Invited Session "Handcycling: from rehabilitation to elite sports performance"

Handcycling to promote health and fitness during and after rehabilitation
Janssen, T. W. J.
VU University Amsterdam

Introduction
Individuals with lowerlimb impairments predominantly depend on upperbody exercise for locomotion, therapy or sports activities.
Wheelchair exercise, the more traditional form of upperbody exercise, is related to a high incidence of upperlimb injuries, probably
as a result of frequent high loads. During the last decades, a relatively new form of upperbody exercise, handcycling, has evolved
from a combination of wheelchair and arm cranking exercise. Handcycling is less straining and more efficient than wheelchair
propulsion, making this exercise an ideal training for upperbody exercise in the context of rehabilitation and an active life style, but
also an attractive and exciting sport to perform for people with lowerlimb disabilities. Several types of handbikes are now available
and handcycling exercise is performed by a very diverse group of individuals, from the rather inactive person during rehabilitation to
the elite athlete.
Methods
This presentation will focus on studies investigating exercise and shoulder loading responses during handcycling in different
populations, especially individuals with spinal cord injury (SCI), and potential mechanisms for health and fitness promotion will be
discussed. Subsequently, handcycling interventions during and after the clinical rehabilitation phase will be discussed, including
effects on variables such as wheelchair performance capacity, muscle strength, and cardiorespiratory function. In addition,
handcycling combined with electricalstimulation induced leg cycling as a means to increase active muscle mass and potential health
and fitness benefits will be discussed.
Results
From several studies it has become clear that handcycling is a more mechanically efficient exercise mode than wheelchair exercise.
In addition, higher metabolic rates and power output levels can be achieved with handcycling than with wheelchair exercise, and
strain on the shoulder joint and muscles prone to overuse injuries is lower (Arnet et al. 2012), suggesting that handcycling is more
suitable for improving health and fitness, especially for those with impaired arm function. Intervention studies during rehabilitation
show that additional hand cycle training leads to favourable results on physical capacity compared with regular care (Valent et al.
2010). After rehabilitation, handcycling can effectively promote health and fitness, even in the inactive ageing population with SCI.
The addition of lowerlimb muscle activation using electrical stimulation can provide additional health and fitness benefits. No studies
have found adverse effects of handcycling.
Conclusion
Despite the limited evidence base, the current literature suggests an important role for handcycling during and after rehabilitation as a
safe and effective exercise mode to promote health and fitness in persons with lowerlimb disabilities.
References
Arnet U, et al. (2012) J Rehabil Med 44(3):2228.
Valent L, et al. (2010). Disabil Rehabil 32(26): 2191–2200.