Physiological demands and court-movement patterns of wheelchair tennis

The wheelchair tennis evidence base has developed considerably in recent years. For those with a spinal cord injury (SCI), or severe physical impairment, tennis participation represents an opportunity for skill and motor development, and potential for disease risk reduction (Abel et al., 2008). However, as a complex series of technical, tactical and physical elements are implicated, participation for novice, developmental or low-skill players can be challenging. Hence, extension of the evidence base to consider the responses of such groups during play is of considerable value. Initial experimental studies in this thesis investigated the validity, reliability and applicability of instrumentation for the assessment of wheelchair tennis court-movement. Comparisons were made between a global positioning system (GPS) and the data logger (DL) device (Study 1). GPS underestimated criterion distance in tennis-specific drills and reported lower match-play values than the DL. In contrast, DL placed on the outside wheel offered an accurate representation of distance. However, underestimations for DL were revealed at speeds > 2.50 m·s-1 during treadmill testing. Consequently, Study 2 extended this work with consideration of DL applicability for wheelchair tennis match-play. Examination of speed profiles revealed that time spent below the threshold for accuracy was trivial, confirming DL applicability for court-movement assessment. Further between-group comparisons for rank [highly-ranked (HIGH), low-ranked (LOW)], sex (male, female) and format (singles, doubles) revealed that LOW were stationary for longer than HIGH and spent more time at low propulsion speeds. Time in higher speed zones was greatest for HIGH and doubles players. Between-group differences (rank) were further scrutinised in Study 3 with attention paid to describing the physiological response of competitive match-play aligned to court-movement. Set outcome (result) was also examined. Independent of result, HIGH covered greater overall, forwards, reverse and forwards-to-reverse distances than LOW. Interestingly, HIGH winners covered greater distances than HIGH losers and had a higher mean average and minimum heart rate (HR) than LOW winners. In contrast, LOW losers had a higher mean average and mean minimum HR than LOW winners. Collectively, these outcomes suggest an enhanced ability for HIGH to respond to ball movement and the physiological and skill challenges of match-play. While this thesis confirmed that the activity duration and playing intensity is sufficient to confer health-related effects (Study 3), differences identified for rank suggested that strategies to 4 enable performance improvements in LOW were merited. The International Tennis Federation (ITF) has suggested that all starter players should be able to serve, rally and score from their first lesson (ITF, 2007). The reality however, is that chair propulsion whilst holding a racket is complex, and therefore, tennis play is challenging for novice and developmental players. Hence, the remainder of experimental work focused on interventions to enable increased court-movement and development of wheelchair tennis-specific court-mobility for LOW. The ITF have endorsed the use of a low-compression ball (LCB) for novices. An LCB bounces lower and moves more slowly through the air than a standard-compression ball (SCB). Novel findings from Study 4 revealed that greater total and forwards distances, greater average speeds and less time stationary result from use of the LCB. Increased movement activity occurred without associated increases in physiological cost, but was considered advantageous, with players adopting stronger positions for shot-play. Further examination of the linkage between movement and physiological variables were explored in the final experimental investigation (Study 5). A short period of organised practice enabled higher overall and forwards distances, and peak and average speeds to be achieved during match-play, without associated increases in physiological cost. Changes were desirable and represented enhanced court-mobility and mechanical efficiency (ME). Wheelchair tennis players were also more self-confident in tennis-specific chair-mobility, post-practice. The racket was a constraint, with lower distances and speeds, and a lower peak physiological response, achieved during tennis practice completed with a racket. This thesis advocates the use of an LCB and a short period of pre-match court-mobility practice for the novice wheelchair tennis player. Collectively, these interventions are likely to prompt greater court-movement enabling better court-positioning, develop confidence in court-mobility and shot-play, develop competence in racket handling whilst pushing, and enhancing ME. These characteristics are likely to enable participation with the likely inference being that greater competence, skill and self-confidence promotes greater enjoyment and therefore enhances longer-term compliance. This is of considerable practical significance given that tennis typically attracts new players to the game, but is less successful at retaining them (ITF, 2007).

[1]  John Lenton,et al.  A comparison of the physiological demands of wheelchair basketball and wheelchair tennis. , 2010, International journal of sports physiology and performance.

[2]  T H Witte,et al.  Accuracy of non-differential GPS for the determination of speed over ground. , 2004, Journal of biomechanics.

[3]  C. Willíams,et al.  Physiological responses of wheelchair athletes at percentages of top speed. , 1997, British journal of sports medicine.

[4]  H.E.J. Veeger,et al.  Opportunities for measuring wheelchair kinematics in match settings; reliability of a three inertial sensor configuration. , 2015, Journal of biomechanics.

[5]  Jacques Prioux,et al.  Effects of Playing Surface (Hard and Clay Courts) on Heart Rate and Blood Lactate During Tennis Matches Played by High-Level Players , 2011, Journal of strength and conditioning research.

[6]  Donatella Spinelli,et al.  Benefits of sports participation for executive function in disabled athletes. , 2010, Journal of neurotrauma.

[7]  L. V. D. van der Woude,et al.  Longitudinal relationship between wheelchair exercise capacity and life satisfaction in patients with spinal cord injury: A cohort study in the Netherlands , 2014, The journal of spinal cord medicine.

[8]  M. Tierney,et al.  Users' experience of physical activity monitoring technology in rheumatoid arthritis. , 2013, Musculoskeletal care.

[9]  J. Holloszy,et al.  Effect of 12 Months of Intense Exercise Training on Stroke Volume in Patients with Coronary Artery Disease , 1983, Circulation.

[10]  Elizabeth T. Hsiao-Wecksler,et al.  Variability in Wheelchair Propulsion: A New Window into an Old Problem , 2015, Front. Bioeng. Biotechnol..

[11]  G. Borg Psychophysical bases of perceived exertion. , 1982, Medicine and science in sports and exercise.

[12]  S. Figoni,et al.  Accommodation of wheelchair-reliant individuals by community fitness facilities , 2015, Spinal Cord.

[13]  L. V. D. van der Woude,et al.  Normative values and determinants of physical capacity in individuals with spinal cord injury. , 2002, Journal of rehabilitation research and development.

[14]  E. McAuley,et al.  The physical activity scale for individuals with physical disabilities: development and evaluation. , 2002, Archives of physical medicine and rehabilitation.

[15]  F. E. Grubbs Procedures for Detecting Outlying Observations in Samples , 1969 .

[16]  James A. Rosenthal,et al.  Qualitative Descriptors of Strength of Association and Effect Size , 1996 .

[17]  Guido Hertel,et al.  Motivation gains of inferior group members: a meta-analytical review. , 2007, Journal of personality and social psychology.

[18]  V L Goosey-Tolfrey,et al.  The intra-push velocity profile of the over-ground racing wheelchair sprint start. , 2005, Journal of biomechanics.

[19]  Victoria L Goosey-Tolfrey,et al.  The psychosocial impact of wheelchair tennis on participants from developing countries , 2017, Disability and rehabilitation.

[20]  Kennon M. Sheldon,et al.  Intrinsic motivation and exercise adherence. , 1997 .

[21]  K I Norton,et al.  Comparison of global positioning and computer-based tracking systems for measuring player movement distance during Australian football. , 2006, Journal of science and medicine in sport.

[22]  V. Goosey-Tolfrey,et al.  Effects of inspiratory muscle training on respiratory function and repetitive sprint performance in wheelchair basketball players , 2008, British Journal of Sports Medicine.

[23]  R. M. Glaser,et al.  Physiological responses to maximal effort wheelchair and arm crank ergometry. , 1980, Journal of applied physiology: respiratory, environmental and exercise physiology.

[24]  VT Grigorean,et al.  Cardiac dysfunctions following spinal cord injury , 2009, Journal of medicine and life.

[25]  Victoria Goosey-Tolfrey,et al.  Supporting the paralympic athlete: focus on wheeled sports , 2010, Disability and rehabilitation.

[26]  S. Fisher,et al.  Energy cost of ambulation in health and disability: a literature review. , 1978, Archives of physical medicine and rehabilitation.

[27]  W G Hopkins,et al.  Measures of Reliability in Sports Medicine and Science , 2000, Sports medicine.

[28]  A. Gray,et al.  Validity and reliability of GPS for measuring distance travelled in field-based team sports , 2010, Journal of sports sciences.

[29]  Krista L Best,et al.  Wheelchair skills training to improve confidence with using a manual wheelchair among older adults: a pilot study. , 2013, Archives of physical medicine and rehabilitation.

[30]  F. Minozzo,et al.  Relationship between aerobic and anaerobic parameters and functional classification in wheelchair basketball players , 2010, Scandinavian journal of medicine & science in sports.

[31]  K Tolfrey,et al.  The effects of experience on the energy cost of wheelchair propulsion. , 2013, European journal of physical and rehabilitation medicine.

[32]  The oxygen uptake-heart rate relationship in trained female wheelchair athletes. , 2004, Journal of rehabilitation research and development.

[33]  Henk J Stam,et al.  A prospective study on physical activity levels after spinal cord injury during inpatient rehabilitation and the year after discharge. , 2008, Archives of physical medicine and rehabilitation.

[34]  B. Pluim,et al.  Intensity of tennis match play , 2006, British Journal of Sports Medicine.

[35]  L. V. D. van der Woude,et al.  Hand-cycling: an active form of wheeled mobility, recreation, and sports. , 2010, Physical medicine and rehabilitation clinics of North America.

[36]  B. Molik,et al.  Relationship Between Functional Classification Levels and Anaerobic Performance of Wheelchair Basketball Athletes , 2010, Research quarterly for exercise and sport.

[37]  B. Marks Health benefits for veteran (senior) tennis players , 2006, British Journal of Sports Medicine.

[38]  B. Pluim,et al.  Health benefits of tennis , 2007, British Journal of Sports Medicine.

[39]  H E Veeger,et al.  Peak oxygen uptake and maximal power output of Olympic wheelchair-dependent athletes. , 1991, Medicine and science in sports and exercise.

[40]  Daniel Theisen,et al.  A multistage field test of wheelchair users for evaluation of fitness and prediction of peak oxygen consumption. , 2002, Journal of rehabilitation research and development.

[41]  Pascual J. Figueroa,et al.  Analysis of the distances covered by first division brazilian soccer players obtained with an automatic tracking method. , 2007, Journal of sports science & medicine.

[42]  R. Thietje,et al.  Influence of physical exercise on quality of life in individuals with spinal cord injury , 2010, Spinal Cord.

[43]  Barry S Mason,et al.  Validity and reliability of an inertial sensor for wheelchair court sports performance. , 2014, Journal of applied biomechanics.

[44]  L. V. D. van der Woude,et al.  Low-Intensity Wheelchair Training in Inactive People with Long-Term Spinal Cord Injury: A Randomized Controlled Trial on Propulsion Technique , 2015, American journal of physical medicine & rehabilitation.

[45]  M. Gotsman,et al.  Cardiovascular risk factor clustering and ratio of total cholesterol to high-density lipoprotein cholesterol in angiographically documented coronary artery disease. , 1991, The American journal of cardiology.

[46]  J. Fernández-Fernández,et al.  The Hit & Turn Tennis Test: An acoustically controlled endurance test for tennis players , 2011, Journal of sports sciences.

[47]  J. Fernández-Fernández,et al.  Match activity and physiological responses during a junior female singles tennis tournament , 2007, British Journal of Sports Medicine.

[48]  Y Schutz,et al.  Assessment of speed of human locomotion using a differential satellite global positioning system. , 2000, Medicine and science in sports and exercise.

[49]  Paul Kennedy,et al.  Athletic Identity and Sports Participation in People With Spinal Cord Injury , 2004 .

[50]  J. R. Thomas,et al.  What is missing in p less than .05? Effect size. , 1991, Research quarterly for exercise and sport.

[51]  G. Torres-Luque,et al.  Match activity and physiological load in wheelchair tennis players: a pilot study , 2015, Spinal Cord.

[52]  John Baker,et al.  Accuracy and reliability of GPS devices for measurement of movement patterns in confined spaces for court-based sports. , 2010, Journal of science and medicine in sport.

[53]  R. Paffenbarger,et al.  Physical activity, all-cause mortality, and longevity of college alumni. , 1986, The New England journal of medicine.

[54]  Han Houdijk,et al.  Effects of Hand Cycle Training on Physical Capacity in Individuals With Tetraplegia: A Clinical Trial , 2009, Physical Therapy.

[55]  van der Lucas Woude,et al.  The longitudinal relationship between lipid profile and physical capacity in persons with a recent spinal cord injury , 2008, Spinal Cord.

[56]  S. Hooker,et al.  Oxygen uptake and heart rate relationship in persons with spinal cord injury. , 1993, Medicine and science in sports and exercise.

[57]  K. A. Ericsson,et al.  Deliberate practice and acquisition of expert performance: a general overview. , 2008, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[58]  Lucas H V van der Woude,et al.  Early motor learning changes in upper-limb dynamics and shoulder complex loading during handrim wheelchair propulsion , 2015, Journal of NeuroEngineering and Rehabilitation.

[59]  B. Levine,et al.  : what do we know, and what do we still need to know? , 2008, The Journal of physiology.

[60]  Riemer J. K. Vegter,et al.  Initial Skill Acquisition of Handrim Wheelchair Propulsion: A New Perspective , 2014, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[61]  Victoria L. Goosey-Tolfrey,et al.  Field-Based Physiological Testing of Wheelchair Athletes , 2012, Sports Medicine.

[62]  J. Middleton,et al.  Influence of neurological lesion level on heart rate variability and fatigue in adults with spinal cord injury , 2015, Spinal Cord.

[63]  G Smekal,et al.  A physiological profile of tennis match play. , 2001, Medicine and science in sports and exercise.

[64]  Feasibility for developing cardiovascular exercise recommendations for persons with motor-complete paraplegia based on manual wheelchair propulsion; A protocol and preliminary data , 2016, The journal of spinal cord medicine.

[65]  Thilo Kroll,et al.  Staying physically active after spinal cord injury: a qualitative exploration of barriers and facilitators to exercise participation , 2009, BMC public health.

[66]  G. Hunter,et al.  PHYSIOLOGICAL RESPONSES OF SKILLED PLAYERS DURING A COMPETITIVE WHEELCHAIR TENNIS MATCH , 2006, Journal of strength and conditioning research.

[67]  M. Reid,et al.  Planning and Periodization for the Elite Junior Tennis Player , 2009 .

[68]  Barry S. Mason,et al.  The Ergonomics of Wheelchair Configuration for Optimal Performance in the Wheelchair Court Sports , 2012, Sports Medicine.

[69]  Selina Khoo,et al.  Motives for adult participation in physical activity: type of activity, age, and gender , 2015, BMC Public Health.

[70]  Sarah F Tyson MSc Mcsp Measurement and Evaluation in Human Performance , 2000 .

[71]  K. Anderson,et al.  Exercise participation barrier prevalence and association with exercise participation status in individuals with spinal cord injury , 2012, Spinal Cord.

[72]  S. Hanton,et al.  Psychological skills usage and the competitive anxiety response as a function of skill level in rugby union. , 2006, Journal of sports science & medicine.

[73]  A. Cliquet,et al.  Impact of Adapted Sports Activities on the Progression of Carotid Atherosclerosis in Subjects With Spinal Cord Injury. , 2016, Archives of physical medicine and rehabilitation.

[74]  Peter Krustrup,et al.  Elite Female Soccer Players Perform More High-Intensity Running When Playing in International Games Compared With Domestic League Games , 2010, Journal of strength and conditioning research.

[75]  Brendan Lay,et al.  A kinematic comparison of successful and unsuccessful tennis serves across the elite development pathway. , 2013, Human movement science.

[76]  Jeffrey Martin,et al.  Multidimensional self-efficacy and affect in wheelchair basketball players. , 2008, Adapted physical activity quarterly : APAQ.

[77]  Lucas H V van der Woude,et al.  Wheelchair-specific fitness of inactive people with long-term spinal cord injury. , 2015, Journal of rehabilitation medicine.

[78]  D. Macfarlane,et al.  Validity, reliability and stability of the portable Cortex Metamax 3B gas analysis system , 2011, European Journal of Applied Physiology.

[79]  Jeffrey J Borckardt,et al.  Shoulder pain: a comparison of wheelchair athletes and nonathletic wheelchair users. , 2003, Medicine and science in sports and exercise.

[80]  G. Snoek,et al.  Longitudinal association between lifestyle and coronary heart disease risk factors among individuals with spinal cord injury , 2012, Spinal Cord.

[81]  Michael L. Boninger,et al.  Investigation of factors associated with manual wheelchair mobility in persons with spinal cord injury. , 2011, Archives of physical medicine and rehabilitation.

[82]  N. Šarabon,et al.  Tournament Structure and Success of Players Based on Location in Men's Professional Tennis. , 2013, Journal of sports science & medicine.

[83]  P. Dijkstra,et al.  Barriers and facilitators of sports in Dutch Paralympic athletes: An explorative study , 2014, Scandinavian journal of medicine & science in sports.

[84]  L. Romer,et al.  Perspective: Does Laboratory-Based Maximal Incremental Exercise Testing Elicit Maximum Physiological Responses in Highly-Trained Athletes with Cervical Spinal Cord Injury? , 2016, Front. Physiol..

[85]  Machar Reid,et al.  Matchplay characteristics of Grand Slam tennis: implications for training and conditioning , 2016, Journal of sports sciences.

[86]  H J Hislop,et al.  Metabolic energy cost of unrestrained walking. , 1976, Physical therapy.

[87]  A. Giombini,et al.  Mental health and social participation skills of wheelchair basketball players: a controlled study. , 2013, Research in developmental disabilities.

[88]  Necmiye Un Yildirim,et al.  Shoulder pain: a comparison of wheelchair basketball players with trunk control and without trunk control. , 2010, Journal of back and musculoskeletal rehabilitation.

[89]  P I Fitzgerald,et al.  Circulatory and metabolic responses of women to arm crank and wheelchair ergometry. , 1990, Archives of physical medicine and rehabilitation.

[90]  H. E. J. Veeger,et al.  Aerobic Work Capacity in Elite Wheelchair Athletes: A Cross-Sectional Analysis , 2002, American journal of physical medicine & rehabilitation.

[91]  Marquell J. Johnson,et al.  ADA Compliance and Accessibility of Fitness Facilities in Western Wisconsin. , 2012, Topics in spinal cord injury rehabilitation.

[92]  C. Zancanaro,et al.  Physique and Performance of Young Wheelchair Basketball Players in Relation with Classification , 2015, PloS one.

[93]  M. Kolber,et al.  Shoulder pain in wheelchair users with tetraplegia and paraplegia. , 1999, Archives of physical medicine and rehabilitation.

[94]  Basia Belza,et al.  Outdoor built environment barriers and facilitators to activity among midlife and older adults with mobility disabilities. , 2013, The Gerontologist.

[95]  P. Armitage,et al.  Analysing Means and Proportions , 2008 .

[96]  Bertrand Perrat,et al.  The validity and reliability of a novel indoor player tracking system for use within wheelchair court sports , 2014, Journal of sports sciences.

[97]  R N Robertson,et al.  Wheelchair racing efficiency , 2003, Disability and rehabilitation.

[98]  J. Spinney,et al.  Weather impacts on leisure activities in Halifax, Nova Scotia , 2011, International journal of biometeorology.

[99]  C. Zancanaro,et al.  Kinematic analysis of the wheelchair tennis serve: Implications for classification , 2014, Scandinavian journal of medicine & science in sports.

[100]  B. Mason,et al.  The physiological and biomechanical effects of forwards and reverse sports wheelchair propulsion , 2015, The journal of spinal cord medicine.

[101]  J. Helgerud,et al.  Arm Crank and Wheelchair Ergometry Produce Similar Peak Oxygen Uptake but Different Work Economy Values in Individuals with Spinal Cord Injury , 2016, BioMed research international.

[102]  A. Buchholz,et al.  Physical activity levels are low in free-living adults with chronic paraplegia. , 2003, Obesity research.

[103]  L. V. D. van der Woude,et al.  Wheelchair skills performance between discharge and one year after inpatient rehabilitation in hand-rim wheelchair users with spinal cord injury. , 2013, Journal of rehabilitation medicine.

[104]  G Atkinson,et al.  Update – Ethical Standards in Sport and Exercise Science Research , 2011, International Journal of Sports Medicine.

[105]  E. Mohammadi,et al.  Barriers and facilitators related to the implementation of a physiological track and trigger system: A systematic review of the qualitative evidence , 2017, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[106]  Rory A Cooper,et al.  Quantifying Wheelchair Activity of Children: A Pilot Study , 2008, American journal of physical medicine & rehabilitation.

[107]  V. Goosey-Tolfrey,et al.  Fluid intake during wheelchair exercise in the heat: effects of localized cooling garments. , 2008, International journal of sports physiology and performance.

[108]  M. Reid,et al.  Motivation in tennis , 2007, British Journal of Sports Medicine.

[109]  Ian Jones,et al.  Research Methods for Sports Studies , 2003 .

[110]  P. Jacobs,et al.  Modes, Benefits, And Risks Of Voluntary And Electrically Induced Exercise In Persons With Spinal Cord Injury , 2001, The journal of spinal cord medicine.

[111]  Stacy N. Scott,et al.  Predicting energy expenditure through hand rim propulsion power output in individuals who use wheelchairs , 2014, British Journal of Sports Medicine.

[112]  Lucas H V van der Woude,et al.  A qualitative examination of wheelchair configuration for optimal mobility performance in wheelchair sports: a pilot study. , 2010, Journal of rehabilitation medicine.

[113]  Vicky Goosey-Tolfrey,et al.  Wheelchair Sport: A Complete Guide for Athletes, Coaches, and Teachers , 2010 .

[114]  C. Perret,et al.  A new test to improve the training quality of wheelchair racing athletes , 2004, Spinal Cord.

[115]  Rory Cooper,et al.  Comparing the Activity Profiles of Wheelchair Rugby Using a Miniaturised Data Logger and Radio-Frequency Tracking System , 2014, BioMed research international.

[116]  M. J. Safrit,et al.  Introduction to measurement in physical education and exercise science , 1986 .

[117]  Jaime Sampaio,et al.  Performance analysis of elite men’s and women’s wheelchair basketball teams , 2014, Journal of sports sciences.

[118]  Dan Ding,et al.  A Wheelchair Usage Monitoring/Logging System , 2005, 2005 IEEE Engineering in Medicine and Biology 27th Annual Conference.

[119]  L. V. D. van der Woude,et al.  Wheelchair-specific fitness of persons with a long-term spinal cord injury: cross-sectional study on effects of time since injury and physical activity level , 2016, Disability and rehabilitation.

[120]  K D Coutts,et al.  Dynamics of wheelchair basketball. , 1992, Medicine and science in sports and exercise.

[121]  Da‐hong Wang,et al.  Effect of sports activity on bone mineral density in wheelchair athletes , 2008, Journal of Bone and Mineral Metabolism.

[122]  Denise G Tate,et al.  Perceived Barriers to Exercise in People with Spinal Cord Injury , 2005, American journal of physical medicine & rehabilitation.

[123]  Greg Atkinson,et al.  The effectiveness of hand cooling at reducing exercise-induced hyperthermia and improving distance-race performance in wheelchair and able-bodied athletes. , 2008, Journal of applied physiology.

[124]  B. Saltin THE INTERPLAY BETWEEN PERIPHERAL AND CENTRAL FACTORS IN THE ADAPTIVE RESPONSE TO EXERCISE AND TRAINING , 1977, Annals of the New York Academy of Sciences.

[125]  Joan L. Duda,et al.  Perceived motivational climate, need satisfaction and indices of well-being in team sports: A longitudinal perspective , 2006 .

[126]  L H V van der Woude,et al.  Mechanical efficiency and propulsion technique after 7 weeks of low-intensity wheelchair training. , 2008, Clinical biomechanics.

[127]  M. Price,et al.  Energy Expenditure and Metabolism during Exercise in Persons with a Spinal Cord Injury , 2010, Sports medicine.

[128]  Han Houdijk,et al.  An Incremental Shuttle Wheel Test for Wheelchair Tennis Players. , 2016, International journal of sports physiology and performance.

[129]  S. Biddle,et al.  Pupil perceptions of enjoyment in physical education. , 1993 .

[130]  A. Webborn Heat-related problems for the Paralympic Games, Atlanta 1996 , 1996 .

[131]  Ales Filipcic,et al.  Comparison of game characteristics of male and female tennis players at Roland Garros 2005 , 2008 .

[132]  David R Bassett,et al.  Validity of Physical Activity Monitors for Estimating Energy Expenditure During Wheelchair Propulsion. , 2015, Journal of physical activity & health.

[133]  T. Little,et al.  Exercise for everyone: a randomized controlled trial of project workout on wheels in promoting exercise among wheelchair users. , 2014, Archives of physical medicine and rehabilitation.

[134]  H J Stam,et al.  Physical capacity in wheelchair-dependent persons with a spinal cord injury: a critical review of the literature , 2006, Spinal Cord.

[135]  P. Ekkekakis,et al.  The Pleasure and Displeasure People Feel When they Exercise at Different Intensities , 2011, Sports medicine.

[136]  D. Cella,et al.  Reliability and Concurrent Validity of Three Visual-Analogue Mood Scales , 1986, Psychological reports.

[137]  S. Mulroy,et al.  Active Lifestyle Is Associated With Reduced Dyspnea and Greater Life Satisfaction in Spinal Cord Injury. , 2016, Archives of physical medicine and rehabilitation.

[138]  R. Bache,et al.  Regulation of coronary blood flow during exercise. , 2008, Physiological reviews.

[139]  J. Houlé,et al.  Exercise after spinal cord injury as an agent for neuroprotection, regeneration and rehabilitation , 2015, Brain Research.

[140]  A. Krassioukov,et al.  Autonomic cardiovascular control and sports classification in Paralympic athletes with spinal cord injury , 2017, Disability and rehabilitation.

[141]  Mathew Yarossi,et al.  Evaluation of wheelchair tire rolling resistance using dynamometer-based coast-down tests. , 2009, Journal of rehabilitation research and development.

[142]  L. V. D. van der Woude,et al.  Patterns of changes in wheelchair exercise capacity after spinal cord injury. , 2013, Archives of physical medicine and rehabilitation.

[143]  W. E. Langbein,et al.  Energy cost of physical activities in persons with spinal cord injury. , 2010, Medicine and science in sports and exercise.

[144]  S. Perreault,et al.  A test of self-determination theory with wheelchair basketball players with and without disability. , 2007, Adapted physical activity quarterly : APAQ.

[145]  Riemer J. K. Vegter,et al.  Inter-Individual Differences in the Initial 80 Minutes of Motor Learning of Handrim Wheelchair Propulsion , 2014, PloS one.

[146]  Rob Duffield,et al.  Physiological, Perceptual, and Technical Responses to On-Court Tennis Training on Hard and Clay Courts , 2013, Journal of strength and conditioning research.

[147]  A. Hicks,et al.  Considerations for the development of a physical activity guide for Canadians with physical disabilities. , 2007, Canadian journal of public health = Revue canadienne de sante publique.

[148]  Brendan Burkett,et al.  The role of the velocometer as an innovative tool for Paralympic coaches to understand wheelchair sporting training and interventions to help optimise performance , 2012 .

[149]  G. Kok,et al.  Correlates of exercise compliance in physical therapy. , 1993, Physical therapy.

[150]  P. Clifford,et al.  Physiologic comparison of forward and reverse wheelchair propulsion. , 1998, Archives of physical medicine and rehabilitation.

[151]  T. Abel,et al.  Energy expenditure in ball games for wheelchair users , 2008, Spinal Cord.

[152]  R. Motl,et al.  Perspectives on Physical Activity Among People with Multiple Sclerosis Who Are Wheelchair Users: Informing the Design of Future Interventions. , 2015, International journal of MS care.

[153]  D. Wolfe,et al.  Leisure time physical activity in a population-based sample of people with spinal cord injury part II: activity types, intensities, and durations. , 2010, Archives of physical medicine and rehabilitation.

[154]  L. Malone,et al.  Comparison of Heart Rate Response to Tennis Activity Between Persons With and Without Spinal Cord Injuries , 2009, Research quarterly for exercise and sport.

[155]  M. Nash,et al.  Reference fitness values in the untrained spinal cord injury population. , 2014, Archives of physical medicine and rehabilitation.

[156]  W L Haskell,et al.  J.B. Wolffe Memorial Lecture. Health consequences of physical activity: understanding and challenges regarding dose-response. , 1994, Medicine and science in sports and exercise.

[157]  P E Hartmann,et al.  Exercise intensity and metabolic response in singles tennis. , 1998, Journal of sports sciences.

[158]  H. Stam,et al.  Exercise self-efficacy and the relation with physical behavior and physical capacity in wheelchair-dependent persons with subacute spinal cord injury , 2015, Journal of NeuroEngineering and Rehabilitation.

[159]  J. Hammond,et al.  Low compression tennis balls and skill development. , 2006, Journal of sports science & medicine.

[160]  Frederick Wolfe,et al.  Fatigue assessments in rheumatoid arthritis: comparative performance of visual analog scales and longer fatigue questionnaires in 7760 patients. , 2004, The Journal of rheumatology.

[161]  V L Goosey-Tolfrey,et al.  Hand-rim Forces and Gross Mechanical Efficiency at Various Frequencies of Wheelchair Propulsion , 2012, International Journal of Sports Medicine.

[162]  D. Bassett,et al.  A compendium of energy costs of physical activities for individuals who use manual wheelchairs. , 2011, Adapted physical activity quarterly : APAQ.

[163]  B. Fernhall,et al.  Physical Activity and High Density Lipoprotein Cholesterol Levels , 1999, Sports medicine.

[164]  Sara J Mulroy,et al.  The Relationship of Shoulder Pain Intensity to Quality of Life, Physical Activity, and Community Participation in Persons With Paraplegia , 2007, The journal of spinal cord medicine.

[165]  Carlo Castagna,et al.  The validity and reliability of a global positioning satellite system device to assess speed and repeated sprint ability (RSA) in athletes. , 2010, Journal of science and medicine in sport.

[166]  L. V. D. van der Woude,et al.  Wheelchair exercise capacity in spinal cord injury up to five years after discharge from inpatient rehabilitation. , 2013, Journal of rehabilitation medicine.

[167]  N. Spencer-Cavaliere,et al.  "What's the difference?" women's wheelchair basketball, reverse integration, and the question(ing) of disability. , 2011, Adapted physical activity quarterly : APAQ.

[168]  B S Mason,et al.  Influence of wheel configuration on wheelchair basketball performance: wheel stiffness, tyre type and tyre orientation. , 2015, Medical engineering & physics.

[169]  Yagesh Bhambhani,et al.  Field evaluation of paralympic athletes in selected sports: implications for training. , 2009, Medicine and science in sports and exercise.

[170]  M. Nash,et al.  Exercise as a Health‐Promoting Activity Following Spinal Cord Injury , 2005, Journal of neurologic physical therapy : JNPT.

[171]  R S Paffenbarger,et al.  The association of changes in physical-activity level and other lifestyle characteristics with mortality among men. , 1993, The New England journal of medicine.

[172]  Comparison of Sport Achievement Orientation between Wheelchair and Able-Bodied Basketball Athletes , 2002, Perceptual and motor skills.

[173]  Victoria L. Goosey-Tolfrey,et al.  Physiological Profiles of Elite Wheelchair Basketball Players in Preparation for the 2000 Paralympic Games , 2005 .

[174]  B Elliott,et al.  Biomechanics and tennis , 2006, British Journal of Sports Medicine.

[175]  François Routhier,et al.  The role of self-efficacy in the wheelchair skills-physical activity relationship among manual wheelchair users with spinal cord injury , 2012, Disability and rehabilitation.

[176]  L. V. D. van der Woude,et al.  Wheelchair propulsion technique and mechanical efficiency after 3 wk of practice. , 2002, Medicine and science in sports and exercise.

[177]  C. Perret Elite-adapted wheelchair sports performance: a systematic review , 2017, Disability and rehabilitation.

[178]  L. Malone,et al.  Exercise intensity during wheelchair rugby training , 2010, Journal of sports sciences.

[179]  Victoria L Goosey-Tolfrey,et al.  Thermoregulation during intermittent exercise in athletes with a spinal-cord injury. , 2015, International journal of sports physiology and performance.

[180]  G. Kolt,et al.  Adherence to sport injury rehabilitation: implications for sports medicine providers and researchers , 2001 .

[181]  V. Goosey-Tolfrey,et al.  Aerobic capacity and peak power output of elite quadriplegic games players , 2006, British Journal of Sports Medicine.

[182]  M. Marmot,et al.  Association of walking speed in late midlife with mortality: results from the Whitehall II cohort study , 2012, AGE.

[183]  J. Micallef,et al.  Specific incremental field test for aerobic fitness in tennis , 2006, British Journal of Sports Medicine.

[184]  T. Seeman Social ties and health: the benefits of social integration. , 1996, Annals of epidemiology.

[185]  M. Boninger,et al.  Assessing mobility characteristics and activity levels of manual wheelchair users. , 2007, Journal of rehabilitation research and development.

[186]  K D Coutts,et al.  Heart rates of participants in wheelchair sports , 1988, Paraplegia.

[187]  Phillip L. Ackerman,et al.  Individual differences in skill acquisition , 2004 .

[188]  J P O'Hara,et al.  Evaluation of Movement and Physiological Demands of Rugby League Referees Using Global Positioning Systems Tracking , 2013, International Journal of Sports Medicine.

[189]  V. Goosey-Tolfrey,et al.  Nutritional practices of competitive British wheelchair games players. , 2010, Adapted physical activity quarterly : APAQ.

[190]  T. Tasiemski,et al.  Sports Injuries in Wheelchair Rugby – A Pilot Study , 2015, Journal of human kinetics.

[191]  Karen L Troy,et al.  An exercise trial targeting posterior shoulder strength in manual wheelchair users: pilot results and lessons learned , 2015, Disability and rehabilitation. Assistive technology.

[192]  B. Cardinal,et al.  ADA Compliance and the Accessibility of Physical Activity Facilities in Western Oregon , 2003, American journal of health promotion : AJHP.

[193]  R. Dionigi,et al.  Psychological Need Fulfillment Among Workers in an Exercise Intervention , 2009, Research quarterly for exercise and sport.

[194]  M Yamasaki,et al.  The effect of frequency and mode of sports activity on the psychological status in tetraplegics and paraplegics , 2000, Spinal Cord.

[195]  S. Forbes,et al.  COMPARISON OF A KAYAKING ERGOMETER PROTOCOL WITH AN ARM CRANK PROTOCOL FOR EVALUATING PEAK OXYGEN CONSUMPTION , 2007, Journal of strength and conditioning research.

[196]  Glen M. Davis,et al.  Comparison of methods to assess energy expenditure and physical activity in people with spinal cord injury , 2012, The journal of spinal cord medicine.

[197]  Justin WL Keogh,et al.  Constraints influencing sports wheelchair propulsion performance and injury risk , 2013, Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology.

[198]  Paul M. Smith,et al.  The influence of crank rate on peak oxygen consumption during arm crank ergometry , 2001, Journal of sports sciences.

[199]  Rory A. Cooper,et al.  Quantification of Activity During Wheelchair Basketball and Rugby at the National Veterans Wheelchair Games: A Pilot Study , 2009, Prosthetics and orthotics international.

[200]  M. Brinkhof,et al.  Determinants of handbike use in persons with spinal cord injury: results of a community survey in Switzerland , 2016, Disability and rehabilitation.

[201]  J. Duda,et al.  Motivational climate and goal orientations as predictors of perceptions of improvement, satisfaction and coach ratings among tennis players , 1999, Scandinavian journal of medicine & science in sports.

[202]  C. Worringham,et al.  Assessment of speed and position during human locomotion using nondifferential GPS. , 2008, Medicine and science in sports and exercise.

[203]  Yagesh Bhambhani,et al.  Physiology of Wheelchair Racing in Athletes with Spinal Cord Injury , 2002, Sports medicine.

[204]  F. Backx,et al.  Arm cranking versus wheelchair propulsion for testing aerobic fitness in children with spina bifida who are wheelchair dependent. , 2015, Journal of rehabilitation medicine.

[205]  N E Fowler,et al.  A telemetry-based velocometer to measure wheelchair velocity. , 2003, Journal of biomechanics.

[206]  C. Velati,et al.  Estimation of cardiovascular risk: total cholesterol versus lipoprotein profile , 1994, International journal of clinical & laboratory research.

[207]  Mary Ann McColl,et al.  Leisure time physical activity in a population-based sample of people with spinal cord injury part I: demographic and injury-related correlates. , 2010, Archives of physical medicine and rehabilitation.

[208]  L. V. D. van der Woude,et al.  Effect of training on physical capacity and physical strain in persons with tetraplegia. , 1997, Scandinavian journal of rehabilitation medicine.

[209]  D. Cardenas,et al.  Upper extremity pain after spinal cord injury , 1999, Spinal Cord.

[210]  M. Boninger,et al.  Physiological Responses to Two Wheelchair-Racing Exercise Protocols , 2001, Neurorehabilitation and neural repair.

[211]  P. Jacobs,et al.  Exercise Recommendations for Individuals with Spinal Cord Injury , 2004, Sports medicine.

[212]  V. Goosey-Tolfrey,et al.  A physiological case study of a paralympic wheelchair tennis player: reflective practise. , 2009, Journal of sports science & medicine.

[213]  L. V. D. van der Woude,et al.  Physical capacity and race performance of handcycle users. , 2001, Journal of rehabilitation research and development.

[214]  Raúl Reina,et al.  Visual behavior and motor responses of novice and experienced wheelchair tennis players relative to the service return. , 2007, Adapted physical activity quarterly : APAQ.

[215]  S. Hitzig,et al.  Influence of Sport Participation on Community Integration and Quality of Life: A Comparison Between Sport Participants and Non-Sport Participants With Spinal Cord Injury , 2009, The journal of spinal cord medicine.

[216]  V. Myers,et al.  Exercise Training and Quality of Life in Individuals With Type 2 Diabetes , 2013, Diabetes Care.

[217]  The Barriers Limiting the Social Integration of Wheelchair Users With Spinal Cord Injury in Turkish Society , 2014 .

[218]  David Bishop,et al.  Activity patterns, blood lactate concentrations and ratings of perceived exertion during a professional singles tennis tournament , 2007, British Journal of Sports Medicine.

[219]  Bertrand Perrat,et al.  Activity profiles of elite wheelchair rugby players during competition. , 2015, International journal of sports physiology and performance.

[220]  K. Cooke,et al.  Tennis ball diameter: the effect on performance and the concurrent physiological responses , 2005, Journal of sports sciences.

[221]  Jacob Cohen Statistical Power Analysis , 1992 .

[222]  François Routhier,et al.  Preliminary examination of the relation between participation and confidence in older manual wheelchair users. , 2013, Archives of physical medicine and rehabilitation.

[223]  Jaime Fernandez-Fernandez,et al.  Match activity and physiological load during a clay-court tennis tournament in elite female players , 2008, Journal of sports sciences.

[224]  C. Baldari,et al.  Accuracy, reliability, linearity of Accutrend and Lactate Pro versus EBIO plus analyzer , 2009, European Journal of Applied Physiology.

[225]  P. Bijur,et al.  Reliability and validity of a visual analog scale for acute abdominal pain in the ED. , 2002, The American journal of emergency medicine.

[226]  C. Gore,et al.  Reliability and accuracy of six hand-held blood lactate analysers. , 2015, Journal of sports science & medicine.

[227]  Tjaša Filipčič,et al.  Time characteristics in wheelchair tennis played on hard surfaces , 2009 .

[228]  Nic James,et al.  Movement characteristics of elite tennis players on hard courts with respect to the direction of ground strokes. , 2013, Journal of sports science & medicine.

[229]  M. Hoffman,et al.  Cardiorespiratory Fitness and Training in Quadriplegics and Paraplegics , 1986, Sports medicine.

[230]  A. Betik,et al.  Determinants of VO2 max decline with aging: an integrated perspective. , 2008, Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme.

[231]  R. Steadward,et al.  Physiological responses during wheelchair racing in quadriplegics and paraplegics , 1994, Paraplegia.

[232]  N. Bishop,et al.  Submaximal exercise responses in tetraplegic, paraplegic and non spinal cord injured elite wheelchair athletes , 2012, Scandinavian journal of medicine & science in sports.

[233]  M. B. Evans,et al.  Collective goals and shared tasks: Interdependence structure and perceptions of individual sport team environments , 2015, Scandinavian journal of medicine & science in sports.

[234]  Ricardo Machado Leite de Barros,et al.  Tracking of wheelchair rugby players in the 2008 Demolition Derby final , 2010, Journal of sports sciences.

[235]  A. Salguero,et al.  Dropout Reasons in Young Spanish Athletes: Relationship to Gender, Type of Sport and Level of Competition , 2006 .

[236]  Y. Ohashi,et al.  Effect of aerobic exercise training on serum levels of high-density lipoprotein cholesterol: a meta-analysis. , 2007, Archives of internal medicine.

[237]  Sung-hyun Park,et al.  Participation motivation and competition anxiety among Korean and non-Korean wheelchair tennis players , 2013, Journal of exercise rehabilitation.

[238]  L. V. D. van der Woude,et al.  Most essential wheeled mobility skills for daily life: an international survey among paralympic wheelchair athletes with spinal cord injury. , 2012, Archives of physical medicine and rehabilitation.

[239]  Jennifer J. Richler,et al.  Effect size estimates: current use, calculations, and interpretation. , 2012, Journal of experimental psychology. General.

[240]  M. Kovacs,et al.  Applied physiology of tennis performance , 2006, British Journal of Sports Medicine.

[241]  Karim Chamari,et al.  Small-Sided Games in Soccer: Amateur vs. Professional Players' Physiological Responses, Physical, and Technical Activities , 2011, Journal of Strength and Conditioning Research.

[242]  T. Williams,et al.  Factors influencing sport participation among athletes with spinal cord injury. , 2001, Medicine and science in sports and exercise.

[243]  Fausto Orsi Medola,et al.  Aspects of Manual Wheelchair Configuration Affecting Mobility: A Review , 2014, Journal of physical therapy science.

[244]  J. Lexell,et al.  Impact of Organized Sports on Activity, Participation, and Quality of Life in People With Neurologic Disabilities , 2015, PM & R : the journal of injury, function, and rehabilitation.

[245]  Rory A Cooper,et al.  Preliminary outcomes of the SmartWheel Users' Group database: a proposed framework for clinicians to objectively evaluate manual wheelchair propulsion. , 2008, Archives of physical medicine and rehabilitation.

[246]  Brendan Lay,et al.  Skill acquisition in tennis: research and current practice. , 2007, Journal of science and medicine in sport.

[247]  B. Chaix,et al.  Spatial accessibility to specific sport facilities and corresponding sport practice: the RECORD Study , 2013, International Journal of Behavioral Nutrition and Physical Activity.

[248]  J. Bussmann,et al.  A more active lifestyle in persons with a recent spinal cord injury benefits physical fitness and health , 2011, Spinal Cord.

[249]  J. Jobin,et al.  Physiological responses to maximal exercise on arm cranking and wheelchair ergometer with paraplegics , 1991, Paraplegia.

[250]  S. Berthoin,et al.  Effects of Modified Multistage Field Test on Performance and Physiological Responses in Wheelchair Basketball Players , 2015, BioMed research international.

[251]  Han Houdijk,et al.  The effects of upper body exercise on the physical capacity of people with a spinal cord injury: a systematic review , 2007, Clinical rehabilitation.

[252]  Machar Reid,et al.  The effect of ball compression on the match-play characteristics of elite junior tennis players , 2015, Journal of sports sciences.

[253]  D. Kokaridas,et al.  Sport Orientation and Athletic Identity of Greek Wheelchair Basketball Players , 2009, Perceptual and motor skills.

[254]  Mary M Rodgers,et al.  Prevalence and identification of shoulder pathology in athletic and nonathletic wheelchair users with shoulder pain: A pilot study. , 2004, Journal of rehabilitation research and development.

[255]  Ross Hall,et al.  Self-confidence and anxiety interpretation: A qualitative investigation , 2004 .

[256]  Marc Portus,et al.  Validity and reliability of GPS units to monitor cricket-specific movement patterns. , 2009, International journal of sports physiology and performance.

[257]  Neil E. Fowler,et al.  Erratum: Effects of 4-weeks of asynchronous hand-rim wheelchair practice on mechanical efficiency and timing (vol 32, pg 2155, 2010) , 2011 .

[258]  Aaron J. Coutts,et al.  Validity and reliability of GPS devices for measuring movement demands of team sports. , 2010, Journal of science and medicine in sport.

[259]  M. Post,et al.  Is manual wheelchair satisfaction related to active lifestyle and participation in people with a spinal cord injury? , 2011, Spinal Cord.

[260]  P. Calmels,et al.  Effects of training programs for spinal cord injury. , 2007, Annales de readaptation et de medecine physique : revue scientifique de la Societe francaise de reeducation fonctionnelle de readaptation et de medecine physique.

[261]  A. King,et al.  Long-term effects of varying intensities and formats of physical activity on participation rates, fitness, and lipoproteins in men and women aged 50 to 65 years. , 1995, Circulation.

[262]  J. Manson,et al.  Walking compared with vigorous exercise for the prevention of cardiovascular events in women. , 2002, The New England journal of medicine.

[263]  J M Bland,et al.  Statistical methods for assessing agreement between two methods of clinical measurement , 1986 .

[264]  Julia O. Totosy de Zepetnek,et al.  A 16-week randomized controlled trial evaluating the physical activity guidelines for adults with spinal cord injury , 2014, Spinal Cord.

[265]  Caroline Sunderland,et al.  The validity of a non-differential global positioning system for assessing player movement patterns in field hockey , 2009, Journal of sports sciences.

[266]  Andrew D White,et al.  Time-on-pitch or full-game GPS analysis procedures for elite field hockey? , 2013, International journal of sports physiology and performance.