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Phys Ther. 2009 Oct;89(10):1051-60. doi: 10.2522/ptj.20080340. Epub 2009 Jul 30.

Effects of hand cycle training on physical capacity in individuals with tetraplegia: a clinical trial.

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  • 1Department of Research and Development/Occupational Therapy, Heliomare Rehabilitation Centre, Relweg 51, 1949 EC, Wijk aan Zee, the Netherlands.



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.


The purpose of this study was to evaluate the effects of a structured hand cycle training program in individuals with chronic tetraplegia.


Pretraining and posttraining outcome measurements of physical capacity were compared.


Structured hand cycle interval training was conducted at home or in a rehabilitation center in the Netherlands.


Twenty-two patients with tetraplegia (American Spinal Injury Association Impairment Scale classification A-D) at least 2 years since injury participated.


The intervention was an 8- to 12-week hand cycle interval training program.


Primary outcomes of physical capacity were: peak power output (POpeak) and peak oxygen uptake (Vo(2)peak), 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.


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]), Vo(2)peak (from 1.32 L.min(-1) [SD=0.40] to 1.43 L.min(-1) [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.


Common health complications, such as urinary tract infections, bowel problems, and pressure sores, led to dropout and nonadherence.


Patients with tetraplegia were able to improve their physical capacity through regular hand cycle interval training, without participant-reported shoulder-arm pain or discomfort.

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