Comparison of peak oxygen uptake and exercise efficiency between upper-body poling and arm crank ergometry in trained paraplegic and able-bodied participants

The Prevalence of Cardiovascular Diseases in Paralympic Athletes

Paralympic participants represent a special subset of athletes. Although sudden cardiac death in this group is a rare event, it should be underlined that, in particular, Paralympians with movement restrictions have a higher prevalence of coronary heart disease. Numerous reports have focused on comparing athletes with spinal cord injury (SCI) and the ones with non-spinal cord injury-NSCI. The first group is more prone to develop arrhythmias, arterial hypertension, hyperlipidaemia including atrial fibrillation and atrial flutter, and this group potentially may have a higher risk of cardiovascular mortality. In ECGs of the disabled athletes with SCI, we more often find changes typically established as consequences of exercise training, such as T-wave inversions. The potential differences in the cardiovascular status of disabled athletes may depend not only on the class of impairment, but also on the discipline of sport and environmental conditions, which makes the analysis relatively complex. The paper analyses up-to-date articles discussing the cardiovascular problems in disabled athletes, pointing to scarce data in several fields of interest. Previous studies on the frequency of abnormalities of the cardiovascular system in Paralympic athletes highlighted the need to intensify preventive cardiology care for this group of athletes, and some activities could be proposed for sportsmen and sportswomen in this group, including more frequent screening ECG, application of 24 h ECG Holter monitoring, echocardiography and cardiological care. Due to the relatively few data available and existing discrepancies in this area, further research is necessary.

Preparing for snow-sport events at the Paralympic Games in Beijing in 2022: recommendations and remaining questions

During the 2022 Winter Paralympic Games in Beijing, the Para snow-sport events will be held at high altitudes and in possibly cold conditions while also requiring adjustment to several time zones. Furthermore, the ongoing COVID-19 pandemic may lead to suboptimal preparations. Another concern is the high rate of injuries that have been reported in the Para alpine and snowboard events. In addition to these challenges, Para athletes various impairments may affect both sports-specific demands and athlete health. However, the group of Para snow-sport athletes is an understudied population. Accordingly, this perspective paper summarises current knowledge to consider when preparing for the Paralympic Games in Beijing and point out important unanswered questions. We here focus specifically on how sport-specific demands and impairment-related considerations are influenced by altitude acclimatisation, cold conditions, travel fatigue and jetlag, complications due to the COVID-19 pandemic, and injury prevention and sports safety considerations. As Para athletes with spinal cord injury, limb deficiency, cerebral palsy and visual impairment account for the majority of the Para snow-sport athletes, the focus is mainly on these impairment groups. In brief, we highlight the extra caution required to ensure athlete health, performance and sports safety among Para athletes participating in the snow-sport events in the 2022 Beijing Paralympic Games. Although there is an urgent need for more high-quality research focusing on Para winter athletes, we hope these non-consensus recommendations will help prepare for the 2022 Beijing Paralympic Winter Games.

Acute physiological comparison of sub-maximal exercise on a novel adapted rowing machine and arm crank ergometry in people with a spinal cord injury

Study design

Non-randomized crossover trial.

Objectives

The objective of this study was to assess the oxygen uptake during exercise using the Adapted ROWing machine (AROW) compared to the more commonly used Arm Crank Ergometry (ACE) for people with spinal cord injury/disease (SCI/D) with or without trunk stability.

Setting

Canada, Vancouver.

Methods

Participants were from a convenience sample of 14 adults with SCI/D (age 21–63 y) which include those with lumbar to low cervical impairments currently exercising at least once per week using cardiovascular exercise equipment at our Physical Activity Research Centre. The interventions were non-randomized steady-state exercise bouts at self-selected low and moderate workloads on the AROW and ACE for 5 min each. Our primary outcomes were the rate of oxygen consumption (mL/kg/min) and the Borg 0–10 Rating Scale of Perceived Exertion (RPE).

Results

A repeated measures two-way ANOVA (p < 0.05) indicated that exercising on the AROW resulted significantly greater oxygen consumption and perceived exertion than ACE at similar sub-maximal workloads which may be explained by the differences in efficiency between the devices (Partial eta squared = 0.84, F stat = 48.25; Partial eta squared = 0.86, F stat = 53.54).

Conclusions

We have demonstrated that this form of upper extremity exercise had a greater RPE and VO₂ on the ACE at a given workload. Thus, the AROW could provide a functional upper extremity workout that can be used for daily exercise for those with varying levels of SCI.

Comparison of Peak Oxygen Uptake Between Upper-Body Exercise Modes: A Systematic Literature Review and Meta-Analysis

Purpose: To compare peak oxygen uptake (VO_2peak) between the asynchronous arm crank ergometry (ACE), and synchronous wheelchair ergometry (WERG), wheelchair treadmill (WTR), and upper-body poling (UBP) mode.

Methods: PubMed, Scopus, CINAHL, and SPORTDiscus™ were systematically searched, and identified studies screened based on title, abstract, and thereafter full-text. Studies comparing VO_2peak between ≥2 of the modes were included. A meta-analysis was performed by pooling the differences in VO_2peak between upper-body exercise modes. The quality of the included studies was assessed and the level of evidence (LoE) established for each mode comparison. Meta-regression analyses investigated the effect of total body mass and participant-related characteristics (% of able-bodied participants, % of participants with tetraplegia and % of participants who are wheelchair athletes) on differences in VO_2peak between modes.

Results: Of the 19 studies included in this review, 14 studies investigated the difference in absolute and body-mass normalized VO_2peak between ACE and WERG, and 5 studies examined the differences between ACE and WTR. No significant difference in absolute or body-mass normalized VO_2peak was found between ACE and WERG (overall effect ±95% CI: 0.01 ± 0.06 L·min⁻¹ and 0.06 ± 1.2 ml·kg⁻¹·min⁻¹, both p > 0.75; LoE: strong). No significant difference in absolute or body-mass normalized VO_2peak was found between ACE and WTR (overall effect ±95% CI: −0.10 ± 0.18 L·min⁻¹ and −1.8 ± 2.5 ml·kg⁻¹·min⁻¹, both p > 0.14; LoE: moderate). Absolute and/or body-mass normalized VO_2peak did not differ between WERG and WTR in one study with 13 participants (LoE: limited) and between ACE and UBP in one study with 18 participants (LoE: moderate). In the meta-regression analyses, there was no significant effect of the investigated factors on differences in VO_2peak.

Conclusions: The differences between the asynchronous ACE and synchronous WERG propulsion, including possible differences in trunk involvement, do not seem to influence VO_2peak. Therefore, ACE and WERG can be used interchangeably to test VO_2peak. Possible differences in VO_2peak in all other mode comparisons remain unclear due to the wide CIs and limited to moderate LoE.

Development of a Framework for the Investigation of Speed, Power, and Kinematic Patterns in Para Cross-Country Sit-Skiing: A Case Study of an LW12 Athlete

Objective: To develop a framework for the investigation of speed, power, and kinematic patterns across varying terrain in cross-country (XC) sit-skiing, and to test this framework in a XC sit-skier of the LW12 class during high- (HIT) and low-intensity (LIT) endurance training.

Methods: One XC sit-skiing athlete of the LW12 class with a single above-the-knee amputation was equipped with a GNSS enabled sports watch with integrated barometry and heart rate monitoring (peak heart rate: 195 beats·min⁻¹), and an inertial measurement unit. After a warm-up, he performed two 20-m maximal speed tests on a flat and an uphill section to determine maximal speed and power, followed by skiing 5.75 km at both LIT and HIT in varying terrain.

Results: 51, 28, and 21% of the time during HIT and 53, 28, and 19% of the time during LIT were spent in uphill, flat and downhill terrain, respectively. Maximal speed in the uphill and flat section was 4.0 and 6.2 m·s⁻¹, respectively, and the corresponding maximal power output 342 and 252 W. The % of maximal speed did not differ between the uphill and the flat section (HIT: 66 vs. 67%, LIT: 47 vs. 50%), whereas the % of maximal power output was lower in the uphill than flat section (HIT: 65 and 80%, LIT: 46 and 58%). Still, the absolute power output was slightly higher in the uphill than the flat section (HIT: 222 vs. 201 W, LIT: 156 vs. 145 W). Furthermore, cycle rate was significantly higher during HIT than LIT (60–61 vs. 45–55 cycles·min⁻¹, across all terrains, all p < 0.03), while cycle length was longer in the uphill terrain (3.0 vs. 2.6 m, p < 0.001). Furthermore, the % of peak heart rate was significantly higher in HIT than LIT (90 vs. 78, 85 vs. 67, and 88 vs. 66%, respectively, in the uphill, flat and downhill terrain, all p < 0.001).

Conclusions: Here, we present a new integrative framework for future investigations of performance, technical and physical demands in XC sit-skiing. In this case study, the increase in speed from LIT to HIT was due to increases in cycle rate in all terrains, while cycle length was less affected. Although the absolute power output was slightly higher in the uphill compared to the flat section both for HIT and LIT, the athlete worked closer to his maximum power output in the flat section.

Effects of different increments in workload and duration on peak physiological responses during seated upper-body poling

PURPOSE

To compare the effects of test protocols with different increments in workload and duration on peak oxygen uptake ([Formula: see text]O_2peak), and related physiological parameters during seated upper-body poling (UBP).

METHODS

Thirteen upper-body trained, male individuals completed four UBP test protocols with increments in workload until volitional exhaustion in a counterbalanced order: 20 W increase/every 30 s, 20 W/60 s, 10 W/30 s and 10 W/60 s. Cardio-respiratory parameters and power output were measured throughout the duration of each test. Peak blood lactate concentration (bLa_peak) was measured after each test.

RESULTS

The mixed model analysis revealed no overall effect of test protocol on [Formula: see text]O_2peak, peak minute ventilation (VE_peak), peak heart rate (HR_peak), bLa_peak (all p ≥ 0.350), whereas an overall effect of test protocol was found on peak power output (PO_peak) (p = 0.0001), respiratory exchange ratio (RER) (p = 0.024) and test duration (p < 0.001). There was no difference in PO_peak between the 20 W/60 s (175 ± 25 W) and 10 W/30 s test (169 ± 27 W; p = 0.092), whereas PO_peak was lower in the 10 W/60 s test (152 ± 21 W) and higher in the 20 W/30 s test (189 ± 30 W) compared to the other tests (all p = 0.001). In addition, RER was 9.9% higher in the 20 W/30 s compared to the 10 W/60 s test protocol (p = 0.003).

CONCLUSIONS

The UBP test protocols with different increments in workload and duration did not influence [Formula: see text]O_2peak, and can therefore be used interchangeably when [Formula: see text]O_2peak is the primary outcome. However, PO_peak and RER depend upon the test protocol applied and the UBP test protocols can, therefore, not be used interchangeably when the latter is the primary outcome parameter.