Carbohydrate Considerations for Athletes with a Spinal Cord Injury.

The Paralympic movement is growing in popularity, resulting in increased numbers of athletes with a spinal cord injury (SCI) competing in various sport disciplines. Athletes with an SCI require specialized recommendations to promote health and to maximize performance, as evidenced by their metabolic and physiological adaptations. Nutrition is a key factor for optimal performance; however, scientifically supported nutritional recommendations are limited. This review summarizes the current knowledge regarding the importance of carbohydrates (CHO) for health and performance in athletes with an SCI. Factors possibly affecting CHO needs, such as muscle atrophy, reduced energy expenditure, and secondary complications are analyzed comprehensively. Furthermore, a model calculation for CHO requirements during an endurance event is provided. Along with assessing the effectiveness of CHO supplementation in the athletic population with SCI, the evaluation of their CHO intake from the available research supplies background to current practices. Finally, future directions are identified. In conclusion, the direct transfer of CHO guidelines from able-bodied (AB) athletes to athletes with an SCI does not seem to be reasonable. Based on the critical role of CHOs in exercise performance, establishing recommendations for athletes with an SCI should be the overall objective for prospective research.

Physiology of handcycling: A current sports perspective.

Handcycling is a mode of mobility, and sport format within Para-cycling, for those with a lower limb impairment. The exercise modality has been researched extensively in the rehabilitation setting. However, there is an emerging body of evidence detailing the physiological responses to handcycling in the competitive sport domain. Competitive handcyclists utilize equipment that is vastly disparate to that used for rehabilitation or recreation. Furthermore, the transferability of findings from early handcycling research to current international athletes regarding physiological profiles is severely limited. This narrative review aims to map the landscape within handcycling research and document the growing interest at the elite end of the exercise spectrum. From 58 experimental/case studies and four doctoral theses, we provide accounts of the aerobic capacity of handcyclists and the influence training status plays; present research regarding the physiological responses to handcycling performance, including tests of sprint performance; and discuss the finite information on handcyclists' training habits and efficacy of bespoke interventions. Furthermore, given the wide variety of protocols employed and participants recruited previously, we present considerations for the interpretation of existing research and recommendations for future work, all with a focus on competitive sport. The majority of studies (n = 21) reported aerobic capacity, detailing peak rates of oxygen uptake and power output, with values >3.0 L min-1 and 240 W shown in trained, male H3-H4 classification athletes. Knowledge, though, is lacking for other classifications and female athletes. Similarly, little research is available concerning sprint performance with only one from eight studies recruiting athletes with an impairment.

Effects of wheelchair Tai Chi ball exercise on physical and mental health and functional abilities among elderly with physical disability.

The purpose of this study was to examine the effect of a 12-week Wheelchair Tai Chi Ball (WTCB) intervention, a combination of mind-body exercise with strength training, on physical and mental health and functional abilities among elderly with disability. Twenty-six elderly persons participated in the study, nine WTCB group participants and ten control group participants completed the study. The WTCB group practised WTCB12 twice/week for one hour each time. The control group did their daily routine without WTCB intervention. The outcomes measures were: Pain Self-Efficacy Questionnaire (PSEQ), SF-36v2 for physical and mental health, heart rate, blood pressure, range of motion and muscle strength of the dominant arm at the shoulder, elbow and wrist joints. The Mixed Model ANOVA was employed to examine the differences between and within the two groups using pre-test and post-test scores. The results demonstrated the WTCB group had significant improvements on PSEQ, general physical health and had positive effects on maintaining muscle strength at the shoulder, elbow and wrist joints as compared to the control group. The WTCB12 exercise had positive effects on self-efficacy for pain management, general physical health, and maintain upper extremity muscle strength and is a feasible exercise for elderly with disability.

May the best-sighted win? The relationship between visual function and performance in Para judo.

This study aimed to establish the optimal cut-off point(s) between classes in a new, evidence-based classification system for VI judo. We collected results from international VI judo competitions held between 2012 and 2018. Data on visual acuity (VA) and visual field (VF) measured during classification were obtained. Performance was determined by calculating a win ratio for each athlete. VA was significantly associated with judo performance (r = -.33, p <.001), VF was not (r =.30, p =.15). Decision tree analysis suggested to split the data into two groups with a VA cut-off of 2.5 logMAR units. Stability assessment using bootstrap sampling suggested a split into two groups, but showed considerable variability in the cut-off point between 2.0 and 3.5 logMAR. We conclude that to minimise the impact of impairment on the outcome of competition, VI judo should be split into two sport classes to separate partially sighted from functionally blind athletes. To establish an exact cut-off point and to decide if other measures of visual function need to be included, we argue for continued research efforts together with careful evaluation of research results from a multidisciplinary perspective.

Kinematic traits of an elite paralympic karateka: a case report.

Karate is a martial art that includes striking, kicking and punching techniques, and requires high levels of functional skills. Karate counts millions of practitioners worldwide and it is also spreading in Paralympic competitions: there is a need for accurate categories definition for disabled athletes. The aim of the current study was to present kinematic data of an elite Paralympic karateka, in comparison with able-bodied athletes, to promote a better classification within the discipline, based on objective evaluations of physical impairments. A male black belt Paralympic karateka (age: 36 years; body weight: 75.5 kg; height: 173 cm) with lower limbs impairments was evaluated. He performed a standardized sequence of movements (kata) from Shotokan karate. Joints and center-of-mass kinematics were collected with an optoelectronic motion capture system and compared with those obtained in two groups of able-bodied (Masters and Practitioners) athletes from a previous study. The sequence performed by the karateka lasted longer than in both able-bodied groups. Center of mass velocity and acceleration lowered in comparison with Masters. Knees range of movement and peak angular velocity were similar to Practitioners but lower than Masters. We concluded that physical impairments negatively affected the function of lower limbs in the Paralympic athlete, as fundamental skills in karate elite performance (dynamic balance control and joint angular velocity) were lower.

Effects of Inspiratory Muscle Training With Progressive Loading on Respiratory Muscle Function and Sports Performance in High-Performance Wheelchair Basketball Athletes: A Randomized Clinical Trial.

PURPOSE: To evaluate the effects of inspiratory muscle training associated with interval training on respiratory muscle strength and fatigue and aerobic physical performance (PP) in high-performance wheelchair basketball athletes. METHODS: Blinded, randomized clinical trial with 17 male wheelchair basketball players, randomized into control group (CG; n = 8) and training group (TG; n = 9). Respiratory muscle strength was evaluated by measuring maximal inspiratory and expiratory pressures (MIP and MEP), aerobic PP by the Yo-Yo test for wheelchair, and recovery of inspiratory muscle fatigue was assessed at 1, 5, 10, and 15 minutes after exercise test. TG performed inspiratory muscle training protocol with incremental loading for 12 weeks with 50%, 60%, and 70% of MIP, while CG performed with load 15% of MIP. RESULTS: After training period, CG presented a significant increase in MIP and MEP (P ≤ .05), with no change in aerobic PP (P ≥ .05). TG showed a significant increase for all variables (≤.05). MIP showed a large effect size for CG (1.00) and TG (1.35), while MEP showed a moderate effect for CG (0.61) and TG (0.73); distance covered had a moderate effect size for TG (0.70). For recovery of inspiratory muscle strength, CG did not present differences, while TG recovered in 10 minutes (≤.05), representing 87% of the pretest value. Positive and significant correlation between MIP and distance (.54; P ≤ .05) was observed. CONCLUSION: Inspiratory muscle training protocol with progressive loading was more effective for increasing aerobic PP and maximal inspiratory strength recovery.

Improvement of Sprint Performance in Wheelchair Sportsmen With Caffeine Supplementation.

PURPOSE: Caffeine can be beneficial during endurance and repeated-sprint exercise in able-bodied individuals performing leg or whole-body exercise. However, little evidence exists regarding its effects during upper-body exercise. This study therefore aimed to investigate the effects of caffeine on sprint (SPR) and 4-min maximal-push (PUSH) performance in wheelchair sportsmen. METHODS: Using a double-blind, placebo-controlled, crossover design, 12 male wheelchair rugby players (age 30.0 ± 7.7 y, body mass 69.6 ± 15.3 kg, training 11.1 ± 3.5 h/wk) completed 2 exercise trials, separated by 7-14 d, 70 min after ingestion of 4 mg/kg caffeine (CAF) or dextrose placebo (PLA). Each trial consisted of four 4-min PUSHes and 3 sets of 3 × 20-m SPRs, each separated by 4 min rest. Participants responded to the Felt Arousal (a measure of perceived arousal), Feeling (a measure of the affective dimension of pleasure/displeasure), and rating-of-perceived-exertion (RPE) scales. Salivary caffeine secretion rates were measured. RESULTS: Average SPR times were faster during CAF than PLA during SPR 1 and SPR 2 (P = .037 and .016). There was no influence of supplementation on PUSHes 2-4 (P > .099); however, participants pushed significantly farther during PUSH 1 after CAF than after PLA (mean ± SD 677 ± 107 and 653 ± 118 m, P = .047). There was no influence of CAF on arousal or RPE scores (P > .132). Feeling scores improved over the course of the CAF trial only (P = .017) but did not significantly differ between trials (P > .167). Pre-warm-up (45 min postingestion) salivary CAF secretion rates were 1.05 ± 0.94 and 0.08 ± 0.05 µg/min for CAF and PLA, respectively. CONCLUSION: Acute CAF supplementation can improve both 20-m-sprint performance and a 1-off bout of short-term endurance performance in wheelchair sportsmen.

The role of initial physical activity experiences in promoting posttraumatic growth in Paralympic athletes with an acquired disability.

PURPOSE: To explore Paralympic athletes' lived experiences of becoming physically active after disability, and the role that this may have played in the development of posttraumatic growth. METHODS: Life history interviews were conducted with 7 individuals with an acquired and traumatic disability, who were aiming to take part in the London 2012 Paralympic Games. This was also informed by observation of sport participation. Data were analysed using a holistic content analysis. RESULTS: Three main themes were identified that reflected participants' initial physical activity experiences and which were linked to posttraumatic growth. These were recognizing possibility by acknowledging limitations, responsibility for choice and consequences, and re-establishing and enhancing meaning. CONCLUSIONS: Posttraumatic growth is a process and consequently, part of this process may include experiencing both positive and negative trauma symptoms. Participation in physical activity may assist an individual in achieving posttraumatic growth by facilitating meaning making, providing an environment where risks and responsibilities can be taken, and allowing an individual to understand their limitations and future possibilities. IMPLICATIONS FOR REHABILITATION: While posttraumatic growth is often associated with positive psychological outcomes, it is important to consider that this can occur alongside the experience of negative trauma symptoms. Participation in physical activity may induce both positive and negative responses following trauma. In order to foster posttraumatic growth, physical activity should be meaningful to the activity and allow a sense of control and personal responsibility.