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Foreword
Feature
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Bulletin 61 print

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| Feature | No.61 May 2011 |

Handcycling: From Racing, to Recreation and Clinical Rehabilitation
Paul M. Smith & Thomas Abel
Introduction
Handcycling, as a generic concept, has existed since the mid 1980s and it is viewed by many as a sport for individuals with physical impairments. It is best described as a dynamic, exciting and liberating sport, which can also be pursued by able-bodied athletes. Handcycling was formally recognised as a sport by the International Paralympic Committee (IPC) in 1999, and has been an integral part of the Paralympic programme since the Athens Games in 2004. Handcycling is very much part of the Paracycling family and, as such, the responsibility for governance of the sport lies with the Union Cycliste Internationale (UCI).
In the 2008 Beijing Paralympic Games, men and women competed in three distinct handcycling groups (HCA, HCB and HCC), although during the London 2012 Paralympic Games, competition will encompass four separate divisions (H1, H2, H3 and H4). For information relating to disability classifications used in handcycling, the technical specification of handbikes and rules relating to safety please refer to the Paracycling area on the official UCI website (http://www.uci.ch/).
The majority of handcycling competitions take place on the road, while a smaller number of athletes also participate in ultra-endurance races, multi-staged (touring) events, off-road riding and downhill handbiking. Athletes with the most severe physical impairments, including tetraplegia, compete in the H1 division - which includes the sub-categories of H1.1 and H1.2. Athletes in divisions H1, H2 and H3 adopt a seated or recumbent position, which is commonly referred to as the arm power (AP) position, while athletes in the H4 division kneel and can, therefore, use their arms and trunk (the ATP position) to develop propulsive forces.
Photo 1: A group of H4 athletes wait on the start line of a criterium race ahead of a larger group of H3 riders. Photo provided courtesy of Dr Paul M. Smith.
It should be noted that while this article will primarily focus upon handcycling as a Paralympic sport, this exercise mode can be also pursued recreationally and used as a daily form of ambulation. Handcycling is more efficient than conventional hand-rim wheelchair propulsion (Mukherjee & Samanta, 2001; Abel, Kröner, Vega, Peters, Klose and Platen, 2003; Abel, Schneider, Platen and Strüder, 2006; Dallmeijer, Zentgraaff, Zijp and van der Woude, 2004b), and it has been postulated that regular engagement with handcycling will likely lead to fewer painful and debilitating overuse injuries (van der Woude, de Groot, and Janssen, 2006). During competition and training, handcycling can be sustained for prolonged periods of time and necessitates a metabolic demand (Janssen, Dallmeijer and van der Woude, 2001; Abel et al., 2003; Groen, van der Woude and de Koning, 2010) that is sufficient to offer protection against the development of secondary conditions such as cardiovascular disease (Abel et al., 2003).
Road Racing and Sportive Events
Most handcyclists compete in road racing competitions that normally take the form of mass start races, criterium (closed circuit) races and individual time trials. During road and criterium races, athletes are permitted to draft one another, but only within their own competitive division. During a classic time trial, the athlete races alone and against the clock, and this form of racing is viewed by many as the most pure and gruelling test of both physical and psychological fortitude. While many standalone handcycling races are organised around the world, a number are embedded within City Marathons. This is interesting as the Marathon is viewed by many and portrayed by the media as an Athletics event, but this racing format facilitates the worthwhile and important integration of disabled athletes into high profile events that often gain invaluable media coverage.
Body position plays a critical role in the trade-off between an athlete`s ability to generate propulsive crank forces and the relative aerodynamic characteristics of the athlete-handbike unit. Prior to the Beijing Paralympic Games a specific rule stated that the back rest of a recumbent handbike could not be set at an angle beyond 45º from the vertical. However, that rule has since been relaxed, and riders can now set their back rest at any angle, though for safety reasons athletes must ensure they have a clear and unobstructed view over the crank housing.
Although more power can be generated by H4 riders adopting an ATP position, competitors who adopt the AP position benefit from a lower racing profile and a smaller frontal surface area. At present, the best athletes in the H3 division are marginally faster than their H4 counterparts, a fact that can be exemplified using the World`s best times for H3 and H4 athletes to compete in a Marathon – even though this is essentially an IPC Athletics event, and no World Championship qualification points are available to handcyclists in such events. Nevertheless, many athletes compete in these races and for H4 athletes the best time stands at 1 hr 03 min 41 s. However, several H3 riders have recently posted a time of 1 hr 00 min 03 s, which translates to an average velocity of approximately 42 km•hr-1 (or 26 mph) for a little over one hour. It is certain that co-operation between several athletes riding together, drafting each other and taking turns to lead the group, will have contributed to this impressive achievement.
In addition to competitive racing, more adventurous athletes participate in ultra-endurance and sportive events. Such ultra-endurance races include the Tour du Lac Léman (Lake Geneva; 174km) and the Styrkeprøven experience in Norway, a 540km race that has to be completed within a time frame of 45 hours (Abel, Burkett, Schneider, Lindschulten and Strüder, 2010). Numerous other staged events also exist such as the Toer de Kapp, South Africa, which is comprised of 6 stages over 557km and the Sadler`s Alaska Challenge, featuring 6 stages over 416km.
Optimising Handcycling Performance
Limited scientific information exists within the field of competitive (elite) Handcycling; little is known about the optimal technical set-up of a handbike, and the physiological characteristics of elite handcyclists are not well understood. Using a small group (n = 4) of Dutch National squad athletes, Groen et al. (2010) recently demonstrated that handcycling performance can be characterised using a power balance model. Janssen et al. (2001) explored the physical capacity of competitive handcyclists and demonstrated that peak aerobic power (r = 0.91) and VO2peak (r = 0.90) correlated well to 10km race performance, and it was also suggested that gross (mechanical) efficiency was an important determinant of performance. However, participants of a wide range of abilities were recruited, and a recreational, upright handbike was employed for the purpose of conducting peak aerobic capacity tests. Furthermore, the authors did not identify the metabolic thresholds of their participants, which might have been a significant omission as such parameters would likely be strong determinants of exercise tolerance and overall performance.
As with all aspects of sport and exercise science, it is important to draw a distinction between the sometimes very pointed objectives and conclusions that can be drawn from a group-based, scientific (research) study, and the holistic attention to detail that is needed to provide an individual athlete with meaningful and effective sports science support. In this regard, it is worth noting that due to individual preferences and distinct athlete idiosyncrasies, interventions and strategies that “work” for one athlete will not necessarily translate and apply to all. This is where the real future challenges for athletes, coaches and scientists lie, especially as the sport of handcycling could realistically benefit from a multi-/interdisciplinary approach. Essentially, knowledge from the respective fields of mechanical engineering, sports biomechanics, exercise physiology, sports nutrition and sport psychology could contribute to optimising an individual athlete`s performance.
In the modern era, athletes are becoming more knowledgeable about the demands of handcycling and are acutely aware of factors that limit their performance. This is particularly true of tetraplegic athletes where the sympathetic division of the autonomic nervous system has sometimes been completely compromised. In such a case, normal functioning on the various physiological systems is absent, resulting in limited functional capacity and considerable thermoregulatory challenges. When the competitive histories of several athletes are considered, it is fair to draw the conclusion that many seasons of competition, combined with chronic physiological and metabolic adaptations are required to enable an athlete to compete at the highest level. This observation might well relate to the fact that many successful athletes with traumatic physical impairments only begin their sporting career somewhat later in life, and following an unexpected incident. Nevertheless, it is possible that the career of a competitive handcyclist could significantly outlast that of an able-bodied competitor, though there is currently no published evidence to support this subjective conjecture.
Photo 2: Two H1 (tetraplegic) athletes attempt to keep cool ahead of an individual time trial in the Czech Republic. Photo provided courtesy of Dr Paul M. Smith.
An increasing number of handcyclists have become professional athletes and, as such, are able to devote more time to the sport. Most athletes are fully aware of nutritional strategies that can be used in preparation for, and during an event, and many athletes use heart rate monitors to help regulate effort during training and competition. A smaller number of athletes use sophisticated and expensive technology in the form of portable power metres such as SRM cranks and the PowerTap hub. These systems facilitate the precise monitoring of effort in real time, and assist in the execution of tactical strategies. This application is of particular relevance for athletes who do not possess normal sympathetic function having sustained a high (cervical level) spinal cord injury. However, if such expensive technology is financially beyond the reach of an athlete, it has been demonstrated that “moderate and vigorous (exercise) intensities” can be effectively controlled using subjective ratings of perceived exertion (Goosey-Tolfrey, Lenton, Goddard, Oldfield, Tolfrey and Eston, 2010). However, paraplegic athletes were used in this study, and whether similar control mechanisms can be implemented by tetraplegic athletes remains to be established.
Some athletes are using other novel approaches in an attempt to optimise their performance. For example, a small number of recumbent athletes have gone to lengths to ensure the footrests of their light-weight, carbon fibre handbikes are moulded to further improve the overall aerodynamics of the system. During time trials, some athletes wear profiled helmets and tight fitting sporting apparel to further improve their aerodynamics; with regard to the latter point, it is also possible that the use of such compression garments could further improve an athlete`s functional capacity by promoting venous return, and preventing blood pooling in the legs, though this theory has not yet been scientifically explored.
Scientific Enquiry in Handcycling
With the exception of purpose-built arm crank ergometers, there is currently no such thing as a commercially-available handcycling testing-rig. Therefore, compared to other disability sports such as wheelchair racing and wheelchair basketball, relatively little information exists for handcycling, although there does appear to be a recent growth in scientific interest and enquiry within this field. Not only has limited handcycling-related research been completed, but diverse scientific approaches have been employed. For example, several studies (Abel et al. 2003; Goosey-Tolfrey Alfano and Fowler, 2008; Goosey-Tolfrey et al., 2010; Faupin, Gorce, Meyer and Thevenon, 2008; Faupin, Gorce, Watelain, Meyer and Thevenon, 2010; Meyer, Weissland, Watelain, Dumas, Baudinet and Faupin, 2009) have used turbo-/ero-trainers to administer laboratory-based tests. Other investigations (van der Woude, Bosmans, Bervoets and Veeger, 2000; Janssen et al. 2001; Dallmeijer, Ottjes, de Waardt and van der Woude, 2004a; Dallmeijer et al., 2004b; Knechtle, Müller and Knecht, 2004; Abbasi Bafghi, de Haan, Horstman and van der Woude, 2008) have used motorised treadmills, and quantified according to the rolling resistance associated with each athlete-handbike combination. Finally, several studies (Maki, Langbein and Reid-Lokos, 1995; Mukherjee & Samanta, 2001; Abel et al., 2006; 2010; Krämer, Schneider, Böhm, Klöpfer-Krämer and Senner, 2009; Groen et al., 2010) have been conducted in a field setting, so it is often very difficult to compare and contrast published findings. Where group-based data has been presented, heterogeneous groups of participants have been used. And this observation especially applies to studies where mixed groups of paraplegic and tetraplegic participants have been used (Janssen et al., 2001; Abel et al., 2003). Not only will this result in a wide range of functional capacities, but there will also be considerable between-participant variations in physiological responses, exercise tolerance and functional capacity.
As emphasised above, there is arguably a need for a multi-/interdisciplinary approach in this field of enquiry. Indeed, Abbasi Bafghi et al. (2008) recently explored the “biophysical” aspects of submaximal handcycling, but for convenience, used able-bodied participants and an upright, recreational device instead of a racing handbike. While the use of novice, able-bodied participants is commonplace within the literature (van der Woude et al., 2000; Dallmeijer et al., 2004a; Faupin, Gorce, Campillo, Thevenon and Rémy-Néris, 2006; Abbasi Bafghi et al., 2008; Krämer et al., 2009), findings from such studies are not directly applicable to individuals with physical impairments. In contrast, several studies have used experienced and/or competitive handcyclists within their experimental set-up (Janssen et al., 2001; Abel et al., 2003; 2006; 2010; Knechtle et al. 2004; Goosey-Tolfrey et al., 2008; Leicht, Smith, Sharpe, Perret and Goosey-Tolfrey, 2010), although as described before, different experimental approaches have been used making inter-study comparisons difficult.
Other publications have used case reports to characterise the physiological requirements of athletes during standard competition (Abel et al., 2006) and an ultra-endurance event (Abel et al., 2010), to assess physiological responses during a laboratory test (Meyer, Weissland, Watelain, Dumas, Baudinet and Faupin, 2009) and to biomechanically analyse the generic movement patterns during “moderate intensity” handcycling (Faupin et al., 2010). Therefore, we conclude that more research is required within the field of competitive handcycling where groups of trained and experienced (elite) handcyclists are purposefully recruited.
Applications for Health & Rehabilitation
As noted earlier, handcycling can be pursued recreationally and can be used as a generic mode of ambulation in everyday life (van der Woude, Dallmeijer, Janssen, and Veeger, 2001; Dallmeijer et al., 2004b). The vast majority of handcycling research conducted to date has focused upon handcycling as a health-related topic. This is unsurprising given that the scientific findings from such enquiries are translational, and hold almost immediate applications for a large number of individuals with physical impairments. There are many anecdotal reports of handcycling being used to encourage clinical patients to become and/or increase their level of physical activity, and Valent, Dallmeijer, Houdijk, Slootman, Post and van der Woude (2008) clearly demonstrated the efficacy of handcycling in developing the functional capacity of tetraplegic individuals beyond hospital discharge.
Photo3: A tetraplegic patient handcycling for the first time in clinical rehabilitation setting. Photo provided courtesy of Dr Paul M. Smith – also pictured.
The daily use of crank-driven systems can be achieved using upright (recreational) handbikes, or temporary clip-on devices that can transform a conventional, rigid wheelchair into a crank-propelled system. Even individuals with the most severe physical impairments can handcycle, and quickly find they are able to safely and effectively travel over a wide variety of terrains such a grass, cobbles and lose-surface tracks. As well as the adoption of a sociable (reclined) body position, most handcycling devices are fitted with gears, which makes it easier for individuals to negotiate inclines unassisted.
In the context of health and rehabilitation, workers have compared physiological responses and functional capacity during wheelchair propulsion, arm crank ergometry and handcycling. While similar peak physiological responses can be achieved during wheelchair propulsion and arm crank ergometry (Glaser, Sawka, Brune and Wilde, 1980; Pitetti, Snell and Stray Gundersen, 1987; Tropp, Samuelsson and Jorfeldt, 1997), it is evident that sub-maximal arm crank ergometry (Glaser et al., 1980; Hintzy, Tordi and Perrey, 2002) and handcycling (van der Woude, Groot, Hollander, van Ingen Schenau and Rozendall, 1986; Mukherjee & Samanta, 2001; Dallmeijer et al., 2004b) is more efficient. Mukherjee & Samanta (2001) reported that experienced participants with “dysfunctional lower extremities” achieved higher ambulatory velocities, and were more efficient using an upright handcycle. This finding was confirmed by Dallmeijer et al. (2004b), who also demonstrated that higher peak power outputs could be achieved using an upright handcycle compared to hand-rim wheelchair propulsion.
In considering the available evidence, it is clear that handcycling represents an alternative and favourable form of ambulation compared to hand-rim wheelchair propulsion. Indeed, van der Woude et al. (2001) suggested that handcycling could help individuals become physically active and prevent the negative health consequences of long-term inactivity. As already mentioned, Abel et al. (2003) reported that moderate intensity handcycling was associated with a suitable level of energy expenditure that could help in the prevention of progressive cardiovascular disease. Furthermore, Knechtle et al. (2004) reported that the optimal rate of fat metabolism in experienced handcyclists occurred at a much lower exercise intensity (55% VO2peak) compared to that of trained able-bodied cyclists (75% VO2peak). Previous work (Bostom, Toner, McArdle, Montelione, Brown and Stein, 1991) demonstrated that the functional capacity of paraplegic men is inversely related to atherogenic lipid-lipoprotein indices, so it appears that even moderate intensity handcycling could be beneficial in this regard.
Future Directions
The physiological correlates of handcycling (road racing and time trial) performance are not that well understood, and this fact alone makes it difficult for Performance Directors and coaching staff within National Cycling Federations to identify (potential) talent. This partly explains why there is a discrepancy in diagnostic tests used by several nations. Moreover, some National Cycling Federations do not use diagnostic tests and performance criteria at all, but instead rely upon the competitive performances of athletes close to major championships to determine squad selection, though this ad hoc approach is neither scientific nor strategic.
Further scientific enquiry within this intriguing field of research is clearly warranted. It is of course important to explore the relative efficacy of nutritional ergogenic aids, and there is a need to further consider fundamental issues of exercise tolerance, functional capacity and mechanical efficiency. It is also important to explore and identify multi-/interdisciplinary correlates of performance; however, due to the limited subpopulation of elite athletes, it is likely that such work will require collaboration between international research groups in order to succeed, and to help realise this ambitious objective, clear standards for scientific research in the field of competitive handcycling need to be established.
Conclusions
Handcycling is a relatively new, dynamic, liberating and energetic sport that can be pursued by individuals in a competitive or recreational format. Handcycling can also be used as a daily mode of ambulation by individuals with even the most severe physical impairments. The sport has been effectively used to improve functional capacity in the context of outpatient rehabilitation and can offer ongoing protection against secondary conditions such as obesity, cardiovascular disease and type II diabetes mellitus. Even though this exercise mode is attracting more research interest, very little is known about the various applications of the sport. Furthermore, between-study comparisons are complicated due to the fact laboratory and/or field-based studies have employed a variety of experimental approaches. A greater amount of scientific enquiry is required where participants with physical impairments are purposefully sampled, and future work should attempt to more fully characterise the physiological demands associated with the sport of handcycling, and endeavour to establish the various multi-/interdisciplinary determinants of elite performance.
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Contact
Paul M. Smith
University of Wales Institute,
Cardiff, United Kingdom
Email: p.smith@uwic.ac.uk
Dr. Thomas Abel
German Sport University Cologne
Cologne, Germany
Email: abel@dshs-koeln.de

http://www.icsspe.org/