Cardiorespiratory and efficiency responses during arm and leg exercises with spontaneously chosen crank and pedal rates

Cardiovascular Risk Profile in Master Paralympic Athletes, a High-Risk Undertreated Population: A Cross-Sectional Longitudinal Study

INTRODUCTION

Recently, European Society of Cardiology (ESC) validated a prediction model to estimate 10-year fatal and non-fatal cardiovascular disease risk (CVDR) in individuals (aged 40-60 years) without previous cardiovascular disease or diabetes (ESC-SCORE2) and to provide indications for treatment. At present, data describing the CVDR in Paralympic athletes (PAs) are scarce and inconsistent. Therefore, we sought to assess the prevalence of risk factors in PAs to estimate their CVDR through SCORE2.

METHODS

We enrolled 99 PAs aged ≥ 40 y.o., who participated at 2012-2022 Paralympic Games, competing in 22 different sport disciplines classified according to sport type (power, skills, endurance and mixed) and disabilities: spinal cord injuries (SCI) and non-SCI. CVDR factors, anthropometric measurements and blood samples were collected.

RESULTS

Among the 99 PAs (78% males, mean age 45.7 ± 4.7 y.o.), 52.5% had SCI; 54% were dyslipidemic and 23% were smokers. According to ESC-SCORE2, 29% had high and 1% very-high CVDR. Women (compared to men) and endurance (compared to other sport) exhibited better CV profile. SCI showed no differences when compared with non-SCI for CVDR, excepted for a lower HDL and lower exercise performance. None of the dyslipidemic athlete was on pharmacologically treatment, despite the altered lipid profile had already been detected at younger age.

CONCLUSION

PAs are a selected population, presenting a high CV risk profile, with 30% showing either high or very-high CVDR according to ESC-SCORE2. Dyslipidemia was the most common risk factor, underestimated and undertreated, emphasizing the need for specific preventive strategies in this special setting of athletes.

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.

Maximal strength training-induced improvements in forearm work efficiency are associated with reduced blood flow

Maximal strength training (MST) improves work efficiency. However, since blood flow is greatly dictated by muscle contractions in arms during exercise and vascular conductance is lower, it has been indicated that arms rely more upon adapting oxygen extraction than legs in response to the enhanced work efficiency. Thus, to investigate if metabolic and vascular responses are arm specific, we used Doppler-ultrasound and a catheter placed in the subclavian vein to measure blood flow and the arteriovenous oxygen difference during steady-state work in seven young men [24 ± 3 (SD) yr] following 6 wk of handgrip MST. As expected, MST improved maximal strength (49 ± 9 to 62 ± 10 kg) and the rate of force development (923 ± 224 to 1,086 ± 238 N/s), resulting in a reduced submaximal oxygen uptake (30 ± 9 to 24 ± 10 ml/min) and concomitantly increased work efficiency (9.3 ± 2.5 to 12.4 ± 3.9%) (all P < 0.05). In turn, the work efficiency improvement was associated with reduced blood flow (486 ± 102 to 395 ± 114 ml/min), mediated by a lower blood velocity (43 ± 8 to 32 ± 6 cm/s) (all P < 0.05). Conduit artery diameter and the arteriovenous oxygen difference remained unaltered. The maximal work test revealed an increased time to exhaustion (949 ± 239 to 1,102 ± 292 s) and maximal work rate (both P < 0.05) but no change in peak oxygen uptake. In conclusion, despite prior indications of metabolic and vascular limb-specific differences, these results reveal that improved work efficiency after small muscle mass strength training in the upper extremities is accompanied by a blood flow reduction and coheres with what has been documented for lower extremities. NEW & NOTEWORTHY Maximal strength training increases skeletal muscle work efficiency. Oxygen extraction has been indicated to be the adapting component with this increased work efficiency in arms. However, we document that decreased blood flow, achieved by blood velocity reduction, is the adapting mechanism responding to the improved aerobic metabolism in the forearm musculature.

Development and Testing of a Novel Arm Cranking-Powered Watercraft

There is a lack of human-powered watercrafts for people with lower-body disabilities. The purpose of this study was therefore to develop a watercraft for disabled people and investigate the metabolic cost and efficiency when pedaling. The watercraft was designed by combining parts of a waterbike and a handbike. Nine able-bodied subjects pedaled the watercraft at different speeds on a lake to provide steady-state metabolic measurements, and a deceleration test was performed to measure the hydrodynamic resistance of the watercraft. The results showed a linear correlation between metabolic power and mechanical power (r² = 0.93). Metabolic expenditure when pedaling the watercraft was similar to other physical activities performed by people with lower-body disabilities. Moreover, the efficiency of the watercraft showed to be comparable to other human-powered watercraft and could, as a result, be an alternative fitness tool especially for people with lower-body disabilities, who seek water activities. A number of suggestions are proposed however, to improve the efficiency and ergonomics of the watercraft.

Different cadences and resistances in sub-maximal synchronous handcycling in able-bodied men: Effects on efficiency and force application

Background

With the introduction of an add-on handcycle, a crank system that can be placed in front of a wheelchair, handcycling was made widely available for daily life. With it, people go into town more easily, e.g. to do groceries; meet up with friends, etc. They have more independency and can be socially active. Our aim is to explore some settings of the handcycle, so that it can be optimally used as a transportation device. Therefore, the effects of cadence and added resistance on gross mechanical efficiency and force application during sub-maximal synchronous handcycling were investigated. We hypothesized that a cadence of 52 rpm with a higher resistance (35 W) would lead to a higher gross mechanical efficiency and a more tangential force application than a higher cadence of 70 rpm and no extra resistance (15 W).

Methods

Twelve able-bodied men rode in an instrumented add-on handcycle on a motorized level treadmill at 1.94 m/s. They performed three sessions of three four-minute blocks of steady state exercise. Gear (70, 60 and 52 rpm) was changed in-between the blocks and resistance (rolling resistance +0 W, +10 W, +20 W) was changed across sessions, both in a counterbalanced order. 3D force production, oxygen uptake and heart rate were measured continuously. Gross mechanical efficiency (ME) and fraction of effective force (FEF) were calculated as main outcomes. The effects of cadence and resistance were analyzed using a repeated measures ANOVA (P<0.05) with Bonferroni-corrected post-hoc pairwise comparisons.

Results

With a decrease in cadence a slight increase in ME (70 rpm: 5.5 (0.2)%, 60 rpm: 5.7 (0.2)%, 52 rpm: 5.8 (0.2)%, P = 0.008, η²_p = 0.38), while an increase in FEF (70 rpm: 58.0 (3.2)%, 60 rpm: 66.0 (2.8)%, 52 rpm: 71.3 (2.3)%, P<0.001, η²_p = 0.79) is seen simultaneously. Also with an increase in resistance an increase in ME (+0 W: 4.0 (0.2)%, +10 W: 6.0 (0.3)%, +20 W: 7.0 (0.2)%, P<0.001, η²_p = 0.92) and FEF (+0 W: 59.0 (2.9)%, +10 W: 66.1 (3.4)%, +20 W: 70.2 (2.4)%, P<0.001, η²_p = 0.56) was found.

Interpretation

A cadence of 52 rpm against a higher resistance of about 35 W leads to a more optimal direction of forces and is more mechanically efficient than propelling at a higher cadence or lower resistance. Therefore, changing gears on a handcycle is important, and it is advised to keep the linear hand velocity relatively low for locomotion purposes.

Implications of altered autonomic control on sports performance in athletes with spinal cord injury

It is well known that athletes with spinal cord injury (SCI) may experience altered autonomic physiology that impacts their exercise capacity and sports performance. This is particularly relevant given the ever-increasing number of individuals with SCI who are actively engaged in sports at all levels, from community-based adaptive sports to elite Paralympic competitions. As such, the purpose of this article is to review the present literature regarding the implications of altered autonomic control on the safety and performance of athletes with SCI. A particular emphasis will be placed on the autonomic aspects of cardiovascular and thermoregulatory control in the athlete population, as well as the implications of autonomic dysreflexia in enhancing sports performance. Further research is needed to understand the autonomic factors that influence athletes with SCI in order to ensure optimal and safe sports competition. Additionally, this information is crucially relevant to the coaches, sports administrators, and team medical staff who work closely with athletes with SCI.

Effect of cadence on locomotor-respiratory coupling during upper-body exercise

Introduction

Asynchronous arm-cranking performed at high cadences elicits greater cardiorespiratory responses compared to low cadences. This has been attributed to increased postural demand and locomotor–respiratory coupling (LRC), and yet, this has not been empirically tested. This study aimed to assess the effects of cadence on cardiorespiratory responses and LRC during upper-body exercise.

Methods

Eight recreationally-active men performed arm-cranking exercise at moderate and severe intensities that were separated by 10 min of rest. At each intensity, participants exercised for 4 min at each of three cadences (50, 70, and 90 rev min⁻¹) in a random order, with 4 min rest-periods applied in-between cadences. Exercise measures included LRC via whole- and half-integer ratios, cardiorespiratory function, perceptions of effort (RPE and dyspnoea), and diaphragm EMG using an oesophageal catheter.

Results

The prevalence of LRC during moderate exercise was highest at 70 vs. 50 rev min⁻¹ (27 ± 10 vs. 13 ± 9%, p = 0.000) and during severe exercise at 90 vs. 50 rev min⁻¹ (24 ± 7 vs. 18 ± 5%, p = 0.034), with a shorter inspiratory time and higher mean inspiratory flow (p < 0.05) at higher cadences. During moderate exercise, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ \dot{V}{\text{O}}_{ 2} $$\end{document}V˙O2 and f_C were higher at 90 rev min⁻¹ (p < 0.05) relative to 70 and 50 rev min⁻¹ (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ \dot{V}{\text{O}}_{ 2} $$\end{document}V˙O2 1.19 ± 0.25 vs. 1.05 ± 0.21 vs. 0.97 ± 0.24 L min⁻¹; f_C 116 ± 11 vs. 101 ± 13 vs. 101 ± 12 b min⁻¹), with concomitantly elevated dyspnoea. There were no discernible cadence-mediated effects on diaphragm EMG.

Conclusion

Participants engage in LRC to a greater extent at moderate-high cadences which, in turn, increase respiratory airflow. Cadence rate should be carefully considered when designing aerobic training programmes involving the upper-limbs.

Cardiovascular determinants of exercise capacity in the Paralympic athlete with spinal cord injury

This report briefly summarizes the cardiovascular factors that influence exercise physiology and, eventually, sports performance of athletes with a spinal cord injury (SCI). The consequences of an SCI are numerous and concern voluntary muscle function, deep and superficial sensitivity, and autonomic function to a degree determined by the level and completeness of the spinal lesion. Athletes with SCI perform with their upper body, which limits their maximal exercise capacity and puts them at a disadvantage compared with leg exercise in terms of mechanical efficiency and physiological adaptations to exercise. Studies generally find that maximal oxygen consumption and mechanical power output are inversely related to spinal lesion level. Athletes with cervical or dorsal lesions down to Th6 have limited maximal heart rates owing to a lack of sympathetic drive to the heart. Blood redistribution from body areas lacking autonomic control is impaired, thus reducing venous return and limiting cardiac stroke volume during exercise. Thermoregulatory function is affected through a lack of afferent neural feedback and limited efferent vasomotor and sudomotor control below the lesion. Strategies to support venous return and to promote body cooling potentially improve physiological responses and athletic performance, especially in individuals with high lesion levels. The latter are subject to autonomic dysreflexia, a generalized sympathetic vasoconstriction below the lesion resulting from nociceptive stimulations in insensate body regions. Acute episodes induce high blood pressure, may enhance exercise performance and must be treated as a clinical emergency. Deliberate triggering of this reflex is prohibited by the International Paralympic Committee.

The effects of an increasing versus constant crank rate on peak physiological responses during incremental arm crank ergometry

We examined the effects of concomitant increases in crank rate and power output on incremental arm crank ergometry. Ten healthy males undertook three incremental upper body exercise tests to volitional exhaustion. The first test determined peak minute power. The subsequent tests involved arm cranking at an initial workload of 40% peak minute power with further increases of 10% peak minute power every 2 min. One involved a constant crank rate of 70 rev · min(-1), the other an initial crank rate of 50 rev · min(-1) increasing by 10 rev · min(-1) every 2 min. Fingertip capillary blood samples were analysed for blood lactate at rest and exhaustion. Local (working muscles) and cardiorespiratory ratings of perceived exertion (RPE) were recorded at the end of each exercise stage. Heart rate and expired gas were monitored continuously. No differences were observed in peak physiological responses or peak minute power achieved during either protocol. Blood lactate concentration tended to be greater for the constant crank rate protocol (P = 0.06). Test duration was shorter for the increasing than for the constant crank rate protocol. The relationship between local RPE and heart rate differed between tests. The results of this study show that increasing cadence during incremental arm crank ergometry provides a valid assessment of peak responses over a shorter duration but alters the heart rate-local RPE relationship.

No gender-specific differences in mechanical efficiency during arm or leg exercise relative to ventilatory threshold

The purpose of this study was to determine economy and mechanical efficiency in men and women during both arm cranking (AC) and leg cycling (LC) at 70%, 85%, 100%, and 115% of mode-specific ventilatory threshold (T(vent)). Recreationally active men (n=9) and women (n=9) with similar values for %VO2peak at T(vent) served as subjects. All subjects performed 5 min of exercise at each intensity of 70%, 85%, 100%, and 115% of T(vent) for both AC and LC. Economy was expressed as W/L/min. Gross efficiency (GE) was determined as the ratio of work accomplished to total energy expended (%). Delta efficiency (DE) was determined as the ratio of delta work accomplished to delta energy expended (%). Economy and efficiency during LC were greater than during AC in men and women. During AC or LC exercise, no sex differences were found in either economy (P=0.93 for AC, 0.98 for LC), GE (P=0.88 for AC, 0.75 for LC), or DE (P=0.57 for AC, 0.51 for LC). These findings indicate that men and women show similar economy and efficiency during both AC and LC exercise when subjects have similar %VO2peak at Tvent.

The effects of arm crank strategy on physiological responses and mechanical efficiency during submaximal exercise

The purpose of this study was to compare submaximal physiological responses and indices of mechanical efficiency between asynchronous and synchronous arm ergometry. Thirteen wheelchair-dependent trained athletes performed eight steady-state incremental bouts of exercise (0 to 140 W), each lasting 4 min, using synchronous and asynchronous arm-cranking strategies. Physiological measures included oxygen uptake (VO2), heart rate, and blood lactate concentration. The power outputs corresponding to fixed whole blood lactate concentrations of 2.0 to 4.0 mmol x l(-1) were calculated using linear interpolation. Mechanical efficiency indices - gross efficiency, net efficiency, and work efficiency - were also calculated. An analysis of variance with repeated measures was applied to determine the effect of crank mode on the physiological parameters. Oxygen uptake was on average 10% lower (P < 0.01), and both net efficiency (P < 0.01) and gross efficiency (P < 0.01) were higher, during the asynchronous strategy at both 60 and 80 W (gross efficiency: 16.9 +/- 2.0% vs. 14.7 +/- 2.4% and 17.5 +/- 1.8% vs. 15.9 +/- 2.6% at 60 and 80 W respectively). There were no differences in heart rate, blood lactate concentration or power output at either of the blood lactate reference points between the asynchronous and synchronous strategies (P > 0.05). In conclusion, test specificity is an important consideration. If a synchronous strategy is to be adopted, it is likely to result in lower efficiency than an asynchronous strategy. The exercise testing scenario may help dictate which method is ultimately chosen.