Objectives To describe the process and outcomes of using a new evidence base to develop scientific guidelines that specify the type and minimum dose of exercise necessary to improve fitness and cardiometabolic health in adults with spinal cord injury (SCI). Setting International. Methods Using Appraisal of Guidelines, Research and Evaluation (AGREE) II reporting criteria, steps included (a) determining the guidelines' scope; (b) conducting a systematic review of relevant literature; (c) holding three consensus panel meetings (European, Canadian and International) to formulate the guidelines; (d) obtaining stakeholder feedback; and (e) process evaluation by an AGREE II consultant. Stakeholders were actively involved in steps (c) and (d). Results For cardiorespiratory fitness and muscle strength benefits, adults with a SCI should engage in at least 20 min of moderate to vigorous intensity aerobic exercise 2 times per week AND 3 sets of strength exercises for each major functioning muscle group, at a moderate to vigorous intensity, 2 times per week (strong recommendation). For cardiometabolic health benefits, adults with a SCI are suggested to engage in at least 30 min of moderate to vigorous intensity aerobic exercise 3 times per week (conditional recommendation). Conclusions Through a systematic, rigorous, and participatory process involving international scientists and stakeholders, a new exercise guideline was formulated for cardiometabolic health benefits. A previously published SCI guideline was endorsed for achieving fitness benefits. These guidelines represent an important step toward international harmonization of exercise guidelines for adults with SCI, and a foundation for developing exercise policies and programs for people with SCI around the world.

The volume of literature on field-based physiological testing of wheelchair sports, such as basketball, rugby and tennis, is considerably smaller when compared with that available for individuals and team athletes in able-bodied (AB) sports. In analogy to the AB literature, it is recognized that performance in wheelchair sports not only relies on fitness, but also sport-specific skills, experience and technical proficiency. However, in contrast to AB sports, two major components contribute towards 'wheeled sports' performance, which are the athlete and the wheelchair. It is the interaction of these two that enable wheelchair propulsion and the sporting movements required within a given sport. Like any other athlete, participants of wheelchair sports are looking for efficient ways to train and/or analyse their technique and fitness to improve their performance. Consequently, laboratory and/or field-based physiological monitoring tools used at regular intervals at key time points throughout the year must be considered to help with training evaluation. The present review examines methods available in the literature to assess wheelchair sports fitness in a field-based environment, with special attention on outcome variables, validity and reliability issues, and non-physiological influences on performance. It also lays out the context of field-based testing by providing details about the Paralympic court sports and the impacts of a disability on sporting performance. Due to the limited availability of specialized equipment for testing wheelchair-dependent participants in the laboratory, the adoption of field-based testing has become the preferred option by team coaches of wheelchair athletes. An obvious advantage of field-based testing is that large groups of athletes can be tested in less time. Furthermore, athletes are tested in their natural environment (using their normal sports wheelchair set-up and floor surface), potentially making the results of such testing more relevant than laboratory testing. However, given that many tests, such as the multistage fitness test and the Yo-Yo intermittent test, have originally been developed for AB games players, the assumption that these can also be used for wheelchair athletes may be erroneous. With the array of AB aerobic and anaerobic field tests available, it is difficult to ascertain which ones may be best suited for wheelchair athletes. Therefore, new, wheelchair sport-specific tests have been proposed and validated. Careful selection of tests to enable coaches to distinguish between disability classifications, wheelchair proficiency and actual performance improvements is paramount as this will not only enhance the value of field-based testing, but also help with the development of meaningful normative data.

Regular exercise-induced acute inflammatory responses are suggested to improve the inflammatory profile and insulin sensitivity. As body temperature elevations partly mediate this response, passive heating might be a viable tool to improve the inflammatory profile. This study investigated the acute and chronic effects of hot water immersion on inflammatory and metabolic markers. Ten sedentary, overweight men [body mass index (BMI): 31.0 ± 4.2 kg/m2, mean ± SD] were immersed in water set at 39°C for 1 h (HWI) or rested for 1 h at ambient temperature (AMB). Venous blood was obtained before the session, immediately postsession, and 2 h postsession for assessment of monocyte intracellular heat shock protein-72 (iHsp72) and plasma concentrations of extracellular Hsp72 (eHsp72), interleukin-6 (IL-6), fasting glucose, insulin, and nitrite. Thereafter, participants underwent a 2-wk intervention period, consisting of 10 hot water immersion sessions (INT). Eight BMI-matched participants (BMI: 30.0 ± 2.5 kg/m2) were included as control (CON). Plasma IL-6 and nitrite concentrations were higher immediately following HWI compared with AMB (IL-6 P < 0.001, HWI: 1.37 ± 0.94 to 2.51 ± 1.49 pg/ml; nitrite P = 0.04, HWI: 271 ± 52 to 391 ± 72 nM), whereas iHsp72 expression was unchanged ( P = 0.57). In contrast to resting iHsp72 expression ( P = 0.59), fasting glucose ( P = 0.04; INT: 4.44 ± 0.93 to 3.98 ± 0.98 mmol/l), insulin ( P = 0.04; INT: 68.1 ± 44.6 to 55.0 ± 29.9 pmol/l), and eHsp72 ( P = 0.03; INT: 17 ± 41% reduction) concentrations were lowered after INT compared with CON. HWI induced an acute inflammatory response and increased nitric oxide bioavailability. The reductions in fasting glucose and insulin concentrations following the chronic intervention suggest that hot water immersion may serve as a tool to improve glucose metabolism. NEW & NOTEWORTHY A single hot water immersion (HWI) session induces an acute increase in plasma interleukin-6 and nitrite concentrations but does not acutely elevate heat shock protein-72 expression in monocytes [intracellular Hsp72 (iHsp72)]. A chronic HWI intervention reduces fasting glucose and insulin concentrations in the absence of changes in resting iHsp72. Therefore, HWI shows potential as a strategy to combat chronic low-grade inflammation and improve glucose metabolism in individuals without the physical capacity to do so using exercise.

The purpose of this study was (1) to examine the value of a verification phase (VER) in a peak testing protocol and (2) to assess the reliability of peak physiological variables in wheelchair athletes. On two separate days, eight tetraplegic (TETRA), eight paraplegic (PARA) and eight non-spinal cord-injured (NON-SCI) athletes performed treadmill ergometry, consisting of a graded exercise test to exhaustion (GXT) followed by a VER. Peak oxygen uptake (.VO2peak) was compared (1) between GXT and VER and (2) between test days. .VO2peak did not differ between GXT and VER (P = 0.27), and coefficients of variation between GXT and VER were in the range of 2.9 and 6.4 % for all subgroups. Coefficients of variation of .VO2peak between test days were 9.3 % (TETRA), 4.5 % (PARA) and 3.3 % (NON-SCI). It is therefore concluded that whilst a VER can be used for a more robust determination of .VO2peak, a deviation of up to ~6 % between GXT and VER should be considered as acceptable. For between-day analyses, relatively large changes in .VO2peak are required to confirm "true" differences, especially in TETRA athletes. This may be due to their lower aerobic capacity, which results in a larger relative variation compared with the other subgroups.

These findings suggest that the sympathetic nervous system plays an important regulatory role in the circulating IL-6 response to exercise and has implications for the metabolic and inflammatory responses to exercise in individuals with injuries above T6.

The purpose of this investigation was to examine the use of subjective rating of perceived exertion (RPE) as a tool to self-regulate the intensity of wheelchair propulsive exercise in individuals with tetraplegia. Eight motor complete tetraplegic (C5/6 and below; ASIA Impairment Scale = A) participants completed a submaximal incremental exercise test followed by a graded exercise test to exhaustion to determine peak oxygen uptake (VO₂(peak)) on a wheelchair ergometer. On a separate day, a 20-min exercise bout was completed at an individualised imposed power output (PO) equating to 70 % of VO₂(peak). On a third occasion, participants were instructed to maintain a workload equivalent to the average RPE for the 20-min imposed condition. VO₂(peak), heart rate (HR) and PO were measured at 1-min intervals and blood lactate concentration [BLa(-)] was measured at 0, 10 and 20 min. No differences (P > 0.17) were found between mean VO₂(peak), % VO₂(peak), HR, % HR(peak), [BLa(-)], velocity or PO between the imposed and RPE-regulated trials. No significant (P > 0.05) time-by-trial interaction was present for VO₂(peak) data. A significant interaction (P < 0.001) for the PO data represented a trend for an increase in PO from 10 min to the end of exercise during the RPE-regulated condition. However, post hoc analysis revealed none of the differences in PO across time were significant (P > 0.05). In conclusion, these findings suggest that RPE can be an effective tool for self-regulating 20 min of wheelchair propulsion in a group of trained participants with tetraplegia who are experienced in wheelchair propulsion.

Increasing physical activity remains the most widely publicized way of improving health and wellbeing. However, in populations that benefit most from exercise (EX), adherence is often poor and alternatives to EX are important to bring about health improvements. Recent work suggests a role for passive heating (PH) and heat shock proteins (HSP) in improving cardio-metabolic health. The aim of this study was to investigate the expression of HSP70 and interleukin-6 in response to either EX or PH and the subsequent effect on glucose control. Fourteen males volunteered and were categorized lean (BMI 23.5 § 2.2 kg¢m ¡2 ) or overweight (29.2 § 2.7 kg¢m ¡2 ) and completed 60 minutes of either moderate cycling at a fixed rate of metabolic heat production (EX) or warm water immersion in 40 C water (PH). Extracellular HSP70 increased from baseline in both conditions with no differences between PH (0.98 § 1.1 ng¢mL ¡1 ) or EX (0.84 § 1.0 ng¢mL ¡1 , p D 0.814). IL-6 increased following both conditions with a two-fold increase after PH and four-fold after EX. Energy expenditure increased by 61.0 § 14.4 kcal¢h ¡1 (79%) after PH. Peak glucose concentration after a meal immediately following PH was reduced when compared with EX (6.3 § 1.4 mmol¢L ¡1 versus 6.8 § 1.2 mmol¢L ¡1 ; p < 0.05). There was no difference in 24-hour glucose area under the curve (AUC) between conditions. These data indicate the potential for thermal therapy as an alternative treatment and management strategy for those at risk of developing metabolic disease where adherence, or ability to EX, may be compromised.

Measuring BLa leads to a higher threshold determination rate compared with ventilatory data and the anaerobic BLa threshold can be used to predict the RCP. The altered breathing in TETRA does not seem to have a pronounced effect on the ventilatory threshold or the RCP.