We are grateful for the assistance from Martina Lienert and Fabienne Schaufelberger during exercise testing, as well as from P. D. Claudio Perret, PhD for his scientific advice.

The study was approved by the local ethical committee (Ethikkommission Nordwest- und Zentralschweiz, Basel, Switzerland), and written informed consent was obtained from the participants before starting the study.
1. Test Preparation and Participant Instruction
<ol>
	<li>Arm crank ergometer
	<ol>
		<li>Turn the power on the rotation speed-dependent arm crank ergometer before opening the software.</li>
		<li>Choose the test protocol for the 3 min, all-out ergometer test.
		<ol...

<ol>
	<li>Conconi, F., Ferrari, M., Ziglio, P. G., Droghetti, P., Codeca, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Determination+of+the+anaerobic+threshold+by+a+noninvasive+field+test+in+runners.">Determination of the anaerobic threshold by a noninvasive field test in runners.</a> J Appl Physiol. 52 (4), 869-873 (1982).</li><li>Strupler, M., Mueller, G., Perret, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Heart+rate-based+lactate+minimum+test:+a+reproducible+method.">Heart rate-based lactate minimum test: a reproducible method.</a> Br J Sports Med. 43 (6), 432-436 (2009).</li><li>Black, M. I., Durant, J., Jones, A. M., Vanhatalo, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Critical+power+derived+from+a+3-min+all-out+test+predicts+16.1-km+road+time-trial+performance.">Critical power derived from a 3-min all-out test predicts 16.1-km road time-trial performance.</a> Eur J Sport Sci. 14 (3), 217-223 (2014).</li><li>Burnley, M., Doust, J. H., Vanhatalo, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+3-min+all-out+test+to+determine+peak+oxygen+uptake+and+the+maximal+steady+state.">A 3-min all-out test to determine peak oxygen uptake and the maximal steady state.</a> Med Sci Sports Exerc. 38 (11), 1995-2003 (2006).</li><li>Vanhatalo, A., Doust, J. 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M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+induced+alkalosis+on+the+power-duration+relationship+of+"all-out"+exercise.">Effect of induced alkalosis on the power-duration relationship of "all-out" exercise.</a> Med. Sci. Sports Exerc. 42 (3), 563-570 (2010).</li><li>Jacobs, P. L., Johnson, B., Somarriba, G. A., Carter, A. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+of+upper+extremity+anaerobic+power+assessment+in+persons+with+tetraplegia.">Reliability of upper extremity anaerobic power assessment in persons with tetraplegia.</a> J Spinal Cord Med. 28 (2), 109-113 (2005).</li><li>Jacobs, P. L., Mahoney, E. T., Johnson, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+of+arm+Wingate+Anaerobic+Testing+in+persons+with+complete+paraplegia.">Reliability of arm Wingate Anaerobic Testing in persons with complete paraplegia.</a> J Spinal Cord Med. 26 (2), 141-144 (2003).</li><li>Flueck, J. L., Lienert, M., Schaufelberger, F., Perret, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+of+a+3-min+all-out+arm+crank+ergometer+exercise+test.">Reliability of a 3-min all-out arm crank ergometer exercise test.</a> Int J Sports Med. 36 (10), 809-813 (2015).</li><li>Erich Jaeger GmbH. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> User Manual Oxycon Pro. , (2016).</li><li>Shrout, P. E., Fleiss, J. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraclass+correlations:+uses+in+assessing+rater+reliability.">Intraclass correlations: uses in assessing rater reliability.</a> Psychol Bull. 86 (2), 420-428 (1979).</li><li>Beckerman, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Smallest+real+difference,+a+link+between+reproducibility+and+responsiveness.">Smallest real difference, a link between reproducibility and responsiveness.</a> Qual Life Res. 10 (7), 571-578 (2001).</li><li>Plichta, S. B., Kelvin, E. A., Munro, B. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Munro's statistical methods for health care research. , (2011).</li><li>Atkinson, G., Nevill, A. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Statistical+methods+for+assessing+measurement+error+(reliability)+in+variables+relevant+to+sports+medicine.">Statistical methods for assessing measurement error (reliability) in variables relevant to sports medicine.</a> Sports Med. 26 (4), 217-238 (1998).</li><li>Bland, J. M., Altman, D. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Measuring+agreement+in+method+comparison+studies.">Measuring agreement in method comparison studies.</a> Stat Methods Med Res. 8 (2), 135-160 (1999).</li><li>van Drongelen, S., Maas, J. C., Scheel-Sailer, A., Van Der Woude, L. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Submaximal+arm+crank+ergometry:+Effects+of+crank+axis+positioning+on+mechanical+efficiency,+physiological+strain+and+perceived+discomfort.">Submaximal arm crank ergometry: Effects of crank axis positioning on mechanical efficiency, physiological strain and perceived discomfort.</a> J. Med. Eng. Technol. 33 (2), 151-157 (2009).</li><li>Bressel, E., Bressel, M., Marquez, M., Heise, G. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effect+of+handgrip+position+on+upper+extremity+neuromuscular+responses+to+arm+cranking+exercise.">The effect of handgrip position on upper extremity neuromuscular responses to arm cranking exercise.</a> J. Electromyogr. Kinesiol. 11 (4), 291-298 (2001).</li><li>West, C. R., Goosey-Tolfrey, V. L., Campbell, I. G., Romer, L. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+abdominal+binding+on+respiratory+mechanics+during+exercise+in+athletes+with+cervical+spinal+cord+injury.">Effect of abdominal binding on respiratory mechanics during exercise in athletes with cervical spinal cord injury.</a> J Appl Physiol (1985). 117 (1), 36-45 (2014).</li><li>West, C. R., Campbell, I. G., Goosey-Tolfrey, V. L., Mason, B. S., Romer, L. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+abdominal+binding+on+field-based+exercise+responses+in+Paralympic+athletes+with+cervical+spinal+cord+injury.">Effects of abdominal binding on field-based exercise responses in Paralympic athletes with cervical spinal cord injury.</a> J. Sci. Med. Sport. 17 (4), 351-355 (2014).</li><li>Kirshblum, S. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=International+standards+for+neurological+classification+of+spinal+cord+injury.">International standards for neurological classification of spinal cord injury.</a> J Spinal Cord Med. 34 (6), 535-546 (2011).</li></ol>

The authors have nothing to disclose.

Exercise testing in spinal-cord injured athletes is crucial to tracking exercise performance over several months or years of training. Only a few exercise tests exist to check short-term, high-intensity exercise performance on the arm crank ergometer. This method describes in detail how an exercise test that was already examined for its reliability in cycling5 and rowing7 might be applied to the arm crank ergometer. To collect reliable and meaningful results, two factors ar...

There are several exercise tests that accurately determine the increase in exercise performance in elite athletes over the course of a training period1,2,3,4,5. One of these tests is the reliable 3-min all-out exercise test on a braked cycling ergometer3,4,5,6. This test was used to determine critical power, but it was also applied to exercise testing with athletes, as well as to research7,8,9. As this test was mainly used for lower-extremity performance, such as in rowing7 and cycling3,5, a similar testing protocol for upper-body exercise was needed. Sport disciplines that mainly use the upper body might be possible beneficiaries for such a new test protocol, in addition to athletes or individuals with an impairment of lower body muscles (e.g., an amputation or an impairment of limbs due to a spinal cord injury). Hence, a test protocol on the arm crank ergometer is a good tool to easily test upper-body exercise performance in a variety of athletes from different sport disciplines.
The existence of a very similar 30 s Wingate arm crank ergometer test10,11 helped with the development of a protocol for a 3 min, all-out arm crank ergometer test. Its duration is very similar to that of a 1,500 m wheelchair race. Therefore, this new test protocol of the 3 min, all-out arm crank ergometer test was tested for its test-retest reliability12. Overall, the reliability of this test protocol was excellent, so it could be a future testing tool in the field of upper-body exercise testing. Nevertheless, the use of this exercise test requires attention, especially when testing individuals with a spinal cord injury. Therefore, the aim of this experimental article is to demonstrate a detailed protocol that describes not only the test settings and analysis of the test results, but that also indicates the differences between testing able-bodied individuals and athletes with a spinal cord injury.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Angio V2 arm crank ergometer</td>
			<td>Lode BV, Groningen, NL</td>
			<td>N/A</td>
			<td>arm crank ergometer</td>
		</tr>
		<tr>
			<td>Lode Ergometry Manager Software</td>
			<td>Lode BV, Groningen, NL</td>
			<td>N/A</td>
			<td>Software</td>
		</tr>
		<tr>
			<td>10ul end-to-end capillary</td>
			<td>EKF-diagnostics GmbH, Barleben, Germany</td>
			<td>0209-0100-005</td>
			<td>Capillaries</td>
		</tr>
		<tr>
			<td>haemolysis cup</td>
			<td>EKF-diagnostics GmbH, Barleben, Germany</td>
			<td>0209-0100-006</td>
			<td>hemolysis cup</td>
		</tr>
		<tr>
			<td>lactate analyzer</td>
			<td>Biosen C line, EKF-diagnostics GmbH</td>
			<td>5213-0051-6200</td>
			<td>lactate analyzer</td>
		</tr>
		<tr>
			<td>Heart rate monitor, Polar 610i</td>
			<td>Polar, Kempele, Finland</td>
			<td>P610i</td>
			<td>heart rate monitor</td>
		</tr>
		<tr>
			<td>metabolic cart, Oxygen Pro</td>
			<td>Jaeger GmbH</td>
			<td>N/A</td>
			<td>metabolic cart</td>
		</tr>
		<tr>
			<td>oxygen mask, Hans Rudolph</td>
			<td>Hans Rudolph Inc. , USA</td>
			<td>113814</td>
			<td>oxygen mask</td>
		</tr>
		<tr>
			<td>statistical software, PSAW Software</td>
			<td>SPSS Inc., Chicago USA</td>
			<td>N/A</td>
			<td>statistical software</td>
		</tr>
		<tr>
			<td>desinfectant, Soft-Zellin</td>
			<td>Hartmann GmbH, Austria</td>
			<td>999979</td>
			<td>desinfectant</td>
		</tr>
		<tr>
			<td>Quality control cup, EasyCon Norm</td>
			<td>EKF-diagnostics GmbH, Barleben, Germany</td>
			<td>0201-005.012P6</td>
			<td>quality control</td>
		</tr>
		<tr>
			<td>Quality control cup 3mmol/L</td>
			<td>EKF-diagnostics GmbH, Barleben, Germany</td>
			<td>5130-6152</td>
			<td>control cup</td>
		</tr>
		<tr>
			<td>Chip sensor lactate analyzer</td>
			<td>EKF-diagnostics GmbH, Barleben, Germany</td>
			<td>5206-3029</td>
			<td>chip sensor</td>
		</tr>
		<tr>
			<td>Lactate system solution</td>
			<td>EKF-diagnostics GmbH, Barleben, Germany</td>
			<td>0201-0002-025</td>
			<td>lactate system solution</td>
		</tr>
		<tr>
			<td>lancet, Mediware Blutlanzetten</td>
			<td>medilab</td>
			<td>54041</td>
			<td>lancet</td>
		</tr>
		<tr>
			<td>Calibration gas,&#160;</td>
			<td>Jaeger GmbH</td>
			<td>36-MC G020</td>
			<td>calibration gas</td>
		</tr>
		<tr>
			<td>chair provided by distributor (ergoselect)</td>
			<td>ergoline GmbH, Germany</td>
			<td>N/A</td>
			<td>chair provided by distributor</td>
		</tr>
	</tbody>
</table>

experimental protocol of a three-minute, all-out arm crank exercise test in spinal-cord injured and able-bodied individuals

Reliable exercise protocols are required to test changes in exercise performance in elite athletes. Performance improvements in these athletes may be small; therefore, sensitive tools are fundamental to exercise physiology. There are currently many exercise tests that allow for the examination of exercise capacity in able-bodied athletes, with protocols mainly for lower-body or whole-body exercise. There is a trend to test athletes in a sport-specific setting that closely resembles the actions that the participants are used to performing. Only a few protocols test short-term, high-intensity exercise capacity in participants with an impairment of the lower body. Most of these protocols are very sport-specific and are not applicable to a wide range of athletes. One well-known test protocol is the 30 s Wingate test, which is well-established in cycling and in arm crank exercise testing. This test analyzes high-intensity exercise performance over a 30 s time duration. In order to monitor exercise performance over a longer duration, a different method was modified for application to the upper body. The 3 min, all-out arm crank ergometer test allows athletes to be tested in a manner specific to 1,500 m wheelchair racing (in terms of exercise duration), as well as to upper body exercises such as rowing or hand-cycling. In order to increase the reliability with identical test conditions, it is crucial to precisely replicate settings such as the resistance (i.e., torque factor) and the position of the participants (i.e., the height of the crank, the distance between the crank and the participant, and the fixation of the participant). Another important issue concerns the beginning of the exercise test. Fixed revolutions per minute are required to standardize the test conditions for the start of the exercise test. This exercise protocol shows the importance of accurate operations to reproduce identical test conditions and settings.

The test-retest reliability was checked in 21 recreationally trained (but not specifically upper-body trained), non-smoking individuals (9 males, 12 females; age: 34 &#177; 11 years; body mass: 69.6 &#177; 11.1 kg; and height: 175.5 &#177; 6.9 cm). Table 1 shows the results for the relative and absolute test-retest reliabilities12. The peak power compared between the test and retest is presented in Figure 112</sup...

Watch this Scientific Journal Video about Experimental Protocol of a Three-minute, All-out Arm Crank Exercise Test in Spinal-cord Injured and Able-bodied Individuals at JoVE.com

Experimental Protocol of a Three-minute, All-out Arm Crank Exercise Test in Spinal-cord Injured and Able-bodied Individuals

We present a protocol to test the aerobic and anaerobic power of the upper body muscles over a duration of 3 min in able-bodied as well as in paraplegic and tetraplegic individuals. The protocol presents specific modifications in its application for upper-body exercise in individuals with or without disability.

Reliable exercise protocols are required to test changes in exercise performance in elite athletes. Performance improvements in these athletes may be ...

The overall goal of this protocol is to objectively measure the arm strength of spinal injury patients, using a three-minute exercise. This method can help answer key questions in the sports science field, such as the influence of dietary supplments on exercise performance. The main advantage of this test is that it is applicable for able-bodied as well as spinal cord injured athletes.First, turn on the arm crank ergometer. Then open the associated software. In the software control, select a three-minute, all-out ergometer test.Based on the participant's mass, set the relative torque factor to 0.2. For example, a 100-kilogram participant would require 20 Newton-meters of torque. The torque factor for a quadriplegic participant however, is based on the lesion.Next adjust the height of the arm crank to the shoulder joint of the participant and take note of the setting. The height is measure from the floor to the fixation of the crank. Next, set the chair.Able-bodied participants can use the provided chair. Set the chair's position and record the distance between the wall fixation and the chair. For wheelchair-bound participants, use the fixation set to secure their wheelchair relative to the arm crank.Then take note of the distance between the chair and the wall. Wheelchair-bound participants also need to have their upper-body secured and if needed, secure their hands to the peddles using wrist bands. To analyze whole blood lactate concentration, first calibrate the blood analyzer, using a 12 millimolar standard.Then disinfect the participant's earlobe and take the first blood sample using a capillary. Release the blood into a commercial hemolysis cup and shake it into the solution. Then place the cup into the first sample position of the lactate analyzer.To monitor the participant's heart rate, secure the heart rate belt around the participant's chest. And fix the monitor to the arm crank ergometer. Using the monitor's controls, collect the data.To collect oxygen consumption data, calibrate the system just before the test with the mask off. From the software control, start the volume calibration and store the results when the error is below 3%Then using the calibration gas, continue the automatic gas calibration. When 8 green lights are displayed, the calibration is complete and the process was successful.Store the results and then securely close the calibration gas bottle. Next, remove the spirometer from the gas mask to calibrate it in the room air. Then start the software-controlled calibration for the spirometer.Now reattach the spirometer to the gas mask and but the mask on the participant. Then, secure the hose to the participant so it does not interfere with the movement of the crank. Oxygen consumption can now be measured.Start the baseline measurements one minute before beginning the test. Then start the test with a two-minute warmup. During the last 30 seconds of the warmup, maintain the cadence at 60 RPM, then countdown the last 10 seconds to the start of the all out test phase.Now have the participant accelerate the arm crank ergometer as fast as possible and try to maintain this cadence for a full three minutes. To maintain standards, do not encourage the participants but do alert them of every 30-second interval. After three minutes, start the cool down phase.And immediately take a blood sample by capillary from the ear lobe for the lactate measurements. Continue taking blood samples on two-minute intervals over the next 10 minutes. After three minutes of cool down, stop measuring oxygen consumption and remove the mask.Once all the blood samples are collected, process them concurrently using the lactate analyzer. The test to retest reliability of the described exercise was investigated using 21 recreational trained, non-smoking individuals. Apart from time-to-peak, which depended on the participant's reaction time, the other parameters were moderately consistent between the two tests.Based on the peak-power comparison between tests, and a Bland-Altman plot of the data, the three-minute all-out arm crank test was reliable in able-bodied participants. In a 2nd experiment, the test was performed on 17 able-bodied participants, 10 paraplegic participants, and seven tetraplegic participants with complete lesions between C5 and C7.Overall, the able-bodied and paraplegic participants showed very similar results for maximal and mean power whereas the tetraplegic participants performed with a significantly lower power output. After watching this video, you should have a good understanding of how to perform a three-minute all-out test at the arm crank ergometer.Once mastered, this technique can be done in 45 minutes if it's performed properly. While attempting this procedure, it's important to remember to perform a familiarization trial beforehand and to calibrate all the devices used during the test procedure.

experimental-protocol-three-minute-all-out-arm-crank-exercise-test

Research

JoVE Journal

Medicine

9.6K vues.  Swiss Paraplegic Center Nottwil. The overall goal of this protocol is to objectively measure the arm strength of spinal injury patients, using a three-minute exercise. This method can help answer key questions in the sports science field, such as the influence of dietary supplments on exercise performance. The main advantage of this test is that it is applicable for able-bodied as well as spinal cord injured athletes.First, turn on the arm crank ergometer. Then open the associated software. In the software control, se...