Biophysical aspects of handcycling performance in rehabilitation, daily life and recreational sports; a narrative review

Figures & data

Figure 1. Two functionally different groups of handcycle configurations following the arm power (AP) and arm-trunk power (ATP) paradigm, combined with the current international classification for handcycle competition (H1–H5) [7,8]. H1, H2: classes for athletes with tetraplegia; H3: athletes lacking trunk function; H4: athletes with trunk function (classes H1, H2, H3, and H4 use arm powered (AP) handcycles); H5: athletes who can sit on their knees, they use arm-trunk powered (ATP) handcycles.

Figure 2. Four conceptual frameworks that fits in the evaluation of handcycle performance. (a) International Classification of Functioning, Disability and Health [29] as applied for persons with a spinal cord injury. Reprinted from [30], Copyright 2006, with permission from Elsevier. (b) Stress Strain Capacity Model [30,31]. Reprinted from [30], Copyright 2006, with permission from Elsevier. (c) Human Activity Assistive Technology Model [32]. (d) Power balance model [33,34]. Reprinted from [33], with permission of author.

Table 1. Overview of research on handcycle training.

First author (year)	Participants		Test design/protocol	Exercise/Training			Outcome Measures
	N (m/f)	Disability		Amount/week	Duration	Type/Intensity
Valent (2008) [67]	162 (120/42)	SCI	T1 = start rehabilitation T2 = discharge T3 = 1 year after discharge Handrim wheelchair peak exercise test	At least once a week (Monitored by questionnaire)	–	–	PO peak, VO2 peak, Peak muscle strength, FVC, PEF
Valent (2009) [76]	22 (18/4)	Tetraplegia	Pre-post test Handcycle peak exercise test on treadmill	3 × 35–45 min 2 × 35–45 min	8 weeks 12 weeks	Interval training At 60–80%HRR	PO peak, VO2 peak, Peak muscle strength, FVC, PEF, Reported shoulder pain
Valent (2010) [81]	17 (14/3)	SCI	Group comparison: Training and control group Wheelchair capacity Handcycle capacity	2 × 35–45 min	Rehabilitation period	Handcycle training on top of regular care 4–7 Borg’s 10-point scale	PO peak, VO2 peak, Peak muscle strength, FVC, PEF
Hettinga (2016) [82]	22 (0/22)	None	Training and control group IET	3 × 30 min	7 weeks	At 65%HRR	PO peak, VO2 peak, HR peak
de Groot (2018) [83]	18 (13/5)	SCI	Pre-post test IET	3 × 60min (Monitored by questionnaire)	4 months	Train for event (Hand Bike Battle)	PO peak, Body mass, BMI, Waist circumference, Fat mass, %fat
Nooijen (2015) [70]	45 (39/6)	SCI	Pre-post test IET	3 × 45–60 min	8 weeks	Interval training 4–7 Borg’s 10-point scale	PO peak, VO2 peak, Feasibility, Satisfaction
Abreu (2016) [84]	15 (15/0)	SCI None	Group comparison In rest	20 min	1 session	4–7 Borg’s 10-point scale SCI: 50–80%HRR Control: 65–90%HRR	HR variability
Schoenmakers (2016) [85]	24 (24/0)	None	Group comparison HIIT MICT Control IET	3 × 30 min	7 weeks	HIIT: 2 × 85%HRR 1 × 55%HRR MICT: 55%HRR Control: no training	PO peak, VO2 peak, VE peak, RER, HR peak
Hoekstra (2017) [65]	59 (48/9/2?)	SCI Amputation Spina Bifida Other	Pre-post test IET	4 hours	4 months	Train for event (Hand Bike Battle)	PO peak, VO2 peak, VE peak, FVC, PEF, BMI, Waist circumference
Mukherjee (2001) [71]	12 (12/0)	SCI	Pre-test Then Every 2 weeks Asynchronous	2 × 15min a day	12 weeks	60–70%HR peak	Propulsion speed, HR peak, VO2, Body weight, Physiological cost index

SCI: spinal cord injury; IET: Incremental Exercise Test; %HRR: percentage of heart rate reserve; PO: power output; VO2: oxygen uptake; FVC: forced vital capacity; PEF: peak expiratory flow; HR: heart rate; BMI: body mass index; %fat: fat percentage; RER: respiratory exchange ratio; VE: ventilation; –: no information available.

Figure 3. Overview of potential adjustments/configurations of a fixed frame handcycle.

Table 2. Overview of research on handcycle dimensions.

First author (year)	Participants		Experimental Set-up	Handcycle Dimensions Tested	Outcome measures
	N (m/f)	Disability
Abel (2003) [164]	35 (27/8)	24 SCI 3 spina bifida 5 amputation	2 IET HC + Ergometer	Propulsion mode; Cadence	VO2, HR, LA
Abel (2015) [94]	21 (15/6)	None	3 IET HC + Ergometer	Grip angle	PO, VO2, HR, LA
Arnet (2014) [139]	13 (9/4)	SCI	Submaximal HC + Tacx DSEM	Crank position; Backrest	PO, GME, Shoulder load
Bafghi (2008) [41]	9 (9/0)	None	Submaximal Treadmill	Propulsion mode; Cadence	PO, GME, FEF, VO2, VCO2, VE, HR, LPD, EMG
Dallmeijer (2004) [165]	13 (13/0)	None	Submaximal Treadmill	Propulsion mode; Cadence	GME,VO2, VE, HR
Faupin (2006) [166]	8 (4/4)	None	8s sprint HC + Ergometer	Cadence	CF, V, RoM
Faupin (2008) [167]	10 (6/4)	None	8s sprint HC + Ergometer	Cadence; Backrest	CF, V, RoM
Faupin (2011) [168]	7 (?)	None	Submaximal HC + Ergometer	Propulsion mode; Backrest; Kneeling position	FEF, Force components, Torque, RoM
Goosey-Tolfrey (2007) [137]	13 (13/0)	Wheelchair users Athletes	Submaximal Ergometer	Propulsion mode	GME, NE, WE, VO2, VE, HR, LA
Goosey-Tolfrey (2008) [136]	8 (8/0)	Wheelchair users Athletes	Submaximal HC + Tacx	Cadence; Crank length	VO2, VE, RER, HR, LA, RPE
Kouwijzer (2018) [88]	10 (7/3)	None	HC + Ergometer	Arm powered vs Arm trunk powered; Foot support	PO, VO2, HR
Kraaijenbrink (2017) [42]	12 (12/0)	None	Submaximal Treadmill	Cadence	PO, CF, GME, FEF, Force components, VO2, HR, RPE
Krämer (2009) [53]	21 (16/5)	None	Ergometer	Handle angle	Work
Krämer (2009) [169]	25 (18/7)	None	Ergometer	Cadence; Crank length; Crank width	PO, CF
Litzenberger (2015) [170]	1 (1/0)	Athlete	HC + Tacx	Seating position; Crank height; Crank length	PO, EMG
Stone (2019) [50]	15 (13/2)	9 SCI 3 amputation 2 cerebral palsy 1 fibromyalgia	IET HC + Ergometer	Crank position	PO, CF, Kinematics, VO2, HR, RPE
van der Woude (2000) [100]	12 (12/0)	None	IET Treadmill	Propulsion mode; Cadence	PO, GME, VO2, VCO2, VE, BF, VT, RER, %HRR, LPD
van der Woude (2008) [109]	9 (9/0)	None	IET Treadmill	Propulsion mode; Cadence; Slope	PO, GME, VO2, VCO2, VE, RER, HR
van Drongelen (2009) [133]	12 (6/6)	None	Ergometer	Crank height; Crank to shoulder distance	PO, GME, VO2, VE, RER, HR, RPE, LPD
Vegter (2019) [49]	12 (12/0)	None	Submaximal HC + Ergometer	Crank position	PO, GME, Torque, Work, Kinematics, VO2, HR
Verellen (2004) [111]	9 (9/0)	SCI	IET Ergometer	Cadence	PO, VO2, VE, RER, HR
Verellen (2012) [43]	12 (12/0)	None	Ergometer	Cadence; Arm powered vs Arm trunk powered	PO, CF, GME, VO2, VE, RER, HR, LA
Weissland (1997) [171]	12 (12/0)	None	IET Ergometer	Cadence	PO, CF, VO2, VE, RER, HR
Zeller (2015) [87]	11 (11/0)	None	IET Sprint HC + Ergometer	Chain wheel (non-circular)	PO, CF, GME, NE, VO2, RER, EE, HR, LA, RPE

SCI: spinal cord injury; IET: Incremental Exercise Test; HC: handcycle; DSEM: Delft Shoulder and Elbow Model; PO: power output; CF: cycle frequency; GME: gross mechanical efficiency; NE: net efficiency; WE: work efficiency; FEF: fraction of effective force; V: velocity; RoM: range of motion; VO2: oxygen uptake; VCO2: carbon dioxide output; VE: ventilation; BF: breathing frequency; VT: tidal volume; RER: respiratory exchange ratio; EE: energy expenditure; HR: heart rate; %HRR: percentage of heart rate reserve; LA: lactate; RPE: rate of perceived exertion; LPD: local perceived discomfort; EMG: electromyography.

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