Clinical Study Arm Crank and Wheelchair Ergometry Produce Similar Peak Oxygen Uptake but Different Work Economy Values in Individuals with Spinal Cord Injury

Objective. To study whether values for peak oxygen uptake (VO 2peak ) and work economy (WE) at a standardized workload are different when tested by arm crank ergometry (ACE) and wheelchair ergometry (WCE). Methods. Twelve paraplegic men with spinal cord injury (SCI) in stable neurological condition participated in this cross-sectional repeated-measures study. We determined VO 2peak and peak power output (PO peak ) values during ACE and WCE in a work-matched protocol. Work economy was tested at a standardized workload of 30 Watts (W) for both ACE and WCE. Results. There were no significant differences in VO 2peak (mL⋅kg −1 ⋅min −1 ) between ACE (27.3 ± 3.2) and WCE (27.4 ± 3.8) trials, and a Bland-Altman plot shows that findings are within 95% level of agreement. WE or oxygen consumption at 30 W (VO 2-30W ) was significantly lower during WCE compared to ACE ( < 0.039). Mean (95% CI) PO peak (W) were 130 (111-138) and 100 (83-110) during ACE and WCE, respectively. Conclusion. The findings in the present study support the use of both ACE and WCE for testing peak oxygen uptake. However, WE differed between the two test modalities, meaning that less total energy is used to perform external work of 30 W during wheelchair exercise when using this WCE (VP100 Handisport ergometer). Clinical Trials Protocol Record is NCT00987155/4.2007.2271

Test–Retest Reliability of Physiological Variables During Submaximal Seated Upper-Body Poling in Able-Bodied Participants

Purpose: To investigate the test–retest reliability of physiological variables across four different test days and four different submaximal exercise intensities during seated upper-body poling (UBP). Methods: Thirteen abled-bodied, upper-body trained men (age 29±3years; body mass 84±12kg; height 183±5cm) performed four submaximal 4-min stages of seated UBP on four separate test days. The four submaximal stages were set at individual power outputs corresponding to a rating of perceived exertion of 9, 11, 13, and 15. The absolute reliability for pairwise test-day comparisons of the physiological variables was investigated with the smallest detectable change percentage (%SDC) and the relative reliability with the interclass correlation coefficient (ICC). Results: Absolute and relative reliability across test-day comparisons and submaximal stages were moderate to excellent for all variables investigated (V̇O2 – %SDC range: 5–13%, ICC range: 0.93–0.99; HR – %SDC range: 6–9%, ICC range: 0.91–0.97) other than blood lactate, for which absolute reliability was poor and relative reliability highly variable (%SDC range: 26–69%, ICC range: 0.44–0.92). Furthermore, absolute and relative reliability were consistent across the low-to-moderate exercise intensity spectrum and across test days. Conclusion: Absolute and relative test–retest reliability were acceptable for all investigated physiological variables but blood lactate. The consistent test–retest reliability across the exercise intensity spectrum and across test days indicates that a familiarization period to the specific exercise modality may not be necessary. For generalizability, these findings need to be confirmed in athletes with a disability by future large-scale studies

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 (V˙O2peak), 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 (bLapeak) was measured after each test. Results The mixed model analysis revealed no overall effect of test protocol on V˙O2peak, peak minute ventilation (VEpeak), peak heart rate (HRpeak), bLapeak (all p ≥ 0.350), whereas an overall effect of test protocol was found on peak power output (POpeak) (p = 0.0001), respiratory exchange ratio (RER) (p = 0.024) and test duration (p < 0.001). There was no difference in POpeak between the 20 W/60 s (175 ± 25 W) and 10 W/30 s test (169 ± 27 W; p = 0.092), whereas POpeak 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 V˙ O2peak, and can therefore be used interchangeably when V˙O2peak is the primary outcome. However, POpeak 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

Comparison of peak oxygen uptake between upper-body exercise modes: A systematic literature review and meta-analysis

Purpose: To compare peak oxygen uptake (VO2peak) 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 VO2peak between ≥2 of the modes were included. A meta-analysis was performed by pooling the differences in VO2peak 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 VO2peak between modes. Results: Of the 19 studies included in this review, 14 studies investigated the difference in absolute and body-mass normalized VO2peak between ACE and WERG, and 5 studies examined the differences between ACE and WTR. No significant difference in absolute or body-mass normalized VO2peak 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 VO2peak 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 VO2peak 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 VO2peak. Conclusions: The differences between the asynchronous ACE and synchronous WERG propulsion, including possible differences in trunk involvement, do not seem to influence VO2peak. Therefore, ACE and WERG can be used interchangeably to test VO2peak. Possible differences in VO2peak in all other mode comparisons remain unclear due to the wide CIs and limited to moderate LoE

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

To compare the effects of test protocols with different increments in workload and duration on peak oxygen uptake (V̇ O2peak), 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: 20W increase/every 30s, 20W/60s, 10W/30s and 10W/60s. Cardio-respiratory parameters and power output were measured throughout the duration of each test. Peak blood lactate concentration (bLapeak) was measured after each test. Results: The mixed model analysis revealed no overall effect of test protocol on V̇ O2peak , peak minute ventilation (VEpeak), peak heart rate (HRpeak), bLapeak, (all p ≥0.350), whereas an overall effect of test protocol was found on peak power output (POpeak), (p=0.0001), respiratory exchange ratio (RER) (p=0.024) and test duration (p<0.001). There was no difference in POpeak between the 20W/60s (175±25W) and 10W/30s test (169±27W; p=0.092), whereas POpeak was lower in the 10W/60s test (152±21W) and higher in the 20W/30s test (189±30W) compared to the other tests, (all p=0.001). In addition, RER was 9.9% higher in the 20W/30s- compared to the 10W/60s test protocol, (p=0.003). Conclusions: The UBP test protocols with different increments in workload and duration did not influence V̇ O2peak and can therefore be used interchangeably when V̇ O2peak is the primary outcome. However, POpeak and RER depend upon the test protocol applied and the UBP test protocols can therefore not be used interchangeably when the latter are primary outcome parameters

Arm Crank and Wheelchair Ergometry Produce Similar Peak Oxygen Uptake but Different Work Economy Values in Individuals with Spinal Cord Injury

Objective. To study whether values for peak oxygen uptake (VO2peak) and work economy (WE) at a standardized workload are different when tested by arm crank ergometry (ACE) and wheelchair ergometry (WCE). Methods. Twelve paraplegic men with spinal cord injury (SCI) in stable neurological condition participated in this cross-sectional repeated-measures study. We determined VO2peak and peak power output (POpeak) values during ACE and WCE in a work-matched protocol. Work economy was tested at a standardized workload of 30 Watts (W) for both ACE and WCE. Results. There were no significant differences in VO2peak (mL·kg−1·min−1) between ACE (27.3 +/- 3.2) and WCE (27.4 +/- 3.8) trials, and a Bland-Altman plot shows that findings are within 95% level of agreement. WE or oxygen consumption at 30 W (VO2-30W) was significantly lower during WCE compared to ACE (P peak (W) were 130 (111–138) and 100 (83–110) during ACE and WCE, respectively. Conclusion. The findings in the present study support the use of both ACE and WCE for testing peak oxygen uptake. However, WE differed between the two test modalities, meaning that less total energy is used to perform external work of 30 W during wheelchair exercise when using this WCE (VP100 Handisport ergometer). Clinical Trials Protocol Record is NCT00987155/4.2007.2271

Peak oxygen uptake in Paralympic sitting sports: A systematic literature review, meta- and pooled-data analysis

<div><p>Background</p><p>Peak oxygen uptake (VO_2peak) in Paralympic sitting sports athletes represents their maximal ability to deliver energy aerobically in an upper-body mode, with values being influenced by sex, disability-related physiological limitations, sport-specific demands, training status and how they are tested.</p><p>Objectives</p><p>To identify VO_2peak values in Paralympic sitting sports, examine between-sports differences and within-sports variations in VO_2peak and determine the influence of sex, age, body-mass, disability and test-mode on VO_2peak.</p><p>Design</p><p>Systematic literature review and meta-analysis.</p><p>Data sources</p><p>PubMed, CINAHL, SPORTDiscus^TM and EMBASE were systematically searched in October 2016 using relevant medical subject headings, keywords and a Boolean.</p><p>Eligibility criteria</p><p>Studies that assessed VO_2peak values in sitting sports athletes with a disability in a laboratory setting were included.</p><p>Data synthesis</p><p>Data was extracted and pooled in the different sports disciplines, weighted by the Dersimonian and Laird random effects approach. Quality of the included studies was assessed with a modified version of the Downs and Black checklist by two independent reviewers. Meta-regression and pooled-data multiple regression analyses were performed to assess the influence of sex, age, body-mass, disability, test mode and study quality on VO_2peak.</p><p>Results</p><p>Of 6542 retrieved articles, 57 studies reporting VO_2peak values in 14 different sitting sports were included in this review. VO_2peak values from 771 athletes were used in the data analysis, of which 30% participated in wheelchair basketball, 27% in wheelchair racing, 15% in wheelchair rugby and the remaining 28% in the 11 other disciplines. Fifty-six percent of the athletes had a spinal cord injury and 87% were men. Sports-discipline-averaged VO_2peak values ranged from 2.9 L∙min^-1 and 45.6 mL∙kg^-1∙min^-1 in Nordic sit skiing to 1.4 L∙min^-1 and 17.3 mL∙kg^-1∙min^-1 in shooting and 1.3 L∙min^-1 and 18.9 mL∙kg^-1∙min^-1 in wheelchair rugby. Large within-sports variation was found in sports with few included studies and corresponding low sample sizes. The meta-regression and pooled-data multiple regression analyses showed that being a man, having an amputation, not being tetraplegic, testing in a wheelchair ergometer and treadmill mode, were found to be favorable for high absolute and body-mass normalized VO_2peak values. Furthermore, high body mass was favourable for high absolute VO_2peak values and low body mass for high body-mass normalized VO_2peak values.</p><p>Conclusion</p><p>The highest VO_2peak values were found in Nordic sit skiing, an endurance sport with continuously high physical efforts, and the lowest values in shooting, a sport with low levels of displacement, and in wheelchair rugby where mainly athletes with tetraplegia compete. However, VO_2peak values need to be interpreted carefully in sports-disciplines with few included studies and large within-sports variation. Future studies should include detailed information on training status, sex, age, test mode, as well as the type and extent of disability in order to more precisely evaluate the effect of these factors on VO_2peak.</p></div

Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) flowchart depicting the study identification, screening, eligibility and inclusion process.

<p>The sports disciplines presented in the box at the bottom are ranked according to their absolute peak oxygen uptake (VO_2peak) values, from highest to lowest. * Note that 1) some of the studies provide values for more than one sports discipline and 2) athletics was divided into throwing events and wheelchair racing due to the distinct differences in movement demands between these two sub-disciplines.</p

Overview of absolute and body-mass normalized peak oxygen uptake (VO_2peak) (mean ± SE [95% CI]) and level of evidence within the separate sitting sports disciplines.

<p>Sports disciplines are presented in order of absolute VO_2peak values, from high to low.</p

Effect of lower extremity functional electrical stimulation pulsed isometric contractions on arm cycling peak oxygen uptake in spinal cord injured individuals

Objective: To compare peak oxygen uptake (VO2peak) between: (i) functional electrical stimulation lower extremity pulsed isometric muscle contractions combined with arm cycling (FES iso hybrid), (ii) functional electrical stimulation cycling combined with arm cycling (FES hybrid cycling), and (iii) arm cycling exercise (ACE) in individuals with spinal cord injury with level of injury above and below T6. Design: Cross-over repeated measures design. Methods/participants: Individuals with spinal cord injury (n = 15) with level of injury between C4 and T12, were divided into groups; above (spinal cord injury – high, n = 8) and below (spinal cord injury – low, n = 7) T6 level. On separate days, VO2peak was compared between: (i) ACE, (ii) FES iso hybrid, and (iii) FES hybrid cycling. Results: In the SCI–high group, FES iso hybrid increased VO2peak (17.6 (standard deviation (SD) 5.0) to 23.6 (SD 3.6) ml/kg/min; p = 0.001) and ventilation (50.4 (SD 20.8) to 58.2 (SD 20.7) l/min; p = 0.034) more than ACE. Furthermore, FES hybrid cycling resulted in a 6.8 ml/kg/min higher VO2peak (p = 0.001) and an 11.0 litres/minute (p = 0.001) higher ventilation. ACE peak workload was 10.5 W (p = 0.001) higher during FES hybrid cycling compared with ACE. In the spinal cord injury – low group, no significant differences were found between the modalities. Conclusion: VO2peak increased when ACE was combined with FES iso hybrid or FES hybrid cycling in persons with spinal cord injury above the T6 level. Portable FES may serve as a less resource-demanding alternative to stationary FES cycling, and may have important implications for exercise prescription for spinal cord injury