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OBJECTIVE: To evaluate the external and internal work load of trained handcyclists during a mountain time trial, to compare the results with a world class (WC) handcyclist, and to identify time trial performance determinants.DESIGN: Ten trained and one WC handcyclists performed a graded exercise test to determine power output (PO) and heart rate (HR) at the ventilatory thresholds (VT1 and VT2) and exhaustion. PO and HR were continuously measured during the race.RESULTS: Absolute POmeanrace (119 ± 21 vs. 203 W, p < 0.001) was lower in the trained handcyclists compared to the WC handcyclist. Absolute and relative HRrace (86 ± 7% vs. 88%, p = 0.40) and relative POrace (66 ± 10% vs. 62%, p = 0.24) were similar. Trained handcyclists cycled significantly less time at a PO between VT1-VT2 (48% vs. 64%, p = 0.02) and more at a PO > VT2 (34% vs. 11%, p = 0.005). POVT2 showed the strongest correlation with finish time (r = -0.78) and POpeak with POmeanrace (r = 0.90).CONCLUSION: Lab outcomes POpeak and POVT2 are important performance determinants for longer time trials in handcyclists and it is, therefore, important to improve these outcomes with training. Since the trained handcyclists cycled most of the race in intensity zones 2 and 3, it is recommended to incorporate these zones also in the training.

22 ABSTRACT 23 Study design Experimental study 24 Objectives To compare lipid metabolism in individuals with a cervical spinal cord injury (SCIC) 25 and able-bodied (AB) persons in response to mild cold stress. 26 Settings Laboratory of Wakayama Medical University, Japan. 27 Methods Nine males with SCIC and 11 AB wore a water-perfusion suit in a supine position. 28 Following 30-min rest thermoneutrality, the whole body was cooled by perfusing 25°C water 29 through the suit for 15-20 minutes (CS). Blood samples were collected before, immediately, and 60 30 (post-CS60) and 120 minutes after CS (post-CS120). Concentrations of serum free fatty acid 31 ([FFA]s), total ketone bodies ([tKB]s), insulin ([Ins]s) and plasma adrenaline ([Ad]p), noradrenaline 32 ([NA]p) and glucose ([Glc]p) were assessed. 33 Results [Ad]p in SCIC were lower than AB throughout the study (p=0.0002) and remained largely 34 unchanged in both groups. [NA]p increased after cold stress in AB only (p

Regular exposure to passive heat stress improves vascular function, but the optimal heating prescription remains undefined. Local limb heating is more feasible than whole body heating, but the evidence demonstrating its efficacy is lacking. The purpose of this study was to determine whether acute improvements in vascular function can be achieved with lower limb heating in 16 young healthy individuals (8 female, 8 male). In separate visits, participants underwent 45 min of ankle- and knee-level hot water immersion (45°C). A subset of seven participants also participated in a time-control visit. Endothelial function was assessed through simultaneous brachial and superficial femoral artery flow-mediated dilation (FMD) tests. Macrovascular function was quantified by %FMD, whereas microvascular function was quantified by vascular conductance during reactive hyperemia. Arterial stiffness was assessed through carotid-femoral and femoral-foot pulse wave velocity (PWV). Plasma concentrations of interleukin-6 and extracellular heat shock protein-72 (eHSP72) were used as indicators of inflammation. Our findings showed that 45 min of lower limb heating-regardless of condition-acutely improved upper limb macrovascular endothelial function (i.e., brachial %FMD; Pre: 4.6 ± 1.7 vs. Post: 5.4 ± 2.0%

Study design Acute experimental study. Objectives To investigate the acute response of markers of lipid metabolism and interleukin (IL)-6 to dopamine infusion in people with a cervical spinal cord injury (CSCI). Setting Laboratory of Wakayama Medical University, Japan. Methods Ten participants, four with CSCI and six AB individuals, underwent 50 min of dopamine infusion. Blood samples were collected prior to, immediately after and 1 h following cessation of dopamine infusion for the determination of circulating catecholamine, lipid, ketone body and IL-6 concentrations. Results The adrenaline concentration following dopamine infusion was increased by 59 ± 7% in CSCI (p = 0.038, Cohen's d effect size (ES): 1.47), while this was not changed in AB (p = 0.223). Triglycerides and acetoacetic acid concentration were increased in both groups, immediately after and 1 h post-infusion (triglycerides p ≤ 0.042, ES CSCI: 1.00, ES AB: 1.12; acetoacetic acid p ≤ 0.030; ES CSCI: 1.72, ES AB: 1.31). 3-Hydroxybutyric acid concentration was increased in CSCI only (48 ± 15%, p = 0.039, ES: 1.44; AB p = 0.115). Dopamine infusion did not affect plasma IL-6 concentration in either group (p ≥ 0.368). Conclusions Dopamine infusion induced a sustained increase in triglyceride and ketone body concentrations in persons with CSCI. In contrast, cytokine concentrations were not affected by dopamine infusion. These findings suggest that circulating catecholamines can stimulate metabolism in people with CSCI despite the presence of autonomic dysfunction.

Purpose Passive elevation of body temperature can induce an acute inflammatory response that has been proposed to be beneficial; however, it can be perceived as uncomfortable. Here, we investigate whether local cooling of the upper body during hot water immersion can improve perception without inhibiting the interleukin-6 (IL-6) response. Methods Nine healthy male participants (age: 22 ± 1 years, body mass: 83.4 ± 9.4 kg) were immersed up to the waist for three 60-min water immersion conditions: 42 °C hot water immersion (HWI), 42 °C HWI with simultaneous upper-body cooling using a fan (FAN), and 36 °C thermoneutral water immersion (CON). Blood samples to determine IL-6 plasma concentration were collected pre- and post-water immersion; basic affect and thermal comfort were assessed throughout the intervention. Results Plasma IL-6 concentration was higher for HWI and FAN when compared with CON (P P = 0.22; pre to post, HWI: 1.0 ± 0.6 to 1.5 ± 0.7 pg·ml−1, FAN: 0.7 ± 0.5 to 1.1 ± 0.5 pg·ml−1, CON: 0.5 ± 0.2 to 0.5 ± 0.2 pg·ml−1). At the end of immersion, basic affect was lowest for HWI (HWI: − 1.8 ± 2.0, FAN: 0.2 ± 1.6, CON 1.0 ± 2.1, P P Conclusion Local cooling of the upper body during hot water immersion improves basic affect and thermal comfort without inhibiting the acute IL-6 response.

Purpose: Paratriathletes may display impairments in autonomic (sudomotor and/or vasomotor function) or behavioral (drinking and/or pacing of effort) thermoregulation. As such, this study aimed to describe the thermoregulatory profile of athletes competing in the heat. Methods: Core temperature (Tc) was recorded at 30-second intervals in 28 mixed-impairment paratriathletes during competition in a hot environment (air temperature = 33°C, relative humidity = 35%–41%, and water temperature = 25°C–27°C), via an ingestible temperature sensor (BodyCap e-Celsius). Furthermore, in a subset of 9 athletes, skin temperature was measured. Athletes’ wetsuit use was noted while heat illness symptoms were self-reported postrace. Results: In total, 22 athletes displayed a Tc ≥ 39.5°C with 8 athletes ≥40.0°C. There were increases across the average Tc for swim, bike, and run sections (P ≤ .016). There was no change in skin temperature during the race (P ≥ .086). Visually impaired athletes displayed a significantly greater Tc during the run section than athletes in a wheelchair (P ≤ .021). Athletes wearing a wetsuit (57% athletes) had a greater Tc when swimming (P ≤ .032), whereas those reporting heat illness symptoms (57% athletes) displayed a greater Tc at various time points (P ≤ .046). Conclusions: Paratriathletes face significant thermal strain during competition in the heat, as evidenced by high Tc, relative to previous research in able-bodied athletes and a high incidence of self-reported heat illness symptomatology. Differences in the Tc profile exist depending on athletes’ race category and wetsuit use.

The purpose of this review was to compare all intervention modalities aimed at increasing skeletal muscle mass (SMM) in the paralysed limbs of persons with chronic (>1-year post-injury), motor complete spinal cord injury (SCI). A systematic review of EMBASE, MEDLINE, Scopus, and SPORTDiscus databases was conducted from inception until December 2021. Published intervention studies aimed to increase SMM (measured by magnetic resonance imaging, computed tomography, ultrasound, muscle biopsy, or lean soft tissue mass by dual X-ray absorptiometry) in the paralysed limbs of adults (>18 years) with SCI were included. Fifty articles were included that, overall, demonstrated a high risk of bias. Studies were categorised into six groups: neuromuscular electrical stimulation (NMES) with and without external resistance, functional electrical stimulation cycling, walking- and standing-based interventions, pharmacological treatments, and studies that compared or combined intervention modalities. Resistance training (RT) using NMES on the quadriceps produced the largest and most consistent increases in SMM of all intervention modalities. Current evidence suggests that clinical practise aiming to increase SMM in the paralysed limbs of persons with motor complete SCI should perform NMES-RT. However, more high-quality randomised control trials are needed to determine how training variables, such as exercise volume and intensity, can be optimised for increasing SMM. Implications for rehabilitationPersons with spinal cord injury (SCI) experience severe reductions in skeletal muscle mass (SMM) post-injury, which may exacerbate their risk of obesity and metabolic disease.Out of all exercise and non-exercise-based interventions, this systematic review shows that neuromuscular electrical stimulation-based resistance training demonstrates the most robust and consistent evidence for increasing skeletal muscle mass in the paralysed limbs of adults with motor complete spinal cord injury.The findings from this review can be used to inform evidence-based practise for exercise practitioners, as well as direct future research focused on increasing muscle mass in this population. Persons with spinal cord injury (SCI) experience severe reductions in skeletal muscle mass (SMM) post-injury, which may exacerbate their risk of obesity and metabolic disease. Out of all exercise and non-exercise-based interventions, this systematic review shows that neuromuscular electrical stimulation-based resistance training demonstrates the most robust and consistent evidence for increasing skeletal muscle mass in the paralysed limbs of adults with motor complete spinal cord injury. The findings from this review can be used to inform evidence-based practise for exercise practitioners, as well as direct future research focused on increasing muscle mass in this population.

Persons with a spinal cord injury (SCI) are at a heightened risk of obesity. However, little is known about the effect of SCI on factors that influence energy intake. This study compared measures of food reward, eating behaviour traits, and appetite perceptions between adults with and without SCI. Twenty wheelchair dependent persons with chronic (1 year) SCI (C1-T12) and twenty non-SCI individuals matched for BMI, age and sex participated. Following a familiarisation visit, participants consumed a breakfast meal, normalised for resting metabolic rate (RMR), and provided subjective appetite perceptions every 30 min for 4 h. Subsequently, energy intake was determined via an ad libitum lunch meal. Explicit liking, explicit wanting, implicit wanting and relative preference were assessed in a hungry and fed state via the Leeds Food Preference Questionnaire prior to and following the lunch meal. Eating behaviour traits were assessed via the Adult Eating Behaviour Questionnaire, Control of Eating Questionnaire, Reasons Individuals Stop Eating Questionnaire, and Three-Factor Eating Questionnaire Revised 18-item version. Sweet appeal bias was greater for explicit liking, explicit wanting, and relative preference in the group with SCI compared to the non-SCI group (p ≤ 0.024). The group with SCI also reported higher levels of cognitive restraint and satiety responsiveness (p ≤ 0.029). No group differences in postprandial appetite perceptions (p ≥ 0.690) or energy intake relative to RMR were seen (p = 0.358). However, the group with SCI demonstrated a trend toward a lower absolute energy intake (p = 0.063). In conclusion, food reward for sweet foods was greater in the group with SCI. Further, our findings suggest that acute appetite perceptions, including satiety profiles, are not different between persons with and without SCI.

The purpose of this study was to experimentally assess the effect of a one touch clamp and rack smart pump on the time needed for patient mobilisation and the clinical staff`s perceived burden associated with these procedures when compared with the traditional type infusion system. Participants were randomly assigned to one of three groups: Multi-layer rack group (MULTI), One-touch pole clamp group (ONE), and a Control group (CON). In CON, traditional type pumps were replaced from pole stands to pole stands. In MULTI, the smart pumps were replaced from multi-layer rack to multi-layer rack, and in ONE the smart pumps were replaced from pole stands to multi-layer rack. In each group, the subject round-transported the simulated patient and re-replaced the pumps. The time of both pump replacements and the transport time were significantly shorter in MULTI and ONE compared with CON (p

The acute inflammatory response to active or passive activities that increase body temperature may aid to reduce chronic low-grade inflammation. This study investigates the impact of temperature and extracellular heat shock protein 72 (eHsp72) on the acute intracellular Hsp72 (iHsp72) and interleukin-6 (iIL-6) response in monocytes. Whole blood was incubated for 2 h at 37.0 °C, 38.5 °C and 40.0 °C, in the absence or presence of 0.5 μg/ml eHsp72. Flow cytometry was used to assess iHsp72 and iIL-6 expression in total monocytes and the three monocyte subsets. Incubation at 40.0 °C (p p = 0.085) increased iHsp72 expression when compared with 37.0 °C, while there was no effect of temperature on iIL-6 expression (p = 0.635). Following incubation with eHsp72, the expression of iHsp72 in classical monocytes was reduced at all temperatures (p p = 0.071). Large temperature elevations are needed to induce an acute iHsp72 response in monocytes. In addition, contrary to its suggested role as a danger signal for the innate immune system, eHsp72 reduced iHsp72 and iIL-6 expression in monocytes.

The aim of this study was to compare the acute cardiometabolic and perceptual responses between local and whole-body passive heating. Using a water-perfused suit, 10 recreationally active males underwent three 90 min conditions: heating of the legs with upper-body cooling (LBH), whole-body heating (WBH) and exposure to a thermoneutral temperature (CON). Blood samples were collected before and up to 3 h post-session to assess inflammatory markers, while a 2 h oral glucose tolerance test was initiated 1 h post-session. Femoral artery blood flow and perceptual responses were recorded at regular intervals. The interleukin (IL)-6 incremental area under the curve (iAUC) was higher for LBH (1096 ± 851 pg/mL × 270 min) and WBH (833 ± 476 pg/mL × 270 min) compared with CON (565 ± 325 pg/mL × 270 min; p < 0.047). Glucose concentrations were higher after WBH compared with LBH and CON (p < 0.046). Femoral artery blood flow was higher at the end of WBH (1713 ± 409 mL/min) compared with LBH (943 ± 349 mL/min; p < 0.001), and higher in LBH than CON (661 ± 222 mL/min; p = 0.002). Affect and thermal comfort were more negative during WBH compared with LBH and CON (p < 0.010). In conclusion, local passive heating elevated blood flow and the IL-6 iAUC. However, while resulting in more positive perceptual responses, the majority of the included cardiometabolic markers were attenuated compared with WBH. Novelty: The increase in the IL-6 iAUC in response to passive heating is not reduced by upper-body cooling. Upper-body cooling attenuates the plasma nitrite, IL-1ra and femoral artery blood flow response to passive heating. Upper-body cooling leads to more positive perceptual responses to passive heating.

Previous research indicates a better improvement of functional independence measure (FIM) at discharge in acute-stroke patients who received physiatrist and registered therapist operating rehabilitation (PROr) within 24 hrs compared with those who received after 24 hrs was reported. The aim of this prospective cohort study was to determine whether PROr provided within 24 hrs for new-onset stroke patients affects home-discharge rate at 6 months later.Acute new-onset stroke patients admitted to our hospital and received PROr (A total of 139 patients [VEM (Starting PROr within 24 hrs of new-onset stroke may help to increase home-discharge rates at 6-month follow-up, simultaneously with a higher FIM. Very early mobilization in our hospital did not increase the risks of recurrence or death.

Acute experimental study.To investigate the acute response of markers of lipid metabolism and interleukin (IL)-6 to dopamine infusion in people with a cervical spinal cord injury (CSCI).Laboratory of Wakayama Medical University, Japan.Ten participants, four with CSCI and six AB individuals, underwent 50 min of dopamine infusion. Blood samples were collected prior to, immediately after and 1 h following cessation of dopamine infusion for the determination of circulating catecholamine, lipid, ketone body and IL-6 concentrations.The adrenaline concentration following dopamine infusion was increased by 59 ± 7% in CSCI (p = 0.038, Cohen's d effect size (ES): 1.47), while this was not changed in AB (p = 0.223). Triglycerides and acetoacetic acid concentration were increased in both groups, immediately after and 1 h post-infusion (triglycerides p ≤ 0.042, ES CSCI: 1.00, ES AB: 1.12; acetoacetic acid p ≤ 0.030; ES CSCI: 1.72, ES AB: 1.31). 3-Hydroxybutyric acid concentration was increased in CSCI only (48 ± 15%, p = 0.039, ES: 1.44; AB p = 0.115). Dopamine infusion did not affect plasma IL-6 concentration in either group (p ≥ 0.368).Dopamine infusion induced a sustained increase in triglyceride and ketone body concentrations in persons with CSCI. In contrast, cytokine concentrations were not affected by dopamine infusion. These findings suggest that circulating catecholamines can stimulate metabolism in people with CSCI despite the presence of autonomic dysfunction.

Chronic low-grade inflammation is increasingly recognized in the aetiology of a range of chronic diseases, including type 2 diabetes mellitus and cardiovascular disease, and may therefore serve as a promising target in their prevention or treatment. An acute inflammatory response can be induced by exercise; this is characterised by the acute increase in proinflammatory markers that subsequently stimulate the production of anti-inflammatory proteins. This may help explain the reduction in basal concentrations of pro-inflammatory markers following chronic exercise training. For sedentary populations, such as people with a disability, wheelchair users, or the elderly, the prevalence of chronic low-grade inflammation- related disease is further increased above that of individuals with a greater capacity to be physically active. Performing regular exercise with its proposed anti-inflammatory potential may not be feasible for these individuals due to a low physical capacity or other barriers to exercise. Therefore, alternatives to exercise that induce a transient acute inflammatory response may benefit their health. Manipulating body temperature may be such an alternative. Indeed, exercising in the heat results in a larger acute increase in inflammatory markers such as interleukin-6 and heat shock protein 72 when compared with exercising in thermoneutral conditions. Moreover, similar to exercise, passive elevation of body temperature can induce acute increases and chronic reductions in inflammatory markers and positively affect markers of glycaemic control. Here we discuss the potential benefits and mechanisms of active (i.e., exercise) and passive heating methods (e.g., hot water immersion, sauna therapy) to reduce chronic low-grade inflammation and improve metabolic health, with a focus on people who are restricted from being physically active.

Regular exercise-induced acute inflammatory responses are suggested to improve the inflammatory profile and insulin sensitivity. As body temperature elevations partly mediate this response, passive heating might be a viable tool to improve the inflammatory profile. This study investigated the acute and chronic effects of hot water immersion on inflammatory and metabolic markers. Ten sedentary, overweight men [body mass index (BMI): 31.0 ± 4.2 kg/m2, mean ± SD] were immersed in water set at 39°C for 1 h (HWI) or rested for 1 h at ambient temperature (AMB). Venous blood was obtained before the session, immediately postsession, and 2 h postsession for assessment of monocyte intracellular heat shock protein-72 (iHsp72) and plasma concentrations of extracellular Hsp72 (eHsp72), interleukin-6 (IL-6), fasting glucose, insulin, and nitrite. Thereafter, participants underwent a 2-wk intervention period, consisting of 10 hot water immersion sessions (INT). Eight BMI-matched participants (BMI: 30.0 ± 2.5 kg/m2) were included as control (CON). Plasma IL-6 and nitrite concentrations were higher immediately following HWI compared with AMB (IL-6 P < 0.001, HWI: 1.37 ± 0.94 to 2.51 ± 1.49 pg/ml; nitrite P = 0.04, HWI: 271 ± 52 to 391 ± 72 nM), whereas iHsp72 expression was unchanged ( P = 0.57). In contrast to resting iHsp72 expression ( P = 0.59), fasting glucose ( P = 0.04; INT: 4.44 ± 0.93 to 3.98 ± 0.98 mmol/l), insulin ( P = 0.04; INT: 68.1 ± 44.6 to 55.0 ± 29.9 pmol/l), and eHsp72 ( P = 0.03; INT: 17 ± 41% reduction) concentrations were lowered after INT compared with CON. HWI induced an acute inflammatory response and increased nitric oxide bioavailability. The reductions in fasting glucose and insulin concentrations following the chronic intervention suggest that hot water immersion may serve as a tool to improve glucose metabolism. NEW & NOTEWORTHY A single hot water immersion (HWI) session induces an acute increase in plasma interleukin-6 and nitrite concentrations but does not acutely elevate heat shock protein-72 expression in monocytes [intracellular Hsp72 (iHsp72)]. A chronic HWI intervention reduces fasting glucose and insulin concentrations in the absence of changes in resting iHsp72. Therefore, HWI shows potential as a strategy to combat chronic low-grade inflammation and improve glucose metabolism in individuals without the physical capacity to do so using exercise.

In persons with spinal cord injury (SCI), reduced fat-free mass and movement-related energy expenditure increase obesity risk. Although plausible mechanisms exist, it remains unknown whether impaired appetite regulation potentiates obesity risk in SCI. This study compared postprandial responses of appetite-related hormones, appetite perceptions and the sensitivity of appetite to covert preload energy manipulation in persons with SCI and able-bodied (AB) controls. In a counterbalanced order, 12 men with high-level SCI (≥T6 vertebrae) and 12 AB controls completed two trials, consuming covert high-energy (HE; 2513 kJ) and low-energy (LE; 1008 kJ) preloads on separate occasions. Subjective appetite perceptions were assessed at 30 min intervals following preload consumption (up to 150 min) and energy intake was determined from ad libitum test meals. Appetite-related hormone (total PYY, GLP-1 and acylated ghrelin) responses were measured in the HE trial only. Within the early postprandial phase (0–60 min), subjective ratings of fullness (d = 0.83) and satisfaction (d = 0.87) were higher (P ≤ 0.028) in the group with SCI. No group differences in PYY, GLP-1 or acylated ghrelin were detected in a fasted state or postprandially (d ≤ 0.64; p ≥ 0.053). Ad libitum energy intake was lower in the SCI group (1086 vs. 1713 kJ, respectively, d = 1.00; P = 0.020) but no effect of trial (preload) was found. These findings suggest that, following isocaloric preloads, postprandial satiety may be augmented, rather than attenuated, in people with SCI.

Purpose To investigate the inflammatory and perceptual responses to three different forms of upper-body exercise. Methods Twelve recreationally active, able-bodied males performed three work-matched arm-crank sessions in a randomised order: 30 min moderate-intensity continuous (CON), 30 min moderate-intensity with changes in cadence (CAD) and 20 min high-intensity interval training (HIIT). Blood samples were taken pre, post and 2-h post-exercise to determine plasma concentrations of interleukin (IL)-6 and IL-1ra. Perceptual responses pre, during and following the trials were assessed using the Feeling Scale, Felt Arousal Scale, Ratings of Perceived Exertion (RPE) and the Physical Activity Enjoyment Scale (PACES). Results All trials were evenly effective in inducing an acute inflammatory response, indicated by similar increases in IL-6 after exercise and in IL-1ra at 2-h post exercise for all trials. More negative affect and higher RPE were reported during HIIT compared to CON and CAD, whereas PACES scores reported after exercise were higher for HIIT and CAD compared to CON. Conclusions When matched for external work, there was no difference in the inflammatory response to HIIT compared to moderate-intensity upper-body exercise. Although HIIT was (perceived as) more strenuous and affective responses were more negative during this mode, the higher ratings of enjoyment for both HIIT and CAD reported after exercise suggest that the inclusion of variation enhances enjoyment in upper-body exercise. As the fashion in which upper-body exercise is performed does not seem to influence the inflammatory response, it might be advised to prescribe varied exercise to enhance its enjoyment.

Background: Chronic hot water immersion (HWI) confers health benefits, including a reduction in fasting blood glucose concentration. Here we investigate acute glycaemic control immediately after HWI. Methods: Ten participants (age: 25 ± 6 years, body mass: 84 ± 14 kg, height 1.85 ± 0.09 m) were immersed in water (39oC) to the neck (HWI) or sat at room temperature (CON) for 60 min. One hour afterwards they underwent an oral glucose tolerance test (OGTT), with blood collected before and after HWI/CON and during the 2 h OGTT. Results: Glucose incremental area under the curve (iAUC) during the OGTT was higher for HWI (HWI 233 ± 88, CON 156 ± 79 mmol·L-1·2h, P = 0.02). Insulin iAUC did not differ between conditions (HWI 4309 ± 3660, CON 3893 ± 3031 mU·L-1·2h, P=0.32). Core temperature increased to 38.6 ± 0.2°C during HWI, but was similar between trials during the OGTT (HWI 37.0 ± 0.2, CON 36.9 ± 0.4°C, P=0.34). Directly following HWI, plasma average adrenaline and growth hormone concentrations increased 2.7 and 10.7-fold, respectively (P < 0.001). Plasma glucagon like peptide-1, peptide YY and acylated ghrelin concentrations were not different between trials during the OGTT (P > 0.11). Conclusions: HWI increased postprandial glucose concentration to an OGTT, which was accompanied by acute elevations of stress hormones following HWI. The altered glycaemic control appears to be unrelated to changes in gut hormones during the OGTT.

This study investigates the relationship between autonomic function and the inflammatory response to a wheelchair half-marathon in people with a spinal cord injury (SCI). Seventeen wheelchair athletes with a cervical SCI (CSCI, N = 7) and without CSCI (NON-CSCI, N = 10) participated in a wheelchair half-marathon. Blood was taken prior, post and 1 h post-race to determine the concentrations of adrenaline, noradrenaline, extracellular heat shock protein 72 (eHsp72) and interleukin-6 (IL-6). A sit-up tilt test was performed to assess autonomic function at rest. CSCI showed a lower supine ratio of the low and high frequency power of the variability in RR intervals (LF/HF RRI

While adaptations to a short-term training program can dampen the acute inflammatory response to exercise, less is known about the influence of chronic modality-specific adaptations to training. This study compares the acute inflammatory response to upper- and lower-body interval exercise in individuals chronically trained in these respective modalities. Ninety minutes of interval exercise matched for relative power output on an arm-crank (ARM) and cycle ergometer (LEG) was performed by 8 trained paddlers and 8 trained cyclists. Blood samples were taken before and after exercise. Interleukin-6 (IL-6) concentrations were analysed in plasma, while the expression of intracellular heat shock protein 72 (iHsp72) was assessed in monocytes. IL-6 was increased following both modalities (fold change – ARM: 7.23 ± 3.56, p < 0.001; LEG: 9.03 ± 4.82, p < 0.001), in both groups (cyclists, p < 0.001; paddlers, p < 0.001), but the increase was smaller in ARM compared with LEG (time × modality, p < 0.001). ARM induced a smaller iHsp72 response compared with LEG (fold change – ARM: 1.07 ± 0.14, p = 0.102; LEG: 1.18 ± 0.14, p < 0.001; time × modality, p = 0.039). Following ARM, iHsp72 expression was increased in the cyclists only (fold change cyclists: 1.12 ± 0.11, p = 0.018; paddlers: 1.03 ± 0.17, p = 0.647), while iHsp72 expression following LEG was increased in both groups (fold change cyclists: 1.14 ± 0.15, p = 0.027; paddlers: 1.22 ± 0.13, p < 0.001). Taken together, the acute inflammatory response to lower-body interval exercise was larger compared with work-matched upper-body interval exercise. Moreover, adaptations to upper-body exercise training dampened the iHsp72 response to this modality. Therefore, exercise may be less effective in reducing chronic low-grade inflammation in individuals relying on their upper body, such as wheelchair users.

BackgroundUlnar neuropathy at the elbow is an entrapment neuropathy, while ulnar nerve dislocation might also be involved in its incidence and severity. Wheelchair marathon athletes may be at an increased risk for Ulnar Neuropathy. However, there is a paucity of research into the prevalence of Ulnar Neuropathy and ulnar nerve dislocation in this population.ObjectiveTo investigate the prevalence of ulnar neuropathy at the elbow and ulnar nerve dislocation in wheelchair marathon athletes.ParticipantsWheelchair marathon athletes (N = 38) who participated in the 2017, 2018, and 2019 Oita International Wheelchair Marathon. 2 athletes participated only one time, 36 athletes repeatedly. Data from athletes`latest assessment were used.MethodsThe day before the race, questionnaires, physical examinations, and ultrasonography were conducted to screen for Ulnar Neuropathy in both upper limbs. Ulnar nerve dislocation was confirmed by physical examination and ultrasonography.Results11 (29%) athletes were diagnosed with Ulnar Neuropathy. There were no significant differences in age, height, weight, Body Mass Index, or history of primary illness between athletes with and without Ulnar Neuropathy. In the group without Ulnar Neuropathy, 44% of athletes reported to have been engaging in other wheelchair sports, compared to 9% in the group with Ulnar Neuropathy (p = 0.037). Ulnar nerve dislocation was diagnosed in 15 (39%) athletes by ultrasonography. Out of the 14 elbows of 11 athletes diagnosed with Ulnar Neuropathy, 9 (64%) elbows had ulnar nerve dislocation.ConclusionThe prevalence of Ulnar Neuropathy in wheelchair marathon athletes was higher than previously reported in able-bodied, non-athlete individuals and lower than in non-athletes with lower limb dysfunction. Therefore, while wheelchair sports may provide some protection against Ulnar Neuropathy, this study further supports the importance of screening for Ulnar Neuropathy, as well as for ulnar nerve dislocation as a potential risk factor for the development of Ulnar Neuropathy.

Recognizing the encouraging effect of challenging events, the HandbikeBattle (HBB) was created to promote exercise among wheelchair users. The purpose of this study was to reveal the effects on physical fitness and health outcomes of four-month handbike training under free-living conditions in preparation for the event.In this prospective cohort study, 59 relatively inexperienced handyclists participated in the HBB of 2013 or 2014. Incremental exercise tests were conducted, respiratory function was tested and anthropometrics were measured before and after the preparation period. Main outcome measures were peak power output (POpeak), peak oxygen uptake (VO2peak) and waist circumference, of which the changes were tested using repeated measures ANOVA. To detect possible determinants of changes in physical fitness, a linear regression analysis was conducted with personal characteristics, executed training volume and upper-extremity complaints during the training period as independent variables.POpeak, VO2peak and waist circumference improved significantly with 17%, 7% and 4.1%, respectively. None of the included variables were significant determinants for the changes in POpeak found as a result of the training.A challenging event such as the HBB provokes training regimes among participants of sufficient load to realize substantial improvements in physical fitness and health outcomes. Implications for Rehabilitation Due to the often impaired muscle function in the lower-limbs and an inactive lifestyle, wheelchair users generally show considerably lower levels of fitness compared to able-bodied individuals. This prospective cohort study showed that four months of handbike training under free-living conditions in preparation for this event resulted in substantial improvements in physical fitness and health outcomes in wheelchair users. The creation of a challenging event such as the HandbikeBattle as part of a follow-up rehabilitation practice can therefore be a useful tool to help wheelchair users initiate or keep training to improve their physical fitness and health.