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Low-Intensity Wheelchair Training in Inactive People with Long-Term Spinal Cord Injury: A Randomized Controlled Trial on Propulsion Technique

van der Scheer, Jan W. MSc; de Groot, Sonja PhD; Vegter, Riemer J.K. MSc; Hartog, Johanneke MSc; Tepper, Marga MD; Slootman, Hans MD; Veeger, DirkJan H.E.J. PhD; van der Woude, Lucas H.V. PhDALLRISC Group

American Journal of Physical Medicine & Rehabilitation: November 2015 - Volume 94 - Issue 11 - p 975–986
doi: 10.1097/PHM.0000000000000289
Original Research Articles

Objective The objective of this study was to investigate the effects of a low-intensity wheelchair training on propulsion technique in inactive people with long-term spinal cord injury.

Design Participants in this multicenter nonblinded randomized controlled trial were inactive manual wheelchair users with spinal cord injury for at least 10 yrs (N = 29), allocated to exercise (n = 14) or no exercise. The 16-wk training consisted of wheelchair treadmill propulsion at 30%–40% heart rate reserve or equivalent in rate of perceived exertion, twice a week, 30 mins per session. Propulsion technique was assessed at baseline as well as after 8, 16, and 42 wks during two submaximal treadmill-exercise blocks using a measurement wheel attached to a participant’s own wheelchair. Changes over time between the groups were analyzed using Mann-Whitney U tests on difference scores (P < 0.05/3).

Results Data of 16 participants could be analyzed (exercise: n = 8). Significant differences between the exercise and control groups were only found in peak force after 8 wks (respective medians, −20 N vs. 1 N; P = 0.01; ru = 0.78).

Conclusions Significant training effects on propulsion technique were not found in this group. Perhaps, substantial effects require a higher intensity or frequency. Investigating whether more effective and feasible interventions exist might help reduce the population’s risk of upper-body joint damage during daily wheelchair propulsion.

From the Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, the Netherlands (JWvdS, SdG, RJKV, JH, LHVvdW); Amsterdam Rehabilitation Research Center|Reade, Amsterdam, the Netherlands (SdG); Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen, University Medical Center Groningen, the Netherlands (MT, LHVvdW); Heliomare, Rehabilitation Center, Wijk aan Zee, the Netherlands (HS); Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, the Netherlands (DHEJV); and Department of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, the Netherlands (DHEJV).

A complete list of the collaborators in the ALLRISC group is provided at the end of this article.

All correspondence and requests for reprints should be addressed to: Jan W. van der Scheer, MSc, Center for Human Movement Sciences, University Medical Center Groningen, Sector F; PO Box 196, 9700 AD, Groningen, the Netherlands.

The study was part of the research program ALLRISC (, supported financially by Fonds NutsOhra under the responsibility of ZonMw (project number 89000006).

The authors certify that they have no affiliations with or involvement in any organization or entity with any interest in the subject matter or materials discussed in this article.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

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