Physiological Considerations to Support Podium Performance in Para-Athletes

Abstract

The twenty-first century has seen an increase in para-sport participation and the number of research publications on para-sport and the para-athlete. Unfortunately, the majority of publications are case reports/case series or study single impairment types in isolation. Indeed, an overview of how each International Paralympic Committee classifiable impairment type impact athlete physiology, health, and performance has not been forthcoming in the literature. This can make it challenging for practitioners to appropriately support para-athletes and implement evidence-based research in their daily practice. Moreover, the lack of a cohesive publication that reviews all classifiable impairment types through a physiological lens can make it challenging for researchers new to the field to gain an understanding of unique physiological challenges facing para-athletes and to appreciate the nuances of how various impairment types differentially impact para-athlete physiology. As such, the purpose of this review is to (1) summarize how International Paralympic Committee classifiable impairments alter the normal physiological responses to exercise; (2) provide an overview of “quick win” physiological interventions targeted toward specific para-athlete populations; (3) discuss unique practical considerations for the para-sport practitioner; (4) discuss research gaps and highlight areas for future research and innovation, and (5) provide suggestions for knowledge translation and knowledge sharing strategies to advance the field of para-sport research and its application by para-sport practitioners.

How Do We Assess Energy Availability and RED-S Risk Factors in Para Athletes?

“…Other factors, such as disability type or severity, may need to be accounted for when it comes to EA assessment in Para athletes [ 16 ], and direct measures of EA, including EI, EEE and FFM have only been examined in able-bodied athletes. Figure 1 identifies the main factors that make the EA formula and LEA cut-off/threshold questionable in Para athletes.…”

“…A compendium of MET scores for the use of a manual wheelchair during different activities has been developed [ 31 ]. This compendium is based on 11 studies, where only 4 studies included Para athletes [ 16 ]. These data are primarily based on older studies with small sample sizes using older style racing equipment, which is not as aerodynamic or lightweight as that used today.…”

“…No study in Para athletes has investigated the direct EA by measuring EEE (instead of estimating it) and evaluating it against EI and FFM. Furthermore, in Para athletes, it is difficult to distinguish whether impaired bone health, reduced resting metabolic rate (RMR), low EI and/or impaired hormone status are related to RED-S or due to their impairment [ 16 ]. The question to ask is whether we can measure the risk of RED-S in Para athletes with the tools and measures currently available.…”

Effects of Arm-Crank Exercise on Fitness and Health in Adults With Chronic Spinal Cord Injury: A Systematic Review

“…Symptoms can range from partial to complete loss of sensation or muscular control over the trunk, legs, and arms as well as impairments of autonomic functions (e.g., cardiovascular control, temperature regulation, bladder and bowel control) and/or breathing ( Jensen et al, 2007 ; Nas et al, 2015 ). As described in detail elsewhere ( Cowley, 2018 ; Gee et al, 2021 ), high-level SCI (at or above the sixth thoracic level) can disrupt supra-spinal sympathetic control of the heart and blood vessels, which is required to initiate and then maintain an appropriate cardiovascular response to aerobic exercise. The extent to which the physiological response to exercise is impaired following SCI is dependent on the severity and level of injury ( West et al, 2012 , 2015 ).…”

Physical activity and chronic disease prevention: Where is the research on people living with disabilities?

“… 6 Yet, accumulating research shows people with certain physical impairments (especially neurologic and limb) have attenuated cardiometabolic responses to physical activity and, thus, may not derive the same health benefits from a particular dose of physical activity as people without impairments. 12 Therefore, we cannot assume that physical activity recommendations for reducing risk of chronic disease in the general population are applicable to people living with disabilities. 12 Population-level observational studies and RCTs involving people living with disabilities are needed to formulate evidence-based recommendations regarding the amount of physical activity required to reduce chronic disease risk in this population.…”