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

References

• Vignier N, Ravaud J, Winance M, et al. Demographics of wheelchair users in France: results of national community-based handicaps-incapacités-dépendance surveys. J Rehabil Med. 2008;40:231–239.
   PubMed Web of Science ®Google Scholar
• Smith EM, Giesbrecht EM, Mortenson WB, et al. Prevalence of wheelchair and scooter use among community-dwelling Canadians. Phys Ther. 2016;96:1135–1142.
   PubMed Web of Science ®Google Scholar
• LaPlante MP, Kaye HS. Demographics and trends in wheeled mobility equipment use and accessibility in the community. Assist Technol. 2010;22:3–17.
   PubMed Web of Science ®Google Scholar
• van der Woude L, Dallmeijer AJ, Janssen TWJ, et al. Alternative modes of manual wheelchair ambulation: an Overview. Am J Phys Med Rehabil. 2001;80:765–777.
   PubMed Web of Science ®Google Scholar
• Hettinga FJ, Valent LJ, Groen W, et al. Hand-cycling: an active form of wheeled mobility, recreation, and sports. Phys Med Rehabil Clin N Am. 2010;21:127–140.
   PubMedGoogle Scholar
• Hettinga FJ, de Groot S, van Dijk F, et al. Physical strain during handcycling under daily living conditions. Med Sci Sport Exerc. 2010;42:570–571. [Internet]. Available from: http://journals.lww.com/00005768-201005001-01685
   Web of Science ®Google Scholar
• van Breukelen K. Handbiken, ongekende mogelijkheden met betrekking tot vervoer, fitness, recreatie en sport. 1999.
   Google Scholar
• van Breukelen K. Rolstoel performance: man-machine-match. Gouda (The Netherlands): Double performance; 2014.
   Google Scholar
• van den Berg-Emons RJ, Bussmann JB, Haisma JA, Sluis TA, et al. prospective study on physical activity levels after spinal cord injury during inpatient rehabilitation and the year after discharge. Arch Phys Med Rehabil. 2008;89:2094–2101.
   PubMed Web of Science ®Google Scholar
• Ellenberg M, MacRitchie M, Franklin B, et al. Aerobic capacity in early paraplegia: implications for rehabilitation. Paraplegia. 1989;27:261–268.
   PubMedGoogle Scholar
• Goswami A, Ghosh AK, Ganguli S, et al. Aerobic capacity of severely disabled Indians. Ergonomics. 1984;27:1267–1269.
   PubMed Web of Science ®Google Scholar
• de Groot S, Post MW, Hoekstra T, et al. Trajectories in the course of body mass index after spinal cord injury. Arch Phys Med Rehabil. 2014;95:1083–1092.
   PubMed Web of Science ®Google Scholar
• 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;21:932–940.
   PubMed Web of Science ®Google Scholar
• Lagerström AC, Wahman K. Food and Weight. In: Lagerström AC, editor. The art of healthy living with physical impairments. Stockholm (Sweden): Spinalis, Instant Book; 2014.
   Google Scholar
• ACSM. Guidelines for exercise testing and prescription. 1995.
   Google Scholar
• Spurway N, MacLaren D, editors. Exercise Physiology in special populations. Edinburgh (UK): Churchill Livingstone Elsevier; 2008.
   Google Scholar
• Durstine JL, Moore GE. ACSM’s Exercise management for persons with chronic diseases and disabilities. Chapaign (IL): Human Kintecs, ACSM; 2003.
   Google Scholar
• Durstine JL, Painter P, Franklin BA, et al. Physical activity for the chronically ill and disabled. Sports Med. 2000;30:207–219.
   PubMed Web of Science ®Google Scholar
• Frontera WR, Slovnik DM, Dawson DM. Exercise in rehabilitation medicine. Champaign (IL): Human Kinetics Publishers; 2006.
   Google Scholar
• Garber CE, Blissmer B, Deschenes MR, et al.; American College of Sports Medicine. 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 prescribing exercise. Med Sci Sports Exerc. 2011;43:1334–1359.
   PubMed Web of Science ®Google Scholar
• Rimmer JH. Health promotion for people with disabilities: the emerging paradigm shift from disability prevention to prevention of secondary conditions. Phys Ther. 1999;79:495–502.
   PubMed Web of Science ®Google Scholar
• Rimmer JH, Marques AC. Physical activity for people with disabilities. Lancet. 2012;380:193–195.
   PubMed Web of Science ®Google Scholar
• Rimmer JH, Braddock D. Health promotion for people with physical, cognitive and sensory disabilities: an emerging national priority. Am J Health Promot. 2002;16:220–224.
   PubMed Web of Science ®Google Scholar
• Anon. Official Website of the Paralympic Movement. Available from: http://www.paralympic.org/cycling
   Google Scholar
• UCI. Union Cycliste Internationale (UCI). 2015.
   Google Scholar
• Vanlandewijck YC, Thompson WR. The Paralympic Athlete. Chichester (UK): Wiley-Blackwell; 2011.
   Google Scholar
• Anon. MoveForward. [cited 2018. April 4]. Available from: http://moveforward.nu/
   Google Scholar
• Anon. Support for soldiers at the Battleback centre. RBL. [cited 2018 Apr 4]. Available from: https://www.britishlegion.org.uk/get-support/recovery/the-battle-back-centre/
   Google Scholar
• WHO. International Classification of Funtioning, Disability and Health. Geneva (Switzerland): WHO; 2001.
   Google Scholar
• van der Woude LHV, de Groot S, Janssen TWJ. Manual wheelchairs: research and innovation in rehabilitation, sports, daily life and health. Med Eng Phys. 2006;28:905–915.
   PubMed Web of Science ®Google Scholar
• Dijk F, Dormolen M, Kompier M, et al. Herwaardering model arbeidsbelastbaarheid. TSG. 1990;68:3–10.
   Google Scholar
• Cook A, Polgar J, Encarnação P. Assistive technologies 5th edition: principles and practice. 5th ed. St. Louis (MO): Elsevier; 2020.
   Google Scholar
• Arnet U. Handcycling: a biophysical analysis. Amsterdam (The Netherlands): Vrije Universiteit; 2012.
   Google Scholar
• Groen WG, van der Woude LV, De Koning JJ. A power balance model for handcycling. Disabil Rehabil. 2010;32:2165–2171.
   PubMed Web of Science ®Google Scholar
• van Ingen Schenau G, Ingen Schenau G. v. Cycle power: a predictive model. Endeav New Ser. 1988;12:44–47.
   PubMed Web of Science ®Google Scholar
• van Ingen Schenau GJ. Power balance applied to speed skating. Vrije Universiteit te Amsterdam; 1981.
   Google Scholar
• van der Woude L, Veeger HE, Dallmeijer AJ, et al. Biomechanics and physiology in active manual wheelchair propulsion. Med Eng Phys. 2001;23:713–733.
   PubMed Web of Science ®Google Scholar
• van der Woude L. Manual wheelchair propulsion: an ergonomic perspective. 1989.
   Google Scholar
• van der Woude LHV, de Groot G, Hollander AP, et al. Wheelchair ergonomics and physiological testing of prototypes. Ergonomics. 1986;29:1561–1573.
   PubMed Web of Science ®Google Scholar
• Mason BS, van der Woude LV, Goosey-Tolfrey VL. The ergonomics of wheelchair configuration for optimal performance in the wheelchair court sports. Sports Med. 2013;43:23–38.
   PubMed Web of Science ®Google Scholar
• Bafghi HA, de Haan A, Horstman A, et al. Biophysical aspects of submaximal hand cycling. Int J Sports Med. 2008;29:630–638.
   PubMed Web of Science ®Google Scholar
• Kraaijenbrink C, Vegter RJK, Hensen AHR, et al. Different cadences and resistances in submaximal synchronous handcycling in able-bodied men: effects on efficiency and force application. PLoS One. 2017;12:e0183502.
   PubMed Web of Science ®Google Scholar
• Verellen J, Meyer C, Janssens L, et al. Peak and submaximal steady-state metabolic and cardiorespiratory responses during arm-powered and arm-trunk-powered handbike ergometry in able-bodied participants. Eur J Appl Physiol. 2012;112:983–989.
   PubMed Web of Science ®Google Scholar
• Kloosterman MGM, Eising H, Schaake L, et al. Comparison of shoulder load during power-assisted and purely hand-rim wheelchair propulsion. Clin Biomech (Bristol, Avon). 2012;27:428–435.
   PubMed Web of Science ®Google Scholar
• Pr GCE, Jr. Levy Dietrich FD, et al. Wheelchair users’ perceptions of and experiences with power assist wheels. Am J Phys Med Rehabil. 2010;89:225–234.
   PubMed Web of Science ®Google Scholar
• Nawoczenski DA, Clobes SM, Gore SL, et al. Three-dimensional shoulder kinematics during a pressure relief technique and wheelchair transfer. Arch Phys Med Rehabil. 2003;84:1293–1300.
   PubMed Web of Science ®Google Scholar
• Kraaijenbrink C, Vegter RJK, Hensen AHR, et al. Biomechanical and physiological differences between synchronous and asynchronous low intensity handcycling during practice-based learning in able-bodied men. J Neuroeng Rehabil. 2020;17:29.
   PubMed Web of Science ®Google Scholar
• Quittmann OJ, Abel T, Albracht K, et al. Biomechanics of all-out handcycling exercise: kinetics, kinematics and muscular activity of a 15-s sprint test in able-bodied participants. Sport Biomech. [Internet]. 2020 May 7 [cited 2020 May 8]:[1–24]. Available from: https://www.tandfonline.com/doi/full/https://doi.org/10.1080/14763141.2020.1745266
   Google Scholar
• Vegter RJK, Mason BS, Sporrel B, et al. Crank fore-aft position alters the distribution of work over the push and pull phase during synchronous recumbent handcycling of able-bodied participants. PLoS One. 2019;14:e0220943
   PubMed Web of Science ®Google Scholar
• Stone B, Mason BS, Warner MB, et al. Horizontal crank position affects economy and upper limb kinematics of recumbent handcyclists. Med Sci Sport Exerc. 2019;51:2265–2273.
   PubMed Web of Science ®Google Scholar
• Verellen J, Meyer C, Reynders S, et al. Consistency of within-cycle torque distribution pattern in hand cycling. J Rehabil Res Dev. 2008;45:1295–1302.
   PubMed Web of Science ®Google Scholar
• Arnet U, van Drongelen S, van der Woude LH, et al. Shoulder load during handcycling at different incline and speed conditions. Clin Biomech (Bristol, Avon). 2012;27:1–6.
   PubMed Web of Science ®Google Scholar
• Krämer C, Schneider G, Böhm H, et al. Effect of different handgrip angles on work distribution during hand cycling at submaximal power levels. Ergonomics. 2009;52:1276–1286.
   PubMed Web of Science ®Google Scholar
• Quittmann OJ, Abel T, Albracht K, et al. Reliability of muscular activation patterns and their alterations during incremental handcycling in able-bodied participants. Sport Biomech. 2019.
   Google Scholar
• Arnet U, Drongelen S, Scheel-Sailer A, et al. Shoulder load during synchronous handcycling and handrim wheelchair propulsion in persons with paraplegia. J Rehabil Med. 2012;44:222–228.
   PubMed Web of Science ®Google Scholar
• Van Drongelen S, Schlüssel M, Arnet U, et al. The influence of simulated rotator cuff tears on the risk for impingement in handbike and handrim wheelchair propulsion. Clin Biomech (Bristol, Avon). 2013;28:495–501.
   PubMed Web of Science ®Google Scholar
• Praagman M, Stokdijk M, Veeger HEJ, et al. Predicting mechanical load of the glenohumeral joint, using net joint moments. Clin Biomech (Bristol, Avon). 2000;15:315–321.
   PubMed Web of Science ®Google Scholar
• Nikooyan AA, Veeger HE, Chadwick EK, et al. Development of a comprehensive musculoskeletal model of the shoulder and elbow. Med Biol Eng Comput. 2011;49:1425–1435.
   PubMed Web of Science ®Google Scholar
• Veeger HEJ, Rozendaal LA, Van der Helm FCT. Load on the shoulder in low intensity wheelchair propulsion. Clin Biomech (Bristol, Avon). 2002;17:211–218.
   PubMed Web of Science ®Google Scholar
• Dallmeijer AJ, Zentgraaff IDB, Zijp NI, et al. Submaximal physical strain and peak performance in handcycling versus handrim wheelchair propulsion. Spinal Cord. 2004;42:91–98.
   PubMed Web of Science ®Google Scholar
• Hettinga FJ, de Groot S, van Dijk F, et al. Physical strain of handcycling: an evaluation using training guidelines for a healthy lifestyle as defined by the American College of Sports Medicine. J Spinal Cord Med. 2013;36:376–382.
   PubMed Web of Science ®Google Scholar
• Nash MS. Exercise as a health-promoting activity following spinal cord injury. J Neurol Phys Ther. 2005;29:87–106.
   PubMedGoogle Scholar
• Nooijen CF, Stam HJ, Bergen MP, et al.; Act-Active Research Group. A behavioural intervention increases physical activity in people with subacute spinal cord injury: a randomised trial. J Physiother. 2016;62:35–41.
   PubMed Web of Science ®Google Scholar
• de Groot S, Post MW, Snoek GJ, et al. Longitudinal association between lifestyle and coronary heart disease risk factors among individuals with spinal cord injury. Spinal Cord. 2013;51:314–318.
   PubMed Web of Science ®Google Scholar
• Hoekstra S, Valent L, Gobets D, et al. Effects of four-month handbike training under free-living conditions on physical fitness and health in wheelchair users. Disabil Rehabil. 2017;39:1581–1588.
   PubMed Web of Science ®Google Scholar
• Martin Ginis KA, Van Der Scheer JW, Latimer-Cheung AE, et al. Evidence-based scientific exercise guidelines for adults with spinal cord injury: an update and a new guideline. Spinal Cord. 2018;56:308–321.
   PubMed Web of Science ®Google Scholar
• Valent LJ, Dallmeijer AJ, Houdijk H, et al. Influence of hand cycling on physical capacity in the rehabilitation of persons with a spinal cord injury: a longitudinal cohort study. Arch Phys Med Rehabil. 2008;89:1016–1022.
   PubMed Web of Science ®Google Scholar
• Knechtle B, Müller G, Knecht H. Optimal exercise intensities for fat metabolism in handbike cycling and cycling. Spinal Cord. 2004;42:564–572.
   PubMed Web of Science ®Google Scholar
• Short KR, Teague AM, Klein JC, et al. The effect of handcycle ergometer exercise on glucose tolerance in ambulatory and non-ambulatory adolescents. Pediatr Exerc Sci. 2017;29:63–72.
   PubMed Web of Science ®Google Scholar
• Nooijen CF, van den Brand IL, ter Horst P, et al. Feasibility of handcycle training during inpatient rehabilitation in persons with spinal cord injury. Arch Phys Med Rehabil. 2015;96:1654–1657.
   PubMed Web of Science ®Google Scholar
• Mukherjee G, Bhowmik P, Samanta A. Physical fitness training for wheelchair ambulation by the arm crank propulsion technique. Clin Rehabil. 2001;15:125–132.
   PubMed Web of Science ®Google Scholar
• Abel T, Kröner M, Rojas VS, et al. Energy expenditure in wheelchair racing and handbiking - a basis for prevention of cardiovascular diseases in those with disabilities. Eur J Cardiovasc Prev Rehabil. 2003;10:371–376.
   PubMedGoogle Scholar
• Babu Rajendra Kurup N, Puchinger M, Gföhler M. Forward dynamic optimization of handle path and muscle activity for handle based isokinetic wheelchair propulsion: a simulation study. Comput Methods Biomech Biomed Engin. 2019;22:55–63.
   PubMed Web of Science ®Google Scholar
• Bresnahan JJ, Farkas GJ, Clasey JL, et al. Arm crank ergometry improves cardiovascular disease risk factors and community mobility independent of body composition in high motor complete spinal cord injury. J Spinal Cord Med. 2019;42:272–280.
   PubMed Web of Science ®Google Scholar
• Brizuela G, Sinz S, Aranda R, et al. The effect of arm-crank exercise training on power output, spirometric and cardiac function and level of autonomy in persons with tetraplegia. Eur J Sport Sci. 2019.
   Google Scholar
• Valent LM, Dallmeijer AJ, Houdijk H, et al. Effects of hand cycle training on physical capacity in individuals with tetraplegia: a clinical trial. Phys Ther. 2009;89:1051–1060.
   PubMed Web of Science ®Google Scholar
• Valent LJM. The effects of hand cycling on physical capacity in persons with spinal cord injury [dissertation]. Vrije Universiteit Amsterdam; 2009.
   Google Scholar
• Barton J, Pretty J. What is the best dose of nature and green exercise for improving mental health? A multi-study analysis. Environ Sci Technol. 2010;44:3947–3955.
   PubMed Web of Science ®Google Scholar
• Pretty J, Peacock J, Sellens M, et al. The mental and physical health outcomes of green exercise. Int J Environ Health Res. 2005;15:319–337.
   PubMed Web of Science ®Google Scholar
• Barton J, Griffin M, Pretty J. Exercise-, nature- and socially interactive-based initiatives improve mood and self-esteem in the clinical population. Perspect Public Health. 2012;132:89–96.
   PubMed Web of Science ®Google Scholar
• Valent L, Dallmeijer A, Houdijk H, et al. Effects of hand cycle training on wheelchair capacity during clinical rehabilitation in persons with a spinal cord injury. Disabil Rehabil. 2010;32:2191–2200.
   PubMed Web of Science ®Google Scholar
• Hettinga FJ, Hoogwerf M, van der Woude LV. Handcycling: training effects of a specific dose of upper body endurance training in females. Eur J Appl Physiol. 2016;116:1387–1394.
   PubMed Web of Science ®Google Scholar
• de Groot S, Kouwijzer I, Baauw M, HandbikeBattle, et al. Effect of self-guided training for the HandbikeBattle on body composition in people with spinal cord injury. Spinal Cord Ser Cases. 2018;4:79.
   PubMedGoogle Scholar
• Abreu E. M d C, Alves R. d S, Borges ACL, et al. Autonomic cardiovascular control recovery in quadriplegics after handcycle training. J Phys Ther Sci. 2016;28:2063–2068.
   PubMedGoogle Scholar
• Schoenmakers P, Reed K, Van Der Woude L, et al. High intensity interval training in handcycling: the effects of a 7 week training intervention in able-bodied men. Front Physiol. 2016;7:638.
   PubMed Web of Science ®Google Scholar
• Krops L, Albada T, Woude L, et al. Anaerobic exercise testing in rehabilitation: a systematic review of available tests and protocols. J Rehabil Med. 2017;49:289–303.
   PubMed Web of Science ®Google Scholar
• Zeller S, Abel T, Smith PM, et al. Influence of noncircular chainring on male physiological parameters in hand cycling. J Rehabil Res Dev. 2015;52:211–220.
   PubMedGoogle Scholar
• Kouwijzer I, Nooijen C, Breukelen K, et al. Effects of push-off ability and handcycle type on handcycling performance in able-bodied participants. J Rehabil Med. 2018;50:563–568.
   PubMed Web of Science ®Google Scholar
• Hutzler Y. Anaerobic fitness testing of wheelchair users. Sports Med. 1998;25:101–113.
   PubMed Web of Science ®Google Scholar
• Balmer J, Davison RCR, Coleman DA, et al. The validity of power output recorded during exercise performance tests using a Kingcycle air-braked cycle ergometer when compared with an SRM powermeter. Int J Sport Med. 2000;21:195–199.
   PubMed Web of Science ®Google Scholar
• Vogt S, Heinrich L, Schumacher YO, et al. Power output during stage racing in professional road cycling. Med Sci Sports Exerc. 2006;38:147–151.
   PubMed Web of Science ®Google Scholar
• Sawka MN, Glaser RM, Laubach LL, et al. Wheelchair exercise performance of the young, middle-aged, and elderly . J Appl Physiol Respir Environ Exerc Physiol. 1981;50:824–828.
   PubMed Web of Science ®Google Scholar
• Smith PM, McCrindle E, Doherty M, et al. Influence of crank rate on the slow component of pulmonary O2 uptake during heavy arm-crank exercise. Appl Physiol Nutr Metab. 2006;31:292–301.
   PubMed Web of Science ®Google Scholar
• Abel T, Burkett B, Thees B, et al. Effect of three different grip angles on physiological parameters during laboratory handcycling test in able-bodied participants. Front Physiol. 2015;6:331.
   PubMed Web of Science ®Google Scholar
• Sawka MN, Foley ME, Pimental NA, et al. Physiological factors affecting upper body aerobic exercise. Ergonomics. 1983;26:639–646.
   PubMed Web of Science ®Google Scholar
• Talbot C, Kay TD, Walker N, et al. A comparison of two anaerobic test measurement systems using an upper body Wingate test. Res Sport Med. 2014;22:265–275.
   PubMed Web of Science ®Google Scholar
• Wicks JR, Oldridge NB, Cameron BJ, et al. Arm cranking and wheelchair ergometry in elite spinal cord-injured athletes. Med Sci Sports Exerc. 1983;15:224–231.
   PubMed Web of Science ®Google Scholar
• Meyer C, Weissland T, Watelain E, et al. Physiological responses in handcycling. Preliminary study. Ann Phys Rehabil Med. 2009;52:311–318.
   PubMedGoogle Scholar
• Jacobs PL, Mahoney ET, Johnson B. Reliability of arm Wingate anaerobic testing in persons with complete paraplegia. J Spinal Cord Med. 2003;26:141–144.
   PubMed Web of Science ®Google Scholar
• van der Woude L, Bosmans I, Bervoets B, et al. Handcycling: different modes and gear ratios. J Med Eng Technol. 2000;24:242–249.
   PubMed Web of Science ®Google Scholar
• VanSumeren A, Bye T, Kilgas M, et al. Influence of the lower body on seated arm cranking performance. Int J Sports Med. 2018;39:757–763.
   PubMed Web of Science ®Google Scholar
• Miles DS, Sawka MN, Glaser RM, et al. Plasma volume shifts during progressive arm and leg exercise. J Appl Physiol Respir Environ Exerc Physiol. 1983;54:491–495.
   PubMed Web of Science ®Google Scholar
• Balmer J, Bird SR, Davison RR, et al. Mechanically braked Wingate powers: agreement between SRM, corrected and conventional methods of measurement. J Sports Sci. 2004;22:661–667.
   PubMed Web of Science ®Google Scholar
• de Groot S, Postma K, van Vliet L, et al. Mountain time trial in handcycling: exercise intensity and predictors of race time in people with spinal cord injury. Spinal Cord. 2014;52:455–461.
   PubMed Web of Science ®Google Scholar
• Pitetti KH, Snell PG, Stray-Gundersen J. Maximal response of wheelchair-confined subjects to four types of arm exercise. Arch Phys Med Rehabil. 1987;68:10–13.
   PubMed Web of Science ®Google Scholar
• Kouwijzer I, Valize M, Valent LJM, et al. The influence of protocol design on the identification of ventilatory thresholds and the attainment of peak physiological responses during synchronous arm crank ergometry in able-bodied participants. Eur J Appl Physiol. 2019;119:2275–2212.
   PubMed Web of Science ®Google Scholar
• Leicht AS, Spinks WL. Effect of shoulder angle on physiological responses during incremental peak arm crank ergometry. J Sports Sci. 2007;25:443–452.
   PubMed Web of Science ®Google Scholar
• Walker R, Powers S, Stuart MK. Peak oxygen uptake in arm ergometry: effects of testing protocol. Br J Sports Med. 1986;20:25–26.
   PubMedGoogle Scholar
• van der Woude L, Horstman A, Faas P, et al. Power output and metabolic cost of synchronous and asynchronous submaximal and peak level hand cycling on a motor driven treadmill in able-bodied male subjects. Med Eng Phys. 2008;30:574–580.
   PubMed Web of Science ®Google Scholar
• Kouwijzer I, Valent L, Osterthun R, et al.; Group on behalf of the H. Peak power output in handcycling of individuals with a chronic spinal cord injury: predictive modeling, validation and reference values. Disabil Rehabil. 2020;42:400–409.
   PubMed Web of Science ®Google Scholar
• Verellen J, Theisen D, Vanlandewijck Y. Influence of crank rate in hand cycling. Med Sci Sports Exerc. 2004;36:1826–1831.
   PubMed Web of Science ®Google Scholar
• Anon. HandbikeBattle. Overwinnen! [cited 2018 Apr 4]. Available from: http://handbikebattle.nl/
   Google Scholar
• Van Leeuwen CMC, Verwer J, Van Koppenhagen CF, et al. Trainen voor de HandbikeBattle: mentale effecten; De eerste resultaten van de HandbikeBattle. Ned Tijdschr Revalidatiegeneeskd. 2014;36:104–107.
   Google Scholar
• Groot S, Hoekstra S, Comtesse P, et al. Relationships between internal and external handcycle training load in people with spinal cord injury training for the handbikebattle. J Rehabil Med. 2018;50:261–268.
   PubMed Web of Science ®Google Scholar
• Bertucci W, Duc S, Villerius V, et al. Validity and reliability of the PowerTap Mobile Cycling Powermeter when compared with the SRM device. Int J Sports Med. 2005;26:868–873.
   PubMed Web of Science ®Google Scholar
• Gardner AS, Stephens S, Martin DT, et al. Accuracy of SRM and power tap power monitoring systems for bicycling. Med Sci Sports Exerc. 2004;36:1252–1258.
   PubMed Web of Science ®Google Scholar
• Bertucci W, Grappe F, Girard A, et al. Effects on the crank torque profile when changing pedalling cadence in level ground and uphill road cycling. J Biomech. 2005;38:1003–1010.
   PubMed Web of Science ®Google Scholar
• Abel T, Burkett B, Schneider S, et al. The exercise profile of an ultra-long handcycling race: the Styrkeprøven experience. Spinal Cord. 2010;48:894–898.
   PubMed Web of Science ®Google Scholar
• Nimmerichter A, Eston RG, Bachl N, et al. Longitudinal monitoring of power output and heart rate profiles in elite cyclists. J Sports Sci. 2011;29:831–840.
   PubMed Web of Science ®Google Scholar
• Rice I, Hettinga FJ, Laterrier J, et al. Biomechanics. In: Vanlandewijck Y, Thompson W, editors. The Paralympic athlete. Chichester (UK): Wiley-Blackwell; 2011. p. 33–50.
   Google Scholar
• Kauzlarich J. Wheelchair rolling resistance and tire design. In: van der Woude L, Hopman M, van Kemenda C, editors. Biomedical aspects of manual wheelchair propulsion: the state of the art III. Assistive technology research series. Amsterdam (The Netherlands): IOS press; 1999. p. 158–172.
   Google Scholar
• van der Woude L, Geurts C, Winkelman H, et al. Measurement of wheelchair rolling resistance with a handle bar push technique. J Med Eng Technol. 2003;27:249–258.
   PubMedGoogle Scholar
• Frank T, Abel E. Drag forces in wheelchairs. In: van der Woude L, Meijs P, Van der Grinten B, De Boer Y, editors. Ergonomics of manual wheelchair propulsion; state of the art. Concerned action “mobility restoration for paralyzed persons”. Amsterdam (The Netherlands): IOS press; 1993. pp 255–267.
   Google Scholar
• Wilson DG, Papadopoulos J, Whitt FR. Bicycling science. 3rd ed. Cambridge (MA): MIT Press; 2004.
   Google Scholar
• de Groot S, Zuidgeest M, van der Woude LV. Standardization of measuring power output during wheelchair propulsion on a treadmill Pitfalls in a multi-center study. Med Eng Phys. 2006;28:604–612.
   PubMed Web of Science ®Google Scholar
• de Groot G, Sargeant A, Geysel J. Air friction and rolling resistance during cycling. Med Sci Sports Exerc. 1995;27:1090–1095.
   PubMed Web of Science ®Google Scholar
• Mannion P, Toparlar Y, Hajdukiewicz M, et al. Aerodynamics analysis of wheel configurations in Paralympic hand-cycling: a computational study. Eur J Mech - B/Fluids. 2019;76:50–65.
   Web of Science ®Google Scholar
• Mannion P, Toparlar Y, Blocken B, et al. Analysis of crosswind aerodynamics for competitive hand-cycling. J Wind Eng Ind Aerodyn. 2018;180:182–190.
   Web of Science ®Google Scholar
• Mannion P, Toparlar Y, Clifford E, et al. The impact of arm-crank position on the drag of a paralympic hand-cyclist. Comput Methods Biomech Biomed Engin. 2019;22:386–395.
   PubMed Web of Science ®Google Scholar
• Belloli M, Cheli F, Bayati I, et al. Handbike aerodynamics: wind tunnel versus track tests. Proc Eng. 2014;72:750–755.
   Google Scholar
• Gaesser G, Brooks GA. Muscular efficiency during steady-rate exercise: effects of speed and work rate. J Appl Physiol. 1975;38:1132–1139.
   PubMed Web of Science ®Google Scholar
• Powers SK, Beadle RE, Mangum M. Exercise efficiency during arm ergometry: effects of speed and work rate. J Appl Physiol Respir Environ Exerc Physiol. 1984;56:495–499.
   PubMed Web of Science ®Google Scholar
• van Drongelen S, Maas JC, Scheel-Sailer A, et al. Submaximal arm crank ergometry: effects of crank axis positioning on mechanical efficiency, physiological strain and perceived discomfort. J Med Eng Technol. 2009;33:151–157.
   PubMedGoogle Scholar
• Romkes J, Groen BE, Koning JJ. Mechanical efficiency in arm cranking exercise. In: Van der Woude L, Hopman M, Kemenade C, editors. Biomedical aspects of manual wheelchair propulsion: the state of the art II. Vol. 5. Amsterdam (The Netherlands): IOS press; 1999. p 172–175.
   Google Scholar
• Lovell D, Shields D, Beck B, et al. The aerobic performance of trained and untrained handcyclists with spinal cord injury. Eur J Appl Physiol. 2012;112:3431–3437.
   PubMed Web of Science ®Google Scholar
• Goosey-Tolfrey VL, Alfano H, Fowler N. The influence of crank length and cadence on mechanical efficiency in hand cycling. Eur J Appl Physiol. 2007;102:189–194.
   PubMed Web of Science ®Google Scholar
• Goosey-Tolfrey VL, Sindall P. The effects of arm crank strategy on physiological responses and mechanical efficiency during submaximal exercise. J Sports Sci. 2007;25:453–460.
   PubMed Web of Science ®Google Scholar
• Arnet U, Marchetto P, van der Woude LV, et al. Propulsion style and mechanical efficiency during handcycling at different power outputs. In: Arnet U, editor. Handcycling: a biophysical analysis. Wageningen (The Netherlands): Ponsen & Looijen B. V.; 2012. p. 88–99.
   Google Scholar
• Arnet U, van Drongelen S, Schlussel M, et al. The effect of crank position and backrest inclination on shoulder load and mechanical efficiency during handcycling. Scand J Med Sci Sports. 2014;24:386–394.
   PubMed Web of Science ®Google Scholar
• Glaser RM, Sawka MN, Brune MF, et al. Physiological responses to maximal effort wheelchair and arm crank ergometry. J Appl Physiol Respir Environ Exerc Physiol. 1980;48:1060–1064.
   PubMed Web of Science ®Google Scholar
• Glaser RM, Sawka MN, Durbin RJ, et al. Exercise program for wheelchair activity. Am J Phys Med. 1981;60:67–75.
   PubMedGoogle Scholar
• Smith PA, Glaser RM, Petrofsky JS, et al. Arm crank vs handrim wheelchair propulsion: metabolic and cardiopulmonary responses. Arch Phys Med Rehabil. 1983;64:249–254.
   PubMed Web of Science ®Google Scholar
• Sawka MN, Gonzalez RR, Drolet LL, et al. Heat exchange during upper- and lower-body exercise. J Appl Physiol Respir Environ Exerc Physiol. 1984;57:1050–1054.
   PubMed Web of Science ®Google Scholar
• Sawka MN, Pimental NA, Pandolf KB. Thermoregulatory responses to upper body exercise. Eur J Appl Physiol Occup Physiol. 1984;52:230–234.
   PubMed Web of Science ®Google Scholar
• Sawka MN, Miles DS, Petrofsky JS, Wilde SW, et al. Ventilation and acid-base equilibrium for upper-body and lower-body exercise. Aviat Sp Environ Med. 1982;53:354–359.
   PubMed Web of Science ®Google Scholar
• Sawka MN, Glaser RM, Wilde SW, et al. Metabolic and circulatory responses to wheelchair and arm crank exercise. J Appl Physiol Respir Environ Exerc Physiol. 1980;49:784–788.
   PubMed Web of Science ®Google Scholar
• Sawka MN, Foley ME, Pimental NA, et al. Determination of maximal aerobic power during upper-body exercise. J Appl Physiol Respir Environ Exerc Physiol. 1983;54:113–117.
   PubMed Web of Science ®Google Scholar
• Sawka MN. Physiology of upper body exercise. Exerc Sport Sci Rev. 1986;14:175–211.
   PubMed Web of Science ®Google Scholar
• Franklin BA. Exercise testing, training and arm ergometry. Sports Med. 1985;2:100–119.
   PubMed Web of Science ®Google Scholar
• Franklin BA, Scherf J, Pamatmat A, et al. Arm exercise testing and training. Pract Cardiol. 1982;8:43–70.
   Google Scholar
• Pandolf KB. Local and central factor contribution in the perception of effort during physical exercise. In: Borg G, Ottoson D, editors. The perception of exertion in physical work. London (UK): Palgrave Macmillan; 1986.
   Google Scholar
• Pandolf KB, Billings DS, Drolet LL, et al. Differential ratings of perceived exertion and various physiological responses during prolonged upper and lower body exercise. Eur J Appl Physiol Occup Physiol. 1984;53:5–11.
   PubMed Web of Science ®Google Scholar
• Hjeltnes N, Stanghelle JK, Skyberg D. Pulmonary function and oxygen uptake during exercise in 16 year old boys with cystic fibrosis. Acta Paediatr Scand. 1984;73:548–553.
   PubMed Web of Science ®Google Scholar
• Hjeltnes N. Cardiorespiratory capacity in tetra- and paraplegia shortly after injury. Scand J Rehabil Med. 1986;18:65–70.
   PubMedGoogle Scholar
• Hjeltnes N. Capacity for physical work and training after spinal injuries and strokes. Scand J Soc Med Suppl. 1982;29:245–251.
   PubMedGoogle Scholar
• Hjeltnes N, Vokac Z. Circulatory strain in everyday life of paraplegics. Scand J Rehabil Med. 1979;11:67–73.
   PubMedGoogle Scholar
• Hjeltnes N. [Physical work capacity and training after spinal cord injuries and cerebrovascular accidents]. Tidsskr. Nor. Laegeforen. 1980;100:862–866.
   PubMedGoogle Scholar
• Hjeltnes N. Oxygen uptake and cardiac output in graded arm exercise in paraplegics with low level spinal lesions. Scand J Rehabil Med. 1977;9:107–113.
   PubMedGoogle Scholar
• Frauendorf H, Kobryn U, Gelbrich W, et al. Changes of the EMG and its relationship to the cardiopulmonary parameters during two-arm cranking of disabled men. Biomed Biochim Acta. 1989;48:S521–S524.
   PubMedGoogle Scholar
• Frauendorf H, Kobryn U, Hoffmann B, et al. Sex- and age-related behaviour of the integrated EMG during one-arm cranking. Biomed Biochim Acta. 1986;45:85–87.
   Google Scholar
• Frauendorf H, Gelbrich W, Kobryn U. [Reactions of the cardiopulmonary and the motor system in work with medium-sized muscles]. Z Gesamte Hyg. 1990;36:357–360.
   PubMedGoogle Scholar
• Goosey-Tolfrey V. Wheelchair sport: a complete guide for athletes, coaches, and teachers. Chaimpaign (IL): Human Kinetics; 2010.
   Google Scholar
• Abel T, Vanlandewijck Y, Verellen J. Handcyling. In: Goosey-Tolfrey VL, editor. Wheelchair sport, a complete guide for athletes, coaches, and teachers. Chaimpaign (IL): Human Kinetics; 2010. pp 187–197.
   Google Scholar
• Abel T, Vega SR, Bleicher I, et al. Handbiking: physiological responses to synchronous and asynchronous crank montage. Eur J Sport Sci. 2003;3:1–9.
   Google Scholar
• Dallmeijer AJ, Ottjes L, de Waardt E, et al. A physiological comparison of synchronous and asynchronous hand cycling. Int J Sports Med. 2004;25:622–626.
   PubMed Web of Science ®Google Scholar
• Faupin A, Gorce P, Campillo P, et al. Kinematic analysis of handbike propulsion in various gear ratios: implications for joint pain. Clin Biomech (Bristol, Avon). 2006;21:560–566.
   PubMed Web of Science ®Google Scholar
• Faupin A, Gorce P, Meyer C, et al. Effects of backrest positioning and gear ratio on nondisabled subjects’ handcycling sprinting performance and kinematics. JRRD. 2008;45:109–116.
   PubMedGoogle Scholar
• Faupin A, Gorce P, Meyer C. Effects of type and mode of propulsion on hand-cycling biomechanics in nondisabled subjects. JRRD. 2011;48:1049–1060.
   PubMedGoogle Scholar
• Krämer C, Hilker L, Böhm H. Influence of crank length and crank width on maximal hand cycling power and cadence. Eur J Appl Physiol. 2009;106:749–757.
   PubMed Web of Science ®Google Scholar
• Litzenberger S, Mally F, Sabo A. Biomechanics of elite recumbent handcycling: a case study. Sports Eng. 2016;19:201–211.
   Google Scholar
• Weissland T, Pelayo P, Vanvelcenaher J, et al. Physiological effects of variations in spontaneously chosen crank rate during incremental upper-body exercise. Eur J Appl Physiol Occup Physiol. 1997;76:428–433.
   PubMed Web of Science ®Google Scholar
• Hopman MTE, van Teeffelen WM, Brouwer J, et al. Physiological responses to asynchronous and synchronous arm-cranking exercise. Eur J Appl Physiol Occup Physiol. 1995;72:111–114.
   PubMed Web of Science ®Google Scholar
• Mossberg K, Willman C, Topor M, et al. Comparison of asynchronous versus synchronous arm crank ergometry. Spinal Cord. 1999;37:569–574.
   PubMed Web of Science ®Google Scholar
• Smith PM, Chapman ML, Hazlehurst KE, et al. The influence of crank configuration on muscle activity and torque production during arm crank ergometry. J Electromyogr Kinesiol. 2008;18:598–605.
   PubMed Web of Science ®Google Scholar
• Foss Ø, Hallén J. The most economical cadence increases with increasing workload. Eur J Appl Physiol. 2004;92:443–451.
   PubMed Web of Science ®Google Scholar
• Litzenberger S, Mally F, Sabo A. Influence of different seating and crank positions on muscular activity in elite handcycling – a case study. Procedia Eng. 2015;112:355–360.
   Google Scholar
• Faupin A, Gorce P. The effects of crank adjustments on handbike propulsion: a kinematic model approach. Int J Ind Ergon. 2008;38:577–583.
   Web of Science ®Google Scholar
• Union Cycliste Internationale. UCI Cycling Regulations. 2016. p. 1–81.
   Google Scholar
• Zipfel E, Olson J, Puhlman J, et al. Design of a custom racing hand-cycle: review and analysis. Disabil Rehabil Assist Technol. 2009;4:119–128.
   PubMedGoogle Scholar
• Krämer DC. Ergonomische Optimierung des Handbike-Antriebes [dissertation]. 2012.
   Google Scholar
• Smith P, Doherty M, Price M. The effect of crank rate on physiological responses and exercise efficiency using a range of submaximal workloads during arm crank ergometry. Int J Sports Med. 2005;27:199–204.
   Web of Science ®Google Scholar
• Chaikhot D, Taylor MJD, Hettinga FJ. Sex differences in wheelchair propulsion biomechanics and mechanical efficiency in novice young able-bodied adults. Eur J Sport Sci. 2018;18:650–658.
   PubMed Web of Science ®Google Scholar