Objective: To describe the effects of upper body training on the physical capacity of people with a spinal cord injury. Data sources: The databases of PubMed, CINAHL, Sport Discus and Cochrane were searched from 1970 to May 2006. Review methods: The keywords 'spinal cord injury', 'paraplegia', 'tetraplegia' and 'quadriplegia' were used in combination with 'training'. The methodological quality of the included articles (both randomized controlled trials and controlled clinical trials) was assessed with the modified 'van Tulder et al.' checklist. Studies were described with respect to population, test design, training protocol and mode of training. The training effects on physical capacity, reflected by peak power output (PO peak ) and oxygen uptake (VO 2peak ), were summarized. Results: Twenty-five studies were included with a mean score of 8.8 out of 17 items on the quality checklist. The methodological quality was quite low, mostly because of the absence of randomized controlled trials. Therefore no metaanalysis was possible. In the 14 articles of acceptable quality the mean (SD) increase in VO 2peak and PO peak, following a period of training, was 17.6 (11.2)% and 26.1 (15.6)%, respectively. Conclusions: Due to the overall low quality of studies it is not possible to draw definitive conclusions on training effects for different lesion groups or training modes. The results of the relatively few studies with an acceptable quality seem to support the view that upper body exercise may increase the physical capacity of people with spinal cord injury. The magnitude of improvement in PO peak and VO 2peak , however, varies considerably among studies.

Patients with tetraplegia were able to improve their physical capacity through regular hand cycle interval training, without participant-reported shoulder-arm pain or discomfort.

NTR2424.

Study design: Cross-sectional analyses. Objectives: To analyze exercise intensity during a mountain time trial in handcycling and to determine predictors of race time. Setting: Eight Dutch rehabilitation centers and Austrian mountain. Methods: Forty participants with spinal cord injury (SCI; high lesion level (4T6): N ¼ 11; low lesion level (pT6): N ¼ 29) handcycled a 20.2-km mountain time trial. Heart rate (HR) was monitored in 17 (high: N ¼ 5, low: N ¼ 12) participants during the race to determine exercise intensity, expressed relative to the heart rate reserve (%HRR). Two weeks before the race all participants completed laboratory tests to measure anthropometrics and peak values for power output (POpeak), oxygen uptake (VO2peak) and HR. Results: Mean race time was 4 h and 1 min (s.d.: 1 h and 24 min), with no difference in race time between lesion groups. Mean exercise intensity during the race was 70 ± 7%HRR. Exercise was mainly (73% of the race time) at a vigorous intensity (60-89%HRR), with 29% of the total time in the 80-89%HRR zone. No clear differences were found in exercise intensities between lesion groups. The strongest predictors for better race times were higher mean %HRR during race (R 2 ¼ 57%), lower waist circumference (R 2 ¼ 39%), higher POpeak (R 2 ¼ 39%) and VO2peak (R 2 ¼ 32%). Conclusion: A 20-km mountain time trial in a handcycle is intensive. Faster race times were achieved by those with a lower waist circumference, greater fitness level and ability to perform at higher average exercise intensities during the race. Level of SCI was not significantly associated with race time.

A challenging event such as the HBB provokes training regimes among participants of sufficient load to realize substantial improvements in physical fitness and health outcomes. Implications for Rehabilitation Due to the often impaired muscle function in the lower-limbs and an inactive lifestyle, wheelchair users generally show considerably lower levels of fitness compared to able-bodied individuals. This prospective cohort study showed that four months of handbike training under free-living conditions in preparation for this event resulted in substantial improvements in physical fitness and health outcomes in wheelchair users. The creation of a challenging event such as the HandbikeBattle as part of a follow-up rehabilitation practice can therefore be a useful tool to help wheelchair users initiate or keep training to improve their physical fitness and health.