Cooling athletes with a spinal cord injury

Cooling strategies that help prevent a reduction in exercise capacity whilst exercising in the heat have received considerable research interest over the past 3 decades, especially in the lead up to a relatively hot Olympic and Paralympic Games. Progressing into the next Olympic/Paralympic cycle, the host, Rio de Janeiro, could again present an environmental challenge for competing athletes. Despite the interest and vast array of research into cooling strategies for the able-bodied athlete, less is known regarding the application of these cooling strategies in the thermoregulatory impaired spinal cord injured (SCI) athletic population. Individuals with a spinal cord injury (SCI) have a reduced afferent input to the thermoregulatory centre and a loss of both sweating capacity and vasomotor control below the level of the spinal cord lesion. The magnitude of this thermoregulatory impairment is proportional to the level of the lesion. For instance, individuals with high-level lesions (tetraplegia) are at a greater risk of heat illness than individuals with lower-level lesions (paraplegia) at a given exercise intensity. Therefore, cooling strategies may be highly beneficial in this population group, even in moderate ambient conditions (~21 °C). This review was undertaken to examine the scientific literature that addresses the application of cooling strategies in individuals with an SCI. Each method is discussed in regards to the practical issues associated with the method and the potential underlying mechanism. For instance, site-specific cooling would be more suitable for an athlete with an SCI than whole body water immersion, due to the practical difficulties of administering this method in this population group. From the studies reviewed, wearing an ice vest during intermittent sprint exercise has been shown to decrease thermal strain and improve performance. These garments have also been shown to be effective during exercise in the able-bodied. Drawing on additional findings from the able-bodied literature, the combination of methods used prior to and during exercise and/or during rest periods/half-time may increase the effectiveness of a strategy. However, due to the paucity of research involving athletes with an SCI, it is difficult to establish an optimal cooling strategy. Future studies are needed to ensure that research outcomes can be translated into meaningful performance enhancements by investigating cooling strategies under the constraints of actual competition. Cooling strategies that meet the demands of intermittent wheelchair sports need to be identified, with particular attention to the logistics of the sport

The influence of crank length and cadence on mechanical efficiency in hand cycling

The purpose of this study was to determine the effect of crank length and cadence on mechanical efficiency in hand cycling. Eight wheelchair dependent, high performance athletes completed four 4-min submaximal exercise bouts at a constant power output of 90 W over the different experimental conditions (crank length, pedal rate) using a sports hand bike (Draft, Godmanchester, UK). Two different crank lengths (180 and 220 mm) were tested at two different cadences (70 and 85 rev min−1) using the synchronous mode of cranking. Physiological measures of oxygen uptake VO2, minute ventilation, blood lactate (B[La]), heart rate (HR), rate of perceived exertion (RPE) were recorded, gross (GE) and net (NE) efficiency were calculated. A two-way ANOVA with repeated measures was applied to determine the effects of crank length, cadence and their interaction on these physiological measures. Both GE and NE were significantly higher and VO2 significantly lower for the 180 mm crank (P 0.05). Likewise, no interactions between crank length and pedal rate were found. There was however, a trend observed with HR and B[La] often lower with the 180 mm crank, indicating lower physiological stress. The RPE data supported this finding, with a tendency for lower ratings with the 180 mm crank (9 ± 2 vs. 10 ± 3). The short crank length when used at 85 rev min−1 was found to be the most efficient (GE 21.4 ± 3.1%). In conclusion, crank length has a significant effect on ME in hand cycling. A shorter crank length of 180 mm was found to be more efficient than the 220 mm, regardless of pedal rate during hand cycling

Field-Based Physiological Testing of Wheelchair Athletes

This article is closed access.The volume of literature on field-based physiological testing of wheelchair sports, such as basketball, rugby and tennis, is considerably smaller when compared with that available for individuals and team athletes in able-bodied (AB) sports. In analogy to the AB literature, it is recognized that performance in wheelchair sports not only relies on fitness, but also sport-specific skills, experience and technical proficiency. However, in contrast to AB sports, two major components contribute towards ‘wheeled sports’ performance, which are the athlete and the wheelchair. It is the interaction of these two that enable wheelchair propulsion and the sporting movements required within a given sport. Like any other athlete, participants of wheelchair sports are looking for efficient ways to train and/or analyse their technique and fitness to improve their performance. Consequently, laboratory and/or field-based physiological monitoring tools used at regular intervals at key time points throughout the year must be considered to help with training evaluation. The present review examines methods available in the literature to assess wheelchair sports fitness in a field-based environment, with special attention on outcome variables, validity and reliability issues, and non-physiological influences on performance. It also lays out the context of field-based testing by providing details about the Paralympic court sports and the impacts of a disability on sporting performance. Due to the limited availability of specialized equipment for testing wheelchair-dependent participants in the laboratory, the adoption of field-based testing has become the preferred option by team coaches of wheelchair athletes. An obvious advantage of field-based testing is that large groups of athletes can be tested in less time. Furthermore, athletes are tested in their natural environment (using their normal sports wheelchair set-up and floor surface), potentially making the results of such testing more relevant than laboratory testing. However, given that many tests, such as the multistage fitness test and the Yo-Yo intermittent test, have originally been developed for AB games players, the assumption that these can also be used for wheelchair athletes may be erroneous. With the array of AB aerobic and anaerobic field tests available, it is difficult to ascertain which ones may be best suited for wheelchair athletes. Therefore, new, wheelchair sport-specific tests have been proposed and validated. Careful selection of tests to enable coaches to distinguish between disability classifications, wheelchair proficiency and actual performance improvements is paramount as this will not only enhance the value of field-based testing, but also help with the development of meaningful normative data

Work-rate-guided exercise testing in patients with incomplete spinal cord injury using a robotics-assisted tilt-table

Purpose: Robotics-assisted tilt-table (RTT) technology allows neurological rehabilitation therapy to be started early thus alleviating some secondary complications of prolonged bed rest. This study assessed the feasibility of a novel work-rate-guided RTT approach for cardiopulmonary training and assessment in patients with incomplete spinal cord injury (iSCI). Methods: Three representative subjects with iSCI at three distinct stages of primary rehabilitation completed an incremental exercise test (IET) and a constant load test (CLT) on a RTT augmented with integrated leg-force and position measurement and visual work rate feedback. Feasibility assessment focused on: (i) implementation, (ii) limited efficacy testing, (iii) acceptability. Results: (i) All subjects were able follow the work rate target profile by adapting their volitional leg effort. (ii) During the IETs, peak oxygen uptake above rest was 304, 467 and 1378 ml/min and peak heart rate (HR) was 46, 32 and 65 beats/min above rest (subjects A, B and C, respectively). During the CLTs, steady-state oxygen uptake increased by 42%, 38% and 162% and HR by 12%, 20% and 29%. (iii) All exercise tests were tolerated well. Conclusion: The novel work-rate guided RTT intervention is deemed feasible for cardiopulmonary training and assessment in patients with iSCI: substantial cardiopulmonary responses were observed and the approach was found to be tolerable and implementable. Implications for Rehabilitation -Work-rate guided robotics-assisted tilt-table technology is deemed feasible for cardiopulmonary assessment and training in patients with incomplete spinal cord injury. -Robotics-assisted tilt-tables might be a good way to start with an active rehabilitation as early as possible after a spinal cord injury. -During training with robotics-assisted devices the active participation of the patients is crucial to strain the cardiopulmonary system and hence gain from the training