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Objective: The purpose of this study was to determine exercise intensity during power wheelchair soccer (PWS) among a sample of persons with mobility impairments. Design: Cross-sectional descriptive. Setting: On-site training facilities of multiple PWS teams. Participants: Thirty participants with severe mobility impairments (MAge = 29.40 ± 15.51 yrs, MBMI = 24.11 ± 6.47, MPower Soccer Experience = 7.91 ± 3.93 yrs, MDisability Sport Experience = 12.44 ± 9.73 yrs) were recruited from multiple PWS teams. Interventions: Portable metabolic carts were used to collect oxygen consumption data during resting (REST) and gameplay (GAME) conditions. Main outcome measure(s): Average VO2 (expressed in METs) for REST and GAME and rate of perceived exertion (RPE) for GAME. Results: VO2 increased from 1.35 ± 0.47 METs at REST to 1.81 ± 0.65 METs during GAME. This 34% increase in exercise intensity was significant (p < .01) and supported by a mean perceived exertion score of approximately 13 (Somewhat Hard). Conclusions: Although not able to sustain an intensity associated with reduced secondary disease risk (i.e., 3 METs), the documented light-intensity exercise in the current study surpassed an intensity threshold associated with improved functional capacity and performance of daily living activities (i.e., 1.5 METs).
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Exercise Intensity During Power Wheelchair Soccer
J.P. Barfield, DA,
Laura Newsome, PhD,
Laurie A. Malone, PhD
From the
Department of Health and Human Performance, Radford University, Radford, VA; and
University of
Alabama-Birmingham/Lakeshore Research Collaborative, Birmingham, AL.
Objective: To determine exercise intensity during power wheelchair soccer among a sample of persons with mobility impairments.
Design: Cross-sectional descriptive.
Setting: On-site training facilities of multiple power wheelchair soccer teams.
Participants: Participants with severe mobility impairments (NZ30) (mean SD, age: 29.4015.51y, body mass index: 24.116.47kg/m
power soccer experience: 7.913.93y, disability sport experience: 12.449.73y) were recruited from multiple power wheelchair soccer teams.
Interventions: Portable metabolic carts were used to collect oxygen consumption (
) data during resting and game play conditions.
Main Outcome Measures: Average
(expressed in metabolic equivalent tasks [METs]) during resting and game play conditions and rating of
perceived exertion for game play.
increased from 1.350.47 METs at rest to 1.810.65 METs during game play. This 34% increase in exercise intensity was
significant (P<.01) and supported by a mean perceived exertion score of approximately 13 (somewhat hard).
Conclusions: Although not able to sustain an intensity associated with reduced secondary disease risk (ie, 3 METs), the documented light-
intensity exercise in the current study surpassed an intensity threshold associated with improved functional capacity and performance of daily
living activities (ie, 1.5 METs).
Archives of Physical Medicine and Rehabilitation 2016;-:-------
ª2016 by the American Congress of Rehabilitation Medicine
Since the classic studies of Blair and Brodney
and Paffenbarger
et al,
research has consistently shown the relationship between
activity-based energy expenditure and reduced risk for chronic
mortality and morbidity. Although this behavioral risk reduction
balance is important to the general population, it becomes even
more essential to persons with disabilities. Disability refers to an
impairment that limits 1 or more activities of daily living.
Unfortunately, persons with disabilities, in particular physical
disabilities, are less likely to engage in healthy physical activity
behavior compared with persons without disabilities.
As a
result, this population not only faces morbidity concerns with their
primary disability, but also secondary disease risk (eg, coronary
artery disease and obesity) becomes profound.
Fortunately, exercise and physical activity behavior have
multiple beneficial outcomes for persons with physical disabil-
ities. Similar to the general population, regular physical activity
among persons with physical disabilities results in improved
improved lipid profiles,
enhanced vascular func-
and reduced chronic disease risk.
For these benefits to
occur, the activity or exercise has to be a regular part of one’s
lifestyle and must be sustained at a specific intensity. The intensity
threshold for the aforementioned health benefits is considered
moderate-intensity exercise and can be quantified as 3 metabolic
equivalent tasks (METs) or, stated differently, an exercise intensity
that is 3 times the energy expenditure at rest.
However, persons with physical disabilities, especially those
with mobility impairments, are more likely to engage in light-
intensity exercise, an effort that falls below the 3-MET
Light-intensity exercise has important benefits to
persons with mobility impairments, including maintenance of
functional capacity or the ability to complete everyday tasks.
For example, a lifestyle that includes light-intensity physical
activity results in improved wheelchair mobility,
improved self-
care skills,
enhanced self-concept,
and enhanced life satisfac-
Although there is debate as to the exact intensity range and
minimum threshold for a behavior to be considered light-intensity
exercise, 1.5 METs is the criteria most often reported as the
Supported by a SEED Grant from the Sponsored Research and Grants Management Depart-
ment of Radford University.
Disclosures: none.
0003-9993/16/$36 - see front matter ª2016 by the American Congress of Rehabilitation Medicine
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Archives of Physical Medicine and Rehabilitation
journal homepage:
Archives of Physical Medicine and Rehabilitation 2016;-:-------
threshold that distinguishes light-intensity exercise from sedentary
behavior (<1.5 METs).
This threshold is an important marker
for persons with mobility impairments because the ability to engage
in light-intensity exercise above 1.5 METs reduces func-
tional decline.
Wheelchair sport as exercise
Increased popularity of disability sport is now exposing more
persons with mobility impairments, especially manual wheel-
chair users, to the protective effects and functional benefits
of regular physical activity. Disability sport is a meaningful
rehabilitation and postrehabilitation physical activity option
and, unlike able-bodied sport, provides greater participation
opportunities as people age.
Sport can be an effective
exercise mode because it has the ability to improve both func-
tional capacity and quality of life.
Functional capacity, or
the ability to do work such as activities of daily living, is un-
questionably enhanced through sport-based fitness improve-
Additionally, quality of life gains are realized through a
variety of mechanisms including enhanced personal relation-
improved self-care skills, and acceptance of
However, the exercise stimulus or demand
varies with each sport, yielding different exercise intensities
during game play that, in turn, yield varied chronic adaptations.
To identify the potential health or functional outcomes of regular
participation in any sport, it is essential to determine the
activity-based exercise intensity for each.
Although there are not an extensive amount of exercise
intensity studies on manual wheelchair sport, the initial efforts
show sustained moderate-intensity exercise across a variety of
competitive sports. Wheelchair basketball has 1 of the highest
activity-based energy demands, resulting in intensities between 4
and 8 METs.
Wheelchair tennis, despite the individual nature
of the sport, does not pose as high a demand. However, sustained
intensities of 3.5e6 METs have been consistently reported.
Energy expenditure has also been examined in wheelchair
rugby, and because of the reduced active muscle mass in these
athletes (ie, players with tetraplegia), sustained energy expendi-
ture appears to be close to the moderate-intensity threshold,
namely 3 METs.
Interestingly, exercise intensity sustained dur-
ing certain active video games appears to be consistent with some
manual wheelchair sports. Sustained intensities of 3e5 METs
have been shown across games such as Wii boxing,
Wii tennis,
and Dance Dance Revolution.
Although one might expect
expenditure during video game play to be lower than the actual
sport, one must remember that the shoulders and upper limbs
serve as the prime movers for both modes of activity. Based on
these initial studies of wheelchair sport, it is clear that certain
sports can meet the threshold for health (3.0 METs) and functional
(1.5 METs) benefits.
Power wheelchair soccer
Power wheelchair soccer is a sanctioned sport for persons with
the most severe mobility impairments. Persons who rely on
power wheelchairs have limited sport/activity opportunities and
are therefore at great risk for a sedentary lifestyle and associated
The sport of power wheelchair soccer requires all
players to use a motorized or electric wheelchair for ambulation,
seemly removing the potential for exercise stress. However,
players have reported perceived exercise efforts during partici-
(ie, participants reported feeling fatigued and tired
after competition, which are typical responses to an exercise
stimulus). Although unexpected, this outcome may be supported
by acute physiological responses demonstrated during activity.
An initial physiological study on power wheelchair soccer
reported that 71% of participants were able to sustain 55% of
maximum heart rate across an entire match.
This acute
response would meet a moderate-intensity threshold; however,
the study did not control for endocrine contributions to the
response. Therefore, it is not clear if the acute heart rate increase
was caused by exercise stress or an elevated hormonal response
to game play.
If exercise stress is demonstrated during power wheelchair
soccer, this sport may be an effective therapeutic modality to
reduce morbidity risk (3 METs) or improve functional capacity
(1.5 METs) among persons with profound mobility impair-
This possibility would be a meaningful outcome
to therapists, physicians, and participants because few physical
activity opportunities exist for power wheelchair users.
Individuals dependent on electric wheelchairs face the greatest
environmental and social barriers to physical activity, and the
need to examine the potential benefits of a viable sport option is
warranted. To determine if power wheelchair soccer exceeds
either a light- or moderate-intensity threshold, it is necessary to
assess exercise intensity during actual participation. Therefore,
the purpose of this study was to determine the exercise intensity
during power wheelchair soccer activity. Our hypothesis,
based on previous studies examining acute responses to power
wheelchair soccer, was that participants would sustain light-
intensity, if not moderate-intensity, exercise during power
wheelchair soccer.
Participants (NZ30) were recruited from 13 regional teams from
the Midwestern, Northeastern, and Southeastern United States. A
description of the project was forwarded to players through team
coaches, but individuals had the option to participate so that there
was no coercion. A convenience sample of approximately 2e3of
each team’s athletes chose to participate within 1 month of
recruitment and consisted primarily of players who were male
(nZ21, 70%) and white (nZ25, 83%). Being a member of a US
Power Soccer Association team was the only eligibility criterion.
Typical of power wheelchair soccer athletes, participants had a
wide range of ages and experience levels (table 1). Power
wheelchair soccer was the only adaptive sport experience among
the majority of participants (nZ18, 60%); however, the partici-
pants’ average of 7 years of power wheelchair soccer experience
shows the veteran status of the group. The participant sample
List of abbreviations:
CP cerebral palsy
MD muscular dystrophy
MET metabolic equivalent task
RPE rating of perceived exertion
SCI spinal cord injury
SMA spinal muscular atrophy
oxygen consumption
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consisted of persons with amputations (nZ1), arthrogryposis
(nZ3), cerebral palsy (CP) (nZ6), spinal muscular atrophy
(SMA) (nZ11), other types of muscular dystrophy (MD) (nZ4),
spinal cord injury (SCI) (nZ4), and traumatic brain injury (nZ1).
Institutional review board approval was obtained before the study,
and all players were required to provide informed consent or
assent with corresponding parent consent before participation.
Exercise intensity was assessed with 2 instruments. A subjective
assessment of exercise intensity was measured with Borg’s 6 to
20 rating of perceived exertion (RPE) scale. The RPE scale
has been used as a valid assessment of effort in the sample
populations, specifically in persons with CP,
and SCI.
The scale criterion associated with light-intensity exercise in the
general population is a score of 11 (fairly light), and the criteria
associated with moderate-intensity exercise is a score of 12e13
(somewhat hard).
An objective assessment of exercise intensity was measured
using 1 of 2 telemetric portable gas analyzers (K4 b2
and Oxycon
). The analyzers were powered 30 minutes before testing
and calibrated according to the instruction manual with gases of
known concentration (16% O
and 4% CO
) before each test day.
Each system was secured to the upper chest with a harness in a
position to minimize impact on movement of the participant. A
flow sensor unit was connected to a face mask fitted over the
participants’ mouth and nose (Hans Rudolph flow sensor
). These
units detect airflow by the rotation of a low-resistance turbine.
Studies have shown both K4 b2 and Oxycon Mobile to be
valid and reliable systems for the measurement of respiration
These systems measure the volume of oxygen
consumption (
) during activity, which is an objective measure
of exercise intensity.
can be reported in multiple units, and
we chose to report units in METs so that we could compare
sustained power wheelchair soccer intensity against the 1.5- and
3.0-MET thresholds of light-intensity and moderate-intensity
exercise, respectively.
was measured breath by breath with
both systems.
Data were collected during regularly scheduled power wheelchair
soccer practices or games. Power wheelchair soccer is played in
two 20-minute continuous-play halves; therefore, we delimited
assessment to continuous game play conditions rather than drill
activity that included stoppage time for coach instruction. At the
start of a practice or game, researchers fitted 1e2 participants
with a portable metabolic analyzer and recorded
every 30
data were converted to METs using a denominator
of 3.5, with the exception of persons with SCI, in which case 2.7
was used to adjust for reduced fat-free muscle mass because of
atrophy in this population.
All recordings were made while the
participant was in his or her game chair, and the portable
equipment was a successful instrument option because players
were able to participate without interruption of data collection or
actual game play. METs were measured over 5 minutes of rest
and at least 10 minutes of continuous game play activity with the
average of 30-second scores reflecting each condition score.
These time frames were selected because they have been used
previously to collect steady-state exercise intensity data, specif-
, for the sample population.
Also, the first 30 sec-
onds of game play was excluded from analyses so that
participants had time to acclimate to the new stage.
RPE was
assessed at the conclusion of at least 10 minutes of continuous
game play.
During practices, game play data were collected on 2 players at
a time during interteam scrimmages (1 player from each team).
Scrimmages typically lasted 10e15 consecutive minutes without
stoppage in play. This time limit was imposed because of the need
for teams to work on other activities within the given practice
time. We collected scores on a regulation power wheelchair soccer
court at 3 distinct practice sites (1 rehabilitation facility, 1 church
gym, and 1 school gym). Data were collected within a 2-day
period at each facility in March, April, and June 2015. Data from
16 independent participants, using both gas analyzers, were
collected during practice conditions. During games, game play
data were collected on 1 player at a time during each game half.
Halves lasted 20 consecutive minutes without stoppage in play.
We aligned testing around conference league play so that we again
collected data within a 2-day period (November 2015) on a
regulation court at an alternative rehabilitation facility. Data from
14 independent participants, using only the K4 b2 unit, were
collected during power wheelchair soccer games.
Although data collection delimited to 1 setting or the other would
have enhanced the internal validity of the study, the dual collection
settings enabled us to double our anticipated sample size, maxi-
mizing the external validity of the current findings. This point is
important because, despite the growth in power wheelchair soccer, it
is difficult to recruit multiple players in any given region, requiring
data collection at multiteam sites. A sample size of 10 participants
was needed to detect a mean increase from 1.0e1.5 METs with 80%
power ( Although 16 partici-
pants were initially recruited, we did not have at least 10 persons
with the same type of physical disability. Fortunately, the ability to
collect data on regulation courts under similar continuous game play
conditions at each facility within 2-day sessions eliminated poten-
tial bias caused by possible seasonal variation or training effects
on responses.
Data check
Because we collected data in 2 settings with 2 gas analyzers, our
first priority was to ensure that data should be grouped together for
analyses. We conducted independent group ttests on mean rest,
game play, and RPE scores to ensure no significant differences
existed between metabolic units or between practice and game
participants (P<.05).
Table 1 Participant demographics
Descriptive Variables Mean SD Range
Age (y) 29.4015.51 7.00e63.00
Height (cm) 162.7915.20 109.00e187.96
Weight (kg) 63.9119.55 27.21e105.20
Body mass index 24.116.47 12.03e39.56
Years in power soccer 7.913.93 0.33e15.00
Years in disability sport 12.449.73 0.33e40.00
Exercise intensity power soccer 3
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Exercise intensity
Mean METs and RPE were computed for game play to determine if
power wheelchair soccer participants sustained light- or moderate-
intensity exercise during game play. A repeated measures ttest was
conducted on METs to determine if exercise intensity increased
significantly from 5 minutes of rest (P<.05). SPSS 22.0
for Mac was
used to analyze all descriptive and inferential statistics. Addition-
ally, we visually inspected scores of players to examine the potential
of disability type to influence acute responses.
Each participant had a complete data set with the exception of 1
practice player missing the 5-minute rest period (because of time
limitation). No significant mean differences existed between gas
analyzers or practice/game participants on mean rest, game play,
or RPE (P>.05) (table 2); therefore, all data were analyzed
collectively as 1 sample (NZ30). Regarding exercise intensity,
participants demonstrated light-intensity exercise, but not
moderate-intensity exercise, during game play conditions while
using a motorized wheelchair (see table 2). Energy expenditure
increased by 34% from the rest period to game play, and this
increase was significant (P<.01). This increase in energy expen-
diture was supported by a mean RPE score of 12.8 after game play
conditions. This perceptual effort score is evaluated as somewhat
hard on the Borg scale.
Twenty of the 30 participants sustained light-intensity exercise
across 10 minutes of power wheelchair soccer activity (ie, 1.5
METs). Although insufficientstatistical power prevented analysesof
subgroups, visual inspection of data did not support disability type as
a discriminating variable between persons who did and did not sus-
tain light-intensity exercise. The majority of participants with each
type of mobility impairment sustained light-intensity exercise;
however, there was at least 1 player with each disability who did not.
In general, athletes with mobility impairments are capable of
sustaining vigorous-intensity exercise (>6 METs) during manual
wheelchair sport.
However, the current population has the
greatest physical challenge to voluntary exercise and, by partici-
pating in power wheelchair soccer, are unable to pursue manual
wheelchair sport options that result in vigorous-intensity exercise.
The purpose of this study was to determine the actual exercise
intensity during power wheelchair soccer, and participants
sustained 1.8 METs or light-intensity exercise across 10 minutes
of game play. Although this intensity does not meet the 3.0-MET
threshold associated with reduced chronic disease risk, the ability
to surpass and sustain 1.5 METs shows exercise stress during
power wheelchair soccer associated with functional benefits. The
objective response to power wheelchair soccer was confirmed by a
perceived increase in effort, with participants ranking game play
as somewhat hard. The current findings identify the ability of
most, but not all, players to sustain light-intensity exercise while
using a power wheelchair.
Comparison to power wheelchair soccer research
The current findings are consistent with initial research into power
wheelchair soccer. Barfield et al
reported that 71% of athletes
with CP and MD sustained moderate-intensity heart rates during
power wheelchair soccer matches. Heart rate can be influenced by
mechanisms associated with physical disability (eg, cocontraction
and increased muscle tone); therefore, the direct assessment of
energy expenditure in the current study is likely a more accurate
measure of exercise intensity. Regardless, our findings and those
reported by Barfield reflect sustained exercise stress during game
play. This finding is further supported by an increase in energy
expenditure from the rest period to drill conditions and drill to
game play followed by a decrease in exercise intensity during
cooldown activities during practice sessions (data not reported).
Even with only a few empirical studies on power wheelchair
soccer, early evidence supports the ability of players to sustain
light-intensity exercise.
The aforementioned physiological data reflect the objective
exercise stress during power wheelchair soccer reported on 2
distinct samples. Jeffress
conducted a longitudinal study of 35
power wheelchair soccer participants and identified exercise
fatigue as a major theme from qualitative responses. His sample
participants repeatedly stressed that power wheelchair soccer was
tiring because of its exercise effect. Perceived exertion was also
reported among a smaller sample (NZ25) of power wheelchair
soccer athletes.
These athletes reported that exercise (ie, power
wheelchair soccer) was difficult and a major barrier to regular
physical activity. The increase in RPE to somewhat hard in the
current study supports the affective perceptions from both
these samples.
Comparison to alternative physical activities
The exercise intensity sustained in the current study is consistent
with a number of functional tasks listed in the compendium of
physical activities including bathing, eating, and washing dishes.
In essence, power wheelchair soccer energy expenditure surpassed
the 1.5-MET threshold for sedentary activity and is comparable
with a number of basic activities of daily living.
light-intensity activity may not have the same health benefits as
sustained moderate-intensity exercise, power wheelchair soccer
requires energy expenditure consistent with everyday self-care
activities reported for the general population. Based on the prin-
ciple of use/disuse, this activity may contribute to increased
longevity of independence and self-care skills. However, caution
is warranted with this assumption because energy expenditure
estimates in the compendium have yet to be validated for varied
populations with mobility impairments.
In addition to functional activities, the acute response in the
current study is similar to the 1.83e2.7 METs reported during
circuit training in manual wheelchair users with SCI.
It is
Table 2 Exercise intensity during power soccer game play
Data Collection
Conditions n Rest METs Game play METs RPE*
Unit 1 8 1.360.51 1.820.72 12.883.53
Unit 2 24 1.320.39 1.760.78 12.632.13
Practice 16 1.290.38 1.830.55 12.332.77
Tournament 14 1.410.56 1.780.76 13.423.26
Sample 30 1.350.47 1.810.65 12.803.11
NOTE. Values are mean SD.
* Borg RPE scale (6e20).
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difficult to speculate as to how power wheelchair activity may
approximate manual wheelchair intensity, but the need to
compensate for atypical muscle tone and involuntary muscle
activity may contribute, at least among players with CP.
need to maintain balance while in the chair, the need to generate
isometric contractions to receive impact, or the need to decelerate
the body after an abrupt spin or stop may also account for some of
the increased energy expenditure during power wheelchair soccer.
The mechanisms that explain the actual intensity increase from the
5-minute rest period need further investigation.
Evaluation by participant group
Although statistical power was lacking to analyze each group,
visual inspection of individual data revealed 2 important find-
ings in this study. The primary finding is that the majority of
participants sustained light- or moderate-intensity exercise
during power wheelchair soccer (nZ20, 67%). At least two-
thirds of players within each disability group surpassed 1.5
METs during game play, with the exception being the double
amputee and athletes with a particular form of MD, namely
SMA (only 55% of these players sustained >1.5 METs). This
outcome highlights the potential of power wheelchair soccer to
serve as an exercise or rehabilitation mode for participants with
a variety of mobility impairments. The second important
outcome is that disability group did not distinguish responders
from nonresponders. In other words, disability group itself did
not distinguish those who sustained light-intensity exercise and
those who did not. Although the subsamples are too small to
draw conclusions, the majority of participants with each type of
disability were able to sustain 1.5 METs during game play
including individuals with arthrogryposis (2/3), CP (5/6), MD
other than SMA (3/4), SCI (3/4), and SMA (6/11). This finding
has important applications to rehabilitation and therapeutic
exercise prescription because questions remain as to which
factors distinguish persons able to sustain light-intensity exer-
cise during power wheelchair soccer (ie, responders) and those
who are not (ie, nonresponders).
Measuring exercise intensity
Although there are multiple ways to examine the exercise in-
tensity of a sport (or energy demand for a given sport), we chose
to use
expressed as METs (1 METZ3.5 mL$kg
Assessment of
is a better option than heart rate in this
sample because persons with mobility impairments can have
either blunted or accelerated heart rate responses to aerobic and
muscular work, making estimates of actual intensity unreliable.
This consideration is especially true for persons with CP
However, METs can be used to determine light- and
moderate-intensity thresholds as well as to compare against
established activities on various compendiums.
Although 1.5
and 3.0 METs may be a meaningful threshold to scientists and
practitioners, a comparison of power wheelchair soccer with
similar compendium activities and self-care skills may be more
meaningful to participants and caregivers.
Study limitations
The major limitation in the current study is the heterogeneous
sample. Caution is warranted when extrapolating these results
because physiological responses can vary within and across
disability types. To address this limitation, we recruited a large
sample size. As a result, the sample findings are robust, less
likely affected by 1 particular group or disability. We maximized
sample size by collecting data under both interteam scrimmages
and conference games. These conditions were synonymous
because both offered continuous game play against an opponent
with no stoppage time. Regardless, future research must test
current findings against larger samples of stratified mobility
impairment groups (nZ10 per group). A second limitation is
that data were collected on-site. This design prevented the
researchers from assessing true resting
; therefore, scores
during the 5-minute rest period are likely higher than actual
resting intensity. To reduce the impact of this limitation, we
determined METs with a denominator of 3.5 (or 2.7 for persons
with SCI) rather than actual resting values. Future research
should assess true resting energy expenditure so that MET values
are relative to actual resting values.
It is worth noting that one should not necessarily use the current
MET values to determine calorie needs. Although assessment of
a valid assessment of energy expenditure, individuals with SPI and CP
may have an altered basal metabolic rate, rendering the use of METs
less useful for energy need usage.
Also, the use of RPE may, ulti-
mately, be a more practical mechanism to estimate energy expenditure
(exercise intensity) during disability sport.
Future research should
investigate the suitability of RPE to determine energy expenditure in
power wheelchair soccer. Finally, our study did not identify mecha-
nisms that distinguished responders from nonresponders. Future
studies on identifying mechanisms that allow players to reach light-
intensity exercise during power wheelchair soccer are needed.
In conclusion, persons with mobility impairments demonstrated
light-intensity exercise during power wheelchair soccer. This
objective assessment was supported by the perceived somewhat
hard effort reported by participants during game play. Although
the threshold may not be sufficient to decrease morbidity risk
(ie, <3.0 METs), the sustained energy expenditure was consistent
with intensities sufficient to enhance functional capacity and
performance of daily living activities (ie, 1.5 METs). The external
validity of the current findings seems strong because the sample
size (NZ30) had adequate power, and the acute responses were
similar across players with different disability types and varied
game play conditions.
a. Wii boxing and tennis; Nintendo.
b. Dance Dance Revolution; Konami.
c. K4 b2 Portable metabolic cart; Cosmed.
d. Oxycon Mobile metabolic cart; Care Fusion Respiratory Care.
e. Hans Rudolph flow sensor; Hans Rudolph, Inc.
f. SPSS 22.0; IBM.
Cerebral palsy; Muscular atrophy, spinal; Muscular dystrophies;
Rehabilitation; Spinal cord injuries
Exercise intensity power soccer 5
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Corresponding author
J.P. Barfield, DA, Box 6957, Radford University, Radford,
VA 24142. E-mail address:
1. Blair SN, Brodney S. Effects of physical inactivity and obesity on
morbidity and mortality: current evidence and research issues. Med
Sci Sports Exerc 1999;31(11 Suppl):S646-62.
2. Paffenbarger RS Jr, Hyde RT, Wing AL, Hsieh CC. Physical activity,
all-cause mortality, and longevity of college alumni. N Engl J Med
3. Centers for Disease Control and Prevention (CDC)National Center for
Health Statistics. DATA 2010. Hyattsville: CDC; 2010. Available at: Accessed September 3, 2015.
4. Haisma JA, Bussmann JB, Stam HJ, et al. Physical fitness in people
with a spinal cord injury: the association with complications and
duration of rehabilitation. Clin Rehabil 2007;21:932-40.
5. Haisma JA, van der Woude LH, Stam HJ, Bergen MP, Sluis TA,
Bussmann JB. Physical capacity in wheelchair-dependent persons
with a spinal cord injury: a critical review of the literature. Spinal
Cord 2006;44:642-52.
6. Malone LA, Barfield JP, Brasher JD. Perceived benefits and barriers
to exercise among persons with physical disabilities or chronic health
conditions within action or maintenance stages of exercise. Disabil
Health J 2012;5:254-60.
7. Kuperminc MN, Stevenson RD. Growth and nutrition disorders in
children with cerebral palsy. Dev Disabil Res Rev 2008;14:137-46.
8. Giacobbi PR Jr, Stancil M, Hardin B, Bryant L. Phyiscal activity and
qualtiy of life experienced by highly active individuals with physical
disabilities. Adapt Phys Activ Q 2008;25:189-207.
9. Devillard X, RimaudD, Roche F, CalmelsP. Effects of training programs
for spinal cord injury. Ann Readapt Med Phys 2007;50. 490-8, 480-9.
10. Nooijen CF, de Groot S, Postma K, et al. A more active lifestyle in
persons with a recent spinal cord injury benefits physical fitness and
health. Spinal Cord 2012;50:320-3.
11. Barfield JP, Malone LA. Perceived exercise benefits and barriers among
power wheelchair soccer players. J Rehabil Res Dev 2013;50:231-8.
12. Garber CE, Blissmer B, Deschenes MR, et al. American College of
Sports Medicine position stand. Quantity and quality of exercise for
developing and maintaining cardiorespiratory, musculoskeletal, and
neuromotor fitness in apparently healthy adults: guidance for pre-
scribing exercise. Med Sci Sports Exerc 2011;43:1334-59.
13. United States Department of Health and Human Services. 2008
physical activity guidelines for Americans. Washington, DC: United
States Department of Health and Human Services; 2008.
14. Manns PJ, Dunstan DW, Owen N, Healy GN. Addressing the
nonexercise part of the activity continuum: a more realistic and
achievable approach to activity programming for adults with mobility
disability? Phys Ther 2012;92:614-25.
15. Warms CA, Whitney JD, Belza B. Measurement and description of
physical activity in adult manual wheelchair users. Disabil Health J
16. Prizer LP, Gay JL, Gerst-Emerson K, Froehlich-Grobe K. The role of
age in moderating the association between disability and light-
intensity physical activity. Am J Health Promot 2016;30:e101-9.
17. Furmaniuk L, Cywinska-Wasilewska G, Kaczmarek D. Influence of
long-term wheelchair rugby training on the functional abilities in
persons with tetraplegia over a two-year post-spinal cord injury.
J Rehabil Med 2010;42:688-90.
18. Sporner ML, Fitzgerald SG, Dicianno BE, et al. Psychosocial impact
of participation in the National Veterans Wheelchair Games and
Winter Sports Clinic. Disabil Rehabil 2009;31:410-8.
19. van Koppenhagen CF, Post M, de Groot S, et al. Longitudinal rela-
tionship between wheelchair exercise capacity and life satisfaction in
patients with spinal cord injury: a cohort study in the Netherlands.
J Spinal Cord Med 2014;37:328-37.
20. Peterson MD, Lukasik L, Muth T, et al. Recumbent cross-training is a
feasible and safe mode of physical activity for significantly motor-
impaired adults with cerebral palsy. Arch Phys Med Rehabil 2013;
21. Mansoubi M, Pearson N, Clemes SA, et al. Energy expenditure
during common sitting and standing tasks: examining the 1.5 MET
definition of sedentary behaviour. BMC Public Health 2015;15:516.
22. Blair CK, Morey MC, Desmond RA, et al. Light-intensity activity
attenuates functional decline in older cancer survivors. Med Sci
Sports Exerc 2014;46:1375-83.
23. McVeigh SA, Hitzig SL, Craven BC. Influence of sport participation
on community integration and quality of life: a comparison between
sport participants and non-sport participants with spinal cord injury. J
Spinal Cord Med 2009;32:115-24.
24. van Langeveld SA, Post MW, van Asbeck FW, et al. Comparing
content of therapy for people with a spinal cord injury in postacute
inpatient rehabilitation in Australia, Norway, and The Netherlands.
Phys Ther 2011;91:210-24.
25. Zamuner AR, Silva E, Teodori RM, Catai AM, Moreno MA. Auto-
nomic modulation of heart rate in paraplegic wheelchair basketball
players: linear and nonlinear analysis. J Sports Sci 2013;31:396-404.
26. Kelly M, Legg D. On-land community-based aerobic and strength
training program for children with cerebral palsy. Eur J Adapt Phys
Act 2009;2:7-20.
27. Kumar A, Karmarkar AM, Collins DM, et al. Pilot study for quan-
tifying driving characteristics during power wheelchair soccer.
J Rehabil Res Dev 2012;49:75-82.
28. Groff DG, Lundberg NR, Zabriskie RB. Influence of adapted sport on
quality of life: perceptions of athletes with cerebral palsy. Disabil
Rehabil 2009;31:318-26.
29. Wessel RD, Wentz J, Markie L. Power soccer: experiences of
students using power wheelchairs in a collegiate athletic club.
J Postsecond Educ Disabil 2011;24:147-59.
30. Goosey-Tolfrey V, Castle P, Webborn N, Abel T. Aerobic capacity
and peak power output of elite quadriplegic games players. Br
J Sports Med 2006;40:684-7.
31. Wu SK, Williams T. Factors influencing sport participation among
athletes with spinal cord injury. Med Sci Sports Exerc 2001;33:177-82.
32. Anneken V, Hanssen-Doose A, Hirschfeld S, Scheuer T, Thietje R.
Influence of physical exercise on quality of life in individuals with
spinal cord injury. Spinal Cord 2010;48:393-9.
33. Martin JJ. Multidimensional self-efficacy and affect in wheelchair
basketball players. Adapt Phys Activ Q 2008;25:275-88.
34. Shapiro DR, Martin JJ. The relationships among sport self-
perceptions and social well-being in athletes with physical disabil-
ities. Disabil Health J 2014;7:42-8.
35. Perrier MJ, Shirazipour CH, Latimer-Cheung AE. Sport participation
among individuals with acquired physical disabilities: group differ-
ences on demographic, disability, and Health Action Process
Approach constructs. Disabil Health J 2015;8:216-22.
36. Abel T, Platen P, Rojas Vega S, Schneider S, Struder HK. Energy
expenditure in ball games for wheelchair users. Spinal Cord 2008;46:
37. Croft L, Dybrus S, Lenton J, Goosey-Tolfrey V. A comparison of the
physiological demands of wheelchair basketball and wheelchair
tennis. Int J Sports Physiol Perform 2010;5:301-15.
38. Perez J, Rabadan M, Pacheco J, Sampedro J. Heart rate assessment
during wheelchair basketball competition: its relationship with
functional classification and specific training design. In: Higgs C,
Vanlandewijck Y, editors. Perspectives. The multidisciplinary series
of physical education and sport science. 7th ed. Berlin: International
Council of Sports Science; 2007. p 151-74.
39. Schmid A, Huonker M, Stober P, et al. Physical performance and
cardiovascular and metabolic adaptation of elite female wheelchair
6 J.P. Barfield et al
FLA 5.4.0 DTD  YAPMR56572_proof  23 July 2016  1:53 pm  ce
basketball players in wheelchair ergometry and in competition.
Am J Phys Med Rehabil 1998;77:527-33.
40. Collins EG, Gater D, Kiratli J, Butler J, Hanson K, Langbein WE.
Energy cost of physical activities in persons with spinal cord injury.
Med Sci Sports Exerc 2010;42:691-700.
41. Roy JL, Menear KS, Schmid MM, Hunter GR, Malone LA. Physi-
ological responses of skilled players during a competitive wheelchair
tennis match. J Strength Cond Res 2006;20:665-71.
42. Howcroft J, Klejman S, Fehlings D, et al. Active video game play in
children with cerebral palsy: potential for physical activity pro-
motion and rehabilitation therapies. Arch Phys Med Rehabil 2012;
43. Hurkmans HL, van den Berg-Emons RJ, Stam HJ. Energy expendi-
ture in adults with cerebral palsy playing Wii Sports. Arch Phys Med
Rehabil 2010;91:1577-81.
44. Jeffress MS. Communication, sport and disability: the case of power
soccer. Surrey, UK: Ashgate; 2015.
45. Barfield JP, Malone LA, Collins JM, Ruble SB. Disability type
influences heart rate response during power wheelchair sport. Med
Sci Sports Exerc 2005;37:718-23.
46. Ensrud E, Kissel JT. Aerobic exercise in muscular dystrophy: gain
without pain. Neurology 2015;85:392-3.
47. Siciliano G, Simoncini C, Giannotti S, Zampa V, Angelini C,
Ricci G. Muscle exercise in limb girdle muscular dystrophies: pitfall
and advantages. Acta Myol 2015;34:3-8.
48. Verschuren O, Peterson MD, Balemans AC, Hurvitz EA. Exercise
and physical activity recommendations for people with cerebral
palsy. Dev Med Child Neurol 2016;58:798-808.
49. Fong DT, Yam KY, Chu VW, Cheung RT, Chan KM. Upper limb
muscle fatigue during prolonged Boccia games with underarm
throwing technique. Sports Biomech 2012:441-51.
50. Love JA, Benson J. Community use of a pushrim activated
power-assisted wheelchair by an individual with facioscapulo-
humeral muscular dystrophy. Physiother Theory Pract 2006;22:
51. Goosey-Tolfrey V, Lenton J, Goddard J, Oldfield V, Tolfrey K,
Eston R. Regulating intensity using perceived exertion in spinal cord-
injured participants. Med Sci Sports Exerc 2010;42:608-13.
52. Duffield R, Dawson B, Pinnington HC, Wong P. Accuracy and reli-
ability of a Cosmed K4b2 portable gas analysis system. J Sci Med
Sport 2004;7:11-22.
53. Rosdahl H, Gullstrand L, Salier-Eriksson J, Johansson P, Schantz P.
Evaluation of the Oxycon Mobile metabolic system against the
Douglas bag method. Eur J Appl Physiol 2010;109:159-71.
54. McCrory MA, Kim HR, Wright NC, Lovelady CA, Aitkens S,
Kilmer DD. Energy expenditure, physical activity, and body
composition of ambulatory adults with hereditary neuromuscular
disease. Am J Clin Nutr 1998;67:1162-9.
55. Campbell IG, Williams C, Lakomy HK. Physiological and meta-
bolic responses of wheelchair athletes in different racing classes to
prolonged exercise. J Sports Sci 2004;22:449-56.
56. Ainsworth BE, Haskell WL, Herrmann SD, et al. 2011 Compendium
of Physical Activities: a second update of codes and MET values.
Med Sci Sports Exerc 2011;43:1575-81.
57. Dirienzo LN, Dirienzo LT, Baceski DA. Heart rate response to
therapeutic riding in children with cerebral palsy: an exploratory
study. Pediatr Phys Ther 2007;19:160-5.
58. Keefer DJ, Tseh W, Caputo JL, Apperson K, McGreal S, Morgan D.
Comparison of direct and indirect measures of walking energy
expenditure in children with hemiplegic cerebral palsy. Dev Med
Child Neurol 2004;46:320-4.
59. Valent LJ, Dallmeijer AJ, Houdijk H, et al. The individual relation-
ship between heart rate and oxygen uptake in people with a tetra-
plegia during exercise. Spinal Cord 2007;45:104-11.
60. Magnuson B, Peppard A, Flomenhoft D. Hypocaloric considerations
in patients with potentially hypometabolic disease states. Nutr Clin
Pract 2011;26:253-60.
61. Leicht CA, Bishop NC, Goosey-Tolfrey VL. Submaximal exercise
responses in tetraplegic, paraplegic and non spinal cord injured elite
wheelchair athletes. Scand J Med Sci Sports 2012;22:729-36.
Exercise intensity power soccer 7
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... The sport prioritizes individuals who do not have the ability to participate in manual wheelchair sports and, unlike partner-assisted programs such as Challenger baseball, allows participants to compete without assistance. This independence is clearly demonstrated through the exercise response as heart rate and calorie consumption both increase to levels considered light-intensity exercise during gameplay (Barfield et al., 2005(Barfield et al., , 2016. Specifically, energy expenditure increases by as much as 34% during gameplay despite the use of a powerchair. ...
... This acute response is due to the characteristics of the sport (contact, change of direction, and acceleration) that require muscle contractions to maintain balance in the chair despite support systems (Jeffress, 2015). This sustained intensity leads to sport-specific benefits such as enhanced functional independence and improved ability to complete activities of daily living (Barfield & Malone, 2013;Barfield et al., 2016;Jeffress & Brown, 2017). ...
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The aim of this study was to identify contextual factors that negatively affect activity and participation among powerchair football (PF) players. Thirty-seven semistructured interviews were conducted with PF players ( M age = 27.9 ± 8.2 years) in France ( n = 18) and the United States ( n = 19). Participants reported acute back and neck pain as the primary morbidities resulting from PF participation, with sustained atypical posture in the sport chair as the primary cause. Competition-related physical and mental stress were also identified as participation outcomes. Accompanying the many benefits of PF, participants recognized negative impacts of discomfort, physical fatigue, and mental fatigue. Interventions such as seating modifications, thermotherapy to combat pain, napping to combat acute physical stress, and mental preparation to manage state anxiety were all identified as prospective interventions.
... The ability of participants to sustain MVPA across multiple WBB training sessions demonstrates its potential effectiveness as an activity promotion initiative. For players unable to sustain moderate-intensity exercise during WBB, light-intensity activity is related to a number of important benefits for persons with physical impairments including improved strength, improved wheelchair propulsion efficiency, improved functional capacity or ability to complete everyday tasks, and improved life satisfaction [47,48]. Additionally, sport for persons with physical impairments, regardless of intensity, has been shown to be essential for optimizing health and performance [45,46]. ...
... Consistent with other sports, scrimmage activities required a greater sustained effort than tactical sport-specific drills. This variation in training intensity has been demonstrated in a number of sports including wheelchair basketball [27,31], wheelchair rugby [49], wheelchair soccer [47,50], and wheelchair tennis [51]. Sport-specific drills typically consist of intermittent, rather than continuous, activity and rest time for instruction. ...
... Mobility is an important indicator of quality of life and is determined by the World Health Organization (WHO) as the key component of activity and social participation [3,4]. However, research has shown that people with disabilities are more likely to live a sedentary lifestyle, which has been proven to be harmful and associated with various chronic diseases, such as cardiovascular disease, diabetes, obesity, etc. [5][6][7]. It is therefore important to quantitatively measure whether a power wheelchair user remains active and therefore lives a healthy lifestyle. ...
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This study is motivated by the fact that there are currently no widely used applications available to quantitatively measure a power wheelchair user’s mobility, which is an important indicator of quality of life. To address this issue, we propose an approach that allows power wheelchair users to use their own mobile devices, e.g., a smartphone or smartwatch, to non-intrusively collect mobility data in their daily life. However, the convenience of data collection brings substantial challenges in data analysis because the data patterns associated with wheelchair maneuvers are not as strong as other activities, e.g., walking, running, etc. In addition, the built-in sensors in different mobile devices create significant heterogeneity in terms of sensitivity, noise patterns, sampling settings, etc. To address the aforementioned challenges, we developed a novel approach composed of algorithms that work collaboratively to reduce noise, identify patterns intrinsic to wheelchair maneuvers, and finalize mobility analysis by removing spikes and dips caused by abrupt maneuver changes. We conducted a series of experiments to evaluate the proposed approach. Experimental results showed that our approach could accurately determine wheelchair maneuvers regardless of the models and placements of the mobile devices.
... Although PF is a four-on-four match played on a regulation indoor basketball court, it is similar to other iterations of football in that athletes demonstrate a sustained exercise stress during competition. Exercise metabolism has been shown to increase by 34% during gameplay and follows a dose-response pattern as average exercise intensity increases from rest to practice to actual gameplay (Barfield et al., 2005(Barfield et al., , 2016Jeffress & Brown, 2017). However, unlike other football variations that serve one primary population (e.g., five-a-side for athletes with visual impairment), PF embraces the Paralympic mission toward social inclusion by empowering persons with varied physical impairments to compete together, including athletes with arthrogryposis, cerebral palsy, muscular dystrophy, spinal cord injury, and spinal muscular atrophy. ...
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The purpose of this study was to initiate the development of an evidence-based sport classification system for powerchair football, a sport that serves athletes with physical impairments. Sport classification is designed to increase participation by minimizing the impact of impairment on competition outcome, and powerchair football lacks an evidence-based system of classification which is required of Paralympic sports. A number of approaches were used to build the theoretical model of sport performance (Step 2 of the International Paralympic Committee model). Key sport activities were identified through surveys of stakeholders and underlying determinants of those key activities were identified through game and database analyses. Current findings support drive control, ball control, communication, and adjustment to the ball as key activities in powerchair football with joint-specific strength and range of motion, sensory, and neurological variables identified as underlying determinants.
... Lower thresholds were considered for this cohort, whose muscle weakness might mean greater exertion produces less activity compared to healthy controls [36]. However, muscle strength is not a direct determinant of limb acceleration [36] and a <100 milli-g/min threshold would have been misleading for more active individuals, including wheelchair users, whose activity and exertion are equivalent to people with other long-term conditions [42]. ...
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Purpose: Measuring the physical activity of adults with progressive muscle diseases is important to inform clinical practice, for activity recommendations and for outcomes meaningful to participants in clinical trials. Despite its wide use, the measurement properties of the International Physical Activity Questionnaire (IPAQ) have not been established in a muscle disease population. Materials and methods: The sample of 103 adults with progressive muscle diseases included independently mobile participants and wheelchair users. Their home-based activity measured by the IPAQ was compared to simultaneous weeks of accelerometer activity data collected remotely in a longitudinal, measure evaluation study. Validity, reliability, and responsiveness were evaluated for the IPAQ alone, and for the IPAQ used in conjunction with a smart activity monitor. Results: The IPAQ did not demonstrate satisfactory criterion validity, reliability or responsiveness and it systematically overestimated moderate and vigorous physical activity time by 161 minutes per week. Measurement properties of the IPAQ were improved when it was used in combination with a smart activity monitor. Conclusions: The IPAQ did not have satisfactory measurement properties compared to accelerometry in adults with progressive muscle disease. Combining self-report and objective activity measures might improve the accuracy of physical activity assessment in this and other comparable populations.Implications for RehabilitationPhysical activity is a meaningful health outcome for adults with progressive muscle diseases, for whom precise activity quantification is important because of the potential for activity-related disease exacerbation.The International Physical Activity Questionnaire (IPAQ) had unsatisfactory measurement properties compared to accelerometry; however, these were improved by adjunctive smart activity monitoring.Objective or combined physical activity measurement is recommended over self-report alone for clinical assessment of physical activity as part of rehabilitation and self-management programmes.
Volt hockey is a team sport developed for persons with physical disabilities, but its influence on well-being is unknown. Elements of well-being have been described as positive emotions, engagement, relationships, meaning, and achievement constituting a theoretical framework referred to as PERMA. The purpose of this study was to describe how well-being according to PERMA is reflected in the experiences of playing volt hockey. Data were collected through focus group and individual interviews including 21 players. A deductive analysis was conducted using the elements in PERMA as preexisting main categories with an additional main category, named resources needed. Findings showed that all five elements constituting well-being according to PERMA were reflected in the experiences of playing volt hockey. In addition, players emphasized the importance of having the resources needed to play volt hockey. In conclusion, having the opportunity to enjoy playing volt hockey enabled the players to flourish and experience feelings of subjective well-being.
Résumé Introduction Le foot-fauteuil (FF) est un sport collectif d’opposition pour personnes ayant un handicap moteur lourd qui se pratique en salle avec un fauteuil électrique spécifique permettant la conduite et la frappe du ballon. Pour les pratiquants de FF, la chaleur d’activation musculaire est limitée. Matériel et méthode L’étude s’est intéressée aux conditions de pratique du FF dans les clubs français pour évaluer l’impact de la température ambiante sur la performance des joueurs. A partir d’études de cas, nous avons vérifié si l’activation musculaire du joueur en situation de match produit une thermogenèse périphérique cutanée permettant d’envisager des mécanismes d’homéostasie. Les informations recueillies par questionnaire ont montré que la température ambiante à l’entraînement est insuffisante (17,7 ± 1,7 °C) et ne correspond pas à celle souhaitée (21,1 ± 2,1 °C). Quelle que soit leur classification, 81 % des joueurs considèrent que le froid impacte négativement leur performance et plusieurs techniques de réchauffement sont utilisées. Au cours de matchs simulés, les enregistrements de la température cutanée par thermo-bouton installé sur le dos de la main de 4 joueurs ont montré une tendance à la thermolyse locale. L’utilisation du sèche-cheveux apporte un rapide bénéfice à court terme (+13,9 et 16,4 °C en 4-5 min) qui ne couvre pas le temps d’une mi-temps de jeu. En conclusion La température ambiante des lieux de pratique trop fraîche serait un facteur limitant pour le contrôle du fauteuil et la sensibilité des joueurs de FF. L’activité musculaire semble insuffisante pour produire une thermogénèse locale et ne permet de compenser l’effet laminaire du vent créé par les déplacements des joueurs sur le terrain. Largement répandue, la technique de réchauffement par un sèche-cheveux pourrait-être une solution rapide et efficace mais son effet n’est pas durable sur une période de jeu. Ces résultats doivent être confortés par l’étude d’un effectif plus important.
Participation in routine physical activity is important for health promotion and prevention of chronic health conditions. Sports and active recreation are activities that are carried out during leisure time and encourage movement and moderate to vigorous physical activity. Participating in sports and active recreation can be beneficial on several levels for children and youth with CP. At the body function and structure level of the ICF, improvements in fitness and endurance have been documented for children and youth with CP. At the activity and participation level of the ICF, improvements in functional mobility, sports skills, and social participation have also been observed. Even with these documented benefits, children and youth with CP participate less in sports and active recreation due to numerous barriers. Healthcare professionals can assist with decreasing barriers to facilitate increased participation. Healthcare professionals should introduce the concept of adaptive sports and active recreation participation to children with CP and their families at an early age. They can facilitate participation by providing resources about adaptive programs and adaptive sports equipment and assisting with sports activity modifications. Healthcare professionals have the expertise to consult with children with CP, their families, and sports coaches or to develop adaptive programs using their knowledge of medical and rehabilitation needs, motor learning and task modification strategies, and adaptive equipment. Information on adaptive sports resources are provided in this chapter.
Purpose: To identify adaptive sports opportunities for individuals who use powered wheelchairs for their primary means of mobility, and to determine barriers and facilitators for new sporting opportunities. Materials and methods: A structured literature review of the peer-reviewed scientific literature and analysis of major adaptive sport competitions information. Pubmed and Scopus were searched for the phrases “Power wheelchair sports” and “complex disability sport” to identify articles discussing competitive sport opportunities for power wheelchair users. Also, the websites and instructional materials were searched to identify what sports exist for power wheelchair users in the Paralympics, the National Veteran Wheelchair Games, the Invictus Games and the Warrior Games. Results: Eleven articles were found from Pubmed and Scopus which met the criteria, most of which were focused on power soccer. The search for sport opportunities from the four major competitions found few events where someone using a power wheelchair could participate, most of which involve a stationary chair during competition (e.g., archery, billiards). Conclusions: This literature review identified few programs for sports for people who use power wheelchairs. Many challenges such as lack of appropriate technology, lack of programs, and challenging classification categories all interact to contribute to this problem. Opportunities exist for better and more appropriate technology to be developed and for new and innovative sports and rules to be adopted for these athletes to benefit more from sport and recreation. • Implications for rehabilitation • Athletes with complex disabilities and high support needs are not provided with the same opportunities as other athletes. • Challenges such as insufficient technology, lack of programs, and challenging classification categories all interact to contribute to the lack of opportunities. • Opportunities exist for better and more appropriate technology to be developed and for new and innovative sports and rules to be adopted for athletes with complex disabilities and high support needs to benefit more from sport and recreation.
Background: Increased understanding of the outcomes associated with physical activity and sports has the potential to guide rehabilitation interventions for children and adolescents with disabilities. Aim: To describe research related to group physical activity and sport participation of children and adolescent wheelchair users. Methods: The five-step framework described by Arksey and O'Malley was used to guide the review. Four electronic databases (MEDLINE, CINAHL, SPORTDiscus, and SCOPUS) were searched for relevant literature and selected articles were screened and evaluated for inclusion. Basic article information, study objectives, participant information, methods, outcome measures (quantitative), and themes (qualitative) were extracted from the selected articles. Outcome measures were coded using the domains of the International Classification of Functioning, Disability, and Health. Results: Seventeen articles were included in the review. The quantitative research articles evaluated outcomes related to test/training parameters (n = 2), evaluation of tools/models (n = 6), and biomechanical/physiological/participation profiles of athletes/equipment (n = 5). Four qualitative studies explored perceptions and experiences with participation, social supports, and identity development. No articles focused on power wheelchair sport. Conclusion: Additional research on evaluating outcomes associated with group physical activity and sport participation is needed to inform clinical practice and guide future research.
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The aim of the research was to measure the physiological demands of Wheelchair Basketball (WB) through individual heart rate (HR) monitoring during high-level competition, as well as individual evaluation in relation to specific team sport variables (functional classification, action/pauses, players´ tactical situation). Five (5) highly trained WB players were monitored using a HR monitor during eleven (11) matches of high-level competition. All players underwent maximal graded exercise tests on a wheelchair ergometer to determine individual maximal aerobic parameters. During all competitions, a video camera was used to film the full events. Video analysis was performed by two trained and independent observer to define players´ tactical situation every 5 sec. Tactical situation is defined by a categorical frame of observation based on rules and depends on role of the player, strategy and opponent behaviour. Average heart rate per match was 132.1 b/min (±31,0), giving a % Heart Rate Reserve (HRR) of 58.4(±25,5). Average heart rate differed by functional class with HR of 115.4(±31.5) b/min (48.1%, ±26.6 of HRR) for class A players, while, for class B average HR was 145.6(±24.6) b/min (66.7%, ±21.3 of HRR). If players’ time on the bench (not playing) is excluded, the average heart rate per match increased to 148.9(±22.8) b/min (72.8%, ±16.5 of HRR). When broken down by class, class A had an average heart rate of 143.9 (±23.3) b/min (73.1% ±15.0 of HRR), while, for class B, the average was 162.7 ±14.5 b/min (81.7% ±11.4 of HRR). To determine the relationship between heart rate reserve %HHR and functional classification, a Spearman correlation coefficient was calculated: showing a coefficient of r=0.33 (p<0.01). Information relating personal %HRR, time and role during games is provided. The interval and non-steady-state nature of WB is clear. The physiological demands were highest when attacking with the ball, as in able-bodied Basketball. The average heart rate is close to 150 b/min during competition (including action and pause situations), so the physiological demand of the sport is very high. Mean recovery is 10% of HRR during pauses during play. Personal %HRR outcomes depend on players, so functional classification plays a major role in physiological performance during competition: the higher the players´ functional potential, the higher %HRR attained. To study physiological demands in team sport competition and, even more so in adapted sports such as WB, HR information has to be related to personal characteristics, and particularly to the players´ functional classification.
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Sports are ubiquitous in American society, and given their prominence in the culture, it is easy to understand how most youth in the United States face pressure to participate in organized sports. But what does this mean for the hundreds of thousands of Americans who live with one or more physical disabilities and, in particular, those in powered wheelchairs? Located at the intersection of sports and disability, this book tells the story of power soccer - the first competitive team sport specifically designed for electric wheelchair users. Beginning in France in the 1970s, today, over sixty teams compete within the United States Power Soccer Association (USPSA) and the sport is actively played in over thirty countries. Using ethnographic research conducted while attending practices, games, and social functions of teams from across the nation, Jeffress builds a strong case that electric wheelchair users deserve more opportunity to play sports. They deserve it because they need the same physical and psychosocial benefits from participation as their peers, who have full use of their arms and legs. It challenges the social constructions and barriers that currently stand in the way. Most importantly, this book tells the story of some amazing power soccer athletes. It is a moving, first-hand account of what power soccer means to them and the implications this has for society.
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Different genetic mutations underlying distinct pathogenic mechanisms have been identified as cause of muscle fibers degeneration and strength loss in limb girdle muscular dystrophies (LGMD). As a consequence, exercise tolerance is affected in patients with LGMD, either as a direct consequence of the loss of muscle fibers or secondary to the sedentary lifestyle due to the motor impairment. It has been debated for many years whether or not muscle exercise is beneficial or harmful for patients with myopathic disorders. In fact, muscular exercise would be considered in helping to hinder the loss of muscle tissue and strength. On the other hand, muscle structural defects in LGMD can result in instability of the sarcolemma, making it more likely to induce muscle damage as a consequence of intense muscle contraction, such as that performed during eccentric training. Several reports have suggested that supervised aerobic exercise training is safe and may be considered effective in improving oxidative capacity and muscle function in patients with LGMD, such as LGMD2I, LGMD2L, LGMD2A. More or less comfortable investigation methods applied to assess muscle function and structure can be useful to detect the beneficial effects of supervised training in LGMD. However, it is important to note that the available trials assessing muscle exercise in patients with LGMD have often involved a small number of patients, with a wide clinical heterogeneity and a different experimental design. Based on these considerations, resistance training can be considered part of the rehabilitation program for patients with a limb-girdle type of muscular dystrophy, but it should be strictly supervised to assess its effects and prevent possible development of muscle damage.
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Sedentary behavior is defined as any waking behavior characterized by an energy expenditure of 1.5 METS or less while in a sitting or reclining posture. This study examines this definition by assessing the energy cost (METs) of common sitting, standing and walking tasks. Fifty one adults spent 10 min during each activity in a variety of sitting tasks (watching TV, Playing on the Wii, Playing on the PlayStation Portable (PSP) and typing) and non-sedentary tasks (standing still, walking at 0.2, 0.4, 0.6, 0.8, 1.0, 1.2, 1.4, and 1.6 mph). Activities were completed on the same day in a random order following an assessment of resting metabolic rate (RMR). A portable gas analyzer was used to measure oxygen uptake, and data were converted to units of energy expenditure (METs). Average of standardized MET values for screen-based sitting tasks were: 1.33 (SD: 0.24) METS (TV), 1.41 (SD: 0.28) (PSP), and 1.45 (SD: 0.32) (Typing). The more active, yet still seated, games on the Wii yielded an average of 2.06 (SD: 0.5) METS. Standing still yielded an average of 1.59 (SD: 0.37) METs. Walking MET values increased incrementally with speed from 2.17 to 2.99 (SD: 0.5 - 0.69) METs. The suggested 1.5 MET threshold for sedentary behaviors seems reasonable however some sitting based activities may be classified as non-sedentary. The effect of this on the definition of sedentary behavior and associations with metabolic health needs further investigation.
Physical activity and its promotion, as well as the avoidance of sedentary behaviour, play important roles in health promotion and prevention of lifestyle-related diseases. Guidelines for young people and adults with typical development are available from the World Health Organisation and American College of Sports Medicine. However, detailed recommendations for physical activity and sedentary behaviour have not been established for children, adolescents, and adults with cerebral palsy (CP). This paper presents the first CP-specific physical activity and exercise recommendations. The recommendations are based on (1) a comprehensive review and analysis of the literature, (2) expert opinion, and (3) extensive clinical experience. The evidence supporting these recommendations is based on randomized controlled trials and observational studies involving children, adolescents, and adults with CP, and buttressed by the previous guidelines for the general population. These recommendations may be used to guide healthcare providers on exercise and daily physical activity prescription for individuals with CP.
One of the first questions patients and families ask when diagnosed with a neuromuscular disorder is “Will exercise help or hurt?” This query is understandable given the multiple historical examples of exercise overcoming weakness and building strength, dating back to Milo of Croton in the 6th century, who practiced the progressive resistance of lifting his growing bull calf, up through more contemporary media proponents as Charles Atlas, Jane Fonda, and Tony Horton in the ubiquitous P90X infomercials. Until recently, however, definitive answers to this query have been elusive, with little hard data on which to base advice. Traditionally, patients with peripheral nerve and muscle disorders were often advised to reduce their physical activity in order to preserve their limited motor function for activities of daily living. Patients with acute radiculopathies, for example, were often admitted to inpatient services for extended bed rest as standard treatment.
Purpose: There's a lack of evidence on the association between light-intensity physical activity and disability. This study examines the relationships in activity by self-reported physical function in five domains (i.e., activities of daily living [ADL], instrumental ADL, leisure activities, lower extremity, and general activities), and whether this association varies by age. Design: Cross-sectional. Setting: Data from National Health and Nutrition Examination Survey 2003-2004 and 2005-2006 waves. Subjects: Participants included 5700 men and women ages 20 to 85 years. Measures: Difficulty with various activities was measured with the Physical Functioning Questionnaire, accelerometer-measured physical activity, demographics, and self-rated health. Analysis: Ordinary least squares regression models were run to examine the relationship between physical function in each domain, light-intensity activity, and the moderating effect of age. Analyses controlled for body mass index, moderate-to-vigorous-intensity activity, self-reported health, accelerometer wear time, and gender. Results: Little variation was seen in light-intensity physical activity among younger adults regardless of disability status. Older adults reporting difficulty with activities engaged in significantly less light-intensity physical activity compared to those with no disability (271.8 vs. 316.5 minutes). Age significantly moderated the association between light-intensity physical activity and leisure activities (p = .048), and lower extremity mobility (p = .039). Age did not moderate other domains of disability. Conclusion: Younger age may be protective regarding the influence of disability on light-intensity activity. In addition, disability may be more debilitating for some older individuals. Interventions to increase light-intensity activity should aim to address disability at all ages, with increased attention for older adults.
Background Despite numerous physical, social, and mental health benefits of engaging in moderate and vigorous intensity physical activities (e.g. sport), few individuals with acquired physical disabilities currently participate in adapted sport. Theory-based sport promotion interventions are one possible way to increase the amount of individuals who engage in sport. Objectives The primary objective of this study was to examine the profiles of three different sport participation groups with respect to demographic, injury, and Health Action Process Approach (HAPA) constructs. Methods ANOVAs and Chi-square tests were used to determine group differences on demographic and disability-related constructs. A MANCOVA was conducted to determine differences between three sport participation groups (non-intenders, intenders, and actors) with age, years post-injury, mode of mobility, and sex included as covariates. Results A cohort of 201 individuals was recruited; 56 (27.9%) were non-intenders, 21 (10.4%) were intenders, and 124 (61.7%) were actors. The MANCOVA revealed significant differences between groups on the HAPA constructs, F(22, 370)=9.02, p<.0001, Pillai’s trace = .70, demonstrating that individuals with acquired physical disabilities will rate important health behaviour constructs differently based on their sport intentions. Conclusion: These results provide an important framework that adapted sport organizations can use to tailor their sport promotion programs.