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

OBJECTIVE: To observe the effect of endurance training on novice users of an arm-propelled three-wheeled chair (APTWC), powered by asynchronous arm crank 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 15 minutes, twice daily. Data were collected at two-week intervals consecutively and this was continued until the maximum beneficial effect was achieved.

SETTING: The study was conducted in outdoor settings similar to those the users encountered in their everyday life.

SUBJECTS: Twelve male paraplegics (below T10), age 30.5 +/- 8.59 years, weight 41.75 kg (+/- 5.76) recommended to use the APTWC as an ambulatory device.

INTERVENTION: The propulsion speed (metres per minute), peak heart rate (beats per minute) and oxygen uptake (litres per minute) were measured in consecutive 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 endurance training for 12 weeks. The propulsion speed increased considerably and the cardiorespiratory parameters were found to be reduced. One-way analysis of variance was done for each parameter separately for seven sets of readings 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 for body weight and oxygen uptake. The pairwise comparison of the biweekly results of the parameters which showed an overall significant change over the study period revealed that after the first two weeks there was considerable 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 values become stable as was revealed by thestatistical tests (p > 0.05). The percentage difference in the mean values from the initial stage (before training) to the 12th week ranged from 10.44% in the case of heart rate to 69.70% 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 driven by an asynchronous arm crank propulsion technique and no special exercise programme is required.