{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T15:49:01Z","timestamp":1790783341830,"version":"4.1.0"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2009,10,1]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Regular physical activity is important for people with tetraplegia to maintain fitness but may not always be easily integrated into daily life. In many countries, hand cycling has become a serious option for daily mobility in people with tetraplegia. However, little information exists regarding the suitability of this exercise mode for this population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>The purpose of this study was to evaluate the effects of a structured hand cycle training program in individuals with chronic tetraplegia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Pretraining and posttraining outcome measurements of physical capacity were compared.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Structured hand cycle interval training was conducted at home or in a rehabilitation center in the Netherlands.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Twenty-two patients with tetraplegia (American Spinal Injury Association Impairment Scale classification A-D) at least 2 years since injury participated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Intervention<\/jats:title><jats:p>The intervention was an 8- to 12-week hand cycle interval training program.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measures<\/jats:title><jats:p>Primary outcomes of physical capacity were: peak power output (POpeak) and peak oxygen uptake (V\u0307o2peak), as determined in hand cycle peak exercise tests on a motor-driven treadmill. Secondary outcome measures were: peak muscle strength (force-generating capacity) of the upper extremities (as assessed by handheld dynamometry), respiratory function (forced vital capacity and peak expiratory flow) and participant-reported shoulder pain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Significant improvements following a mean of 19 (SD=3) sessions of hand cycle training were found in POpeak (from 42.5 W [SD=21.9] to 50.8 W [SD=25.4]), V\u0307o2peak (from 1.32 L\u00b7min\u22121 [SD=0.40] to 1.43 L\u00b7min\u22121 [SD=0.43]), and mechanical efficiency, as reflected by a decrease in submaximal oxygen uptake. Except for shoulder abduction strength, no significant effects were found on the secondary outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Limitations<\/jats:title><jats:p>Common health complications, such as urinary tract infections, bowel problems, and pressure sores, led to dropout and nonadherence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patients with tetraplegia were able to improve their physical capacity through regular hand cycle interval training, without participant-reported shoulder-arm pain or discomfort.<\/jats:p><\/jats:sec>","DOI":"10.2522\/ptj.20080340","type":"journal-article","created":{"date-parts":[[2009,7,31]],"date-time":"2009-07-31T00:56:25Z","timestamp":1249001785000},"page":"1051-1060","source":"Crossref","is-referenced-by-count":69,"title":["Effects of Hand Cycle Training on Physical Capacity in Individuals With Tetraplegia: A Clinical Trial"],"prefix":"10.1093","volume":"89","author":[{"given":"Linda J.M.","family":"Valent","sequence":"first","affiliation":[{"name":"L.J.M. Valent, PhD, is Occupational Therapist and Senior Researcher, Department of Research and Development\/Occupational Therapy, Heliomare Rehabilitation Centre, Relweg 51, 1949 EC, Wijk aan Zee, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annet J.","family":"Dallmeijer","sequence":"additional","affiliation":[{"name":"A.J. Dallmeijer, PhD, is Assistant Professor, Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han","family":"Houdijk","sequence":"additional","affiliation":[{"name":"H. Houdijk, PhD, is a staff member in the Department of Research and Development, Heliomare Rehabilitation Centre, and Assistant Professor, Research Institute MOVE, Institute for Fundamental and Clinical Human Movement Sciences, Faculty of Human Movement Sciences, VU University, Amsterdam, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans J.","family":"Slootman","sequence":"additional","affiliation":[{"name":"H.J. Slootman, MD, is a medical doctor in the Spinal Cord Unit, Heliomare Rehabilitation Centre."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas W.","family":"Janssen","sequence":"additional","affiliation":[{"name":"T.W. Janssen, PhD, is Professor, Research Institute MOVE, Institute for Fundamental and Clinical Human Movement Sciences, Faculty of Human Movement Sciences, VU University, and Rehabilitation Center Amsterdam, Amsterdam, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel W.M.","family":"Post","sequence":"additional","affiliation":[{"name":"M.W.M. Post, PhD, is Senior Researcher, De Hoogstraat Rehabilitation Centre and Rudolf Magnus Institute for Neuroscience, University Medical Hospital Utrecht, Utrecht, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas H.","family":"van der Woude","sequence":"additional","affiliation":[{"name":"L.H. van der Woude, PhD, is Professor, Research Institute MOVE, Institute for Fundamental and Clinical Human Movement Sciences, Faculty of Human Movement Sciences, VU University, and Rehabilitation Center Amsterdam."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","reference":[{"issue":"5 suppl","key":"2019123106481247400_R1","first-page":"S149","article-title":"Arm exercise training for wheelchair users","volume":"21","author":"Glaser","year":"1989","journal-title":"Med Sci Sports Exerc"},{"key":"2019123106481247400_R2","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1682\/JRRD.2005.10.0159","volume":"44","author":"Krassioukov","year":"2007","journal-title":"J Rehabil Res Dev"},{"key":"2019123106481247400_R3","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1097\/01.phm.0000171172.96290.67","article-title":"Perceived barriers to exercise in people with spinal cord injury","volume":"84","author":"Scelza","year":"2005","journal-title":"Am J Phys Med Rehabil"},{"key":"2019123106481247400_R4","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1097\/PHM.0b013e31802f0247","article-title":"Cardiovascular disease in spinal cord injury: an overview of prevalence, risk, evaluation, and management","volume":"86","author":"Myers","year":"2007","journal-title":"Am J Phys Med Rehabil"},{"key":"2019123106481247400_R5","doi-asserted-by":"crossref","first-page":"226","DOI":"10.2165\/00007256-199520040-00003","article-title":"Spinal cord injury, exercise and quality of life","volume":"20","author":"Noreau","year":"1995","journal-title":"Sports Med"},{"key":"2019123106481247400_R6","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1016\/S1350-4533(01)00083-2","article-title":"Biomechanics and physiology in active manual wheelchair propulsion","volume":"23","author":"Van der Woude","year":"2001","journal-title":"Med Eng Phys"},{"key":"2019123106481247400_R7","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/S0003-9993(99)90285-X","article-title":"Shoulder pain in wheelchair users with tetraplegia and paraplegia","volume":"80","author":"Curtis","year":"1999","journal-title":"Arch Phys Med Rehabil"},{"key":"2019123106481247400_R8","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1097\/00002060-199805000-00006","article-title":"Effectiveness of force application in manual wheelchair propulsion in persons with spinal cord injuries","volume":"77","author":"Dallmeijer","year":"1998","journal-title":"Am J Phys Med Rehabil"},{"key":"2019123106481247400_R9","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1038\/sj.sc.3101566","article-title":"Submaximal physical strain and peak performance in hand cycling versus hand-rim wheelchair propulsion","volume":"42","author":"Dallmeijer","year":"2004","journal-title":"Spinal Cord"},{"key":"2019123106481247400_R10","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1177\/0269215507073385","article-title":"The effects of upper body exercise on the physical capacity of people with a spinal cord injury: a systematic review","volume":"21","author":"Valent","year":"2007","journal-title":"Clin Rehabil"},{"key":"2019123106481247400_R11","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/S0003-9993(95)80023-9","article-title":"Effect of body training position on outcomes of an aerobic training study on individuals with quadriplegia","volume":"76","author":"McLean","year":"1995","journal-title":"Am J Phys Med Rehabil"},{"key":"2019123106481247400_R12","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1093\/ptj\/68.1.40","article-title":"Effect of arm ergometry training on wheelchair propulsion endurance of individuals with quadriplegia","volume":"68","author":"DiCarlo","year":"1988","journal-title":"Phys Ther"},{"key":"2019123106481247400_R13","first-page":"251","article-title":"Improved physical fitness and work capacity in quadriplegics by wheelchair exercise","volume":"3","author":"Whiting","year":"1983","journal-title":"J Cardiac Rehabil"},{"key":"2019123106481247400_R14","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1249\/00005768-198610000-00005","article-title":"Hydraulic resistance exercise benefits cardiovascular fitness of spinal cord injured","volume":"18","author":"Cooney","year":"1986","journal-title":"Med Sci Sports Exercise"},{"key":"2019123106481247400_R15","doi-asserted-by":"crossref","first-page":"181","DOI":"10.2340\/165019771997181186","article-title":"Effect of training on physical capacity and physical strain in persons with tetraplegia","volume":"29","author":"Dallmeijer","year":"1997","journal-title":"Scand J Rehabil Med"},{"key":"2019123106481247400_R16","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1191\/026921501666069173","article-title":"Physical fitness training for wheelchair ambulation by the arm crank propulsion technique","volume":"15","author":"Mukherjee","year":"2001","journal-title":"Clin R"},{"key":"2019123106481247400_R17","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1016\/j.apmr.2007.10.034","article-title":"Influence of hand cycling on physical capacity in the rehabilitation of persons with a spinal cord injury: a longitudinal cohort study","volume":"89","author":"Valent","year":"2008","journal-title":"Am J Phys Med Rehabil"},{"issue":"suppl 1","key":"2019123106481247400_R18","doi-asserted-by":"crossref","first-page":"S50","DOI":"10.1080\/10790268.2003.11754575","article-title":"International standards for neurological classification of spinal cord injury","volume":"26","author":"Marino","year":"2003","journal-title":"J Spinal Cord Med"},{"key":"2019123106481247400_R19","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1038\/sj.sc.3101826","article-title":"Upper extremity musculoskeletal pain during and after rehabilitation in wheelchair-using persons with a spinal cord injury","volume":"44","author":"Van Drongelen","year":"2006","journal-title":"Spinal Cord"},{"key":"2019123106481247400_R20","volume-title":"ACSM's Guidelines for Exercise Testing and Prescription","author":"Franklin","year":"2000"},{"key":"2019123106481247400_R21","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1038\/sj.sc.3101946","article-title":"The individual relationship between heart rate and oxygen uptake in people with a tetraplegia during exercise","volume":"45","author":"Valent","year":"2007","journal-title":"Spinal Cord"},{"key":"2019123106481247400_R22","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1249\/00005768-198315060-00015","article-title":"A category-ratio perceived exertion scale: relationship to blood and muscle lactates and heart rate","volume":"15","author":"Noble","year":"1983","journal-title":"Med Sci Sports Exercise"},{"key":"2019123106481247400_R23","doi-asserted-by":"crossref","first-page":"1561","DOI":"10.1080\/00140138608967269","article-title":"Wheelchair ergonomics and physiological testing of prototypes","volume":"29","author":"Van der Woude","year":"1986","journal-title":"Ergonomics"},{"key":"2019123106481247400_R24","volume-title":"Principles of Exercise Testing and Interpretation","author":"Wasserman","year":"1999"},{"key":"2019123106481247400_R25","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1093\/ptj\/76.3.248","article-title":"Normative values for isometric muscle force measurements obtained with hand-held dynamometers","volume":"76","author":"Andrews","year":"1996","journal-title":"Phys Ther"},{"key":"2019123106481247400_R26","first-page":"653","article-title":"Muscle force measured using \u201cbreak\u201d testing with a hand-held myometer in normal subjects aged 20 to 69 years","volume":"81","author":"Phillips","year":"2000","journal-title":"Am J Phys Med Rehabil"},{"key":"2019123106481247400_R27","first-page":"49","article-title":"Exercise research issues in the spinal cord injured population","volume":"33","author":"Ginis","year":"2005","journal-title":"Exerc Sport Sci Rev"},{"key":"2019123106481247400_R28","doi-asserted-by":"crossref","first-page":"307","DOI":"10.2165\/00007256-200636040-00003","article-title":"The impact of exercise training intensity on change in physiological function in patients with chronic obstructive pulmonary disease","volume":"36","author":"Butcher","year":"2006","journal-title":"Sports Med"},{"key":"2019123106481247400_R29","first-page":"433","article-title":"Exercise responses and quadriplegia","volume":"25","author":"Figoni","year":"1993","journal-title":"Med Sci Sports Exerc"},{"key":"2019123106481247400_R30","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1080\/10790268.2005.11753844","article-title":"Preservation of upper limb function following spinal cord injury: a clinical practice guideline for health-care professionals","volume":"28","author":"Bonninger","year":"2005","journal-title":"J Spinal Cord Med"},{"key":"2019123106481247400_R31","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1038\/sj.sc.3100687","article-title":"Improved work capacity but unchanged peak oxygen uptake during primary rehabilitation in tetraplegic patients","volume":"36","author":"Hjeltnes","year":"1998","journal-title":"Spinal Cord"},{"key":"2019123106481247400_R32","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/S0966-6362(03)00097-3","article-title":"Validation of the portable VmaxST system for oxygen-uptake measurement","volume":"20","author":"Brehm","year":"2004","journal-title":"Gait Posture"},{"key":"2019123106481247400_R33","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1097\/00005768-200205000-00005","article-title":"Wheelchair propulsion technique and mechanical efficiency after 3 wk of practice","volume":"34","author":"De Groot","year":"2002","journal-title":"Med Sci Sports Exercise"},{"key":"2019123106481247400_R34","volume-title":"Management of Spinal Cord Injury","author":"Harvey","year":"2008"},{"key":"2019123106481247400_R35","doi-asserted-by":"crossref","first-page":"61","DOI":"10.2340\/1650197712061065","article-title":"The effects of physical training on high level spinal lesion patients","volume":"12","author":"Gass","year":"1980","journal-title":"Scand J Rehabil Med"},{"key":"2019123106481247400_R36","first-page":"435","article-title":"The effect of exercise training on pulmonary function in persons with quadriplegia","volume":"32","author":"Crane","year":"1994","journal-title":"Paraplegia"},{"key":"2019123106481247400_R37","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1249\/00005768-199501000-00004","article-title":"Exercise prescription for sitting and supine exercise in subjects with quadriplegia","volume":"27","author":"McLean","year":"1995","journal-title":"Med Sci Sports Exercise"}],"container-title":["Physical Therapy"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ptj\/article-pdf\/89\/10\/1051\/31663172\/ptj1051.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ptj\/article-pdf\/89\/10\/1051\/31663172\/ptj1051.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T15:47:54Z","timestamp":1739288874000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ptj\/article\/89\/10\/1051\/2737585"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,10,1]]},"references-count":37,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2009,10,1]]}},"URL":"https:\/\/doi.org\/10.2522\/ptj.20080340","relation":{},"ISSN":["0031-9023","1538-6724"],"issn-type":[{"value":"0031-9023","type":"print"},{"value":"1538-6724","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,10,1]]}}}