title: Influence of training on biomechanics of wheelchair propulsion. Physical work capacity after 7 wk of wheelchair training: effect of intensity in able-bodied subjects. A more active lifestyle in persons with a recent spinal cord injury benefits physical fitness and health The longitudinal relation between physical capacity and wheelchair skill performance during inpatient rehabilitation of people with spinal cord injury. Effects of inspiratory muscle training on respiratory function and repetitive sprint performance in wheelchair basketball players Physical capacity after 7 weeks of low-intensity wheelchair training Aerobic high-intensity intervals improve VO2max more than moderate training. Interval training program on a wheelchair ergometer for paraplegic subjects The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. Specific and transfer effects induced by arm or leg training. Effects of resistance training on strength, pain and shoulder functionality in paraplegics Physical training of school children with spastic cerebral palsy: effects on daily activity, fat mass and fitness
abstract: A quasi-experimental longitudinal design was used to compare pre- and posttraining biomechanical and physiological characteristics of wheelchair propulsion in manual wheelchair users ( MWCU ) across fresh and fatigue states . An instrumented wheelchair ergometer , 3D motion analysis , and computerized open-circuit spirometry were used to collect joint kinetics and kinematics , h and rim kinetics , propulsion temporal characteristics , and oxygen uptake pre- and posttraining during a submaximal exercise test to exhaustion . Each subject ( n = 19 ) participated in a specific intervention program of supervised therapeutic exercise ( strengthening , stretching , and aerobic exercise ) for 6 weeks . Pre- and posttraining measurements were compared with the use of ANOVA with repeated measures . Significant training effects included increased exercise loads for all strengthening activities , decreased stroke frequency , increased maximum elbow extension angle , increased trunk and shoulder flexion/extension range of motion ( ROM ) , increased h and rim propulsive moment , increased wrist extension moment , and increased power output . Results suggest that this training program increased biomechanical economy ( as defined by propulsive moment ) without increasing shoulder or elbow joint stresses PURPOSE The purpose of this study was to study the effects of a 7-wk wheelchair training program on physical work capacity in able-bodied subjects . Effects of training intensities of 50 and 70 % heart rate ( HR ) reserve ( HRR ) were studied for different subject groups . METHODS Twenty-seven able-bodied male subjects participated in this study . They were r and omly divided into a control group ( N = 8) , a 50%-intensity group ( N = 9 ) , and a 70%-intensity group ( N = 10 ) . The 50%- and the 70%-intensity groups received a 7-wk wheelchair training program : three times a week , one-half hour wheelchair exercise on a motor driven treadmill at an average intensity of 50 and 70 % of the HRR , respectively . Before and after the training period , parameters for physical work capacity ( maximal isometric strength ( Fiso ) , sprint power ( P30 ) , maximal power output ( POmax ) and peak oxygen uptake ( VO2peak ) ) , and submaximal performance ( mechanical efficiency , HR ) at 20 and 40 % of the estimated POmax ( ME20 , ME40 ; HR20 , HR40 ) were obtained during tests on a stationary wheelchair ergometer . RESULTS A two-factor ANOVA for repeated measures on the within-subjects factor " pre-post tests , " the between-subject factor training ( 50 % and 70 % training vs control ) and the interaction term showed that the 50%-intensity group significantly increased on P30 and POmax compared with the control group . The 70 % intensity group significantly increased on P30 , POmax and VO2peak compared with the control group ( P < 0.05 ) . The 70 % group did not show significantly higher increases in P30 and POmax over training than the 50 % intensity . No significant effects were found for the Fiso and the parameters at submaximal PO . CONCLUSIONS The wheelchair training at both intensities can have favorable effects on maximal physical work capacity in able-bodied subjects , and possibly also on mechanical efficiency at submaximal power output . Effects are seen in parameters for both aerobic and anaerobic work capacities . Although training at 70 % intensity was more effective than the 50 % intensity , training at 50 % HRR may initially be more appropriate in untrained individuals , such as novice wheelchair users at the start of their rehabilitation , to prevent fatigue and enhance motivation Study design : A prospect i ve cohort study . Objectives : To study the longitudinal relationship between objective ly measured everyday physical activity level , and physical fitness and lipid profile in persons with a recent spinal cord injury ( SCI ) . Setting : A rehabilitation centre in the Netherl and s and the participant 's home environment . Methods : Data of 30 persons with a recent SCI were collected at the start of active rehabilitation , 3 months later , at discharge from inpatient rehabilitation , and 1 year after discharge .  Physical activity level ( duration of dynamic activities as % of 24 h ) was measured with an accelerometry-based activity monitor . Regarding physical fitness , peak oxygen uptake ( VO2peak ) and peak power output ( POpeak ) were determined with a maximal wheelchair exercise test , and  upper extremity muscle strength was measured with a h and held dynamometer . Fasting blood sample s were taken to determine the lipid profile . Results : An increase in physical activity level was significantly related to an increase in VO2peak and POpeak , and an increase in physical activity level favourably affected the lipid profile . A nonsignificant relation was found with muscle strength . Conclusion : Everyday physical activity  seems to have an important role in the fitness and health of persons with a recent SCI . An increase in  physical activity level was associated with an increase in physical fitness and with a lower risk of cardiovascular disease OBJECTIVE To study the longitudinal relation between physical capacity and wheelchair skill performance in subjects with spinal cord injury ( SCI ) during rehabilitation . DESIGN Observational prospect i ve cohort study . Measurements were taken 3 times during subjects ' rehabilitation . SETTING Eight rehabilitation centers in the Netherl and s. PARTICIPANTS Ninety-seven subjects with SCI . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Parameters of physical capacity were upper-extremity muscle strength ( manual muscle test [ MMT ] sum score ) , peak oxygen uptake , and peak power output ( POpeak ) . The Wheelchair Circuit consists of 8 wheelchair skills and results in 3 test scores : ability , performance time , and physical strain . RESULTS POpeak was related to all 3 scores of the Wheelchair Circuit , and the MMT sum score was related to the ability score and the performance time score . The results indicate that ( 1 ) subjects with higher values of POpeak and /or the MMT sum score had better scores on the Wheelchair Circuit than subjects with lower values and ( 2 ) when a subject increased his/her POpeak and /or MMT sum score , this was associated with better wheelchair skill scores . CONCLUSIONS There is a significant longitudinal relation between wheelchair skill performance and POpeak and MMT sum score during the rehabilitation of people with SCI . To optimize wheelchair skill performance , attention should be directed toward manual wheelchair exercise training and strength training of the upper body Background There is considerable evidence that respiratory muscle training improves pulmonary function , quality of life and exercise performance in healthy athletic population s. The benefits for wheelchair athletes are less well understood . Therefore , in the present study , influence of inspiratory muscle training ( IMT ) on respiratory function and repetitive propulsive sprint performance in wheelchair basketball players was examined . Methods Using a placebo-controlled design , 16 wheelchair athletes were divided to an experimental ( IMT ; n=8 ) or placebo ( sham-IMT ; n=8 ) group based on selective grouping criteria . 30 dynamic breaths were performed by the IMT group twice daily at a resistance equivalent to 50 % maximum inspiratory pressure ( MIP ) , and 60 slow breaths were performed by the sham-IMT group once a day at 15 % MIP for a period of 6 weeks . Results In the IMT group , both MIP and maximum expiratory pressure ( 17 % and 23 % , respectively ; p≤0.03 ) were improved . Similar improvements were noted for the sham-IMT group with 23 % and 33 % from baseline for MIP and maximum expiratory pressure , respectively ( p≤0.03 ) . There were no significant changes in pulmonary function at rest and any of the performance parameters associated with the repetitive sprint test ( sprint and recovery times , peak heart rate and peak blood lactate concentration ) . Reported experiences of using the IMT training device suggested “ less breathlessness ” and “ less tightness in the chest during the training ” . Conclusions Although there was no improvement in sprint performance , an improved respiratory muscle function and quality of life were reported by participants in both the IMT and sham-IMT groups Purpose . To simulate the effect of low-intensity exercise in early rehabilitation , we investigated the effect of a 7-week low-intensity norm duration h and rim wheelchair training on the physical capacity in untrained able-bodied individuals . Method . Twenty-five able-bodied participants were r and omly assigned to an experimental and control group : 10 participants exercised 7 weeks , three times a week at 30 % heart rate reserve ( HRR ) for 30 min ( experimental group ) . The control group consisted of  15 participants who did not receive training .  Physical capacity ( maximal isometric strength , sprint power , peak power output and peak oxygen uptake ) and submaximal performance [ heart rate ( HR ) , oxygen uptake ( VO2 ) , mechanical efficiency ( ME ) ] were assessed pre- and post-training . The levels of upper-body discomfort were determined with the use of a Local Perceived Discomfort scale . Results . Compared to the control group the experimental group significantly improved on sprint power ( + 31.2 % ) , peak aerobic power output ( + 34 % ) , submaximal HR , VO2 and ME ( + 16.9 % ) . The participants did not experience high levels of local discomfort in the upper body during the training . Conclusions . Low-intensity norm duration h and rim wheelchair training which significantly improved peak aerobic and sprint power output , efficiency and physical strain in able-bodied untrained individuals . Training at 30 % HRR ( 3 × /week , 30 min/session ) may be appropriate in untrained individuals , such as novice wheelchair users at the start of their rehabilitation , to prevent early fatigue and overuse and enhance motivation . Please note that this article was published in error in a previous issue of the Journal . This paper was su bmi tted and accepted as part of the Special Issue entitled 4th International State-of-the-art-Congress ‘ Rehabilitation : Mobility , Exercise & Sports ’ and has therefore been republished in this issue . The publisher apologises for this error PURPOSE The present study compared the effects of aerobic endurance training at different intensities and with different methods matched for total work and frequency . Responses in maximal oxygen uptake ( VO2max ) , stroke volume of the heart ( SV ) , blood volume , lactate threshold ( LT ) , and running economy ( CR ) were examined . METHODS Forty healthy , nonsmoking , moderately trained male subjects were r and omly assigned to one of four groups:1 ) long slow distance ( 70 % maximal heart rate ; HRmax ) ; 2)lactate threshold ( 85 % HRmax ) ; 3 ) 15/15 interval running ( 15 s of running at 90 - 95 % HRmax followed by 15 s of active resting at 70 % HRmax ) ; and 4 ) 4 x 4 min of interval running ( 4 min of running at 90 - 95 % HRmax followed by 3 min of active resting at 70%HRmax ) . All four training protocol s result ed in similar total oxygen consumption and were performed 3 d.wk for 8 wk . RESULTS High-intensity aerobic interval training result ed in significantly increased VO2max compared with long slow distance and lactate-threshold training intensities ( P<0.01 ) . The percentage increases for the 15/15 and 4 x 4 min groups were 5.5 and 7.2 % , respectively , reflecting increases in V O2max from 60.5 to 64.4 mL x kg(-1 ) x min(-1 ) and 55.5 to 60.4 mL x kg(-1 ) x min(-1 ) . SV increased significantly by approximately 10 % after interval training ( P<0.05 ) . CONCLUSIONS : High-aerobic intensity endurance interval training is significantly more effective than performing the same total work at either lactate threshold or at 70 % HRmax , in improving VO2max . The changes in VO2max correspond with changes in SV , indicating a close link between the two Background : Various combinations of training intensity , duration and frequency are often proposed to people with spinal cord injuries in order to improve their fitness . However , no consensus about a specific training program has been reached for such a population . Objective : This study investigated the effects of a short interval training program specifically design ed for patients with spinal cord injuries . Methods : Paraplegic men performed 30-min wheelchair ergometry three times per week , for 4 weeks .  Maximal dynamic performance and endurance capacity were studied before and after the training program with an incremental test ( 10 W/2 min ) until volitional fatigue and a constant work rate test , respectively . Cardiorespiratory responses were continuously studied during each of these tests . Results : Training induced significant improvement in maximal tolerated power ( + 27.9 % ) , and in peak oxygen consumption ( [ Vdot ] O2 , + 18.5 % ) . After training the subjects were able to maintain the load applied during the constant test ( total mechanical work + 210.7 % ) , for a significantly longer time . The heart rate , [ Vdot ] O2 and ventilation values observed when the volunteers ended their first constant load test were significantly higher ( + 10 % , + 10 % , + 40 % respectively ) than those obtained after a similar time period during the second constant load test which was performed after the training program . Conclusion : After this short training period , with an appropriate combination of different types of training , duration , intensity and frequency exercises , we observed a significant improvement in the fitness level and endurance capacity of paraplegic subjects . Spinal Cord ( 2001 ) 39 , 532–537 Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item pool contained all items from existing criteria lists . Subsequently , we reduced the number of items by using the Delphi consensus technique . Each Delphi round comprised a question naire , an analysis , and a feedback report . The feedback report included staff team decisions made on the basis of the analysis and their justification . A total of 33 international experts agreed to participate , of whom 21 completed all question naires . The initial item pool of 206 items was reduced to 9 items in three Delphi rounds . The final criteria list ( the Delphi list ) was satisfactory to all participants . It is a starting point on the way to a minimum reference st and ard for RCTs on many different research topics . This list is not intended to replace , but rather to be used alongside , existing criteria lists The purpose of the present study was to examine both the specific and the transfer effects of a Square Wave Endurance Exercise Test ( SWEET ) and to investigate the determining factors of transfer effect . A control group ( CG , n = 5 ) and 2 experimental groups were studied . Experimental groups completed 3 days/week a 45 min SWEET over 6 weeks , either with the arms using a wheelchair ergometer ( AG , n = 5 ) or with the legs using a cycling ergometer ( LG , n = 5 ) . All subjects performed before and after training two maximal progressive tests : the first one with the arms and the second with the legs . During those tests oxygen uptake ( VO(2 ) ) and cardiorespiratory parameters were continuously measured . Specific effects ( changes between the tests performed with trained limbs ) were observed : the peak power output ( W(p ) ) and VO(2 ) were significantly increased by both arm ( + 66 % , + 35 % ) and leg ( + 17 % , + 14 % ) training . At ventilatory threshold ( VT ) , power output ( W ) and VO(2 ) were significantly increased with arm ( + 145 % and + 51 % ) and leg ( + 53 % and + 46 % ) training . Transfer effects ( changes between pre and post tests performed with untrained limbs ) were observed : W(p ) and VO(2 ) were not increased in AG while W(p ) was increased in LG ( + 11 % ) . At VT , W and VO(2 ) were increased with arm ( + 19 % and + 23 % ) and leg ( + 33 % and + 46 % ) training . For AG and LG the VO(2 ) expressed in percent of the VO(2 ) peak was increased ( + 19 % and + 33 % , respectively ) and the O(2p ) was also increased ( + 30 % ) for LG . These results show that SWEET training induced specific and transfer effects . Moreover , the initial level of the subjects , the type and the intensity of the training seem to be the major factors for effective observable transfer effects Study design : Time series design . Objectives : To determine the effects of a shoulder resistance training programme on isokinetic and isometric strength , body composition , pain and functionality in paraplegic subjects . Setting : University of Valencia , Valencia , Spain . Methods : A total of 15 subjects with thoracic spinal cord injury ( SCI ) performed three testing sessions with an 8-week period between the sessions . Subjects were not disturbed between the first and the second testing sessions . Subjects performed an 8-week resistance training programme after the second testing session . Variations in isometric and isokinetic shoulder muscle strength , body composition , reported pain and shoulder functionality were evaluated . Results : The training programme produced a significant increase ( P<0.05 ) in the isometric and isokinetic strength of several shoulder movements as well as an increase ( P<0.05 ) in arm fat-free mass and a decrease in arm fat mass ( FM ) . Furthermore , reported pain was decreased , ( P<0.05 ) and upper-limb functionality was increased ( P<0.05 ) . Conclusion : Implementing resistance training programmes as physical therapy in SCI subjects effectively increases strength , muscle mass and upper-limb functionality , whereas decreasing FM and pain perception Effects of two 9-month sports programmes ( four or two sessions per week ) on level of daily physical activity ( PA ) , fat mass ( FM ) , and physical fitness were assessed in children with spastic cerebral palsy ( CP ; n = 20 , 9.2 + /- 1.4 yr ) , r and omly assigned to an experimental and control group after matching . Four sessions per week tended to increase PA ratio ( 24-h energy expenditure/sleeping ( resting ) energy expenditure ) after 9 months from 1.34 + /- 0.25 to 1.55 + /- 0.18 ( P = 0.07 ; not different versus controls ) . FM increased continuously in the control group ( after 9 months + 1.1 + /- 1.6 kg , P < 0.05 ) , whereas the experimental groups showed no changes . Training ( respectively four and two sessions ) increased peak aerobic power 35 % ( P < 0.01 ; P < 0.05 versus controls ) and 21 % ( P < 0.01 ; P = 0.17 versus controls ) . Results also suggest that training has a favourable effect on isokinetic muscle strength . No training-related effects were found on anaerobic power . It was concluded that although aerobic training has a limited effect on PA in children with CP , it may prevent deterioration in body composition and muscle strength . Furthermore , training has a favourable effect on peak aerobic power
target: Conclusion : Exercise training programs seem to be effective in improving wheelchair propulsion capacity .
  However , there is remarkably little research , particularly for individuals who do not have spinal-cord injury
background: Objective : An adequate wheelchair propulsion capacity is required to perform daily life activities .
  Exercise training may be effective to gain or improve wheelchair propulsion capacity .
  This review investigates whether different types of exercise training programs are effective in improving wheelchair propulsion capacity .