Physical fitness training for wheelchair ambulation by the arm crank propulsion technique

Objective: To observe the effect of endurance training on novice users of a n arm-propelled three-wheeled chair (APTWC), powered by asynchronous arm cr ank propulsion, in actual locomotive conditions. Study design: A continuous endurance training programme was administered by instructing subjects to propel themselves at free chosen speed (FCS) for 1 5 minutes, twice daily. Data were collected at two-week intervals consecuti vely and this was continued until the maximum beneficial effect was achieve d. Setting: The study was conducted in outdoor settings similar to those the u sers encountered in their everyday life. Subjects: Twelve male paraplegics (below T10), age 30.5 +/- 8.59 years, wei ght 41.75 kg (+/- 5.76) recommended to use the APTWC as an ambulatory devic e. Intervention: The propulsion speed (metres per minute), peak heart rate (beats per minute) and oxygen uptake (litres per minute) were measured in c onsecutive sessions at two-week intervals. Physiological cost index (beats m(-1)), oxygen consumption (ml kg(-1) min(-1)) and oxygen cost (ml kg(-1) m (-1)) were derived to assess fitness level. Results: Significant changes were observed in the variables following endur ance training for 12 weeks. The propulsion speed increased considerably and the cardiorespiratory parameters were found to be reduced. One-way analysi s of variance was done for each parameter separately for seven sets of read ings taken to assess the overall change over the study period of 12 weeks. The F-ratios were found to be significant (p < 0.01) in each case, except f or body weight and oxygen uptake. The pairwise comparison of the biweekly r esults of the parameters which showed an overall significant change over th e study period revealed that after the first two weeks there was considerab le change (p < 0.01) for all the parameters. The trend was upward for speed and downward for the other cardiovascular stress parameters. These trends continued until the 10th week showing significant change, after which the v alues become stable as was revealed by the statistical tests (p > 0.05). Th e percentage difference in the mean values from the initial stage (before t raining) to the 12th week ranged from 10.44% in the case of heart rate to 6 9.70% in the case of propulsion speed. Conclusion: Self-ambulation at free chosen speed regularly for 10-12 weeks provides efficiency and improves fitness status required for wheelchairs dr iven by an asynchronous arm crank propulsion technique and no special exerc ise programme is required.