title: Effects of hybrid cycling versus handcycling on wheelchair-specific fitness and physical activity in people with long-term spinal cord injury: a 16-week randomized controlled trial.
abstract: METHODS
  This is an open randomized controlled trial.
  
  
  OBJECTIVE
  The objective of this study was to investigate the effects of a 16-week hybrid cycle versus handcycle exercise program on fitness and physical activity in inactive people with long-term spinal cord injury (SCI).
  
  
  METHODS
  The study was conducted in two rehabilitation centers with a specialized SCI unit.
  
  
  METHODS
  Twenty individuals (SCI⩾8 years) were randomly assigned to a hybrid cycle (voluntary arm exercise combined with functional electrical stimulation (FES)-induced leg exercise) or a handcycle group. During 16 weeks, both groups trained twice a week for 30 min at 65-75% heart rate reserve. Outcome measures obtained before, during and after the program were fitness (peak power output, peak oxygen consumption), submaximal VO2 and heart rate (HR), resting HR, wheelchair skill performance time score) and physical activity (distance travelled in wheelchair and Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) score). Changes were examined using a two-factor mixed-measures analysis of variance.
  
  
  RESULTS
  For all fitness parameters, except for submaximal VO2, no interaction effects were found. The hybrid cycle group showed a decrease in VO2 over time in contrast to the handcycle group (P=0.045). An overall reduction in HRrest (5±2 b.p.m.; P=0.03) and overall increase in PASIPD score (6.5±2.1; P=0.002) were found after 16 weeks of training. No overall training effects were found for the other fitness and activity outcome measures.
  
  
  CONCLUSIONS
  In the current study, hybrid cycling and handcycling showed similar effects on fitness and physical activity, indicating that there seem to be no additional benefits of the FES-induced leg exercise over handcycle training alone.
authors.affiliation: 1] Faculty of Human Movement Sciences, MOVE Research Institute Amsterdam, VU University Amsterdam, Amsterdam, The Netherlands [2] Amsterdam Rehabilitation Research Centre | Reade, Amsterdam, The Netherlands.
authors.forename: A J T
authors.initials: AJ
authors.lastname: Bakkum
authors.affiliation: 1] Amsterdam Rehabilitation Research Centre | Reade, Amsterdam, The Netherlands [2] University of Groningen, University Medical Centre Groningen, Center for Human Movement Sciences, Groningen, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: de Groot
authors.affiliation: Department of Rehabilitation Medicine, Meander Medical Center, Amersfoort, The Netherlands.
authors.forename: J M
authors.initials: JM
authors.lastname: Stolwijk-Swüste
authors.affiliation: Sint Maartenskliniek, Nijmegen, The Netherlands.
authors.forename: D J
authors.initials: DJ
authors.lastname: van Kuppevelt
authors.affiliation: 1] University of Groningen, University Medical Centre Groningen, Center for Human Movement Sciences, Groningen, The Netherlands [2] University of Groningen, University Medical Centre Groningen, Center for Rehabilitation, Groningen, The Netherlands.
authors.forename: L H V
authors.initials: LH
authors.lastname: van der Woude
authors.affiliation: 1] Faculty of Human Movement Sciences, MOVE Research Institute Amsterdam, VU University Amsterdam, Amsterdam, The Netherlands [2] Amsterdam Rehabilitation Research Centre | Reade, Amsterdam, The Netherlands.
authors.forename: T W J
authors.initials: TW
authors.lastname: Janssen
mesh_terms: D000328:Adult; D000368:Aged; D004599:Electric Stimulation Therapy; D005080:Exercise Test; D005081:Exercise Therapy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D017063:Outcome Assessment, Health Care; D010101:Oxygen Consumption; D010809:Physical Fitness; D012047:Rehabilitation Centers; D013119:Spinal Cord Injuries / Q000503:physiopathology* / Q000534:rehabilitation*; D014910:Wheelchairs / Q000145:classification