Influence of training on biomechanics of wheelchair propulsion. Handrim wheelchair propulsion training effect on overground propulsion using biomechanical real-time visual feedback. Effect of an abdominal binder during wheelchair exercise. Power-assisted wheels ease energy costs and perceptual responses to wheelchair propulsion in persons with shoulder pain and spinal cord injury. Effects of inspiratory muscle training on respiratory function and repetitive sprint performance in wheelchair basketball players The COSTAR wheelchair study: a two-centre pilot study of self-propulsion in a wheelchair in early stroke rehabilitation EMG Biofeedback and Exercise for Treatment of Cervical and Shoulder Pain in Individuals with a Spinal Cord Injury: A Pilot Study. Strengthening and Optimal Movements for Painful Shoulders (STOMPS) in Chronic Spinal Cord Injury: A Randomized Controlled Trial Exercise with physically restrained nursing home residents: maximizing benefits of restraint reduction. The longitudinal relation between physical capacity and wheelchair skill performance during inpatient rehabilitation of people with spinal cord injury. Physical work capacity after 7 wk of wheelchair training: effect of intensity in able-bodied subjects. Physical capacity after 7 weeks of low-intensity wheelchair training Interval training program on a wheelchair ergometer for paraplegic subjects Effect of push frequency on the economy of wheelchair racers. Does physical activity improve sleep in impaired nursing home residents? The effects of an arm ergometer training programme on wheelchair subjects Effects of a Controlled Exercise Trial on Pain in Nursing Home Residents Wheelchair skills training program: A randomized clinical trial of wheelchair users undergoing initial rehabilitation. Effects of hybrid cycling versus handcycling on wheelchair-specific fitness and physical activity in people with long-term spinal cord injury: a 16-week randomized controlled trial Elastic Band Exercises Improved Activities of Daily Living and Functional Fitness of Wheelchair-bound Older Adults with Cognitive Impairment: A Cluster Randomized Controlled Trial Effects of Respiratory Resistance Training With a Concurrent Flow Device on Wheelchair Athletes Effects of 2 Exercise Training Programs on Physical Activity in Daily Life in Patients With COPD Towards evidence-based classification in wheelchair sports: Impact of seating position on wheelchair acceleration
A quasi-experimental longitudinal design was used to compare pre- and posttraining biomechanical and physiological characteristics of wheelchair propulsion in manual wheelchair users ( MWCU ) across fresh and fatigue states . An instrumented wheelchair ergometer , 3D motion analysis , and computerized open-circuit spirometry were used to collect joint kinetics and kinematics , h and rim kinetics , propulsion temporal characteristics , and oxygen uptake pre- and posttraining during a submaximal exercise test to exhaustion . Each subject ( n = 19 ) participated in a specific intervention program of supervised therapeutic exercise ( strengthening , stretching , and aerobic exercise ) for 6 weeks . Pre- and posttraining measurements were compared with the use of ANOVA with repeated measures . Significant training effects included increased exercise loads for all strengthening activities , decreased stroke frequency , increased maximum elbow extension angle , increased trunk and shoulder flexion/extension range of motion ( ROM ) , increased h and rim propulsive moment , increased wrist extension moment , and increased power output . Results suggest that this training program increased biomechanical economy ( as defined by propulsive moment ) without increasing shoulder or elbow joint stresses OBJECTIVE To compare the effects of 2 manual wheelchair propulsion training programs on h and rim kinetics , contact angle , and stroke frequency collected during overground propulsion . DESIGN R and omized controlled trial comparing h and rim kinetics between 3 groups : a control group that received no training , an instruction-only group that review ed a multimedia presentation , and a feedback group that review ed the multimedia presentation and real-time visual feedback . SETTING Research laboratory . PARTICIPANTS Full-time manual wheelchair users ( N=27 ) with spinal cord injury living in the Pittsburgh area . INTERVENTIONS Propulsion training was given 3 times over 3 weeks , and data were collected at baseline , immediately after training , and at 3 months . MAIN OUTCOME MEASURES Contact angle , stroke frequency , peak result ant force , and peak rate of rise of result ant force . RESULTS Both feedback and instruction-only groups improved their propulsion biomechanics across all surfaces ( carpet , tile , and ramp ) at both target and self-selected speeds compared with the control group . While controlling for velocity , both intervention groups showed long-term reductions in the peak rate or rise of result ant force , stroke frequency , and increased contact angle . CONCLUSIONS Long-term wheelchair users in both intervention groups significantly improved many aspects of their propulsion technique immediately after training and 3 months from baseline . Furthermore , training with a low-cost instructional video and slide presentation was an effective training tool alone The purpose of this study was to determine whether use of an abdominal binder would affect oxygen uptake , trunk range of motion , and duration of the stroke phase during wheelchair propulsion . The subjects were six paraplegic wheelchair athletes with T1-T6 injuries and no abdominal muscle function . Each subject performed two trials , one while wearing the binder and one without the binder . Each trial consisted of submaximal and maximal exercise tests conducted on wheelchair rollers . Oxygen uptake was determined by open circuit spirometry while heart rate was determined by telemetry . Max VO2 values averaged 2.51 l.min-1 while average maximum heart rate values were 190 b.min-1 . A 3-D video-based motion analysis system was used to obtain kinematic parameters of wheelchair propulsion . In general , 30 % of the cycle time was comprised of the stroke phase , while 70 % was comprised of the recovery phase across speeds . There were no statistically significant effects of the abdominal binder on any of the cardiovascular or kinematic variables at submaximal or maximal levels of exercise . Under the conditions of this laboratory investigation , it appears that an abdominal binder does not alter physiological or selected biomechanical measures in highly trained athletes OBJECTIVE Test effects of pushrim-activated power-assisted wheelchairs ( PAPAWs ) on the energetics and perceptual responses to steady-state and intensity- grade d wheelchair propulsion in persons with paraplegia and tetraplegia having chronic shoulder pain . DESIGN Test , retest with a control condition . SETTING Academic medical center . PARTICIPANTS Subjects ( N=18 ) aged 19 to 70 years with chronic , motor-complete paraplegia and tetraplegia having confirmed shoulder pain . INTERVENTIONS Study participants underwent testing on 4 r and omized nonconsecutive days during either 6 minutes of steady-state or 12 minutes of intensity- grade d wheelchair propulsion on stationary rollers . Participants used their own manual wheelchair and either their customary wheels or power-assist wheels attached with an axle bracket . MAIN OUTCOME MEASURES Oxygen consumption ( V(.)O2 , L/min ) , distance ( m ) , energy cost ( L/m ) , and ratings of perceived exertion ( RPE ; Borg Categorical 6 - 20 Scale ) were measured during propulsion . RESULTS Significant main effects of testing were observed for V(.)O2 , heart rate , and RPE in both subject groups . Distances propelled were significantly increased in both groups across both tests and in each of their 2-minute exercise stages . CONCLUSIONS Use of PAPAWs by persons with paraplegia and tetraplegia having shoulder pain significantly lowers energy cost responses and perceived exertion compared with manual wheelchair propulsion while significantly increasing the distanced propelled Background There is considerable evidence that respiratory muscle training improves pulmonary function , quality of life and exercise performance in healthy athletic population s. The benefits for wheelchair athletes are less well understood . Therefore , in the present study , influence of inspiratory muscle training ( IMT ) on respiratory function and repetitive propulsive sprint performance in wheelchair basketball players was examined . Methods Using a placebo-controlled design , 16 wheelchair athletes were divided to an experimental ( IMT ; n=8 ) or placebo ( sham-IMT ; n=8 ) group based on selective grouping criteria . 30 dynamic breaths were performed by the IMT group twice daily at a resistance equivalent to 50 % maximum inspiratory pressure ( MIP ) , and 60 slow breaths were performed by the sham-IMT group once a day at 15 % MIP for a period of 6 weeks . Results In the IMT group , both MIP and maximum expiratory pressure ( 17 % and 23 % , respectively ; p≤0.03 ) were improved . Similar improvements were noted for the sham-IMT group with 23 % and 33 % from baseline for MIP and maximum expiratory pressure , respectively ( p≤0.03 ) . There were no significant changes in pulmonary function at rest and any of the performance parameters associated with the repetitive sprint test ( sprint and recovery times , peak heart rate and peak blood lactate concentration ) . Reported experiences of using the IMT training device suggested “ less breathlessness ” and “ less tightness in the chest during the training ” . Conclusions Although there was no improvement in sprint performance , an improved respiratory muscle function and quality of life were reported by participants in both the IMT and sham-IMT groups Objective : It is uncertain whether self-propulsion in a wheelchair should be encouraged or discouraged in the early stages of stroke rehabilitation . Design : A two-centre pilot study to assess the feasibility of performing a multicentre r and omized controlled trial on this subject . Setting : Clatterbridge and Aintree Stroke Rehabilitation Units , Merseyside , UK . Subjects : Forty early stroke patients ( mean age 67 years ) in whom it was uncertain whether self-propulsion in a wheelchair should be encouraged were studied . Intervention : A central r and omization service at Newcastle University was used to determine the policy about wheelchair provision and use for each patient . They were allocated to either an ‘ encouraged to self-propel ’ or a ‘ discouraged from self-propulsion group ’ . Outcome measures used : Independent outcome assessment was performed by postal question naire and telephone interview using the Barthel ADL Scale , Nottingham Extended ADL Scales and the shortened General Health Question naire ( GHQ-12 ) at 3 and 12 months . Patient 's length of stay and their Ashworth tone score were also measured either at three months or when they were discharged from hospital . Results : After considerable preparation time it was possible to conduct a trial on self-propulsion in early stroke rehabilitation in the two-pilot centres . No major differences were found between the pilot groups for any of the outcome measures . Conclusions : A multicentre r and omized controlled trial to assess this question is feasible but further work is being conducted before proceeding , to satisfy the concerns expressed to our group regarding the appropriateness of the intervention and the outcome measures . Address for correspondence : JA Barrett , Clatterbridge Hospital , Wirral , Merseyside CH69 4JY , UK . e-mail : BACKGROUND Chronic or recurrent musculoskeletal pain in the cervical and shoulder region is a common secondary problem after spinal cord injury ( SCI ) , reported by 30 % to 70 % of individuals . OBJECTIVE The purpose of this study was to investigate the effect of electromyographic ( EMG ) biofeedback training , in addition to a st and ard exercise program , on reducing shoulder pain in manual wheelchair users with SCI . METHODS Fifteen individuals with SCI , C6 or lower , who were manual wheelchair users with shoulder pain were r and omly assigned to 1 of 2 interventions . The Exercise group ( n = 7 ) received instruction on a st and ard home-based exercise program . The EMG Biofeedback plus Exercise group ( n = 8) received identical exercise instruction plus EMG biofeedback training to improve muscle balance and muscle relaxation during wheelchair propulsion . Shoulder pain was assessed by the Wheelchair Users Shoulder Pain Index ( WUSPI ) at baseline , at posttest 10 weeks after the start of intervention , and at follow-up 16 weeks after posttest . RESULTS The number of participants per group allowed only within-group comparisons ; however , the findings indicated a beneficial effect from EMG biofeedback training .  Shoulder pain , as measured by WUSPI , decreased 64 % from baseline to posttest for the EMG Biofeedback plus Exercise group ( P = .02 ) . Shoulder pain for the Exercise group decreased a nonsignificant 27 % . At follow-up , both groups showed continued improvement , yet the benefit of EMG biofeedback training was still discernible . The EMG Biofeedback plus Exercise group had an 82 % reduction in shoulder pain from baseline to follow-up ( P = .004 ) , while the Exercise group showed a 63 % reduction ( P = .03 ) over the same time period . CONCLUSIONS This study provides preliminary evidence that EMG biofeedback has value when added to an exercise intervention to reduce shoulder pain in manual wheelchair users with SCI . These findings indicate that EMG biofeedback may be valuable in remediating musculoskeletal pain as a secondary condition in SCI . This preliminary conclusion will need to be studied and verified through future work Background Shoulder pain is a common problem after spinal cord injury ( SCI ) , with negative effects on daily activities and quality of life ( QOL ) . Objective The purpose of this study was to determine the effect of an exercise program and instruction to optimize performance of upper-extremity tasks on shoulder pain in people with paraplegia from SCI . Methods / Design Eighty individuals with paraplegia from SCI and shoulder pain were r and omly assigned to receive either an exercise/movement optimization intervention or an attention control intervention . The exercise/movement optimization intervention consisted of a 12-week home-based program of shoulder strengthening and stretching exercises , along with recommendations on how to optimize the movement technique of transfers , raises , and wheelchair propulsion . The attention control group viewed a 1-hour educational video . Outcome measures of shoulder pain , muscle strength ( force-generating capacity ) , activity , and QOL were assessed at baseline , immediately after intervention , and 4 weeks later . Results Shoulder pain , as measured with the Wheelchair User 's Shoulder Pain Index , decreased to one third of baseline levels after the intervention in the exercise/movement optimization group , but remained unchanged in the attention control group . Shoulder torques , most 36-Item Short-Form Health Survey question naire ( SF-36 ) subscale scores , and QOL scores also were improved in the exercise/movement optimization group , but not in the attention control group . Improvements were maintained at the 4-week follow-up assessment . Limitations Many of the outcome measures were self-reported , and the participant dropout rate was high in both groups . Additional studies are needed to determine whether the results of this study can be generalized to individuals with tetraplegia . Conclusions This home-based intervention was effective in reducing long-st and ing shoulder pain in people with SCI . The reduction in pain was associated with improvements in muscle strength and health-related and overall QOL OBJECTIVE To evaluate an exercise protocol design ed to improve strength and mobility , and to decrease injury risk factors in physically restrained nursing home residents . DESIGN A r and omized controlled trial . PARTICIPANTS Ninety-seven residents were r and omized into either exercise or control groups . Thirty-five exercise and 37 control group residents completed all post- assessment s after a 9-week trial . INTERVENTION Walking or wheelchair movement training was supplemented by rowing exercise three times per week . Practice in behaviors related to safe movement was provided incidental to the exercise . MEASUREMENT Endurance , speed , and injury risk measures relevant to walking , wheelchair propulsion , and st and ing were assessed by st and ardized protocol s. Rowing endurance , rowing range of motion , and h and grip strength measures were collected to assess the effect of the rowing component of the exercise protocol . RESULTS Fifty-four percent of the subjects who provided consent did not complete the protocol because of health status changes , lack of cooperation , or physical limitations that precluded exercise . The subjects who completed the exercise program showed significant improvement on injury risk and measures related to upper body strength ( h and grip strength , rowing endurance , wheelchair endurance , and speed ) . Measures related to lower body strength did not significantly improve . CONCLUSION Physically restrained residents are very frail , and it is difficult to implement a long-term exercise program with many residents because of the frailty . However , a substantial proportion of residents did cooperate well with the exercise program and showed improvement on measures correlated with decreased injury risk . The exercise program could be easily modified to include more lower body exercise , and the result ant protocol would be an important adjunct to restraint reduction programs OBJECTIVE To study the longitudinal relation between physical capacity and wheelchair skill performance in subjects with spinal cord injury ( SCI ) during rehabilitation . DESIGN Observational prospect i ve cohort study . Measurements were taken 3 times during subjects ' rehabilitation . SETTING Eight rehabilitation centers in the Netherl and s. PARTICIPANTS Ninety-seven subjects with SCI . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Parameters of physical capacity were upper-extremity muscle strength ( manual muscle test [ MMT ] sum score ) , peak oxygen uptake , and peak power output ( POpeak ) . The Wheelchair Circuit consists of 8 wheelchair skills and results in 3 test scores : ability , performance time , and physical strain . RESULTS POpeak was related to all 3 scores of the Wheelchair Circuit , and the MMT sum score was related to the ability score and the performance time score . The results indicate that ( 1 ) subjects with higher values of POpeak and /or the MMT sum score had better scores on the Wheelchair Circuit than subjects with lower values and ( 2 ) when a subject increased his/her POpeak and /or MMT sum score , this was associated with better wheelchair skill scores . CONCLUSIONS There is a significant longitudinal relation between wheelchair skill performance and POpeak and MMT sum score during the rehabilitation of people with SCI . To optimize wheelchair skill performance , attention should be directed toward manual wheelchair exercise training and strength training of the upper body PURPOSE The purpose of this study was to study the effects of a 7-wk wheelchair training program on physical work capacity in able-bodied subjects . Effects of training intensities of 50 and 70 % heart rate ( HR ) reserve ( HRR ) were studied for different subject groups . METHODS Twenty-seven able-bodied male subjects participated in this study . They were r and omly divided into a control group ( N = 8) , a 50%-intensity group ( N = 9 ) , and a 70%-intensity group ( N = 10 ) . The 50%- and the 70%-intensity groups received a 7-wk wheelchair training program : three times a week , one-half hour wheelchair exercise on a motor driven treadmill at an average intensity of 50 and 70 % of the HRR , respectively . Before and after the training period , parameters for physical work capacity ( maximal isometric strength ( Fiso ) , sprint power ( P30 ) , maximal power output ( POmax ) and peak oxygen uptake ( VO2peak ) ) , and submaximal performance ( mechanical efficiency , HR ) at 20 and 40 % of the estimated POmax ( ME20 , ME40 ; HR20 , HR40 ) were obtained during tests on a stationary wheelchair ergometer . RESULTS A two-factor ANOVA for repeated measures on the within-subjects factor " pre-post tests , " the between-subject factor training ( 50 % and 70 % training vs control ) and the interaction term showed that the 50%-intensity group significantly increased on P30 and POmax compared with the control group . The 70 % intensity group significantly increased on P30 , POmax and VO2peak compared with the control group ( P < 0.05 ) . The 70 % group did not show significantly higher increases in P30 and POmax over training than the 50 % intensity . No significant effects were found for the Fiso and the parameters at submaximal PO . CONCLUSIONS The wheelchair training at both intensities can have favorable effects on maximal physical work capacity in able-bodied subjects , and possibly also on mechanical efficiency at submaximal power output . Effects are seen in parameters for both aerobic and anaerobic work capacities . Although training at 70 % intensity was more effective than the 50 % intensity , training at 50 % HRR may initially be more appropriate in untrained individuals , such as novice wheelchair users at the start of their rehabilitation , to prevent fatigue and enhance motivation Purpose . To simulate the effect of low-intensity exercise in early rehabilitation , we investigated the effect of a 7-week low-intensity norm duration h and rim wheelchair training on the physical capacity in untrained able-bodied individuals . Method . Twenty-five able-bodied participants were r and omly assigned to an experimental and control group : 10 participants exercised 7 weeks , three times a week at 30 % heart rate reserve ( HRR ) for 30 min ( experimental group ) . The control group consisted of  15 participants who did not receive training .  Physical capacity ( maximal isometric strength , sprint power , peak power output and peak oxygen uptake ) and submaximal performance [ heart rate ( HR ) , oxygen uptake ( VO2 ) , mechanical efficiency ( ME ) ] were assessed pre- and post-training . The levels of upper-body discomfort were determined with the use of a Local Perceived Discomfort scale . Results . Compared to the control group the experimental group significantly improved on sprint power ( + 31.2 % ) , peak aerobic power output ( + 34 % ) , submaximal HR , VO2 and ME ( + 16.9 % ) . The participants did not experience high levels of local discomfort in the upper body during the training . Conclusions . Low-intensity norm duration h and rim wheelchair training which significantly improved peak aerobic and sprint power output , efficiency and physical strain in able-bodied untrained individuals . Training at 30 % HRR ( 3 × /week , 30 min/session ) may be appropriate in untrained individuals , such as novice wheelchair users at the start of their rehabilitation , to prevent early fatigue and overuse and enhance motivation . Please note that this article was published in error in a previous issue of the Journal . This paper was su bmi tted and accepted as part of the Special Issue entitled 4th International State-of-the-art-Congress ‘ Rehabilitation : Mobility , Exercise & Sports ’ and has therefore been republished in this issue . The publisher apologises for this error Background : Various combinations of training intensity , duration and frequency are often proposed to people with spinal cord injuries in order to improve their fitness . However , no consensus about a specific training program has been reached for such a population . Objective : This study investigated the effects of a short interval training program specifically design ed for patients with spinal cord injuries . Methods : Paraplegic men performed 30-min wheelchair ergometry three times per week , for 4 weeks .  Maximal dynamic performance and endurance capacity were studied before and after the training program with an incremental test ( 10 W/2 min ) until volitional fatigue and a constant work rate test , respectively . Cardiorespiratory responses were continuously studied during each of these tests . Results : Training induced significant improvement in maximal tolerated power ( + 27.9 % ) , and in peak oxygen consumption ( [ Vdot ] O2 , + 18.5 % ) . After training the subjects were able to maintain the load applied during the constant test ( total mechanical work + 210.7 % ) , for a significantly longer time . The heart rate , [ Vdot ] O2 and ventilation values observed when the volunteers ended their first constant load test were significantly higher ( + 10 % , + 10 % , + 40 % respectively ) than those obtained after a similar time period during the second constant load test which was performed after the training program . Conclusion : After this short training period , with an appropriate combination of different types of training , duration , intensity and frequency exercises , we observed a significant improvement in the fitness level and endurance capacity of paraplegic subjects . Spinal Cord ( 2001 ) 39 , 532–537 PURPOSE The aim of the study was to examine the effect of varying push frequency on pushing economy ( oxygen uptake at a given speed ) . METHODS Eight male wheelchair racers completed a series of exercise bouts on a wheelchair ergometer ( Bromking Turbo Trainer , Bromakin , UK ) at 6.58 m x s(-1 ) . Initially , subjects self-selected their freely chosen push frequency ( FCF ) ; this was followed by 4 r and om trials pushing at 60 , 80 , 120 , and 140 % of this FCF . Steady state VO2 was determined using Douglas bags , and heart rate was recorded by telemetry . After each condition , a small capillary blood sample was obtained and analyzed for blood lactate concentration ( BLa ) and a rating of perceived exertion ( RPE ) was recorded . RESULTS At 6.58 m x s(-1 ) oxygen uptake , RPE , and gross mechanical efficiency were nonlinearly related to push frequency . Analysis of variance showed a significant effect ( P < 0.05 ) of cycle frequency on VO2 . VO2 was 11 % higher at the 140 % FCF compared with the 100 % FCF condition . Changes in push frequency had little effect on HR although BLa increased linearly and was higher at the 140 % FCF condition compared with 60 % FCF ( P < 0.05 ) . A two-dimensional sagittal plane video analysis showed large interindividual differences in propulsion style . Both cycle time and the propulsion phase ( % ) decreased as the push frequency increased . The start angle and end angle of h and contact were similar for conditions , whereas the range of trunk motion decreased with push frequency ( P < 0.05 ) . CONCLUSION The results of this study showed that the push frequency had an effect on pushing economy , and that the athletes ' FCF was the most economical OBJECTIVES To determine if two physical activity programs of varying intensity would result in improved sleep among incontinent and physically restrained nursing home residents . DESIGN Controlled trials of two physical activity programs . SETTING Seven community nursing homes in the Los Angeles area . PARTICIPANTS Residents were included if they had urinary incontinence or were physically restrained . Sixty-five subjects were studied . Mean age was 84.8 years , 85 % were female , mean length of residency in the nursing home was 19.9 months , and mean Mean Mini-Mental State Exam score was 13.1 . INTERVENTION The first physical activity program involved sit-to-st and repetitions and /or transferring and walking or wheelchair propulsion . These activities were performed every 2 hours during the daytime , 5 days per week for 9 weeks . The second , less frequent physical activity program involved rowing in a wheelchair-accessible rowing machine plus walking or wheelchair propulsion once per day three times per week for 9 weeks . MEASUREMENTS The physical function measures reported here include mobility endurance ( maximum time walking or wheeling ) and physical activity as measured by motion sensors ( Caltrac ) . Nighttime sleep was estimated by wrist activity monitors . Nighttime sleep measures included total time asleep , percent sleep , average duration of sleep , and peak duration of sleep . Daytime sleep was measured by timed behavioral observations of sleep versus wakefulness performed every 15 minutes during the day . RESULTS Nighttime sleep was markedly disrupted in both groups at baseline . Across all subjects at baseline , the average total sleep time was 6.2 hours and the percent sleep was 72.0 % , but the average duration of sleep episodes was only 21.2 minutes and the peak duration of sleep episode averaged only 83.8 minutes . During the daytime , subjects were observed asleep during 14.5 % of observations . Although there was improvement in mobility endurance in the intervention subjects compared with controls ( MANOVA F = 4.36 , P = .042 ) , there were no differences in the night and day sleep measures at follow-up testing . Even among a subgroup of intervention subjects who showed a 30 % or greater improvement in mobility endurance , sleep did not improve at follow-up compared with baseline . CONCLUSION This study supports our previous findings of marked sleep disruption in impaired nursing home residents . In addition , despite documented improvements in physical function with activity , we did not find improvements in sleep in the intervention versus control groups . These results suggest that increasing daytime physical activity alone is not adequate to improve sleep in impaired NH residents . Future efforts to improve sleep in this population should take into account the multifactorial nature of sleep disruption , including individual health problems that effect sleep and the disruptive nature of the nighttime NH environment The purpose of the present investigation was to study the effects of an arm ergometer training programme on several physiological variables of recreational wheelchair subjects . Ten paraplegics ( 5 experimental , 5 control ) were tested prior to and immediately after a 2 month exercise regimen at 80 % of peak heart rate ( 30 min per day , 5 days per week , for 8 consecutive weeks at 50 rev/min ) . The results demonstrated significant increases ( P<0.05 ) in VO2max ( 1 min-1 & ml kg-1 min-1 ) and workload but only mild improvements in maximal heart rate and post exercise blood lactates . Body fat , vital capacity and forced expiratory volume did not change with training . Triceps lateralis fibre distribution and fast twitch ( FT ) fibre area were unaffected by the endurance training programme . However , slow twitch ( ST ) fibre area increased ( P < 0·05 ) with training . The results indicate that physiological variables of paraplegic subjects  following an arm ergometer endurance training programme react similarly to changes previously observed in non-h and icapped subjects . The values when compared with normals are low as a result of the relative inactivity of the subjects due to the lack of available exercise programmes for wheelchair people Objectives To report preliminary data relevant to the effects of an exercise and toileting intervention on  pain among incontinent nursing home ( NH ) residents . Design A r and omized controlled intervention trial . Setting and Participants Fifty-one incontinent residents in one skilled NH . InterventionThe intervention was implemented by research staff for a total of 4 times a day ( every 2 hours ) , 5 days a week , for 32 weeks . Residents were provided with incontinence care and assistance to either walk or , if nonambulatory , wheel their chairs , and to repeat sit-to-st and movements . Measurements Pain was measured in two ways at baseline and again at 32 weeks : ( 1 ) a count of the number of  verbal expressions and pain behaviors  during a st and ardized physical performance assessment ; and ( 2 ) a modified Geriatric Pain Measure  administered in a one-on-one interview format . Results There were significant differences between intervention and control groups on all physical performance measures over time , with the intervention group remaining stable and the control group showing a significant decline in sit-to-st and , walking , and wheelchair propulsion endurance . Both groups showed mild to moderate pain at baseline according to each of the two pain measures , while there were no significant changes in pain reports between groups over time based on either measure . There was , however , a trend for pain to increase in the intervention group . Conclusions No significant changes in pain reports were attributable to exercise despite significant improvements in physical performance . In fact , there was a tendency for pain reports to increase with exercise . These preliminary findings suggest that exercise alone may be ineffective for pain management among incontinent NH residents . Care providers should consider that exercise to improve physical function may increase pain symptoms , requiring preemptive analgesia , other pain control strategies , or modified exercise techniques for this frail segment of the NH population OBJECTIVE To test the hypothesis that a brief , formalized period of additional wheelchair skills training is safe and results in significantly greater improvements in wheelchair skills performance than a st and ard rehabilitation program . DESIGN R and omized controlled trial . SETTING Rehabilitation center . PARTICIPANTS Thirty-five wheelchair users ( 20 with musculoskeletal disorders , 15 with neurologic disorders ) admitted for initial rehabilitation . Subjects ' mean age + /- st and ard deviation ( SD ) was 59+/-18.3 years . INTERVENTION Subjects r and omly allocated to the treatment group participated in the Wheelchair Skills Training Program ( WSTP ) , averaging 4.5+/-1.5 training sessions , each 30 minutes long . Subjects in the control group did not receive any wheelchair skills training beyond that given in a typical rehabilitation stay . MAIN OUTCOME MEASURES Wheelchair Skills Test ( WST ) , version 2.4 , before and after training . Changes in total percentage WST score and individual skill scores were examined . RESULTS There were no adverse incidents . The control group 's mean percentage score + /- SD increased from 60.1%+/-14.4 % to 64.9%+/-13.3 % , an 8 % improvement of the posttest relative to the pretest ( P=.01 ) . The WSTP group 's mean score increased from 64.9%+/-9.4 % to 80.9%+/-5.6 % , a 25 % improvement of the posttest relative to the pretest ( P<.000 ) . The WSTP group showed significantly greater improvements than the control group ( P<.000 ) . Among the specific skills , significantly greater improvements were seen in the WSTP group for the gravel and high-curb descent skills ( P<.001 ) . CONCLUSIONS The WSTP is safe and practical and has a clinical ly significant effect on the independent wheeled mobility of new wheelchair users . These findings have implication s for the st and ards of care in rehabilitation programs Study design : This is an open r and omized controlled trial . Objective : The objective of this study was to investigate the effects of a 16-week hybrid cycle versus h and cycle exercise program on fitness and physical activity in inactive people with long-term spinal cord injury ( SCI ) . Setting : The study was conducted in two rehabilitation centers with a specialized SCI unit . Methods : Twenty individuals ( SCI⩾8 years ) were r and omly assigned to a hybrid cycle ( voluntary arm exercise combined with functional electrical stimulation (FES)-induced leg exercise ) or a h and cycle group . During 16 weeks , both groups trained twice a week for 30 min at 65–75 % heart rate reserve . Outcome measures obtained before , during and after the program were fitness ( peak power output , peak oxygen consumption ) , submaximal VO2 and heart rate ( HR ) , resting HR , wheelchair skill performance time score ) and physical activity ( distance travelled in wheelchair and Physical Activity Scale for Individuals with Physical Disabilities ( PASIPD ) score ) . Changes were examined using a two-factor mixed- measures analysis of variance . Results : For all fitness parameters , except for submaximal VO2 , no interaction effects were found . The hybrid cycle group showed a decrease in VO2 over time in contrast to the h and cycle group ( P=0.045 ) . An overall reduction in HRrest ( 5±2 b.p.m . ; P=0.03 ) and overall increase in PASIPD score ( 6.5±2.1 ; P=0.002 ) were found after 16 weeks of training . No overall training effects were found for the other fitness and activity outcome measures . Conclusion : In the current study , hybrid cycling and h and cycling showed similar effects on fitness and physical activity , indicating that there seem to be no additional benefits of the FES-induced leg exercise over h and cycle training alone Objective The purpose of this study was to test the effects of a 6-month Wheelchair-bound Senior Elastic B and ( WSEB ) exercise program on the activities of daily living ( ADL ) and functional fitness of wheelchair-bound older adults with cognitive impairment . Design Cluster r and omized controlled trial was used . A convenience sample of 138 wheelchair-bound older adults with cognitive impairment were recruited from 8 nursing homes in southern Taiwan and were r and omly assigned based on the nursing homes they lived to the experimental ( 4 nursing homes ; n = 73 ) or the control group ( 4 nursing homes ; n = 65 ) . The experimental group performed WSEB exercises 3 times per week and 40 minutes per session for 6 months . The ADL and functional fitness ( cardiopulmonary function , body flexibility , range of joint motion , and muscle strength and endurance ) were examined at baseline , 3 months , and the end of 6-month study . Results The ADL and functional fitness indicators of participants in the experimental group showed significant improvements compared to the control group ( all P < 0.05 ) . Conclusions The WSEB exercises have positive benefits for the ADL and functional fitness of wheelchair-bound older adults with cognitive impairment . It is suggested that WSEB exercises be included as a routine activity in nursing homes . To Cl aim CME Credits : Complete the self- assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME Objectives : Upon completion of this article the reader should be able to : ( 1 ) Underst and the risk factors for functional decline in older adults with dementia ; ( 2 ) Articulate the benefits of structured activities and exercises in the older adult with dementia ; and ( 3 ) Incorporate elastic b and exercises into the treatment plan of wheelchair bound older adults with dementia . Level : Advanced Accreditation : The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians . The Association of Academic Physiatrists design ates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s) ™ . Physicians should only cl aim credit commensurate with the extent of their participation in the activity Abstract Background / Objective : To determine the effect of respiratory resistance training ( RRT ) with a concurrent flow respiratory ( CFR ) device on respiratory function and aerobic power in wheelchair athletes . Methods : Ten male wheelchair athletes ( 8 with spinal cord injuries , 1 with a neurological disorder , and 1 with postpolio syndrome ) , were matched by lesion level and /or track rating before r and om assignment to either a RRT group ( n = 5 ) or a control group ( CON , n = 5 ) . The RRT group performed 1 set of breathing exercises using Exp and -a-Lung , a CFR device , 2 to 3 times daily for 10 weeks . Pre/posttesting included measurement of maximum voluntary ventilation ( MW ) , maximum inspiratory pressure ( MIP ) , and peak oxygen consumption ( Vo2peak ) . Results : Repeated measures ANOVA revealed a significant group difference in change for MIP from pre- to posttest ( P < 0.05 ) . The RRT group improved by 33.0 cm H2O , while the CON group improved by 0.6 cm H2O . Although not significant , the MW increased for the RRT group and decreased for the CON group . There was no significant group difference between Vo2peak for pre/posttesting . Due to small sample sizes in both groups and violations of some parametric statistical assumptions , nonparametric tests were also conducted as a crosscheck of the findings . The results of the nonparametric tests concurred with the parametric results . Conclusions : These data demonstrate that 10 weeks of RRT training with a CFR device can effectively improve MIP in wheelchair athletes . Further research and a larger sample size are warranted to further characterize the impact of Exp and -a-Lung on performance and other cardiorespiratory variables in wheelchair athletes BACKGROUND : The effects of different exercise training programs on the level of physical activity in daily life in patients with COPD remain to be investigated . OBJECTIVE : In patients with COPD we compared the effects of 2 exercise/training regimens ( a high-intensity whole-body endurance- and -strength program , and a low-intensity calisthenics- and -breathing-exercises program ) on physical activity in daily life , exercise capacity , muscle force , health-related quality of life , and functional status . METHODS : We r and omized 40 patients with COPD to perform either endurance- and -strength training ( no. = 20 , mean ± SD FEV1 40 ± 13 % of predicted ) at 60–75 % of maximum capacity ,  or calisthenics- and -breathing-exercises training  ( no. = 20 , mean ± SD FEV1 39 ± 14 % of predicted ) . Both groups underwent 3 sessions per week for 12 weeks . Before and after the training programs the patients underwent activity monitoring with motion sensors , incremental cycle-ergometry , 6-min walk test , and peripheral-muscle-force test , and responded to question naires on health-related quality of life and functional status ( activities of daily living , pulmonary functional status , and dyspnea ) . RESULTS : Time spent active and energy expenditure in daily life were not significantly altered in either group . Exercise capacity and muscle force significantly improved only in the endurance- and -strength group . Health-related quality of life and functional status improved significantly in both groups . CONCLUSIONS : Neither training program significantly improved time spent active or energy expenditure in daily life . The training regimens similarly improved quality of life and functional status . Exercise capacity and muscle force significantly improved only in the high-intensity endurance- and -strength group Abstract In most Paralympic wheelchair sports , active trunk range of movement is assessed by observing shoulder girdle excursion during active trunk movements and is a key determinant of an athlete 's class . However , to date research evaluating the impact of reduced trunk range of movement on wheelchair sports performance has not been conducted . In the present study , 15 non-disabled male participants performed two 20-s sprints on a wheelchair ergometer in each of three seating positions . Positions were typical of those used to enhance sitting stability in wheelchair sport and each impacted available trunk range of movement differently : condition-90 ( seated with thighs horizontal ; unrestricted range of movement ) condition-45 ( seated with thighs in 45 ° ) , and condition-0 ( seated with hips maximally flexed ; minimum range of movement ) . In condition-90 , the trunk only actively contributed to the first push ; for the remainder of the sprint , the trunk was held almost isometrically at 48.2 ° to the horizontal ( range 42.1–56.4 ° ) . Similar patterns were observed for both condition-45 and condition-0 . Compared with condition-90 , participants in condition-0 had reduced capacity to accelerate of statistical ( P < 0.05 ) and practical significance . These findings are an important initial step towards evidence -based decision making in classification . Future research should evaluate the individual and collective impact of other factors that affect the trunk 's contribution to wheelchair sports performance , including strapping , seating position , and impairments of trunk muscle power and coordination
Conclusion : Exercise training programs seem to be effective in improving wheelchair propulsion capacity .
However , there is remarkably little research , particularly for individuals who do not have spinal-cord injury
Objective : An adequate wheelchair propulsion capacity is required to perform daily life activities .
Exercise training may be effective to gain or improve wheelchair propulsion capacity .
This review investigates whether different types of exercise training programs are effective in improving wheelchair propulsion capacity .