human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A quasi-experimental longitudinal design was used to compare pre- and posttraining biomechanical and physiological characteristics of wheelchair propulsion in manual wheelchair users ( MWCU ) across fresh and fatigue states . An instrumented wheelchair ergometer , 3D motion analysis , and computerized open-circuit spirometry were used to collect joint kinetics and kinematics , h and rim kinetics , propulsion temporal characteristics , and oxygen uptake pre- and posttraining during a submaximal exercise test to exhaustion . Each subject ( n = 19 ) participated in a specific intervention program of supervised therapeutic exercise ( strengthening , stretching , and aerobic exercise ) for 6 weeks . Pre- and posttraining measurements were compared with the use of ANOVA with repeated measures . Significant training effects included increased exercise loads for all strengthening activities , decreased stroke frequency , increased maximum elbow extension angle , increased trunk and shoulder flexion/extension range of motion ( ROM ) , increased h and rim propulsive moment , increased wrist extension moment , and increased power output . Results suggest that this training program increased biomechanical economy ( as defined by propulsive moment ) without increasing shoulder or elbow joint stresses PURPOSE The purpose of this study was to study the effects of a 7-wk wheelchair training program on physical work capacity in able-bodied subjects . Effects of training intensities of 50 and 70 % heart rate ( HR ) reserve ( HRR ) were studied for different subject groups . METHODS Twenty-seven able-bodied male subjects participated in this study . They were r and omly divided into a control group ( N = 8) , a 50%-intensity group ( N = 9 ) , and a 70%-intensity group ( N = 10 ) . The 50%- and the 70%-intensity groups received a 7-wk wheelchair training program : three times a week , one-half hour wheelchair exercise on a motor driven treadmill at an average intensity of 50 and 70 % of the HRR , respectively . Before and after the training period , parameters for physical work capacity ( maximal isometric strength ( Fiso ) , sprint power ( P30 ) , maximal power output ( POmax ) and peak oxygen uptake ( VO2peak ) ) , and submaximal performance ( mechanical efficiency , HR ) at 20 and 40 % of the estimated POmax ( ME20 , ME40 ; HR20 , HR40 ) were obtained during tests on a stationary wheelchair ergometer . RESULTS A two-factor ANOVA for repeated measures on the within-subjects factor " pre-post tests , " the between-subject factor training ( 50 % and 70 % training vs control ) and the interaction term showed that the 50%-intensity group significantly increased on P30 and POmax compared with the control group . The 70 % intensity group significantly increased on P30 , POmax and VO2peak compared with the control group ( P < 0.05 ) . The 70 % group did not show significantly higher increases in P30 and POmax over training than the 50 % intensity . No significant effects were found for the Fiso and the parameters at submaximal PO . CONCLUSIONS The wheelchair training at both intensities can have favorable effects on maximal physical work capacity in able-bodied subjects , and possibly also on mechanical efficiency at submaximal power output . Effects are seen in parameters for both aerobic and anaerobic work capacities . Although training at 70 % intensity was more effective than the 50 % intensity , training at 50 % HRR may initially be more appropriate in untrained individuals , such as novice wheelchair users at the start of their rehabilitation , to prevent fatigue and enhance motivation Study design : A prospect i ve cohort study . Objectives : To study the longitudinal relationship between objective ly measured everyday physical activity level , and physical fitness and lipid profile in persons with a recent spinal cord injury ( SCI ) . Setting : A rehabilitation centre in the Netherl and s and the participant 's home environment . Methods : Data of 30 persons with a recent SCI were collected at the start of active rehabilitation , 3 months later , at discharge from inpatient rehabilitation , and 1 year after discharge .  Physical activity level ( duration of dynamic activities as % of 24 h ) was measured with an accelerometry-based activity monitor . Regarding physical fitness , peak oxygen uptake ( VO2peak ) and peak power output ( POpeak ) were determined with a maximal wheelchair exercise test , and  upper extremity muscle strength was measured with a h and held dynamometer . Fasting blood sample s were taken to determine the lipid profile . Results : An increase in physical activity level was significantly related to an increase in VO2peak and POpeak , and an increase in physical activity level favourably affected the lipid profile . A nonsignificant relation was found with muscle strength . Conclusion : Everyday physical activity  seems to have an important role in the fitness and health of persons with a recent SCI . An increase in  physical activity level was associated with an increase in physical fitness and with a lower risk of cardiovascular disease OBJECTIVE To study the longitudinal relation between physical capacity and wheelchair skill performance in subjects with spinal cord injury ( SCI ) during rehabilitation . DESIGN Observational prospect i ve cohort study . Measurements were taken 3 times during subjects ' rehabilitation . SETTING Eight rehabilitation centers in the Netherl and s. PARTICIPANTS Ninety-seven subjects with SCI . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Parameters of physical capacity were upper-extremity muscle strength ( manual muscle test [ MMT ] sum score ) , peak oxygen uptake , and peak power output ( POpeak ) . The Wheelchair Circuit consists of 8 wheelchair skills and results in 3 test scores : ability , performance time , and physical strain . RESULTS POpeak was related to all 3 scores of the Wheelchair Circuit , and the MMT sum score was related to the ability score and the performance time score . The results indicate that ( 1 ) subjects with higher values of POpeak and /or the MMT sum score had better scores on the Wheelchair Circuit than subjects with lower values and ( 2 ) when a subject increased his/her POpeak and /or MMT sum score , this was associated with better wheelchair skill scores . CONCLUSIONS There is a significant longitudinal relation between wheelchair skill performance and POpeak and MMT sum score during the rehabilitation of people with SCI . To optimize wheelchair skill performance , attention should be directed toward manual wheelchair exercise training and strength training of the upper body Background There is considerable evidence that respiratory muscle training improves pulmonary function , quality of life and exercise performance in healthy athletic population s. The benefits for wheelchair athletes are less well understood . Therefore , in the present study , influence of inspiratory muscle training ( IMT ) on respiratory function and repetitive propulsive sprint performance in wheelchair basketball players was examined . Methods Using a placebo-controlled design , 16 wheelchair athletes were divided to an experimental ( IMT ; n=8 ) or placebo ( sham-IMT ; n=8 ) group based on selective grouping criteria . 30 dynamic breaths were performed by the IMT group twice daily at a resistance equivalent to 50 % maximum inspiratory pressure ( MIP ) , and 60 slow breaths were performed by the sham-IMT group once a day at 15 % MIP for a period of 6 weeks . Results In the IMT group , both MIP and maximum expiratory pressure ( 17 % and 23 % , respectively ; p≤0.03 ) were improved . Similar improvements were noted for the sham-IMT group with 23 % and 33 % from baseline for MIP and maximum expiratory pressure , respectively ( p≤0.03 ) . There were no significant changes in pulmonary function at rest and any of the performance parameters associated with the repetitive sprint test ( sprint and recovery times , peak heart rate and peak blood lactate concentration ) . Reported experiences of using the IMT training device suggested “ less breathlessness ” and “ less tightness in the chest during the training ” . Conclusions Although there was no improvement in sprint performance , an improved respiratory muscle function and quality of life were reported by participants in both the IMT and sham-IMT groups Purpose . To simulate the effect of low-intensity exercise in early rehabilitation , we investigated the effect of a 7-week low-intensity norm duration h and rim wheelchair training on the physical capacity in untrained able-bodied individuals . Method . Twenty-five able-bodied participants were r and omly assigned to an experimental and control group : 10 participants exercised 7 weeks , three times a week at 30 % heart rate reserve ( HRR ) for 30 min ( experimental group ) . The control group consisted of  15 participants who did not receive training .  Physical capacity ( maximal isometric strength , sprint power , peak power output and peak oxygen uptake ) and submaximal performance [ heart rate ( HR ) , oxygen uptake ( VO2 ) , mechanical efficiency ( ME ) ] were assessed pre- and post-training . The levels of upper-body discomfort were determined with the use of a Local Perceived Discomfort scale . Results . Compared to the control group the experimental group significantly improved on sprint power ( + 31.2 % ) , peak aerobic power output ( + 34 % ) , submaximal HR , VO2 and ME ( + 16.9 % ) . The participants did not experience high levels of local discomfort in the upper body during the training . Conclusions . Low-intensity norm duration h and rim wheelchair training which significantly improved peak aerobic and sprint power output , efficiency and physical strain in able-bodied untrained individuals . Training at 30 % HRR ( 3 × /week , 30 min/session ) may be appropriate in untrained individuals , such as novice wheelchair users at the start of their rehabilitation , to prevent early fatigue and overuse and enhance motivation . Please note that this article was published in error in a previous issue of the Journal . This paper was su bmi tted and accepted as part of the Special Issue entitled 4th International State-of-the-art-Congress ‘ Rehabilitation : Mobility , Exercise & Sports ’ and has therefore been republished in this issue . The publisher apologises for this error PURPOSE The present study compared the effects of aerobic endurance training at different intensities and with different methods matched for total work and frequency . Responses in maximal oxygen uptake ( VO2max ) , stroke volume of the heart ( SV ) , blood volume , lactate threshold ( LT ) , and running economy ( CR ) were examined . METHODS Forty healthy , nonsmoking , moderately trained male subjects were r and omly assigned to one of four groups:1 ) long slow distance ( 70 % maximal heart rate ; HRmax ) ; 2)lactate threshold ( 85 % HRmax ) ; 3 ) 15/15 interval running ( 15 s of running at 90 - 95 % HRmax followed by 15 s of active resting at 70 % HRmax ) ; and 4 ) 4 x 4 min of interval running ( 4 min of running at 90 - 95 % HRmax followed by 3 min of active resting at 70%HRmax ) . All four training protocol s result ed in similar total oxygen consumption and were performed 3 d.wk for 8 wk . RESULTS High-intensity aerobic interval training result ed in significantly increased VO2max compared with long slow distance and lactate-threshold training intensities ( P<0.01 ) . The percentage increases for the 15/15 and 4 x 4 min groups were 5.5 and 7.2 % , respectively , reflecting increases in V O2max from 60.5 to 64.4 mL x kg(-1 ) x min(-1 ) and 55.5 to 60.4 mL x kg(-1 ) x min(-1 ) . SV increased significantly by approximately 10 % after interval training ( P<0.05 ) . CONCLUSIONS : High-aerobic intensity endurance interval training is significantly more effective than performing the same total work at either lactate threshold or at 70 % HRmax , in improving VO2max . The changes in VO2max correspond with changes in SV , indicating a close link between the two Background : Various combinations of training intensity , duration and frequency are often proposed to people with spinal cord injuries in order to improve their fitness . However , no consensus about a specific training program has been reached for such a population . Objective : This study investigated the effects of a short interval training program specifically design ed for patients with spinal cord injuries . Methods : Paraplegic men performed 30-min wheelchair ergometry three times per week , for 4 weeks .  Maximal dynamic performance and endurance capacity were studied before and after the training program with an incremental test ( 10 W/2 min ) until volitional fatigue and a constant work rate test , respectively . Cardiorespiratory responses were continuously studied during each of these tests . Results : Training induced significant improvement in maximal tolerated power ( + 27.9 % ) , and in peak oxygen consumption ( [ Vdot ] O2 , + 18.5 % ) . After training the subjects were able to maintain the load applied during the constant test ( total mechanical work + 210.7 % ) , for a significantly longer time . The heart rate , [ Vdot ] O2 and ventilation values observed when the volunteers ended their first constant load test were significantly higher ( + 10 % , + 10 % , + 40 % respectively ) than those obtained after a similar time period during the second constant load test which was performed after the training program . Conclusion : After this short training period , with an appropriate combination of different types of training , duration , intensity and frequency exercises , we observed a significant improvement in the fitness level and endurance capacity of paraplegic subjects . Spinal Cord ( 2001 ) 39 , 532–537 Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item 
    Output:
    
agent
Conclusion : Exercise training programs seem to be effective in improving wheelchair propulsion capacity .
However , there is remarkably little research , particularly for individuals who do not have spinal-cord injury
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A quasi-experimental longitudinal design was used to compare pre- and posttraining biomechanical and physiological characteristics of wheelchair propulsion in manual wheelchair users ( MWCU ) across fresh and fatigue states . An instrumented wheelchair ergometer , 3D motion analysis , and computerized open-circuit spirometry were used to collect joint kinetics and kinematics , h and rim kinetics , propulsion temporal characteristics , and oxygen uptake pre- and posttraining during a submaximal exercise test to exhaustion . Each subject ( n = 19 ) participated in a specific intervention program of supervised therapeutic exercise ( strengthening , stretching , and aerobic exercise ) for 6 weeks . Pre- and posttraining measurements were compared with the use of ANOVA with repeated measures . Significant training effects included increased exercise loads for all strengthening activities , decreased stroke frequency , increased maximum elbow extension angle , increased trunk and shoulder flexion/extension range of motion ( ROM ) , increased h and rim propulsive moment , increased wrist extension moment , and increased power output . Results suggest that this training program increased biomechanical economy ( as defined by propulsive moment ) without increasing shoulder or elbow joint stresses PURPOSE The purpose of this study was to study the effects of a 7-wk wheelchair training program on physical work capacity in able-bodied subjects . Effects of training intensities of 50 and 70 % heart rate ( HR ) reserve ( HRR ) were studied for different subject groups . METHODS Twenty-seven able-bodied male subjects participated in this study . They were r and omly divided into a control group ( N = 8) , a 50%-intensity group ( N = 9 ) , and a 70%-intensity group ( N = 10 ) . The 50%- and the 70%-intensity groups received a 7-wk wheelchair training program : three times a week , one-half hour wheelchair exercise on a motor driven treadmill at an average intensity of 50 and 70 % of the HRR , respectively . Before and after the training period , parameters for physical work capacity ( maximal isometric strength ( Fiso ) , sprint power ( P30 ) , maximal power output ( POmax ) and peak oxygen uptake ( VO2peak ) ) , and submaximal performance ( mechanical efficiency , HR ) at 20 and 40 % of the estimated POmax ( ME20 , ME40 ; HR20 , HR40 ) were obtained during tests on a stationary wheelchair ergometer . RESULTS A two-factor ANOVA for repeated measures on the within-subjects factor " pre-post tests , " the between-subject factor training ( 50 % and 70 % training vs control ) and the interaction term showed that the 50%-intensity group significantly increased on P30 and POmax compared with the control group . The 70 % intensity group significantly increased on P30 , POmax and VO2peak compared with the control group ( P < 0.05 ) . The 70 % group did not show significantly higher increases in P30 and POmax over training than the 50 % intensity . No significant effects were found for the Fiso and the parameters at submaximal PO . CONCLUSIONS The wheelchair training at both intensities can have favorable effects on maximal physical work capacity in able-bodied subjects , and possibly also on mechanical efficiency at submaximal power output . Effects are seen in parameters for both aerobic and anaerobic work capacities . Although training at 70 % intensity was more effective than the 50 % intensity , training at 50 % HRR may initially be more appropriate in untrained individuals , such as novice wheelchair users at the start of their rehabilitation , to prevent fatigue and enhance motivation Study design : A prospect i ve cohort study . Objectives : To study the longitudinal relationship between objective ly measured everyday physical activity level , and physical fitness and lipid profile in persons with a recent spinal cord injury ( SCI ) . Setting : A rehabilitation centre in the Netherl and s and the participant 's home environment . Methods : Data of 30 persons with a recent SCI were collected at the start of active rehabilitation , 3 months later , at discharge from inpatient rehabilitation , and 1 year after discharge .  Physical activity level ( duration of dynamic activities as % of 24 h ) was measured with an accelerometry-based activity monitor . Regarding physical fitness , peak oxygen uptake ( VO2peak ) and peak power output ( POpeak ) were determined with a maximal wheelchair exercise test , and  upper extremity muscle strength was measured with a h and held dynamometer . Fasting blood sample s were taken to determine the lipid profile . Results : An increase in physical activity level was significantly related to an increase in VO2peak and POpeak , and an increase in physical activity level favourably affected the lipid profile . A nonsignificant relation was found with muscle strength . Conclusion : Everyday physical activity  seems to have an important role in the fitness and health of persons with a recent SCI . An increase in  physical activity level was associated with an increase in physical fitness and with a lower risk of cardiovascular disease OBJECTIVE To study the longitudinal relation between physical capacity and wheelchair skill performance in subjects with spinal cord injury ( SCI ) during rehabilitation . DESIGN Observational prospect i ve cohort study . Measurements were taken 3 times during subjects ' rehabilitation . SETTING Eight rehabilitation centers in the Netherl and s. PARTICIPANTS Ninety-seven subjects with SCI . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Parameters of physical capacity were upper-extremity muscle strength ( manual muscle test [ MMT ] sum score ) , peak oxygen uptake , and peak power output ( POpeak ) . The Wheelchair Circuit consists of 8 wheelchair skills and results in 3 test scores : ability , performance time , and physical strain . RESULTS POpeak was related to all 3 scores of the Wheelchair Circuit , and the MMT sum score was related to the ability score and the performance time score . The results indicate that ( 1 ) subjects with higher values of POpeak and /or the MMT sum score had better scores on the Wheelchair Circuit than subjects with lower values and ( 2 ) when a subject increased his/her POpeak and /or MMT sum score , this was associated with better wheelchair skill scores . CONCLUSIONS There is a significant longitudinal relation between wheelchair skill performance and POpeak and MMT sum score during the rehabilitation of people with SCI . To optimize wheelchair skill performance , attention should be directed toward manual wheelchair exercise training and strength training of the upper body Background There is considerable evidence that respiratory muscle training improves pulmonary function , quality of life and exercise performance in healthy athletic population s. The benefits for wheelchair athletes are less well understood . Therefore , in the present study , influence of inspiratory muscle training ( IMT ) on respiratory function and repetitive propulsive sprint performance in wheelchair basketball players was examined . Methods Using a placebo-controlled design , 16 wheelchair athletes were divided to an experimental ( IMT ; n=8 ) or placebo ( sham-IMT ; n=8 ) group based on selective grouping criteria . 30 dynamic breaths were performed by the IMT group twice daily at a resistance equivalent to 50 % maximum inspiratory pressure ( MIP ) , and 60 slow breaths were performed by the sham-IMT group once a day at 15 % MIP for a period of 6 weeks . Results In the IMT group , both MIP and maximum expiratory pressure ( 17 % and 23 % , respectively ; p≤0.03 ) were improved . Similar improvements were noted for the sham-IMT group with 23 % and 33 % from baseline for MIP and maximum expiratory pressure , respectively ( p≤0.03 ) . There were no significant changes in pulmonary function at rest and any of the performance parameters associated with the repetitive sprint test ( sprint and recovery times , peak heart rate and peak blood lactate concentration ) . Reported experiences of using the IMT training device suggested “ less breathlessness ” and “ less tightness in the chest during the training ” . Conclusions Although there was no improvement in sprint performance , an improved respiratory muscle function and quality of life were reported by participants in both the IMT and sham-IMT groups Purpose . To simulate the effect of low-intensity exercise in early rehabilitation , we investigated the effect of a 7-week low-intensity norm duration h and rim wheelchair training on the physical capacity in untrained able-bodied individuals . Method . Twenty-five able-bodied participants were r and omly assigned to an experimental and control group : 10 participants exercised 7 weeks , three times a week at 30 % heart rate reserve ( HRR ) for 30 min ( experimental group ) . The control group consisted of  15 participants who did not receive training .  Physical capacity ( maximal isometric strength , sprint power , peak power output and peak oxygen uptake ) and submaximal performance [ heart rate ( HR ) , oxygen uptake ( VO2 ) , mechanical efficiency ( ME ) ] were assessed pre- and post-training . The levels of upper-body discomfort were determined with the use of a Local Perceived Discomfort scale . Results . Compared to the control group the experimental group significantly improved on sprint power ( + 31.2 % ) , peak aerobic power output ( + 34 % ) , submaximal HR , VO2 and ME ( + 16.9 % ) . The participants did not experience high levels of local discomfort in the upper body during the training . Conclusions . Low-intensity norm duration h and rim wheelchair training which significantly improved peak aerobic and sprint power output , efficiency and physical strain in able-bodied untrained individuals . Training at 30 % HRR ( 3 × /week , 30 min/session ) may be appropriate in untrained individuals , such as novice wheelchair users at the start of their rehabilitation , to prevent early fatigue and overuse and enhance motivation . Please note that this article was published in error in a previous issue of the Journal . This paper was su bmi tted and accepted as part of the Special Issue entitled 4th International State-of-the-art-Congress ‘ Rehabilitation : Mobility , Exercise & Sports ’ and has therefore been republished in this issue . The publisher apologises for this error PURPOSE The present study compared the effects of aerobic endurance training at different intensities and with different methods matched for total work and frequency . Responses in maximal oxygen uptake ( VO2max ) , stroke volume of the heart ( SV ) , blood volume , lactate threshold ( LT ) , and running economy ( CR ) were examined . METHODS Forty healthy , nonsmoking , moderately trained male subjects were r and omly assigned to one of four groups:1 ) long slow distance ( 70 % maximal heart rate ; HRmax ) ; 2)lactate threshold ( 85 % HRmax ) ; 3 ) 15/15 interval running ( 15 s of running at 90 - 95 % HRmax followed by 15 s of active resting at 70 % HRmax ) ; and 4 ) 4 x 4 min of interval running ( 4 min of running at 90 - 95 % HRmax followed by 3 min of active resting at 70%HRmax ) . All four training protocol s result ed in similar total oxygen consumption and were performed 3 d.wk for 8 wk . RESULTS High-intensity aerobic interval training result ed in significantly increased VO2max compared with long slow distance and lactate-threshold training intensities ( P<0.01 ) . The percentage increases for the 15/15 and 4 x 4 min groups were 5.5 and 7.2 % , respectively , reflecting increases in V O2max from 60.5 to 64.4 mL x kg(-1 ) x min(-1 ) and 55.5 to 60.4 mL x kg(-1 ) x min(-1 ) . SV increased significantly by approximately 10 % after interval training ( P<0.05 ) . CONCLUSIONS : High-aerobic intensity endurance interval training is significantly more effective than performing the same total work at either lactate threshold or at 70 % HRmax , in improving VO2max . The changes in VO2max correspond with changes in SV , indicating a close link between the two Background : Various combinations of training intensity , duration and frequency are often proposed to people with spinal cord injuries in order to improve their fitness . However , no consensus about a specific training program has been reached for such a population . Objective : This study investigated the effects of a short interval training program specifically design ed for patients with spinal cord injuries . Methods : Paraplegic men performed 30-min wheelchair ergometry three times per week , for 4 weeks .  Maximal dynamic performance and endurance capacity were studied before and after the training program with an incremental test ( 10 W/2 min ) until volitional fatigue and a constant work rate test , respectively . Cardiorespiratory responses were continuously studied during each of these tests . Results : Training induced significant improvement in maximal tolerated power ( + 27.9 % ) , and in peak oxygen consumption ( [ Vdot ] O2 , + 18.5 % ) . After training the subjects were able to maintain the load applied during the constant test ( total mechanical work + 210.7 % ) , for a significantly longer time . The heart rate , [ Vdot ] O2 and ventilation values observed when the volunteers ended their first constant load test were significantly higher ( + 10 % , + 10 % , + 40 % respectively ) than those obtained after a similar time period during the second constant load test which was performed after the training program . Conclusion : After this short training period , with an appropriate combination of different types of training , duration , intensity and frequency exercises , we observed a significant improvement in the fitness level and endurance capacity of paraplegic subjects . Spinal Cord ( 2001 ) 39 , 532–537 Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item 
    Output:
    