The effect of arm‐crank exercise training on power output, spirometric and cardiac function and level of autonomy in persons with tetraplegia

Brizuela, Gabriel; Sinz, Sandra; Aranda, Rafael; Martínez-Navarro, Ignacio

doi:10.1080/17461391.2019.1674927

Cited by 10 publications

(18 citation statements)

References 42 publications

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“…Lastly, aerobic capacity gains were greatest in the first three months of training. It is possible that participants reached a plateau in aerobic capacity after three months of FESRT and encountered physiological barriers, due to muscle,( 39 ) cardiac,( 40 ) or to ventilatory limits. ( 1 , 26 , 40 ) For example, Qui and colleagues previously reported that after several months of FES rowing, training-related increases in peak aerobic capacity were markedly dependent on peak ventilation in those with high-level SCI.…”

Section: Discussionmentioning

confidence: 99%

“…It is possible that participants reached a plateau in aerobic capacity after three months of FESRT and encountered physiological barriers, due to muscle,( 39 ) cardiac,( 40 ) or to ventilatory limits. ( 1 , 26 , 40 ) For example, Qui and colleagues previously reported that after several months of FES rowing, training-related increases in peak aerobic capacity were markedly dependent on peak ventilation in those with high-level SCI. ( 26 ) Improvements in muscle metabolism and/or cardiovascular function after FESRT may outstrip the pulmonary system’s ability to generate greater ventilation, and Vivodtzev and colleagues showed that ventilatory support can reverse both VE peak and VO 2peak limitations in these individuals.…”

Section: Discussionmentioning

confidence: 99%

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Gains in aerobic capacity with whole-body functional electrical stimulation row training and generalization to arms-only exercise after spinal cord injury

et al. 2020

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Study Design: Longitudinal study in adults (n=27; 19–40 years old) with tetraplegic or paraplegic spinal cord injury (SCI). Objectives: Determine physiological adaptations and generalizable fitness effects of six months of whole-body exercise training using volitional arm and functional electrical stimulation (FES) leg rowing. Setting: Outpatient hospital-based exercise facility and laboratory Methods: Participants enrolled in hybrid FES row training (FESRT) and performed peak exercise tests with arms-only (AO; baseline and 6-Mo) and FES rowing (baseline, 3-Mo, 6-Mo). Results: Participants demonstrated increased aerobic capacity (VO 2peak ) after FESRT (p<0.001, n p 2 =0.56) that tended to be higher when assessed with FES than AO rowing tests (0.15 ± 0.20 vs. 0.04 ± 0.22 L/min; p=0.10). Changes in FES and AO VO 2peak were significantly correlated (r=0.55; p<0.01), and 11 individuals demonstrated improvements (>6%) on both test formats. Younger age was the only difference between those who showed generalization of training effects and those who did not (mean age 26.6 ± 5.6 vs. 32.0 ± 5.7 years; p<0.05) but changes in FES VO 2peak correlated to time since injury in individuals <2 years post-SCI (r=−0.51, p<0.01, n=24). Lastly, VO 2peak improvements were greater during the first three months vs. months 4–6 (+7.0% vs. +3.9%; p<0.01) which suggests early training adaptations during FESRT. Conclusions: Gains in aerobic capacity after whole-body FESRT are better reflected during FES row testing format. They relate to high-intensity exercise and appear early during training, but they may not generalize to equivalent increases in AO exercise in all individuals with SCI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Gains in aerobic capacity with whole-body functional electrical stimulation row training and generalization to arms-only exercise after spinal cord injury

et al. 2020

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“…Nevertheless, given its physiological and biomechanical benefits, handcycling is also suitable as a safe training mode to regain and maintain fitness [7,62,[64][65][66][67][68][69][70][71][72]. It is also possible to safely train patients who have a very low physical capacity for instance due to a high cervical spinal cord lesion [73][74][75] or because they are at the early start of rehabilitation [6,67,76,77]. Especially for those who are undertrained or those with a relatively high body mass in relation to their available active arm muscle mass, arm crank ergometers can be useful to be able to start training at a very low power output level [74,75].…”

Section: Health Benefitsmentioning

confidence: 99%

“…Within an experimental set-up a crank axis height at acromion/shoulder level is often used or recommended [43,133,177]. In practice, however, an even lower setting is used; the crank axis height at mid-sternum is often seen, especially with "bullhorn" cranks [75,76,81].…”

Section: Synchronous Versus Asynchronous Synchronous Handcycling Wasmentioning

confidence: 99%

Biophysical aspects of handcycling performance in rehabilitation, daily life and recreational sports; a narrative review

Kraaijenbrink

Vegter

Groot

et al. 2020

Disability and Rehabilitation

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Aim: In this narrative review the potential and importance of handcycling are evaluated. Four conceptual models form the framework for this review; (1) the International Classification of Functioning, Disability and Health; (2) the Stress-Strain-Capacity model; (3) the Human-Activity-Assistive Technology model; and(4) the power balance model for cyclic exercise. Methods: Based on international handcycle experience in (scientific) research and practice, evidencebased benefits of handcycling and optimization of handcycle settings are presented and discussed for rehabilitation, daily life and recreational sports. Results: As the load can be distributed over the full 360 cycle in handcycling, peak stresses in the shoulder joint and upper body muscles reduce. Moreover, by handcycling regularly, the physical capacity can be improved. The potential of handcycling as an exercise mode for a healthy lifestyle should be recognized and advocated much more widely in rehabilitation and adapted sports practice. The interface between handcycle and its user should be optimized by choosing a suitable person-specific handcycle, but mainly by optimizing the handcycle dimensions to one's needs and desires. These dimensions can influence efficient handcycle use and potentially improve both endurance and speed of handcycling. Conclusion:To optimize performance in rehabilitation, daily life and recreational sports, continued and more systematic research is required. ä IMPLICATIONS FOR REHABILITATIONHandcycling allows users to travel farther distances at higher speeds and to train outdoors. It should be recognized as an alternative exercise modality for daily outdoor use, also already in early rehabilitation, while it contributes to a healthy lifestyle. To individualize handcycle performance, the user-handcycle (assistive device) interface as well as the vehicle mechanics should be optimized to minimize external power and reduce friction, so that the upper body capacity can be efficiently used. To optimize handcycling individual performance, both the physiological and biomechanical aspects of handcycling should be considered when monitoring or testing handcycle exercise.

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“…Handcycling is a popular form of outdoor propulsion for persons who are dependent on their upper body for locomotion during and after rehabilitation (Kraaijenbrink et al, 2020b ). To practice or test handcycle performance, the arm crank ergometer is often used as an indoor alternative, especially in early rehabilitation (Krops et al, 2017 ; Kouwijzer et al, 2018b ; Bresnahan et al, 2019 ; Williams et al, 2019 ; Brizuela et al, 2020 ). Outdoor handcycling requires steering, hence the front wheel and fork must rotate freely around the steering axis.…”

Section: Introductionmentioning

confidence: 99%

Steering Does Affect Biophysical Responses in Asynchronous, but Not Synchronous Submaximal Handcycle Ergometry in Able-Bodied Men

Kraaijenbrink¹,

Vegter²,

Ostertag³

et al. 2021

Front. Sports Act. Living

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Real-life daily handcycling requires combined propulsion and steering to control the front wheel. Today, the handcycle cranks are mostly mounted synchronously unlike the early handcycle generations. Alternatively, arm cycle ergometers do not require steering and the cranks are mostly positioned asynchronously. The current study aims to evaluate the effects of combining propulsion and steering requirements on synchronous and asynchronous submaximal handcycle ergometry. We hypothesize that asynchronous handcycling with steering results in the mechanically least efficient condition, due to compensation for unwanted rotations that are not seen in synchronous handcycling, regardless of steering. Sixteen able-bodied male novices volunteered in this lab-based experiment. The set-up consisted of a handcycle ergometer with 3D force sensors at each crank that also allows “natural” steering. Four submaximal steady-state (60 rpm, ~35 W) exercise conditions were presented in a counterbalanced order: synchronous with a fixed steering axis, synchronous with steering, asynchronous with a fixed axis and asynchronous with steering. All participants practiced 3 × 4 mins with 30 mins rest in between every condition. Finally, they did handcycle for 4 mins in each of the four conditions, interspaced with 10 mins rest, while metabolic outcomes, kinetics and kinematics of the ergometer were recorded. The additional steering component did not influence velocity, torque and power production during synchronous handcycling and therefore resulted in an equal metabolically efficient handcycling configuration compared to the fixed condition. Contrarily, asynchronous handcycling with steering requirements showed a reduced mechanical efficiency, as velocity around the steering axis increased and torque and power production were less effective. Based on the torque production around the crank and steering axes, neuromuscular compensation strategies seem necessary to prevent steering movements in the asynchronous mode. To practice or test real-life daily synchronous handcycling, a synchronous crank set-up of the ergometer is advised, as exercise performance in terms of mechanical efficiency, metabolic strain, and torque production is independent of steering requirements in that mode. Asynchronous handcycling or arm ergometry demands a different handcycle technique in terms of torque production and results in higher metabolic responses than synchronous handcycling, making it unsuitable for testing.

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The effect of arm‐crank exercise training on power output, spirometric and cardiac function and level of autonomy in persons with tetraplegia

Cited by 10 publications

References 42 publications

Gains in aerobic capacity with whole-body functional electrical stimulation row training and generalization to arms-only exercise after spinal cord injury

Gains in aerobic capacity with whole-body functional electrical stimulation row training and generalization to arms-only exercise after spinal cord injury

Biophysical aspects of handcycling performance in rehabilitation, daily life and recreational sports; a narrative review

Steering Does Affect Biophysical Responses in Asynchronous, but Not Synchronous Submaximal Handcycle Ergometry in Able-Bodied Men

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