and Paralympics, median race speed of the five fastest athletes in each class was calculated (n = 175). Para-cycling results were expressed as a percentage of able-bodied performance using race results from the same years (n = 35). To assess differences between consecutive classes, Kruskal-Wallis tests with Mann-Whitney U post hoc tests were performed, correcting for multiple testing (p < 0.013). RESULTS: Para-cyclists in C1 reached 75% (median ± interquartile range = 44.8 ± 4.2 km/h) and in C5 90% (53.5 ± 2.9 km/h) of able-bodied race speed (59.4 ± 0.9 km/h). Median race speed between consecutive classes was significantly different (χ2 = 142.6, p < 0.01), except for C4 (52.1 ± 2.8 km/h) and C5 (U = 447.0, p = 0.05). CONCLUSION: Current para-cycling classification does not clearly differentiate between classes with least impairments. IMPLICATIONS FOR REHABILITATIONThe current classification system is not evidence-based and does not clearly differentiate between relevant groups of para-cyclists.An evidence-based para-cycling classification system is essential for a fair and equitable competition.Fair competition will make it more interesting and increase participation.Para-cycling can inspire everyone with and even those without disabilities to be physically active.

Interrater Reliability of the New Sport-Specific Evidence-Based Classification System for Para Va'a.

The purpose of this study was to examine the interrater reliability of a new evidence-based classification system for Para Va'a. Twelve Para Va'a athletes were classified by three classifier teams each consisting of a medical and a technical classifier. Interrater reliability was assessed by calculating intraclass correlation for the overall class allocation and total scores of trunk, leg, and on-water test batteries and by calculating Fleiss's kappa and percentage of total agreement in the individual tests of each test battery. All classifier teams agreed with the overall class allocation of all athletes, and all three test batteries exhibited excellent interrater reliability. At a test level, agreement between classifiers was almost perfect in 14 tests, substantial in four tests, moderate in four tests, and fair in one test. The results suggest that a Para Va'a athlete can expect to be allocated to the same class regardless of which classifier team conducts the classification.

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.

Three-Dimensional Kinematics and Power Output in Elite Para-Kayakers and Elite Able-Bodied Flat-Water Kayakers.

Trunk, pelvis, and leg movements are important for performance in sprint kayaking. Para-kayaking is a new Paralympic sport in which athletes with trunk and/or leg impairment compete in 3 classification groups. The purpose of this study was to identify how physical impairments impact on performance by examining: differences in 3-dimensional joint range of motion (RM) between 10 (4 females and 6 males) elite able-bodied kayakers and 41 (13 females and 28 males) elite para-kayakers from the 3 classification groups, and which joint angles were correlated with power output during high-intensity kayak ergometer paddling. There were significant differences in RM between the able-bodied kayakers and the 3 para-kayak groups for the shoulders (flexion, rotation: able-bodied kayakers < para-kayakers); trunk and pelvis (rotation: able-bodied kayakers > para-kayakers); and legs (hip, knee, and ankle flexion: able-bodied kayakers > para-kayakers) during paddling. Furthermore, athletes with greater impairment exhibited lower trunk and leg RM compared with those with less impairment. Significant positive correlations were observed for both males and females between power output and peak shoulder and trunk flexion; trunk and pelvis rotation RM; and hip, knee, and ankle flexion RM. This information is important for understanding how key kinematic and kinetic variables for para-kayaking performance vary between athletes from different classification groups.

Three-dimensional kinematic analysis and power output of elite flat-water kayakers.

The purpose was to examine power output and three-dimensional (3D) kinematic variables in the upper limbs, lower limbs and trunk in elite flat-water kayakers during kayak ergometer paddling. An additional purpose was to analyse possible changes in kinematics with increased intensity and differences between body sides. Six male and four female international level flat-water kayakers participated. Kinematic and kinetic data were collected during three tasks; low (IntL), high (IntH) and maximal (IntM) intensities. No differences were observed in any joint angles between body sides, except for shoulder abduction. Significantly greater range of motion (RoM) values were observed for IntH compared to IntL and for IntM compared to IntL in trunk and pelvis rotation, and in hip, knee and ankle flexion. The mean maximal power output was 610 ± 65 and 359 ± 33 W for the male and female athletes, respectively. The stroke frequencies were significantly different between all intensities (IntL 59.3 ± 6.3; IntH 108.0 ± 6.8; IntM 141.7 ± 18.4 strokes/min). The results showed that after a certain intensity level, the power output must be increased by other factors than increasing the joint angular RoM. This information may assist coaches and athletes to understand the relationship between the movement of the kayaker and the paddling power output.

Cortical and vestibular stimulation reveal preserved descending motor pathways in individuals with motor-complete spinal cord injury.

OBJECTIVE: To use a combination of electrophysiological techniques to determine the extent of preserved muscle activity below the clinically-defined level of motor-complete spinal cord injury. METHODS: Transcranial magnetic stimulation and vestibular-evoked myogenic potentials were used to investigate whether there was any preserved muscle activity in trunk, hip and leg muscles of 16 individuals with motor-complete spinal cord injury (C4-T12) and 16 able-bodied matched controls. RESULTS: Most individuals (14/16) with motor-complete spinal cord injury were found to have transcranial magnetic stimulation evoked, and/or voluntary evoked muscle activity in muscles innervated below the clinically classified lesion level. In most cases voluntary muscle activation was accompanied by a present transcranial magnetic stimulation response. Furthermore, motor-evoked potentials to transcranial magnetic stimulation could be observed in muscles that could not be voluntarily activated. Vestibular-evoked myogenic potentials responses were also observed in a small number of subjects, indicating the potential preservation of other descending pathways. CONCLUSION: These results highlight the importance of using multiple electrophysiological techniques to assist in determining the potential preservation of muscle activity below the clinically-defined level of injury in individuals with a motor-complete spinal cord injury. These techniques may provide clinicians with more accurate information about the state of various motor pathways, and could offer a method to more accurately target rehabilitation.

Assessment of abdominal muscle function in individuals with motor-complete spinal cord injury above T6 in response to transcranial magnetic stimulation.

OBJECTIVE: To use transcranial magnetic stimulation and electromyography to assess the potential for preserved function in the abdominal muscles in individuals classified with motor-complete spinal cord injury above T6. SUBJECTS: Five individuals with spinal cord injury (C5-T3) and 5 able-bodied individuals. METHODS: Transcranial magnetic stimulation was delivered over the abdominal region of primary motor cortex during resting and sub-maximal (or attempted) contractions. Surface electromyography was used to record motor-evoked potentials as well as maximal voluntary (or attempted) contractions in the abdominal muscles and the diaphragm. RESULTS: Responses to transcranial magnetic stimulation in the abdominal muscles occurred in all spinal cord injury subjects. Latencies of muscle response onsets were similar in both groups; however, peak-to-peak amplitudes were smaller in the spinal cord injury group. During maximal voluntary (or attempted) contractions all spinal cord injury subjects were able to elicit electromyography activity above resting levels in more than one abdominal muscle across tasks. CONCLUSION: Individuals with motor-complete spinal cord injury above T6 were able to activate abdominal muscles in response to transcranial magnetic stimulation and during maximal voluntary (or attempted) contractions. The activation was induced directly through corticospinal pathways, and not indirectly by stretch reflex activations of the diaphragm. Transcranial magnetic stimulation and electromyography measurements provide a useful method to assess motor preservation of abdominal muscles in persons with spinal cord injury.

Effects of seated double-poling ergometer training on aerobic and mechanical power in individuals with spinal cord injury.

OBJECTIVE: To determine whether regular interval training on a seated double-poling ergometer can increase physical capacity and safely improve performance towards maximal level in individuals with spinal cord injury. METHODS: A total of 13 subjects with spinal cord injury (injury levels T5-L1) performed 30 sessions of seated double-poling ergometer training over a period of 10 weeks. Sub-maximal and maximal double-poling ergometer tests were performed before (test-retest) and after this training period. Oxygen uptake was measured using the Douglas Bag system. Three-dimensional kinematics were recorded using an optoelectronic system and piezoelectric force sensors were used to register force in both poles. RESULTS: The mean intra-class correlation coefficient for test-retest values was 0.83 (standard deviation 0.11). After training significant improvements were observed in people with spinal cord injury in oxygen uptake (22.7%), ventilation (20.7%) and blood lactate level (22.0%) during maximal exertion exercises. Mean power per stroke and peak pole force increased by 15.4% and 23.7%, respectively. At sub-maximal level, significantly lower values were observed in ventilation (-12.8%) and blood lactate level (-25.0%). CONCLUSION: Regular interval training on the seated double-poling ergometer was effective for individuals with spinal cord injury below T5 level in terms of improving aerobic capacity and upper-body power output. The training was safe and did not cause any overload symptoms.

Deep and superficial abdominal muscle activation during trunk stabilization exercises with and without instruction to hollow.

The deepest muscle of the human ventro-lateral abdominal wall, the Transversus Abdominis (TrA), has been ascribed a specific role in spine stabilization, which has motivated special core stability exercises and hollowing instruction to specifically involve this muscle. The purpose here was to evaluate the levels of activation of the TrA and the superficial Rectus Abdominis (RA) muscles during five common stabilization exercises performed in supine, bridging and four-point kneeling positions, with and without instruction to hollow, i.e. to continuously pull the lower part of the abdomen towards the spine. Nine habitually active women participated and muscle activity was recorded bilaterally from TrA and RA with intramuscular fine-wire electrodes introduced under the guidance of ultrasound. Results showed that subjects were able to selectively increase the activation of the TrA, isolated from the RA, with the specific instruction to hollow and that side differences in the amplitude of TrA activity, related to the asymmetry of the exercises, remained even after the instruction to hollow. The exercises investigated caused levels of TrA activation from 4 to 43% of that during maximal effort and can thus be used clinically to grade the load on the TrA when designing programs aiming at training that muscle.

Trunk muscle activation in a person with clinically complete thoracic spinal cord injury.

OBJECTIVE: The aim of this study was to assess if, and how, upper body muscles are activated in a person with high thoracic spinal cord injury, clinically classified as complete, during maximal voluntary contractions and in response to balance perturbations. METHODS: Data from one person with spinal cord injury (T3 level) and one able-bodied person were recorded with electromyography from 4 abdominal muscles using indwelling fine-wire electrodes and from erector spinae and 3 upper trunk muscles with surface electrodes. Balance perturbations were carried out as forward or backward support surface translations. RESULTS: The person with spinal cord injury was able to activate all trunk muscles, even those below the injury level, both in voluntary efforts and in reaction to balance perturbations. Trunk movements were qualitatively similar in both participants, but the pattern and timing of muscle responses differed: upper trunk muscle involvement and occurrence of co-activation of ventral and dorsal muscles were more frequent in the person with spinal cord injury. CONCLUSION: These findings prompt further investigation into trunk muscle function in paraplegics, and highlight the importance of including motor tests for trunk muscles in persons with thoracic spinal cord injury, in relation to injury classification, prognosis and rehabilitation.

Shoulder muscle strength in paraplegics before and after kayak ergometer training.

The purpose was to investigate if shoulder muscle strength in post-rehabilitated persons with spinal cord injury (SCI) was affected by kayak ergometer training and to compare shoulder strength in persons with SCI and able-bodied persons. Ten persons with SCI (7 males and 3 females, injury levels T3-T12) performed 60 min kayak ergometer training three times a week for 10 weeks with progressively increased intensity. Maximal voluntary concentric contractions were performed during six shoulder movements: flexion and extension (range of motion 65 degrees ), abduction and adduction (65 degrees ), and external and internal rotation (60 degrees ), with an angular velocity of 30 degrees s(-1). Position specific strength was assessed at three shoulder angles (at the beginning, middle and end of the range of motion) in the respective movements. Test-retests were performed for all measurements before the training and the mean intraclass correlation coefficient was 0.941 (95% CI 0.928-0.954). There was a main effect of kayak ergometer training with increased shoulder muscle strength after training in persons with SCI. The improvements were independent of shoulder movement, and occurred in the beginning and middle positions. A tendency towards lower shoulder muscle strength was observed in the SCI group compared to a matched reference group of able-bodied persons. Thus, it appears that post-rehabilitated persons with SCI have not managed to fully regain/maintain their shoulder muscle strength on a similar level as that of able-bodied persons, and are able to improve their shoulder muscle strength after a period of kayak ergometer training.

Sitting balance and effects of kayak training in paraplegics.

OBJECTIVES: The objectives of this study were to evaluate biomechanical variables related to balance control in sitting, and the effects of kayak training, in individuals with spinal cord injury. SUBJECTS: Twelve individuals with spinal cord injury were investigated before and after an 8-week training period in open sea kayaking, and 12 able-bodied subjects, who did not train, served as controls. METHODS: Standard deviation and mean velocity of centre of pressure displacement, and median frequency of centre of pressure acceleration were measured in quiet sitting in a special chair mounted on a force plate. RESULTS: All variables differed between the group with spinal cord injury, before training, and the controls; standard deviation being higher and mean velocity and median frequency lower in individuals with spinal cord injury. A significant training effect was seen only as a lowering of median frequency. CONCLUSION: The results indicate that individuals with spinal cord injury may have acquired and consolidated an alternative strategy for balance control in quiet sitting allowing for only limited further adaptation even with such a vigorous training stimulus as kayaking.