{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:44:29Z","timestamp":1790815469581,"version":"4.1.0"},"reference-count":66,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,10,24]],"date-time":"2023-10-24T00:00:00Z","timestamp":1698105600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Sports Act. Living"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Heart rate (HR) monitors are rarely used by people living with disabilities (PLWD), and their accuracy is undocumented. Thus, this study aims to describe the HR response during the Team Twin co-running program and, secondly, to assess the agreement and accuracy of using HR monitors among PLWD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This 16-week single-arm observational study included 18 people with various disabilities. During the study, the subjects wore a Garmin Vivosmart 4 watch (wrist). To evaluate the agreement and accuracy we applied Garmin\u2019s HRM-DUAL\u2122 chest-worn HR monitors for comparison with the Vivosmart 4. The HR response analysis was performed descriptively and with a mixed regression model. The HR agreement and accuracy procedure was conducted on a subsample of five subjects and analyzed using Lin\u2019s concordance analysis, Bland and Altman\u2019s limits of agreement, and Cohen\u2019s kappa analysis of intensity zone agreement. This study was prospectively registered at Clinical Trials.gov (NCT04536779).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The subjects had a mean age of 35 (\u00b112.6), 61% were male, 72% had cerebral palsy were 85% had GMFCS V-IV. HR was monitored for 202:10:33 (HH:MM:SS), with a mean HR of 90\u2009\u00b1\u200917 bpm during training and race. A total of 19% of the time was spent in intensity zones between light and moderate (30%\u201359% HR reserve) and 1% in vigorous (60%\u201384% HR reserve). The remaining 80% were in the very light intensity zone (&amp;lt;29% HR reserve). HR was highest at the start of race and training and steadily decreased. Inter-rater agreement was high (k\u2009=\u20090.75), limits of agreement were between \u221216 and 13 bpm, and accuracy was acceptable (Rc\u2009=\u20090.86).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Disability type, individual, and contextual factors will likely affect HR responses and the agreement and accuracy for PLWD. The Vivosmart 4, while overall accurate, had low precision due to high variability in the estimation. These findings implicate the methodical and practical difficulties of utilizing HR monitors to measure HR and thus physical activity in adapted sports activities for severely disabled individuals.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fspor.2023.1213655","type":"journal-article","created":{"date-parts":[[2023,10,24]],"date-time":"2023-10-24T21:30:09Z","timestamp":1698183009000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Heart rate responses, agreement and accuracy among persons with severe disabilities participating in the indirect movement program: Team Twin\u2014an observational study"],"prefix":"10.3389","volume":"5","author":[{"given":"Andreas","family":"J\u00f8rgensen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mette","family":"Toftager","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Egh\u00f8j","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathias","family":"Ried-Larsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Bj\u00f8rk Petersen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,10,24]]},"reference":[{"key":"B1","volume-title":"World report on disability 2011","year":""},{"key":"B2","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1111\/dmcn.13737","article-title":"The risk, burden, and management of non-communicable diseases in cerebral palsy: a scoping review","volume":"60","author":"Ryan","year":"2018","journal-title":"Dev Med Child Neurol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1123\/jpah.2020-0629","article-title":"The first global physical activity and sedentary behavior guidelines for people living with disability","volume":"18","author":"Carty","year":"2021","journal-title":"J Phys Act Health"},{"key":"B4","doi-asserted-by":"publisher","first-page":"871","DOI":"10.1016\/j.apmr.2011.11.032","article-title":"Impact of cerebral palsy on health-related physical fitness in adults: systematic review","volume":"93","author":"Hombergen","year":"2012","journal-title":"Arch Phys Med Rehabil"},{"key":"B5","doi-asserted-by":"publisher","first-page":"915","DOI":"10.1111\/dmcn.14028","article-title":"Cardiovascular disease and related risk factors in adults with cerebral palsy: a systematic review","volume":"61","author":"Mcphee","year":"2019","journal-title":"Dev Med Child Neurol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"2196","DOI":"10.1016\/j.apmr.2017.03.013","article-title":"Long-term deterioration of perceived health and functioning in adults with cerebral palsy","volume":"98","author":"Benner","year":"2017","journal-title":"Arch Phys Med Rehabil Psychol"},{"key":"B7","volume-title":"WHO Guidelines on physical activity and sedentary behaviour","year":"2020"},{"key":"B8","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1016\/S0140-6736(21)01164-8","article-title":"Participation of people living with disabilities in physical activity: a global perspective","volume":"398","author":"Martin Ginis","year":"2021","journal-title":"Lancet"},{"key":"B9","doi-asserted-by":"publisher","first-page":"2022","DOI":"10.2105\/AJPH.2004.051870","article-title":"Accessibility of health clubs for people with mobility disabilities and visual impairments","volume":"95","author":"Rimmer","year":"2005","journal-title":"Am J Public Health"},{"key":"B10","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1097\/JSA.0000000000000242","article-title":"Impact of adaptive sports participation on quality of life","volume":"27","author":"Diaz","year":"2019","journal-title":"Sports Med Arthrosc"},{"key":"B11","doi-asserted-by":"publisher","first-page":"578","DOI":"10.1016\/j.apmr.2014.12.008","article-title":"Environmental barriers and supports to everyday participation: a qualitative insider perspective from people with disabilities","volume":"96","author":"Hammel","year":"2015","journal-title":"Arch Phys Med Rehabil"},{"key":"B12","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1016\/j.amepre.2004.02.002","article-title":"Physical activity participation among persons with disabilities: barriers and facilitators","volume":"26","author":"Rimmer","year":"2004","journal-title":"Am J Prev Med"},{"key":"B13","doi-asserted-by":"publisher","first-page":"588","DOI":"10.1080\/17430437.2019.1703683","article-title":"\u2018I\u2019ll always find a perfectly justified reason for not doing it\u2019: challenges for disability sport and physical activity in the United Kingdom","volume":"24","author":"Ives","year":"2021","journal-title":"Sport in Society"},{"key":"B14","doi-asserted-by":"publisher","first-page":"2030","DOI":"10.3109\/09638288.2013.802377","article-title":"Benefits and barriers to physical activity for individuals with disabilities: a social-relational model of disability perspective","volume":"35","author":"Martin","year":"2013","journal-title":"Disabil Rehabil"},{"key":"B15","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1080\/17483107.2020.1767220","article-title":"A review of adaptive sport opportunities for power wheelchair users","volume":"16","author":"Duvall","year":"2021","journal-title":"Disabil Rehabil Assist Technol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"10008","DOI":"10.3390\/ijerph181910008","article-title":"When movement moves: study protocol for a multi-method pre\/post evaluation study of two programmes; the danish team twin and cycling without age","volume":"18","author":"J\u00f8rgensen","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"B17","volume-title":"Forunders\u00f8gelse om team tvilling: N\u00e5r bev\u00e6gelse bev\u00e6ger: om betydningen af positive kropsoplevelser, ligev\u00e6rdige relationer og identitetsudviklende f\u00e6llesskaber for mennesker med store bev\u00e6gelsesbegr\u00e6nsninger. English; pilot study on team twin: when movement moves: the importance of positive body experiences, equal relationships and identity-developing communities for people with severe movement limitations","author":"Winther","year":"2018"},{"key":"B18","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1097\/PEP.0b013e31804a57a8","article-title":"Heart rate response to therapeutic riding in children with cerebral palsy: an exploratory study","volume":"19","author":"Dirienzo","year":"2007","journal-title":"Pediatr Phys Ther"},{"key":"B19","doi-asserted-by":"publisher","first-page":"718","DOI":"10.1249\/01.MSS.0000161807.77552.8B","article-title":"Disability type influences heart rate response during power wheelchair sport","volume":"37","author":"Barfield","year":"2005","journal-title":"Med Sci Sports Exerc"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1938","DOI":"10.1016\/j.apmr.2016.05.012","article-title":"Exercise intensity during power wheelchair soccer","volume":"97","author":"Barfield","year":"2016","journal-title":"Arch Phys Med Rehabil"},{"key":"B21","article-title":"ACSM\u2019s guidelines for exercise testing and prescription","volume-title":"Medicine ACoS","author":"Riebe","year":"2018"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1858","DOI":"10.3390\/s21051858","article-title":"Wearable sensors in sports for persons with disability: a systematic review","volume":"21","author":"Rum","year":"2021","journal-title":"Sensors (Basel, Switzerland)"},{"key":"B23","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1249\/FIT.0000000000000732","article-title":"Worldwide survey of fitness trends for 2022","volume":"26","author":"Thompson","year":"2022","journal-title":"ACSM\u2019s Health Fit J"},{"key":"B24","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1001\/jamacardio.2016.3340","article-title":"Accuracy of wrist-worn heart rate monitors","volume":"2","author":"Wang","year":"2017","journal-title":"JAMA Cardiology"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1697","DOI":"10.1249\/MSS.0000000000001284","article-title":"Variable accuracy of wearable heart rate monitors during aerobic exercise","volume":"49","author":"Gillinov","year":"2017","journal-title":"Med Sci Sports Exerc"},{"key":"B26","doi-asserted-by":"publisher","first-page":"379","DOI":"10.21037\/cdt.2019.06.05","article-title":"Accuracy of commercially available heart rate monitors in athletes: a prospective study","volume":"9","author":"Pasadyn","year":"2019","journal-title":"Cardiovasc Diagn Ther"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13102-018-0090-8","article-title":"Wrist-worn optical and chest strap heart rate comparison in a heterogeneous sample of healthy individuals and in coronary artery disease patients","volume":"10","author":"Sartor","year":"2018","journal-title":"BMC Sports Sci Med Rehabil Vol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"e000106","DOI":"10.1136\/bmjsem-2015-000106","article-title":"How accurate are the wrist-based heart rate monitors during walking and running activities? Are they accurate enough?","volume":"2","author":"Stahl","year":"2016","journal-title":"BMJ Open Sport Exerc Med"},{"key":"B29","doi-asserted-by":"publisher","first-page":"112","DOI":"10.12691\/jpar-2-2-8","article-title":"The accuracy of wrist-worn heart rate monitors across a range of exercise intensities","volume":"2","author":"Hough","year":"2017","journal-title":"J Phys Activ Res"},{"key":"B30","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1080\/026404198366920","article-title":"Heart rate monitors: state of the art","volume":"16","author":"Laukkanen","year":"1998","journal-title":"J Sports Sci"},{"key":"B31","doi-asserted-by":"publisher","first-page":"234","DOI":"10.3390\/app10010234","article-title":"Use of wearable sensor technology in gait, balance, and range of motion analysis","volume":"10","author":"D\u00edaz","year":"2020","journal-title":"Appl Sci"},{"key":"B32","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1080\/1091367X.2011.539089","article-title":"Validity of the smarthealth watch to measure heart rate during rest and exercise","volume":"15","author":"Lee","year":"2011","journal-title":"Meas Phys Educ Exerc Sci"},{"key":"B33","doi-asserted-by":"publisher","first-page":"S439","DOI":"10.1097\/00005768-200009001-00001","article-title":"Introduction: evaluation of some measurements of physical activity and energy expenditure","volume":"32","author":"Montoye","year":"2000","journal-title":"Med Sci Sports Exerc"},{"key":"B34","doi-asserted-by":"publisher","first-page":"S465","DOI":"10.1097\/00005768-200009001-00005","article-title":"Evaluation of heart rate as a method for assessing moderate intensity physical activity","volume":"32","author":"Strath","year":"2000","journal-title":"Med Sci Sports Exerc"},{"key":"B35","doi-asserted-by":"publisher","first-page":"e18694","DOI":"10.2196\/18694","article-title":"Reliability and validity of commercially available wearable devices for measuring steps, energy expenditure, and heart rate: systematic review","volume":"8","author":"Fuller","year":"2020","journal-title":"JMIR Mhealth Uhealth"},{"key":"B36","doi-asserted-by":"publisher","first-page":"e10108","DOI":"10.2196\/10108","article-title":"Methodological shortcomings of wrist-worn heart rate monitors validations","volume":"20","author":"Sartor","year":"2018","journal-title":"J Med Internet Res"},{"key":"B37","article-title":"Declaration of Helsinki","volume-title":"Ethical principles for medical research involving human subjects WMA general assembly","year":"2008"},{"key":"B38","year":"2020"},{"key":"B39","year":"2021"},{"key":"B40","year":"2022"},{"key":"B41","doi-asserted-by":"publisher","first-page":"e0243214","DOI":"10.1371\/journal.pone.0243214","article-title":"Assessing the performance of a commercial multisensory sleep tracker","volume":"15","author":"Mouritzen","year":"2020","journal-title":"PloS One"},{"key":"B42","doi-asserted-by":"publisher","first-page":"1655","DOI":"10.1097\/00005768-200110000-00007","article-title":"Prediction of maximal heart rate in individuals with mental retardation","volume":"33","author":"Fernhall","year":"2001","journal-title":"Med Sci Sports Exerc"},{"key":"B43","first-page":"307","article-title":"The effects of training on heart rate: a longitudinal study","volume":"35","author":"Karvonen","year":"1957","journal-title":"Ann Med Exp Biol Fenn"},{"key":"B44","doi-asserted-by":"publisher","first-page":"1334","DOI":"10.1249\/MSS.0b013e318213fefb","article-title":"American college of sports medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise","volume":"43","author":"Garber","year":"2011"},{"key":"B45","doi-asserted-by":"publisher","first-page":"2259","DOI":"10.1161\/01.cir.0000435708.67487.da","article-title":"Guide to the assessment of physical activity: clinical and research applications","volume":"128","author":"Strath","year":"2013","journal-title":"Circulation"},{"key":"B46","year":"2022"},{"key":"B47","doi-asserted-by":"publisher","first-page":"255","DOI":"10.2307\/2532051","article-title":"A concordance correlation coefficient to evaluate reproducibility","volume":"45","author":"Lawrence","year":"1989","journal-title":"Biometrics"},{"key":"B48","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1177\/1536867X0200200206","article-title":"A note on the concordance correlation coefficient","volume":"56","author":"Lawrence","year":"2000","journal-title":"JMIR Cardio"},{"key":"B49","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1177\/1536867X0200200206","article-title":"A note on the concordance correlation coefficient","volume":"2","author":"Steichen","year":"2002","journal-title":"Stata J"},{"key":"B50","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1016\/S0140-6736(86)90837-8","article-title":"Statistical methods for assessing agreement between two methods of clinical measurement","volume":"327","author":"Bland J","year":"1986","journal-title":"Lancet"},{"key":"B51","doi-asserted-by":"publisher","first-page":"159","DOI":"10.2307\/2529310","article-title":"The measurement of observer agreement for categorical data","volume":"33","author":"Landis","year":"1977","journal-title":"Biometrics"},{"key":"B52","volume-title":"SCPE Scientific report 1998-20182018","author":"Arnaud","year":""},{"key":"B53","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1097\/01241398-198905000-00004","article-title":"Energy cost of walking in normal children and in those with cerebral palsy: comparison of heart rate and oxygen uptake","volume":"9","author":"Rose","year":"1989","journal-title":"J Pediatr Orthop"},{"key":"B54","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1016\/S0003-9993(98)90099-5","article-title":"Cardiorespiratory endurance in people with cerebral palsy measured using an arm ergometer","volume":"79","author":"Tobimatsu","year":"1998","journal-title":"Arch Phys Med Rehabil"},{"key":"B55","doi-asserted-by":"publisher","first-page":"1498","DOI":"10.1097\/00005768-199612000-00009","article-title":"Role of cocontraction in the O2 cost of walking in children with cerebral palsy","volume":"28","author":"Unnithan","year":"1996","journal-title":"Med Sci Sports Exerc"},{"key":"B56","doi-asserted-by":"publisher","first-page":"1703","DOI":"10.1097\/00005768-199912000-00003","article-title":"Role of mechanical power estimates in the O2 cost of walking in children with cerebral palsy","volume":"31","author":"Unnithan","year":"1999","journal-title":"Med Sci Sports Exerc"},{"key":"B57","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1097\/00006842-198108000-00007","article-title":"Cardiovascular differentiation of happiness, sadness, anger, and fear following imagery and exercise","volume":"43","author":"Schwartz","year":"1981","journal-title":"Psychosom Med"},{"key":"B58","doi-asserted-by":"publisher","first-page":"e0154420","DOI":"10.1371\/journal.pone.0154420","article-title":"Accuracy of heart rate watches: implications for weight management","volume":"11","author":"Wallen","year":"2016","journal-title":"PLoS One"},{"key":"B59","doi-asserted-by":"publisher","first-page":"e14707","DOI":"10.2196\/14707","article-title":"Accuracy of optical heart rate sensing technology in wearable fitness trackers for young and older adults: validation and comparison study","volume":"8","author":"Chow","year":"2020","journal-title":"JMIR Mhealth Uhealth"},{"key":"B60","year":""},{"key":"B61","doi-asserted-by":"publisher","first-page":"e8199","DOI":"10.2196\/cardio.8199","article-title":"Consumer wearable devices for activity monitoring among individuals after a stroke: a prospective comparison","volume":"2","author":"Rozanski","year":"2018","journal-title":"JMIR Cardio"},{"key":"B62","doi-asserted-by":"crossref","first-page":"471","DOI":"10.70252\/BBTU4889","article-title":"Validity and wearability of consumer-based fitness trackers in free-living children","volume":"12","author":"Brazendale","year":"2019","journal-title":"Int J Exerc Sci"},{"key":"B63","doi-asserted-by":"publisher","first-page":"e8233","DOI":"10.2196\/mhealth.8233","article-title":"Fitbit Charge HR Wireless Heart Rate Monitor: Validation Study Conducted Under Free-Living Conditions","volume":"5","author":"Gorny","year":"2017"},{"key":"B64","doi-asserted-by":"publisher","first-page":"1141","DOI":"10.3390\/jcm9041141","article-title":"Heart rate variability in children and adolescents with cerebral palsy-a systematic literature review","volume":"9","author":"G\u0105sior","year":"2020","journal-title":"J Clin Med"},{"key":"B65","doi-asserted-by":"publisher","first-page":"822","DOI":"10.1097\/mss.0b013e31803349c6","article-title":"Longitudinal modeling of the relationship between age and maximal heart rate","volume":"39","author":"Gellish","year":"2007","journal-title":"Medicine Science in Sports and Exercise"},{"key":"B66","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1016\/j.jacc.2007.04.079","article-title":"Resting heart rate in cardiovascular disease","volume":"50","author":"Fox","year":"2007","journal-title":"J Am Coll Cardiol"}],"container-title":["Frontiers in Sports and Active Living"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fspor.2023.1213655\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,31]],"date-time":"2024-10-31T19:16:28Z","timestamp":1730402188000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fspor.2023.1213655\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,24]]},"references-count":66,"alternative-id":["10.3389\/fspor.2023.1213655"],"URL":"https:\/\/doi.org\/10.3389\/fspor.2023.1213655","relation":{},"ISSN":["2624-9367"],"issn-type":[{"value":"2624-9367","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,24]]},"article-number":"1213655"}}