title: Exercise training programs to improve hand rim wheelchair propulsion capacity: a systematic review.
abstract: OBJECTIVE
  An adequate wheelchair propulsion capacity is required to perform daily life activities. Exercise training may be effective to gain or improve wheelchair propulsion capacity. This review investigates whether different types of exercise training programs are effective in improving wheelchair propulsion capacity.
  
  
  METHODS
  PubMed and EMBASE databases were searched from their respective inceptions in October 2013.
  
  
  METHODS
  Exercise training studies with at least one outcome measure regarding wheelchair propulsion capacity were included. In this study wheelchair propulsion capacity includes four parameters to reflect functional wheelchair propulsion: cardio-respiratory fitness (aerobic capacity), anaerobic capacity, muscular fitness and mechanical efficiency. Articles were not selected on diagnosis, training type or mode. Studies were divided into four training types: interval, endurance, strength, and mixed training. Methodological quality was rated with the PEDro scale, and the level of evidence was determined.
  
  
  RESULTS
  The 21 included studies represented 249 individuals with spinal-cord injury (50%), various diagnoses like spina bifida (4%), cerebral palsy (2%), traumatic injury, (3%) and able-bodied participants (38%). All interval training studies found a significant improvement of 18-64% in wheelchair propulsion capacity. Three out of five endurance training studies reported significant effectiveness. Methodological quality was generally poor and there were only two randomised controlled trials.
  
  
  CONCLUSIONS
  Exercise training programs seem to be effective in improving wheelchair propulsion capacity. However, there is remarkably little research, particularly for individuals who do not have spinal-cord injury.
authors.affiliation: Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht, The Netherlands Shared Utrecht Pediatric Exercise Research (SUPER) Lab, Utrecht, The Netherlands m.zwinkels@dehoogstraat.nl.
authors.forename: Maremka
authors.initials: M
authors.lastname: Zwinkels
authors.affiliation: Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht, The Netherlands Network for Childhood Disability Research, The Netherlands.
authors.forename: Olaf
authors.initials: O
authors.lastname: Verschuren
authors.affiliation: Rehabilitation Research Centre Reade, Amsterdam, The Netherlands Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, The Netherlands.
authors.forename: Thomas Wj
authors.initials: TW
authors.lastname: Janssen
authors.affiliation: Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht, The Netherlands Network for Childhood Disability Research, The Netherlands.
authors.forename: Marjolijn
authors.initials: M
authors.lastname: Ketelaar
authors.affiliation: Shared Utrecht Pediatric Exercise Research (SUPER) Lab, Utrecht, The Netherlands Child Development & Exercise Center, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands.
authors.forename: Tim
authors.initials: T
authors.lastname: Takken
mesh_terms: D000203:Activities of Daily Living; D016206:Databases, Bibliographic; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D010806:Physical Education and Training / Q000379:methods*; D010807:Physical Endurance / Q000502:physiology*; D010809:Physical Fitness / Q000502:physiology*; D016896:Treatment Outcome; D014910:Wheelchairs
keywords: Exercise; physical capacity; physical fitness; physical training; wheelchair