Changes in body satisfaction during and after a 5-month handcycle training period and associations with physical capacity and body composition in individuals with a physical impairment

Figures & data

Figure 1. Study design. Measurements are performed at the start of the training period (January, T1); after the training period, prior to the event (June, T2); and follow-up, four months after the event (October, T3) and one year after the event (June, T4). abbreviations: GXT = graded exercise test, POpeak = peak power output, VO₂peak = peak oxygen uptake.

A timeline representing the longitudinal study design, with four measurement time points starting in January and ending in June next year.

Table 1. Characteristics and outcomes at T1 for participants and non-participants.

Characteristics	N	Participants		N	Non-participants
Sex (male/female) (%male)	143	96/47	(67%)	62	44/18	(71%)
Age (years)	143	43 ± 13*		60	37 ± 12*
Acquired/congenital impairment (%acquired)	143	119/24*	(83%)	55	37/18*	(67%)
Time since injury (years)	116	9 ± 12		33	11 ± 10
Impairment type	143	*		54	*
Spinal cord injury		74	(52%)		27	(50%)
Tetraplegia		17	(12%)		3	(6%)
Paraplegia		57	(40%)		24	(44%)
Leg amputation		21	(15%)		3	(5%)
Multi trauma		5	(3%)		1	(2%)
Spina bifida		11	(8%)		8	(15%)
Cerebral palsy		4	(3%)		8	(15%)
Other		28	(19%)		7	(13%)
Functional satisfaction	134	0.69 ± 1.18		30	0.38 ± 1.22
Appearance satisfaction	134	0.57 ± 1.70		30	−0.02 ± 1.75
POpeak (W)	140	109 ± 37		56	107 ± 47
VO2peak (l/min)	137	1.74 ± 0.49		55	1.76 ± 0.60
Body mass (kg)	137	78.9 ± 17.3		52	76.6 ± 18.0
Waist circumference (cm)	127	95.0 ± 13.6		43	92.7 ± 16.4
Musculoskeletal pain (no-mild/moderate-severe) (%no-mild)	135	89/46	(66%)	33	19/14	(58%)
Handcycling classification (H1-H3/H4-H5) (%H1-H3)	143	70/73	(49%)	49	27/22	(55%)

Data represent N (%) or mean (SD). POpeak: peak power output; VO₂peak: peak oxygen uptake. Musculoskeletal pain: two categories: (1) no-mild pain and (2) moderate-severe pain. Handcycling classification: two categories: (1) H1–H3 and (2) H4–H5.

* Significant difference with p < 0.05 between participants and non-participants.

Table 2. Descriptive data and outcome measures of participants at all time points.

	N	T1		N	T2		N	T3		N	T4
Functional satisfaction	134	0.69 ± 1.18		136	1.48 ± 0.92		119	0.88 ± 1.24		67	0.79 ± 1.49
Appearance satisfaction	134	0.57 ± 1.70		136	1.18 ± 1.57		119	0.61 ± 1.69		67	0.32 ± 1.70
POpeak (W)	140	109 ± 37		136	132 ± 44
VO2peak (l/min)	137	1.74 ± 0.49		134	2.04 ± 0.59
Waist circumference (cm)	127	95.0 ± 13.6		116	91.6 ± 12.6
Musculoskeletal pain (no-mild/moderate-severe) (%no-mild)	135	89/46	(66%)	136	92/44	(68%)
Sports participation (h/week)	–	–		127	7.3	[5.5–10.0]	112	5.0	[3.0–7.0]	65	6.3	[3.0-8.3]

Data represent N (%), mean (SD) or Median [IQR]. POpeak: peak power output; VO₂peak: peak oxygen uptake. T1: start of the training period. T2: after the training period, prior to the HandbikeBattle event. T3: follow-up measurement, four months after the event. T4: follow-up measurement, one year after the event.

Table 3. Longitudinal trajectory of body satisfaction (N = 143).

	Functional satisfaction			Appearance satisfaction
	Regression coefficient	SE	p value	Regression coefficient	SE	p value
Constant (reference T2)	1.468	0.099		1.155	0.141
Δ T2-T1	−0.766	0.106	< 0.01*	−0.604	0.126	< 0.01*
Δ T2-T3	−0.606	0.110	< 0.01*	−0.540	0.131	< 0.01*
Δ T2-T4	−0.666	0.135	< 0.01*	−0.862	0.161	< 0.01*

T1: start of the training period. T2: after the training period, prior to the HandbikeBattle event. T3: follow-up measurement, four months after the event. T4 = follow-up measurement, one year after the event. *Significance with p < 0.05. The Δ T2-T1 = a negative regression coefficient representing an improvement of the dependent variable over time. The Δ T2–T3 and Δ T2–T4 = a negative regression coefficient representing a deterioration of the dependent variable over time.

Figure 2. Longitudinal trajectory of functional satisfaction (A) and appearance satisfaction (B) for different Subgroups. A1, B1 = sex: M/F. A2, B2 = waist circumference at T1: healthy (men ≤ 102 cm, women ≤ 88 cm) and unhealthy (men > 102 cm, women > 88 cm). A3, B3 = handcycling classification as a proxy for severity of the impairment: H1-H3 (most impaired)/H4-H5 (least impaired). T1 = start of the training period. T2 = after the training period, prior to the HandbikeBattle event. T3 = follow-up measurement, four months after the event. T4 = follow-up measurement, one year after the event.

A1. Longitudinal trajectory of functional satisfaction, categorized by sex. There were no interaction effects. B1. Longitudinal trajectory of appearance satisfaction, categorized by sex. There were no interaction effects. A2. Longitudinal trajectory of functional satisfaction, categorized by waist circumference. There were no interaction effects. B2. Longitudinal trajectory of appearance satisfaction, categorized by waist circumference. There were no interaction effects. A3. Longitudinal trajectory of functional satisfaction, categorized by severity of the impairment. Participants with a more severe impairment showed a significant decrease in functional satisfaction during follow-up compared to participants with a less severe impairment. B3. Longitudinal trajectory of appearance satisfaction, categorized by severity of the impairment. Participants with a more severe impairment showed a significant decrease in appearance satisfaction during follow-up compared to participants with a less severe impairment.

Table 4. Longitudinal trajectory of body satisfaction of groups with different sex, waist circumference or handcycling classification and interaction effects (time * group).

	Sex	Waist circumference	Handcycling classification
Functional satisfaction
Constant (reference: T2)	1.532 (0.119)	1.509 (0.136)	1.348 (0.140)
Δ T2-T1	−0.659 (0.127)*	−0.738 (0.148)*	−0.877 (0.151)*
Δ T2-T3	−0.463 (0.132)*	−0.512 (0.152)*	−0.665 (0.159)*
Δ T2-T4	−0.615 (0.163)*	−0.700 (0.184)*	−0.983 (0.187)*
Determinant	−0.192 (0.209)	−0.214 (0.214)	0.237 (0.194)
(Δ T2-T1) x determinant	−0.332 (0.225)	−0.130 (0.232)	0.218 (0.210)
(Δ T2-T3) x determinant	−0.446 (0.234)	−0.198 (0.241)	0.110 (0.219)
(Δ T2-T4) x determinant	−0.156 (0.285)	−0.025 (0.309)	0.663 (0.267)*
Appearance satisfaction
Constant (reference: T2)	1.341 (0.168)	1.514 (0.176)	1.220 (0.201)
Δ T2-T1	−0.546 (0.153)*	−0.437 (0.174)*	−0.733 (0.179)*
Δ T2-T3	−0.547 (0.159)*	−0.424 (0.179)*	−0.653 (0.190)*
Δ T2-T4	−0.838 (0.196)*	−0.941 (0.218)*	−1.277 (0.224)*
Determinant	−0.566 (0.295)	−1.087 (0.277)*	−0.121 (0.280)
(Δ T2-T1) x determinant	−0.183 (0.270)	−0.474 (0.273)	0.249 (0.250)
(Δ T2-T3) x determinant	0.020 (0.281)	−0.185 (0.284)	0.214 (0.261)
(Δ T2-T4) x determinant	−0.071 (0.344)	−0.015 (0.365)	0.852 (0.320)*

Data represent regression coefficient (SE). For both outcome parameters (functional satisfaction and appearance satisfaction), three separate models were created (one model for each determinant). Each model consisted of the time dummies, one determinant, and the interaction effect between time and determinant. Sex: M/F, reference: male. Waist circumference at T1: healthy (men ≤ 102 cm, women ≤ 88 cm) and unhealthy (men > 102 cm, women > 88 cm), reference: healthy. Handcycling classification as a proxy for severity of the impairment: H1-H3/H4-H5, reference: H1-H3. T1 start of the training period. T2: after the training period, prior to the HandbikeBattle event. T3: follow-up measurement, four months after the event. T4: follow-up measurement, one year after the event. The Δ T2–T1 = a negative regression coefficient representing an improvement of the dependent variable over time. The Δ T2–T3 and Δ T2–T4 = a negative regression coefficient representing a deterioration of the dependent variable over time. *Significance with p < 0.05.

Table 5. Longitudinal and cross-sectional associations between physical capacity or body composition and body satisfaction during the training period (T1–T2).

	Functional satisfaction				Appearance satisfaction
	Regression coefficient	SE	p value	Confounders	Regression coefficient	SE	p value	Confounders
POpeak (W)
Constant	0.621	0.330			0.527	0.535
Between-subject	0.004	0.003	0.18	♦§†	0.005	0.004	0.21	♦§
Within-subject	0.025	0.004	<0.01*		0.018	0.005	<0.01*
Waist circumference (cm)
Constant	2.251	0.680			6.590	0.975
Between-subject	−0.010	0.007	0.15	♦§	−0.058	0.010	<0.01*	§
Within-subject	−0.071	0.020	<0.01*		−0.071	0.021	<0.01*

POpeak: peak power output; Possible confounders:  sex §, musculoskeletal pain; ♦: handcycling classification †. A variable was included as confounder if the regression coefficient(s) of POpeak or waist circumference changed with more than 10% when adding the potential confounder. * Significance with p < 0.05.

Data availability statement

The data that support the findings of this study are available from the corresponding author, IK, upon reasonable request.