The effects on self-efficacy, motivation and perceived barriers of an intervention targeting physical activity and sedentary behaviours in office workers: a cluster randomized control trial.

BACKGROUND: The importance of physical activity on health is clear, but changing behaviour is difficult. Successful interventions aiming to improve physical activity and reduce sedentary behaviour is therefore of importance. The aim of this study was to evaluate effects on motivation, self-efficacy and barriers to change behaviour from two different behavioural intervention focusing either on reducing sedentary behaviour or on increasing physical activity as compared to a waiting list control group. METHODS: The study was designed as a cluster randomized control trial (RCT) within two private companies. Self-efficacy, motivation and perceived barriers were together with demographic variables assessed before and after a 6-month intervention. Participant cluster teams were randomly allocated to either the physical activity intervention (iPA), the sedentary behaviour intervention (iSED), or control group. The intervention was multi componential and included motivational counselling based on Cognitive behaviour therapy and Motivational interviewing, group activities and management involvement. Group differences were determined using Bayesian multilevel modelling (parameter estimate; credible interval (CI)), analysing complete cases and those who adhered to the protocol by adhering to at least 3 out of 5 intervention sessions. RESULTS: After the intervention, the complete cases analysis showed that the iPA group had significantly higher autonomous motivation (0.33, CI: 0.05-0.61) and controlled motivation (0.27, CI: 0.04-0.51) for physical activity compared with the control group. The iSED group scored less autonomous and controlled motivation compared to the iPA group (0.38, CI: - 0.69- -0.087 respectively - 0.32, CI: - 0.57-0.07) but no significant differences compared with the control group. Among individuals that adhered to the protocol, the results showed higher scores on Exercise (3.03, CI: 0.28-6.02) and Sedentary self-efficacy (3.59, CI: 0.35-7.15) for individuals in the iPA group and on Sedentary self-efficacy (4.77, CI: 0.59-9.44) for the iSED group compared to the control group. CONCLUSION: These findings indicate that the interventions were successful in increasing self-efficacy in each intervention group and autonomous motivation for exercise in the iPA group, in particular when actively participating in the motivational counselling sessions.

A Role for Trunk Function in Elite Recumbent Handcycling Performance?

Handcycling classification considers trunk function, but there is limited scientific evidence of trunk involvement in recumbent performance. This study investigated the association between trunk function and recumbent handcycling performance of athletes without upper-limb impairments (H3-H4 sport classes). The study was divided into two parts. First, 528 time-trial results from 81 handcyclists with spinal cord injury (SCI) were obtained between 2014 and 2020. Average time-trial velocity was used as performance measure and SCI level as trunk function determinant. Multilevel regression analysis was performed to analyse differences in performance among SCI groups while correcting for lesion completeness, sex, and age. Second, in 26 handcyclists, standardised trunk flexion strength was measured with a handheld dynamometer. Peak and mean power-output from a sprint test and time-trial average velocity were used as performance measures. Spearman correlations were conducted to investigate the association between trunk strength and performance. Results showed that the different SCI groups did not exhibit significant differences in performance. Furthermore, trunk flexion strength and performance exhibited non-significant weak to moderate correlations (for time-trial speed: rs = 0.36; p = 0.07). Results of both analyses suggest that trunk flexion strength does not seem to significantly impact recumbent handcycling performance in athletes without upper-limb impairments.

The effectiveness of multi-component interventions targeting physical activity or sedentary behaviour amongst office workers: a three-arm cluster randomised controlled trial.

BACKGROUND: Interventions to increase physical activity or reduce sedentary behaviour within the workplace setting have shown mixed effects. This cluster randomised controlled trial assessed whether multi-component interventions, focusing on changes at the individual, environmental, and organisational levels, either increased physical activity or reduced sedentary behaviour, compared to a passive control group. METHODS: Teams of office-workers from two companies participated in one of two interventions (iPA: targeting physical activity; or iSED: targeting sedentary behaviour), or wait-list control group (C). Exclusion criterion was very high physical activity level (MVPA ≥30 min/day in ≥10 min bouts every day). Randomisation occurred at the level of workplace cluster, and groups were randomly allocated (1:1) with stratification for company and cluster size. Personnel involved in data collection and processing were blinded to group allocation. Both interventions included five sessions of cognitive behavioural therapy counselling for 6 months. iPA included counselling focused on physical activity, access to a gym, and encouragement to exercise, and go for lunch walks. iSED included counselling on sedentary behaviour and encouragement to reduce sitting and increase engagement in standing- and walking-meetings. At baseline and the 6-month mark accelerometers were worn on the hip and thigh for 7 days. The primary outcomes were group differences in time spent in moderate-to-vigorous intensity physical activity (%MVPA) and in sedentary behaviour (%), analysed using Bayesian multilevel modelling for those with complete data. RESULTS: Two-hundred and sixty three office workers (73% women, mean age 42 ± 9 years, education 15 ± 2 years) were randomised into 23 cluster teams (iPA n = 84, 8 clusters; iSED n = 87, 7 clusters; C n = 92, 7 clusters). No significant group differences (posterior mean ratios: 95% credible interval) were found after the intervention for %MVPA or for %Sedentary. %MVPA: iPA vs C (0·04: - 0·80-0·82); iSED vs C (0·47: - 0·41-1·32); iPA vs iSED (0·43: - 0·42-1·27). %Sedentary: iPA vs C (1·16: - 1·66-4·02); iSED vs C (- 0·44: - 3·50-2·64); iPA vs iSED (- 1·60: - 4·72-1·47). CONCLUSIONS: The multi-component interventions focusing on either physical activity or sedentary behaviour were unsuccessful at increasing device-measured physical activity or reducing sedentary behaviour compared to a control group. TRIAL REGISTRATION: ISRCTN, ISRCTN92968402 . Registered 27/2/2018, recruitment started 15/03/2018.

Do Handcycling Time-Trial Velocities Achieved by Para-Cycling Athletes Vary Across Handcycling Classes?

The classification system for handcycling groups athletes into five hierarchical classes, based on how much their impairment affects performance. Athletes in class H5, with the least impairments, compete in a kneeling position, while athletes in classes H1 to H4 compete in a recumbent position. This study investigated the average time-trial velocity of athletes in different classes. A total of 1,807 results from 353 athletes who competed at 20 international competitions (2014-2018) were analyzed. Multilevel regression was performed to analyze differences in average velocities between adjacent pairs of classes, while correcting for gender, age, and event distance. The average velocity of adjacent classes was significantly different (p < .01), with higher classes being faster, except for H4 and H5. However, the effect size of the differences between H3 and H4 was smaller (d = 0.12). Hence, results indicated a need for research in evaluating and developing evidence-based classification in handcycling, yielding a class structure with meaningful performance differences between adjacent classes.

Improving office workers' mental health and cognition: a 3-arm cluster randomized controlled trial targeting physical activity and sedentary behavior in multi-component interventions.

BACKGROUND: Physically inactive and sedentary lifestyles are negatively related to both mental health and cognition. For office-workers, who spend two-thirds of their workday sitting, it is important to improve these lifestyles. The aim of this study is to assess the effectiveness of multi-component interventions, incorporating individual, environmental and organizational changes, to increase physical activity or reduce sedentary behavior among office-workers in order to improve mental health and cognition. METHODS: a 3-arm, clustered randomized controlled trial (RCT) with waiting list control group amongst adult office-workers of two large Swedish companies. Cluster teams will be randomized into 6-month interventions or to a passive waiting list control group which will receive the allocated intervention with a 6-month delay. Two multicomponent interventions will be studied of which one focuses on improving physical activity and the other on reducing sedentary behavior. Both interventions include 5 sessions of motivational counselling. In the physical activity intervention persons also get access to a gym and team leaders will organize lunch walks and encourage to exercise. In the sedentary behavior intervention standing- and walking meetings will be implemented and team leaders will encourage to reduce sitting. The recruitment target is 110 office-workers per arm (330 in total). Measurements will be repeated every 6 months for a total intended duration of 24 months. Proximal main outcomes are physical activity measured with accelerometers and sedentary behavior with inclinometers. Distal outcomes are self-reported mental health and a cognition test battery. Additional outcomes will include cardiovascular fitness, body composition, sleep, self-reported physical activity and sedentary behavior, other health habits, physical health, and working mechanisms from blood samples and questionnaires. DISCUSSION: This cluster RCT will contribute to the currently available evidence by comparing the effectiveness of multi-component interventions targeting physical activity or sedentary behavior with the end goal of improving mental health and cognition. This study is strong in its cluster randomized design, numerous objective outcome measures and long-term follow-up. The exact content of the interventions has been defined by combining theory with results from a larger research project as well as having a continuous dialogue with the involved companies. TRIAL REGISTRATION: ISRCTN92968402 .

Physical activity in wheelchair-using youth with spina bifida: an observational study.

BACKGROUND: Even though typically developing youth are already at risk for physical inactivity, youth with spina bifida may be even at higher risk as a consequence of their reduced mobility. No objective data is available for youth with spina bifida who use a manual wheelchair, so the seriousness of the problem is unknown. The purpose of this observational study was to quantify physical activity in wheelchair-using youth with spina bifida and evaluate the intensity of activities. METHODS: Fifty-three children and adolescents (5-19 years) with spina bifida who use a manual wheelchair for daily life, long distances or sports were included. To assess time spent in several types of activities VitaMove data of 34 participants were used and were presented as time spent sedentary and time spent physically active. This was compared to reference data of typically developing youth. To assess time spent in several intensities Actiheart data of 36 participants were used. The intensities were categorized according to the American College of Sports Medicine, ranging from very light intensity to near to maximal intensity. Data of 25 participants were used to combine type of activity and intensity. RESULTS: Children and adolescents with spina bifida who use a manual wheelchair were more sedentary (94.3% versus 78.0% per 24 h, p < 0.000) and less physically active (5.0% versus 12.2% per 24 h, p < 0.000) compared to typically developing peers. Physical activity during weekend days was worse compared to school days; 19% met the Guidelines of Physical Activity during school days and 8% during weekend days. The intensities per activity varied extensively between participants. CONCLUSIONS: Children and adolescents with spina bifida who use a manual wheelchair are less physically active and more sedentary than typically developing youth. The physical activity levels on school days seem to be more favorable than the physical activity levels on a weekend day. The low levels of physical activity need our attention in pediatric rehabilitation practice. The different intensities during activities indicate the importance of individually tailored assessments and interventions.

Are changes in occupational physical activity level compensated by changes in exercise behavior?

Background: Physically active occupations with high-energy expenditure may lead to lower motivation to exercise during leisure time, while the reverse can be hypothesized for sedentary occupations. The aim of this study was to investigate the impact of changing occupational activity level on exercise behavior. Methods: Data on occupational physical activity and leisure time exercise were taken from a population-based cohort, with surveys completed in 2010 and 2014. Using data on those employed in both years, two trajectories were analyzed: (i) participants who changed from sedentary to active occupations and (ii) participants who changed from active to sedentary occupations. Exercise was reported in hours per week and changes from 2010 to 2014 were categorized as decreased, increased or stable. Associations were expressed as ORs and 95% CIs adjusting for age, gender and education. Results: Data were available for 12 969 participants (57% women, aged 45 ± 9 years, 57% highly educated). Relative to participants whose occupational activity was stable, participants who changed to active occupations (n = 549) were more likely to decrease exercise (OR = 1.22, 95% CI = 1.02-1.47) and those who changed to sedentary occupations (n = 373) more likely to increase exercise levels (OR = 1.21, 95% CI = 0.97-1.52). Conclusion: People changing from sedentary to active occupations compensate by exercising less, and those changing from physically active to sedentary occupations seem to compensate by exercising more in their leisure time. When developing and evaluating interventions to reduce occupational sedentary behavior or to promote exercise, mutual influences on physical activity of different contexts should be considered.

Do unfavourable alcohol, smoking, nutrition and physical activity predict sustained leisure time sedentary behaviour? A population-based cohort study.

Comparing lifestyle of people remaining sedentary during longer periods of their life with those favourably changing their behaviour can provide cues to optimize interventions targeting sedentary behaviour. The objective of this study was to determine lifestyle predictors of sustained leisure time sedentary behaviour and assess whether these predictors were dependent on gender, age, socioeconomic position and occupational sedentary behaviour. Data from a large longitudinal population-based cohort of adults (aged 18-97years) in Stockholm responding to public health surveys in 2010 and 2014 were analysed (n=49,133). Leisure time sedentary behaviour was defined as >3h per day of leisure sitting time e.g. watching TV, reading or using tablet. Individuals classified as sedentary at baseline (n=9562) were subsequently categorized as remaining sedentary (n=6357) or reduced sedentary behaviour (n=3205) at follow-up. Lifestyle predictors were unfavourable alcohol consumption, smoking, nutrition, and physical activity. Odds ratios (OR) and corresponding 95% Confidence Intervals (CI) were calculated, adjusting for potential confounders. Unfavourable alcohol consumption (OR=1.22, CI:1.11-1.34), unfavourable candy- or cake consumption (OR=1.15, CI:1.05-1.25), and unfavourable physical activity in different contexts were found to predict sustained sedentary behaviour, with negligible differences according to gender, age, socioeconomic position and occupational sedentary behaviour. People with unfavourable lifestyle profiles regarding alcohol, sweets, or physical activity are more likely to remain sedentary compared to sedentary persons with healthier lifestyle. The impact of combining interventions to reduce leisure time sedentary behaviour with reducing alcohol drinking, sweet consumption and increasing physical activity should be tested as a promising strategy for behavioural modification.

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.

Feasibility of Handcycle Training During Inpatient Rehabilitation in Persons With Spinal Cord Injury.

OBJECTIVE: To assess the feasibility of a handcycle training program during inpatient rehabilitation and the changes in physical capacity in persons with subacute spinal cord injury (SCI). DESIGN: Before-after trial. SETTING: Rehabilitation centers. PARTICIPANTS: Persons with subacute SCI in regular rehabilitation (N=45). INTERVENTIONS: A structured handcycle interval training program during the last 8 weeks of inpatient rehabilitation. Training was scheduled 3 times per week (24 sessions total), with an intended frequency of ≥2 times per week. Intended intensity was a Borg score of 4 to 7 on a 10-point scale. MAIN OUTCOME MEASURES: Feasibility was assessed, and participant satisfaction was evaluated (n=30). A maximal handcycling test was performed 8 weeks prior to discharge and at discharge to determine peak power output and peak oxygen uptake (VO2peak) (n=23). RESULTS: Of the participants, 91% completed the handcycle training, and no adverse events were reported. Mean training frequency was 1.8±0.5 times per week, and mean Borg score was 6.2±1.4. Persons with complete lesions demonstrated lower training feasibility. Most participants were satisfied with the handcycle training. Peak power output and VO2peak improved significantly after the training period (P<.01) by 36.4% and 9.6%, respectively. CONCLUSIONS: Overall, handcycle training during inpatient rehabilitation in persons with SCI was feasible except for the training frequency. Persons with complete lesions likely need extra attention to benefit optimally from handcycling training. Because the improvements in physical capacity were larger than those known to occur in persons with paraplegia receiving regular rehabilitation, the results suggest that the addition of handcycle training may result in larger increases in physical capacity compared with regular rehabilitation only.

Validation of an activity monitor for children who are partly or completely wheelchair-dependent.

BACKGROUND: Children who are wheelchair-dependent are at risk for developing unfavorable physical behavior; therefore, assessment, monitoring and efforts to improve physical behavior should start early in life. VitaMove is an accelerometer-based activity monitor and can be used to detect and distinguish different categories of physical behavior, including activities performed in a wheelchair and activities using the legs. The purpose of this study was to assess the validity of the VitaMove activity monitor to quantify physical behavior in children who are partly or completely wheelchair-dependent. METHODS: Twelve children with spina bifida (SB) or cerebral palsy (CP) (mean age, 14 ± 4 years) performed a series of wheelchair activities (wheelchair protocol) and, if possible, activities using their legs (n = 5, leg protocol). Activities were performed at their own home or school. In children who were completely wheelchair-dependent, VitaMove monitoring consisted of one accelerometer-based recorder attached to the sternum and one to each wrist. For children who were partly ambulatory, an additional recorder was attached to each thigh. Using video-recordings as a reference, primary the total duration of active behavior, including wheeled activity and leg activity, and secondary agreement, sensitivity and specificity scores were determined. RESULTS: Detection of active behaviour with the VitaMove activity monitor showed absolute percentage errors of 6% for the wheelchair protocol and 10% for the leg protocol. For the wheelchair protocol, the mean agreement was 84%, sensitivity was 80% and specificity was 85%. For the leg protocol, the mean agreement was 83%, sensitivity was 78% and specificity was 90%. Validity scores were lower in severely affected children with CP. CONCLUSIONS: The VitaMove activity monitor is a valid device to quantify physical behavior in children who are partly or completely wheelchair-dependent, except for severely affected children and for bicycling.

Exercise self-efficacy and the relation with physical behavior and physical capacity in wheelchair-dependent persons with subacute spinal cord injury.

BACKGROUND: Since physical activity and exercise levels are known to be generally low in persons with spinal cord injury (SCI), there seems to be a need for intervention. Exercise self-efficacy (ESE), the confidence persons have in their ability to be physically active and exercise, is an important and modifiable predictor of physical behavior. The goal of this study was to 1) describe ESE in persons with subacute SCI, 2) to assess ESE in subgroups based on demographic and lesion characteristics, and 3) to explore the relation between ESE and physical behavior and physical capacity. METHODS: Thirthy-seven persons with subacute SCI who are wheelchair dependent participated. Participants completed the Exercise Self-Efficacy Scale. We recorded age and lesion characteristics, measured physical behavior (physical activity, motility and sedentary day time, n = 35) with an accelerometer-based activity monitor and measured physical capacity (peak power output, n = 28 and peak oxygen uptake, n = 24) during a maximal hand-cycling test. Measurements were performed 2 months prior to discharge from inpatient rehabilitation. Mann-Whitney tests were used to test for differences between subgroups based on age and lesion characteristics and spearman correlations were used to assess the relation between ESE and physical activity and physical capacity. RESULTS: Persons with tetraplegia had lower ESE compared to persons with paraplegia (Z = -1.93, p = 0.05). No differences in ESE were found between subgroups based on age and motor completeness of the lesion. In persons with paraplegia, ESE was positively related to peak power output (ρ = 0.58, p = 0.02). The relation of ESE with wheeled physical activity was ρ = 0.36, p = 0.09. CONCLUSIONS: In persons with SCI who are dependent on a manual wheelchair, lesion level when categorized as paraplegic and tetraplegic affected ESE whereas age categories and completeness categories did not. Persons with tetraplegia were found to have lower confidence with regard to physical activity and exercise indicating that this subgroup can benefit from extra attention in the promotion of physical activity and exercise. In persons with paraplegia, ESE seemed to be lower in persons with less peak power output and less daily physical activity.

Inactive and sedentary lifestyles amongst ambulatory adolescents and young adults with cerebral palsy.

BACKGROUND: To assess physical behaviour, including physical activity and sedentary behaviour, of ambulatory adolescents and young adults with cerebral palsy (CP). We compared participant physical behaviour to that of able-bodied persons and assessed differences related to Gross Motor Functioning Classification System (GMFCS) level and CP distribution (unilateral/bilateral). METHODS: In 48 ambulatory persons aged 16 to 24 years with spastic CP and in 32 able-bodied controls, physical behaviour was objectively determined with an accelerometer-based activity monitor. Total duration, intensity and type of physical activity were assessed and sedentary time was determined (lying and sitting). Furthermore, distribution of walking bouts and sitting bouts was specified. RESULTS: Adolescents and young adults with CP spent 8.6% of 24 hours physically active and 79.5% sedentary, corresponding with respectively 123 minutes and 1147 minutes per 24 hours. Compared to able-bodied controls, persons with CP participated 48 minutes less in physical activities (p < 0.01) and spent 80 minutes more sedentary per 24 hours (p < 0.01). Physical behaviour was not different between persons with GMFCS level I and II and only number of short sitting bouts were significantly more prevalent in persons with bilateral CP compared to unilateral CP (p < 0.05). CONCLUSIONS: Ambulatory adolescents and young adults with CP are less physically active and spend more time sedentary compared to able-bodied persons, suggesting that this group may be at increased risk for health problems related to less favourable physical behaviour. TRIAL REGISTRATION: Nederlands trial register: NTR1785.

Comorbidities and medical complexities of mobility device users: a retrospective study.

OBJECTIVE: To determine the medical complexities and comorbidities of individuals who utilise wheeled mobility devices. As well as, to examine costly events including the number of urinary tract infections (UTIs), hospitalizations, urgent care(UC)/emergency department (ED) visits that are commonly seen in this population over a period of time one year prior to and one year post receiving their wheeled mobility equipment. DESIGN/SETTING: A retrospective data review of 857 individual medical charts at a Level 1 Trauma Hospital and Clinic System. PARTICIPANTS: 330 male and female (24-92 years old) mobility device users with a wide range of diagnoses, of which: 56 used manual wheelchairs (MWC),138 scooters (POV), 123 power wheelchairs without integrated standing (PWC), and 13 power wheelchairs with integrated standing (iS-PWC). RESULTS: Overall, 92% (n = 304) had at least three medical comorbidities and medical complexities. The most common comorbidity was pain (91%). A change was noted in a lower incidence of UTIs in those using an iS-PWC, respectively 23% with at least 1 UTI in the year prior to and 8% in the year after the mobility device evaluation. CONCLUSIONS: The large number of comorbidities and medical complexities amongst all mobility device users is concerning. The burden and the accompanying healthcare costs of this population is high. The potential that iS-PWC and other interventions could have on reducing these issues should be explored further.Implications of rehabilitationRegardless of a person's primary diagnosis or the wheeled mobility device they use, 100% have at least one and 92% have at least three comorbidities and medical complexities if they spend the majority of their day sittingThe high healthcare cost situations such as Emergency Department visits, Urgent Care visits, hospitalizations, and Urinary Tract Infections are present across those that use all mobility device types and the means to potentially reduce these incidences should be further exploredThe introduction of integrated standing within a power wheelchair, as a means to minimize the frequency of comorbidities and medical complications, should also be investigated further.

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.

The impact of lower-limb function on upper-limb pull and push strength in elite handcycling athletes.

This study investigated the impact of performing a closed kinetic chain with the lower limbs on isometric upper-limb pull and push strength. Sixty-two elite handcyclists were assessed with the Manual Muscle Test and allocated to groups with partial to normal (LLF) or no lower-limb (no-LLF) function. Both groups performed upper-limb strength measurements under two kinetic-chain conditions. During the closed-chain condition, the lower limbs were attached to two footrests, providing horizontal and vertical support. During the open-chain condition, the footrests were removed and the limbs were supported vertically by a horizontal plate. Repeated-measures ANOVA were conducted to investigate main effects (open vs. closed chain, LLF vs. no-LLF) and their interaction. During pull, LLF performed better (p < 0.001, +11%) by pushing against the footrests. However, this increase in pulling strength during a closed-chain condition was not observed in the no-LLF. Therefore, findings suggest an advantage for the least impaired athletes by being able to perform lower-limb closed chains during pulling. Handcyclists with LLF can maximise pulling performance by adjusting the footrests. The classification system should consider the implications of these findings on the allocation of athletes with different levels of LLF and/or on the equipment regulation.

Bicycling and Tricycling Road Race Performance in International Para-Cycling Events Between 2011 and 2019.

ABSTRACT: This study described bicycling (C classes) and tricycling (T classes) performance in the International Cycling Federation road race events between 2011 and 2019. A total of 3243 race results from 33 events were analyzed. Race velocity was calculated for each result. Bicycling and tricycling data were separately modeled using a linear mixed-effects model. Bicycling velocity was statistically different between all adjacent men's classes (Cohen d = 0.14-0.73) and between the women's C1 and C2 (d = 1.15) and C3 and C4 (d = 0.48) classes. The absence of statistical differences between some women's bicycling classes may be due to a limited number of observations in these classifications. As expected, velocity was statistically different between men's (d = 1.64) and women's (d = 1.38) T1 and T2 classes. Road race performance was hierarchical within the disciplines of bicycling and tricycling, although not all adjacent women's bicycling classes were statistically different. The existence of a performance hierarchy does not necessarily validate the classification system. The integration of information regarding athlete impairment type and severity, with performance data, would provide greater insight into the validity of the classification system and should be prioritized as an area of future research.

Association between upper-limb isometric strength and handcycling performance in elite athletes.

This study investigated the association among isometric upper-limb strength of handcyclists and sport-specific performance outcomes. At two international events, 62 athletes were tested on upper-limb strength, measured with an isometric-strength setup and with Manual Muscle Test (MMT). Horizontal force (Fz), effectiveness, rate of development, variability, and asymmetries were calculated for upper-limb pull and push. Performance measures were mean (POmean) and peak (POpeak) 20-s sprint power output and average time-trial velocity (TTvelocity). Regression models were conducted to investigate which pull and push strength variables associated strongest with performance measures. Additional regression analyses were conducted with an MMT sum score as predictor. Push and pull Fz showed the strongest associations with all outcomes. Combined push and pull Fz explained (p < .001) 80-81% of variance of POmean and POpeak. For TTvelocity, only push Fz was included in the model explaining 29% of the variance (p < .001). MMT models revealed weaker associations with sprint PO (R2 = .38-.40, p < .001) and TTvelocity (R2 = .18, p = 0.001). The findings confirmed the relevance of upper-limb strength on handcycling performance and the significance of ratio-scaled strength measures. Isometric strength outcomes are adequate sport-specific indicators of impairment in handcycling classification, but future research should corroborate this notion and its potential to discriminate between sports classes.

Validation of the Physical Activity Scale for individuals with physical disabilities.

OBJECTIVE: To determine the criterion validity of the Physical Activity Scale for Individuals With Physical Disabilities (PASIPD) by means of daily physical activity levels measured by using a validated accelerometry-based activity monitor in a large group of persons with a physical disability. DESIGN: Cross-sectional. SETTING: Participants' home environment. PARTICIPANTS: Ambulatory and nonambulatory persons with cerebral palsy, meningomyelocele, or spinal cord injury (N=124). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Self-reported physical activity level measured by using the PASIPD, a 2-day recall questionnaire, was correlated to objectively measured physical activity level measured by using a validated accelerometry-based activity monitor. RESULTS: Significant Spearman correlation coefficients between the PASIPD and activity monitor outcome measures ranged from .22 to .37. The PASIPD overestimated the duration of physical activity measured by using the activity monitor (mean ± SD, 3.9±2.9 vs 1.5±0.9h/d; P<.01). Significant correlation (ρ=-.74; P<.01) was found between average number of hours of physical activity per day measured by using the 2 methods and difference in hours between methods. This indicates larger overestimation for persons with higher activity levels. CONCLUSIONS: The PASIPD correlated poorly with objective measurements using an accelerometry-based activity monitor in people with a physical disability. However, similar low correlations between objective and subjective activity measurements have been found in the general population. Users of the PASIPD should be cautious about overestimating physical activity levels.

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.