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Analysis of Physiological and Kinematic Demands of Wheelchair Basketball Games—A Review

Seron, Bruna Barboza1; Oliveira de Carvalho, Emanuel Messias2; Greguol, Márcia2

The Journal of Strength & Conditioning Research: May 2019 - Volume 33 - Issue 5 - p 1453–1462
doi: 10.1519/JSC.0000000000003069
Brief Review

Seron, BB, Oliveira de Carvalho, EM, and Greguol, M. Analysis of physiological and kinematic demands of wheelchair basketball games—A review. J Strength Cond Res 33(5): 1453–1462, 2019—In wheelchair basketball (WB), knowledge of the specificities of the game is essential for efficient planning of training strategies for high performance. This study aimed to review the literature concerning studies that have investigated physiological and kinematic measures during WB games. The literature search took place in 4 electronic databases: Scopus, MEDLINE–PubMed, SPORTDiscus, and CINAHL. The inclusion criteria for this review were as follows: (a) articles that evaluated the behavior of physiological and kinematic variables during WB games; (b) athletes aged at least 18 years; and (c) participants with a minimum of 1 year in the modality practice. The selected studies (n = 16) were divided into 2 groups: physiological analysis (n = 11) and kinematic analysis (n = 5). In analyzing the studies, it was observed that the WB game is very demanding in relation to cardiovascular requirements (∼65% of the time is spent in zones of high heart rate [HR] intensity and 70% of VO2peak). Edwards and Stagno methods seem to be adequate for the control of internal loads imposed on WB players, and moderate correlations were found between rating of perceived exertion measures and HR-based methods. Considering the methodological limitations, kinematic analysis in WB games is rather inconsistent (distance traveled between 2.6 and 5 km; average speed between 1.8 and 2.0 m·s−1; maximum speed = 4 m·s−1). Despite the gaps observed in this context, the execution of rotational movements seems to have great relevance for WB. We can conclude that different methods have been adequate for the internal load control in WB games. However, the results of the external demands are not enough to determine a profile nor to serve as parameters for the training prescription for athletes of the modality.

1Department of Physical Education, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil; and

2Department of Sports Science, State University of Londrina, Londrina, Paraná, Brazil

Address correspondence to Dr. Bruna Barboza Seron,

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Currently, wheelchair basketball (WB) is the most prominent sport in Paralympic events (60). Moreover, according to Molik et al. (43), among the competitive modalities that include individuals with physical disabilities, WB is the most developed sport in relation to number of participants, understanding by the audience, organization, standardization of rules, and quality of training. Thus, this modality involves a variety of different types of disabilities and, consequently, athletes with differentiated functionalities.

Considering the heterogeneity of disabilities found and growing interest in the development of the sport, some studies have been conducted to identify the physiological profile of WB athletes, through laboratory and field tests, while also considering the level of functional classification (18,27,42,44,58,63).

Goosey-Tolfrey and Leicht (28) discussed the use of these tests in wheelchair sports and claimed that because of the limited availability of specialized equipment for wheelchair users in the laboratory, field tests have become the preferred option for coaches. In addition, application in the field presents the advantages of enabling the evaluation of large groups in a shorter time and testing athletes in the natural environment. In addition to the physiological variables, some studies have investigated the biomechanics of technical skills through field tests, propulsion, and position in the wheelchair (11,16,22,41,57,59).

However, there is a criticism that descriptive studies, especially regarding physiological aspects, have limited applicability for prescribing and planning training sessions because they are performed out of the real game context. On the other hand, there are very few studies evaluating athletes' responses during real or simulated competitions (7).

In WB, knowledge about the specificities of the game is essential for efficient planning of training strategies for high performance (51). From this perspective, there is a paucity of research investigating this issue in WB. This can be considered an important gap because knowledge about the dynamics of the game and physiological behavior of players during a game, considering the specificities of their disabilities, could contribute to the planning process and improvement in training, reflecting in the development of athletic performance.

Given the above, we propose some questions: Do professionals working with WB have enough scientific evidence to support methods of controlling game load? Is there enough evidence to direct the planning processes of the training sessions in the modality? Therefore, this study aimed to perform a brief review with the objective of locating researches that have evaluated physiological or kinematic variables of WB players during the games. Moreover, the results of this article can provide to technicians and physical trainers information regarding the specific demands of the modality, as well as identify gaps in knowledge in this area.

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Search Strategy and Inclusion Criteria

The literature search took place in 4 electronic databases—Scopus, 1960–July 2017; MEDLINE–PubMed, 1950–July 2017; SPORTDiscus, 1975–July 2017; CINAHL, 1982–July 2017—to identify studies that investigated physiological or kinematic aspects during WB games.

To this end, an initial search was conducted using the following search terms: wheelchair basketball, wheelchair basketball games, wheelchair basketball team, wheelchair athletes, wheelchair basketball players, wheelchair basketball athletes, wheelchair sports, wheelchair courts ports, and paraplegic basketball. The terms were used alone or combined in groups of two simultaneously, connected by “and” and “or,” to broaden the search. No specific language was imposed. Monographs, dissertations, and theses were excluded from the study because of the difficulty of systematically searching them.

The inclusion criteria of this review were as follows: (a) articles that evaluated the behavior of physiological or kinematic variables during WB games; (b) articles that included a sample of athletes aged at least 18 years; and (c) articles that included participants with a minimum of 1 year in the modality practice.

Two reviewers independently evaluated the titles and abstracts found through the search strategy, taking into account the inclusion criteria. If the title and abstract did not clearly indicate the possibility of inclusion, the article was read in its entirety to determine whether it met the inclusion criteria. Disagreements about the selection of the studies were resolved by consensus. This study was part of the doctoral project approved by the State University of Londrina.

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Selection of the Studies

After the search conducted using the selected terms, the total number of items found in all databases was 1343. Next, the selection of the articles was performed as shown in Figure 1.

Figure 1

Figure 1

The studies that met the inclusion criteria were then presented in accordance with (a) year of publication and author, (b) characteristics of the sample, (c) purpose of the study, (d) variable(s) measured and time of game monitored, and (e) results obtained. All the studies found had a cross-sectional design.

The selected studies (n = 16) are presented below, divided into 2 groups: physiological analysis (n = 11) and kinematic analysis (n = 5). In total, 230 WB athletes were evaluated; the average age was between 25 and 38 years, and most athletes investigated were male. In addition, 50 games and 11 small-sided games (SSGs) were analyzed from championships from the highest level of the sport (Tables 1 and 2).

Table 1-a

Table 1-a

Table 1-b

Table 1-b

Table 2

Table 2

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The investigations found on the physiological performance of the game allow us to state that WB is considered a modality with activities of intermittent efforts that require high-intensity activities with long periods of recovery.

However, the heterogeneity of disabilities may respond differently to the physical stimuli of the game. Despite the many types of motor disabilities found in WB, they are generally divided into 2 classes: neurological disabilities (e.g., spinal cord injury and poliomyelitis) and musculoskeletal disabilities (e.g., amputation) (12). Therefore, for training, it is important to know what game demands were found for the main control variables and how they differ with respect to disability or functional classification.

Heart rate (HR) is the most commonly used measure to monitor training intensity in many sports because it is an important indicator of exercise intensity (4,17).

Wheelchair basketball is considered a modality with a high cardiovascular demand because it was identified that for around 68% of played time, athletes present an HR corresponding to values above the anaerobic threshold (17). In absolute terms, the HR mean values ranged between 148 and 163 b·min−1 during the game for athletes in general, whereas the HR peaks were 174 ± 11 b·min−1 when analyzing only 2 quarters of the game (7) and 190 ± 12 b·min−1 when monitoring throughout the game (17). Furthermore, for SSGs (4 × 4), these values ranged between 167 ± 12 b·min−1 (64) and 173 ± 17 b·min−1 (32).

However, some caution is needed when considering HR as a measure of exercise intensity for individuals with spinal cord injury. Heart rate is regulated by the autonomic innervation of the heart. This variable is altered through medial cortex innervation and also under the influence of muscle receptors sensitive to metabolism which send impulses to the circulatory center, increasing the sympathetic tone (61). As a result, some disabilities can lead to prejudice in HR responses, particularly for people with spinal cord injury at level T-6 or above because they present reduced maximum HR as a result of partial loss of sympathetic cardiac control (13). Thus, Jacobs and Nash (36) stated that individuals with complete spinal cord injury above the fourth thoracic level exhibit maximum HR under 130 b·min−1. Moreover, the working capacity of these individuals is limited by reductions in cardiac output and blood circulation to exercised muscles.

Regarding the differences in HR responses between different disabilities during the game, the results do not allow identification of behavior patterns for this variable. Burnham et al. (12) monitored the HR of 20 WB elite athletes (10 with neurological injuries and 10 with musculoskeletal injuries) during the International Wheelchair Basketball Championship in Edmonton (Canada) and compared HR before and after games. They observed that an hour after starting, athletes with SCI presented lower increases in HR compared to athletes with musculoskeletal disabilities. However, the authors explained that the post-game HR in general was very low (120 ± 19 b·min−1) for all players and claimed that this difference in HR may not have been caused by alterations in the autonomic nervous system, but by age, because those with spinal cord injury were significantly older.

On the other hand, in a game of the German National Basketball Team, it was observed that athletes with spinal cord injuries at higher levels (T-1 to T-10, n = 3) presented higher values of HR during the first period of the game when compared to athletes with spinal cord injuries between T-11 and L-5 (n = 6) and also to athletes with amputations of lower limbs or poliomyelitis (n = 4). However, this difference was not observed in the second period of the game (52). The small number of subjects (n = 3) and the prevalence of higher levels of lesion (T-1 to T-10) may have hampered the analysis of the results.

In a more recent study, Iturricastillo et al. (35) found results indicating that athletes without neurological injuries, when compared to athletes with spinal cord injuries, presented higher HR mean (149.85 ± 13.49 × 160.30 ± 8.95) and HRmax values (161.85 ± 13.88 × 173 ± 13.88) in SSGs. On the other hand, when comparing these groups according to the % HRmax reached during an SSG, this difference was not observed. In this way, monitoring of the effort measured by HR performed by WB players should be performed in an individualized way, and relative values according to the maximum percentage should be used.

In addition, a greater understanding about the demands of the modality can be obtained by stratifying arbitrary ranges of intensity. In this sense, some authors have used HRmax to establish the limits of intensity zones. The proposals for stratification of the HR range were given by Edwards, Stagno, and Delextrat (33–35,55).

Recent studies have used the yo-yo test to evaluate the HRmax of WB athletes and made comparisons with the maximum values obtained during official games. The researches of Urteaga et al. (55) and Iturricastillo et al. (34) indicate that athletes achieve higher HR values during games compared with field tests (189 ± 13 × 178 ± 13 and 188 ± 13 ×178 ± 12). However, for SSGs, the values are slightly higher in the tests in relation to the games (177 ± 13 × 173 ± 17). Thus, it seems that using the HRmax obtained during the game could be an interesting alternative in conditions where it is impossible to evaluate this variable by means of maximum tests. In addition, it is a much more interesting alternative than the use of age-predictive formulas.

Quantification of the time spent in the intensity zones has been performed using the proposal of Delextrat et al. (20) with 4 intensity zones (low < 75% of HRmax; moderate 75–85% of HRmax; high 85–95% of HRmax; and maximal >95% of HRmax). Thus, for official matches, athletes spend between 26% (55) and 38% of the time (33) in high and maximum intensity zones, whereas for SSGs, Iturricastillo et al. (35) indicate a variation between 24% and 40% of the time spent in high and maximum intensity zones.

The concept of training impulse (TRIMP) proposed by Banister aims to integrate the components of the activity into a single measure. However, only one study has quantified the internal load in official games (34) and another in SSGs (32). Both studies found a strong correlation between both methods (Iturricastillo et al. (33): r = 0.959; Iturricastillo et al. (32): r = 0.940). Thus, both methods for the quantification of internal load can be used for determining the loads imposed on athletes during games and trainings.

Therefore, despite evidence that individuals with high spinal cord injury (above T-6) present dysfunction in the autonomic nervous system, the research conducted so far presents divergent results about HR responses according to the type and degrees of disability. Therefore, the use of individual criteria for the control and prescription of HR-based training may be the best strategy. Furthermore, Edwards and Stagno methods seem to be adequate for the control of internal loads imposed on WB players. Nevertheless, regardless of the disability, the WB game seems to require high cardiovascular demands (high rates of HR) and therefore requires high-intensity training to meet the physiological specificities of the game.

Up to the present moment, comparisons between disabilities have been made only from mean and maximum values achieved during games. These comparisons used methods that stratify the time spent in different intensity zones and can contribute to the understanding of the cardiac stress imposed on WB players according to disability or functional class. Also, the relationship between cardiac responses and the external demands imposed during WB games is still unknown; therefore, future studies should investigate these relationships.

The quantification of the game and training load based on the rating of perceived exertion (RPE) of athletes is a practical and low-cost alternative that can provide important information for technicians and physical trainers because it allows for measurement of the local (muscle), central (respiratory), and general effort regarding the demands of the activity performed (10). Therefore, this method has been used in team sports for people without disabilities (31), in laboratory tests for people with disabilities (5), and in some sports for people with disabilities (46).

Only 3 articles that described and correlated (with methods based on HR) the internal load of WB players using RPE were found, one performed in official games (34) and the other two in SSGs (4 quarters of 4 minutes) (32,35). All studies used the scale from 0 to 10 proposed by Foster et al. (24).

The results indicate that the internal load was 521 ± 188.7 AU for the respiratory RPE method and 536 ± 185.8 AU for the muscular RPE method in official games, whereas for the SSG, the values were 99.3 ± 26.9 and 100.8 ± 31.2 AU for respiratory RPE and muscular RPE, respectively. The values between the SSG quarters ranged from 22.3 to 26.2 AU for respiratory RPE and 21.4 to 27.3 AU for muscular RPE. The authors found significantly higher values in the third and fourth quarters compared with the first quarter for muscular RPE. These values are lower than those observed in conventional basketball (45).

Strong correlations were observed in official games and SSGs between respiratory and muscular RPE, but only moderate correlations were found between RPE measures and HR-based methods (Edwards and Stagno) for official games and SSGs. The possible reasons for the low levels of correlation between the methods may be related to the disability, especially for athletes with neurological injury because the loss of sympathetic innervation and alterations in sensory–motor function can affect the perception of effort capacity (46). In addition, the intermittent nature of the modality and the tendency for athletes to report lower values during competitions may also explain the low correlations.

Therefore, the use of this strategy for the quantification of internal load of athletes seems to be a complementary tool. Thus, studies comparing the responses between types of disability (because they present different physiological responses) and functional classes (because they have different functions in games) may broaden the understanding of athletes' responses during the game.

Moreover, the study of Iturricastillo et al. (34) presents a graph in which it is possible to identify variations in RPE values during the 16 analyzed games. Therefore, studies are still needed to investigate the relation between RPE and actions performed by the player during games (e.g., distance traveled, time spent in speed bands, high-intensity activities, and number of technical actions performed), aspects related to technical–tactical difficulties imposed by the match, the differences in technical quality between teams, and the final outcome of the game (victory/defeat).

Knowledge about the energy expenditure of the WB athlete is very important for identifying the intensity of the game. Measurement of the total volume of O2 consumed per unit of time, denominated oxygen consumption, is an important parameter of the global functionality of an individual, reflecting the energy requirement in a given situation (23).

Generally, the intensity of the effort provided by oxygen consumption is analyzed in relation to the percentage of maximum consumption or peak oxygen consumption, which is usually measured in laboratory tests. The peak oxygen consumption (VO2peak) is the primary variable of aerobic capacity and is determined by several factors, especially the quantity of muscle mass exercised, maximal cardiac output, and quantity of oxygen delivered, extracted, and used by the body (26,40,50).

To contextualize, regarding WB, some authors claim that the VO2peak tends to be more limited as the severity of the disability increases (15,29). In this sense, according to Janssen and Hopman (37), the limitation in VO2peak in spinal cord injuries occurs more due to peripheral factors (e.g., low muscular mass and muscular metabolism) than central factors. Part of the limited VO2peak in this population is due to the reduced maximum values of stroke volume and cardiac output in athletes with spinal cord injury when compared with athletes without disabilities. The stroke volume is usually reduced due to the loss of activity in the sympathetic nervous system below the injury, which does not allow the blood level to be redirected effectively to areas of the body not exercised. The result is that less blood returns to the heart with each beat (26).

The WB game provides a rapid increase in VO2 measured during periods of intense activity, with quick recovery to the resting level during periods of lower intensity (7). Unfortunately, few studies investigated oxygen consumption during a WB game, and they did not differentiate this consumption according to the type of disability. Therefore, it is not yet known whether the quantity of energy spent during the game is dependent on functional class or disability.

Despite using different methods for the VO2 measurement, studies have shown that the average oxygen consumption during a WB game is approximately 70% of VO2peak (68.9% ± 7.7% and 72.1% ± 5.72% in the studies of Croft et al. (17) and Bernardi et al. (7), respectively). In the study of Croft et al. (17), the %VO2peak mean in the lactate turn-point (LTP) was 66.7%. On the other hand, in the study of Bernardi et al. (7), the ventilatory threshold was found in 70.7% of VO2peak, similar to that found by Leicht et al. (38) with athletes with paraplegia. Therefore, in relation to the average % of VO2peak during the game, 1 study indicates that the demand was above the second threshold (LTP), pointing out an anaerobic requirement (17), whereas the other (7) expresses this demand close to the first threshold, with more aerobic characteristics.

The different methods of checking thresholds (lactate and ventilatory) and also the intermittent characteristic of the game do not allow to accurately affirm the game demand through VO2peak. However, these results demonstrate that the WB game places high demands on the cardiorespiratory system because there is a predominance of vigorous intensities.

As with the aerobic parameters, anaerobic capacity demonstrates reductions depending on the level of disability; i.e., peak ventilation values and blood lactate concentration, for example, are inversely proportional to the severity of the disability (8,30). Athletes with spinal cord injury, depending on the level, are likely to demonstrate changes in lactate metabolism due to inactive muscles and peripheral sympathetic denervation of the active central areas. Thus, untrained individuals with spinal cord injury or those with higher spinal cord injury do not reach the maximum lactate of 4 mmol·l−1 at the subjective point of exhaustion (52).

Blood lactate concentration gradually increases when the lactate produced in the muscles exceeds its removal, which occurs above the anaerobic threshold intensity. This fact represents the transition from a predominantly aerobic activity to an activity in which anaerobic metabolism increases. Therefore, at intensities above this point, there is extra accumulation of lactate, causing fatigue to the muscles (2).

Croft et al. (17) demonstrated that the majority of time in a WB game is performed above the LTP. Accordingly, the greatest amount of time spent above the LTP can promote increased muscle adaptations, which can remove lactate, causing the LTP to occur at a higher exercise intensity. The WB game is characterized as high-intensity activity, with about 28% of the actions being anaerobic efforts (9). Despite this, 3 studies sought to identify the blood lactate concentration responses to the game, which, although presenting low values, were higher than those investigated in a WB training session (3).

Similarly to the HR results, Schmid et al. (52) found that athletes with a higher level (T-1 to T-10, n = 3) of spinal cord injury presented higher lactate concentration values in the first period of the game compared to athletes with lower levels (T-11 and L-5, n = 6), (2.30 ± 0.70 × 1.81 ± 0.33 mmol·l−1). However, this difference was not observed in the second period (1.80 ± 0.32 × 1.36 ± 0.36 mmol·l−1). The low responses of lactate concentration during a WB game can be understood through the intermittent nature of this modality. Thus, although there are periods of intense activity approaching peak values, lactate is metabolized during the long rest periods or recovery, which represent about 50% of the game (1,7,9,53).

When lactate concentrations were analyzed as a function of the time spent on the court, Urteaga et al. (55) found exponential increases in lactate concentrations as a function of time played. Thus, players who participated in at least 30 minutes of the game presented a higher mean variation in lactate concentrations than those ones who played between 20 and 30 or 1 and 19 minutes (2.25 × 1.42; 1.16 mmol·l−1). In this way, the ability to withstand greater acidosis is required of players who participate in longer periods during the games. However, the analysis of these results should be performed with caution because the last 5 minutes of the game have a great influence on lactate concentrations (1,41) and, because all collections were performed after the games closed, the fact of not playing the final minutes may have contributed to these results.

Owing to the large number of variables that can influence lactate concentrations, the control of games and training intensity through this measure can be compromised, so its use can be replaced by HR control, which is presented as an alternative method, more practical and less invasive to control the intensity of activities performed by WB athletes. However, using the thresholds of lactate concentrations obtained in stress tests to define ranges of intensity may be an interesting alternative to individualize the training prescriptions.

Body temperature is considered an important component of physical performance and has been associated with fatigue in athletes (62). In this sense, a good strategy to maintain temperature at appropriate levels is through fluid intake during games.

The ability to perspire and the ability to perform vasodilation are important mechanisms of thermoregulation. Individuals with spinal cord injury present reduced ability to exercise these mechanisms below the level of the injury. Thus, the regulation of body temperature in people with tetraplegia or high spinal cord injury may be affected because body temperature correlates positively with the ambient temperature (8,12,25).

Thereby, athletes with low-level spinal cord injury have a greater active area for sweating and performing vasodilation compared to individuals with high spinal cord injury. Price et al. (47) cited some studies (48,49) which found sweat rates from 0.7 to 1 L per hour during exercise in hot temperatures in individuals with paraplegia, whereas in athletes without disabilities, at the same relative intensity of exercises with the arms, 0.8–1.3 L per hour were observed.

Studies that investigated the responses of body temperature in a WB game found no risk of hyperthermia. Burnham et al. (12) found a significant but modest increase in body temperature (0.3 ± 0.4° C) after a full WB game, not observing differences between athletes with spinal cord injury and those with other disabilities. More recently, Urteaga et al. (55) found a significant mean increase of 0.69° C between pre-game and post-game tympanic temperature values in playoff matches. In addition, when separated according to time of action in the game, significant increases were also observed; however, the values of temperature increase were 0.74 for the athletes who played between 30 and 40 minutes, 0.66 for those between 20 and 20 minutes, and 0.53 for those between 1 and 19 minutes. It should be noted that the differences observed in the magnitude of temperature increase between studies may be associated with the control of fluid intake and temperature (12) and also to the possible difference in intensity due to the phase of the championship and the games (55).

Another study in an SSG (4 × 4 players) but with the same rules as an official game (4 quarters of 10 minutes) also observed a small but significant temperature increase only in the fourth quarter. In this protocol, the athletes could not ingest any type of liquid, a factor which may have influenced the temperature rise in the final quarter because dehydration is also one of the possible causes of increased temperature (64).

Therefore, although increases in temperature may cause risk of hyperthermia, this situation was not observed in WB athletes after a game. Nevertheless, guidance is suggested about adequate hydration, especially in hotter environments.

Kinematic analysis of human motion has been used as a quantitative evaluation method which, through interpretation of the results, allows for inference of movement details (39). According to some authors, for a WB team to gain competitive advantage, it is necessary to understand both the dynamics of the game and the characteristics of the players involved. The distance traveled by players according to their position or functional classification, for example, can be used to plan subsequent training sessions and even evaluate athletes during competitions (6,21).

By observing the results in the literature, it is not possible to have a clear understanding about the dynamics of a WB game in relation to a player's trajectory, distance, speed, or acceleration. In this sense, 3 studies were conducted and presented very different methodologies and characteristics (14,54). The differences in distances and mean velocities found in the studies were probably due to the different measurement times and the wide variations in age and technical level among the athletes.

Only 3 articles were carried out and present very different objectives, methods, and characteristics. Coutts (14) estimated that players traveled 5 km during the WB game, and Sporner et al. (54) found an average distance traveled of 2.6 km. The players with higher functional classification traveled greater distances than those with lower classes. Regarding the mean speed, the results were very similar, 2 m·s−1 in the first study and 1.8 m·s−1 in the second study; a peak speed of 4 m·s−1 was observed.

The study by Coutts (14) used a system based on a magnetic reed switch attached to the wheelchair and connected to a computer. However, the main limitation was the number of participants and the monitoring time because only 2 players (1 man and 1 woman) were monitored for 6 minutes of a game, and the results were extrapolated for the whole game. Therefore, these results disregard the possible impacts that factors such as fatigue and strategy changes during games may have on the displacements performed by the athletes.

Sporner et al. (54) evaluated 20 military veteran athletes throughout a tournament using Miniaturized Data Logger equipment. However, the analysis was performed at the National Veteran Wheelchair Games where participants were, on average, 39 years old. For this reason, caution is needed when interpreting the results because the features and intensity of the game may not reflect the most representative elite games.

The study of van der Slikke et al. (56) used a new measuring instrument, inertial measurement units, to quantify the displacement demands of WB players. Inertial measurement units provide a significant amount of information, so the authors investigated which kinematic outcomes are key to the performance of athletes of the sport. Results indicated 6 kinematic outcomes that can be divided into 2 groups of movements: forward propulsions (average forward acceleration in the first 2 m from standstill; average forward speed; and average of 5 best forward speeds) and rotational movements (average of the best 5 rotational speeds in a turn; average rotational acceleration; and average rotational speed in a curve). The performance comparisons of these outcomes, according to functional class, competitive level (international or national), and sex, show that international and upper class athletes present the best performances in these variables. In addition, men and women of international level differ only in the outcome average rotational acceleration.

Tracking information is important because the physiological characteristics of a modality are characterized more by the quantity and intensity of propulsion of the wheelchair than the specific skills of that sport. Thus, WB is composed by 64% propulsion and 36% braking actions, with about 240 stops, and restarts in 30 minutes of activity. These actions contribute significantly to the identity of WB as a high-intensity and intermittent modality (14,54). This idea is affirmed and complemented by Bloxham et al. (9), who verified the need for high aerobic and anaerobic demands of the players, observing through time motion analysis that 27.7% of game actions are performed in high-intensity anaerobic actions. These data confirm the high HR values found and discussed above.

Nevertheless, according to the authors, more than half of the game is spent at rest or in low activity actions (12.4% standing on the court during play and 35.9% in substitution actions on the bench or in technical time). Thus, these data also reinforce the results that blood lactate concentration is not a determining factor in a WB game because it is metabolized in these low-activity moments.

Differences have also been observed between the propulsion techniques used by players of different competitive levels (national vs. international) with international players spending less time propelling their chair forward (5 minutes) and making stops (0.7 ± 0.4 vs. 1.2 ± 0.7 minutes) compared with national players. International players perform 7% more rotations and 1% fewer stops compared with national players. However, for the comparisons by positions, the observed differences are minimal (19). Although these results are significant in this area, it is worth noting that the time motion analysis used in the study was performed through visual analysis from video to categorize the actions, which enables many built-in errors.

Although the research is still scarce, the findings in the literature are important for the development of training actions that meet and reflect the activities and demands of the game. However, research relating to the kinematic aspects of the WB game is still needed, specially related to the position of the player on the court, type of disability, and functional classification.

Owing to the low number of studies aimed at quantifying distance and speed values, it is not possible to establish a displacement profile for WB players. However, the characteristics of the propulsion activities and techniques used during the games indicate the importance of the athlete's ability to perform agile rotational movements to make changes in direction. Still, the wheelchair-handling training can be performed without distinction between athletes with different functions (pivot, forward, and guard).

The results of the articles related to the kinematic measures of WB games indicate the existence of important knowledge gaps in this area. Thus, investigating the patterns of displacement of players from different functional classes is still necessary.

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Practical Applications

This research sought to bring together studies that investigated physiological and kinematic aspects of the game of WB. In short, it was revealed that the WB game is very demanding in relation to cardiovascular requirements, translated into high demands of HR (approximately 65% of the time is spent in high-intensity zones) and oxygen consumption (70% of VO2peak). However, its intermittent nature allows large recovery periods during the game, inhibiting large accumulation of lactate, and body temperature increases. Nevertheless, the lactate values obtained in laboratory tests can be used as reference for stratification of HR ranges for intensity control. It seems appropriate the use of the Edwards and Stagno methods for the control of internal loads and the use of PSE measures. Therefore, it is suggested that when planning training, the proposed intensity of the activities is similar to those required in the game.

Kinematic analysis of WB games is rather inconsistent considering the methodological limitations set forth in the few studies found. However, it is still possible to recognize the sport as highly dependent on wheelchair propulsion and braking, expressed by the large number of stops and restarts, which reflect that the major focus should be given to training in relation to the player's ability to move their wheelchairs, especially in rotational movements during the game.

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disability sport; Paralympic; internal load; external load

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