The effect of 16-week low-intensity wheelchair training on functions, activities, and participation in inactive people with a spinal cord injury.

People with a spinal cord injury are often dependent on a (hand rim) wheelchair
and have an inactive lifestyle. Therefore, it is important to develop a good
protocol for wheelchair training, which prevents overuse of the musculoskeletal
system on one hand and improves the physical capacity and prevents the
occurrence of secondary complications on the other hand.
In the world of sport the training guidelines of the ACMS (ACSM, 1993, 1997)
are often used. An intensity of 70-80%HRR, a frequency of 3-5x/week and a
duration of 20-30 min. are in general accepted criteria to induce a training
effect.
However, Haskell (1994) proposed different training guidelines to improve
physical fitness and health. According to Haskell, exercise at a lower
intensity (30-40%HRR) and with a more divers pattern of light activities of
different durations performed every day (like activities of daily living),
might be more suitable for (extreme) inactive people. Additionally the risk for
overuse injuries will be smaller. In 2006 a research project has been performed
to study the effect of a 7-week low-intensity (30%HRR, 3x 70 min/week)
wheelchair training in able-bodied subjects. The results showed that a
low-intensity wheelchair training can improve the physical capacity and
propulsion technique in healty young men. The next step is to investigate the
effect of this training in inactive people with a chronic spinal cord injury.

The primary objective is to evaluate the effectiveness of low-intensity hand
rim wheelchair exercise training on physical capacity, daily (wheelchair)
functioning, participation and quality of life in people with a spinal cord
injury. Furthermore, the effect on secondary complications such as upper body
overuse and cardiovascular risk factors in inactive people with a chronic
spinal cord injury will be studied.

A controlled randomized trial

The experimental groups will receive 16-week low-intensity wheelchair exercise
training (35%HRR; 2x30min/week) or handcycling training (70%HRR, 2x30 min/week)
while the control group will not receive any training.

Subjects will participate in a 10-months research project executing a 16 week
wheelchair or handbike training-program on a treadmill, 2 days/week 30 min on
35%HRR (wheelchair) or 30 min on 70%HRR (handbike).
Measurements will be performed at 4 different time slots.
Subject may experience some discomfort and/or muscle soreness after the peak
exercise test or training. Furthermore, the risks during training and testing
sessions are relatively low because of thorough screening prior to
participation, use of skilled and licensed therapists and safety precautions
throughout training and testing. The expected beneficial training effects in
combination with the limited risks would justify execution of the proposed
study.