Article | Published:

Effect of self-guided training for the HandbikeBattle on body composition in people with spinal cord injury

Spinal Cord Series and Casesvolume 4, Article number: 79 (2018) | Download Citation


Study design

Single-group pre-test post-test study.


Examine the change in (1) fitness and body composition due to self-guided training in preparation for the HandbikeBattle in people with spinal cord injury (SCI); and (2) whether these possible body composition changes are associated with changes in fitness.


Handcycling teams of Dutch rehabilitation centers training for the HandbikeBattle, a handcycling race on an Austrian mountain.


Fitness (peak power output (POpeak) determined during a graded handcycling exercise test) and body composition (body mass, body mass index (BMI), waist circumference (WC), %fat determined with skinfolds and fat and fat free mass (% and kg) assessed by bio-impedance analysis (BIA)) of 18 persons with SCI were evaluated before and after 4 months of training for the HandbikeBattle. The effects of training were evaluated with repeated measures ANOVA. Associations among changes in POpeak and changes in body composition were calculated with Pearson correlation coefficients.


Training for the HandbikeBattle led to significant improvements in POpeak, fat mass measured by BIA (19.6 ± 9.6 kg to 18.5 ± 8.3 kg, p = 0.02), %fat measured by skinfolds (28.4 ± 7.8% to 27.2 ± 7.2%, p = 0.02), while body mass and WC approached significance (p = 0.06). Association among changes in body composition and changes in POpeak ranged from trivial (e.g., for %fat BIA r = −0.023) to moderate (e.g., for WC, r = −0.32).


Self-guided training for the HandbikeBattle led to a large increase in fitness but had a small effect on body composition, e.g., nutrition may play a more important role than exercise.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.


  1. 1.

    de Groot S, Post M, Postma K, Sluis T, van der Woude L. Prospective analysis of body mass index during and up to 5 years after discharge from inpatient spinal cord injury rehabilitation. J Rehabil Med. 2010;42:922–8.

  2. 2.

    Sedlock DA, Laventure SJ. Body composition and resting energy expenditure in long term spinal cord injury. Spinal Cord. 1990;28:448–54.

  3. 3.

    de Groot S, Postma K, van Vliet L, Timmermans R, Valent LJM. Mountain time trial in handcycling: exercise intensity and predictors of race time in people with spinal cord injury. Spinal Cord. 2014;52:455–61.

  4. 4.

    Hoekstra S, Valent L, Gobets D, van der Woude L, de Groot S. Effects of four-month handbike training under free-living conditions on physical fitness and health in wheelchair users. Disabil Rehabil. 2017;39:1581–8.

  5. 5.

    von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61:344–9.

  6. 6.

    American College of Sports Medicine. Guidelines for exercise testing and prescription. (Wolters Kluwer/Lippincott Williams & Wilkins Health, 1991).

  7. 7.

    Stewart AA, Marfell-Jones M, Olds T, Al E. International standards for anthropometric assessment. Low Hutt, New Zeal Int Soc Adv Kinanthropometry. 2011; 125f. Accessed 25 Apr 2018.

  8. 8.

    de Vet HC, Terwee CB, Mokkink LB, Knol DL. Measurment in medicine. A practical guide. Cambridge: Cambridge University Press; 2011.

  9. 9.

    Durnin JV, Womersley J. Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16 to 72 years. Br J Nutr. 1974;32:77–97.

  10. 10.

    SIRI WE. The gross composition of the body. Adv Biol Med Phys. 1956;4:239–80.

  11. 11.

    Zweers H, Kruizenga H, Berg A van den, Reijven N, Hulshof P. Single Frequency Bio-Impedantie Analyse, Standard Operating Procedures. Nutritional Assessment Platform. 2016, Accessed 25 Apr 2018.

  12. 12.

    Schutz Y, Kyle U, Pichard C. Fat-free mass index and fat mass index percentiles in Caucasians aged 18–98 y. Int J Obes. 2002;26:953–60.

  13. 13.

    Hopkins WG. A scale of magnitudes for effect statistics. Sport Sci. 2002;5:1–7.

  14. 14.

    de Groot S, Adriaansen JJ, Tepper M, Snoek GJ, van der Woude LHV, Post MWM. Metabolic syndrome in people with a long-standing spinal cord injury: associations with physical activity and capacity. Appl Physiol Nutr Metab. 2016;41:1190–6.

  15. 15.

    Mojtahedi MC, Valentine RJ, Evans EM. Body composition assessment in athletes with spinal cord injury: comparison of field methods with dual-energy X-ray absorptiometry. Spinal Cord. 2009;47:698–704.

  16. 16.

    Goosey-Tolfrey V, Keil M, Brooke-Wavell K, de Groot S. A comparison of methods for the estimation of body composition in highly trained wheelchair games players. Int J Sports Med. 2016;37:799–806.

  17. 17.

    Kim D-I, Lee H, Lee B-S, Kim J, Jeon JY. Effects of a 6-week indoor hand-bike exercise program on health and fitness levels in people with spinal cord injury: a randomized controlled trial study. Arch Phys Med Rehabil. 2015;96:2033–40.e1.

  18. 18.

    Bakkum A, Paulson T, Bishop N, Goosey-Tolfrey V, Stolwijk-Swüste J, Kuppevelt D, et al. Effects of hybrid cycle and handcycle exercise on cardiovascular disease risk factors in people with spinal cord injury: a randomized controlled trial. J Rehabil Med. 2015;47:523–30.

  19. 19.

    Rosety-Rodriguez M, Camacho A, Rosety I, Fornieles G, Rosety MA, Diaz AJ, et al. Low-grade systemic inflammation and leptin levels were improved by arm cranking exercise in adults with chronic spinal cord injury. Arch Phys Med Rehabil. 2014;95:297–302.

  20. 20.

    Taylor AW, McDonell E, Brassard L. The effects of an arm ergometer training programme on wheelchair subjects. Spinal Cord. 1986;24:105–14.

  21. 21.

    Fisher JA, McNelis MA, Gorgey AS, Dolbow DR, Goetz LL. Does upper extremity training influence body composition after spinal cord injury? Aging Dis. 2015;6:271–81.

Download references


The assistance of Suzanne de Groot during part of the data collection is greatly appreciated.

Author information

Author notes

  1. The members of HandbikeBattle group are listed below Acknowledgements.


  1. Amsterdam Rehabilitation Research Center | Reade, Amsterdam, The Netherlands

    • Sonja de Groot
    •  & Ingrid Kouwijzer
  2. University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands

    • Sonja de Groot
    •  & Ingrid Kouwijzer
  3. Research & Development, Rehabilitation Center Heliomare, Wijk aan Zee, The Netherlands

    • Ingrid Kouwijzer
    •  & Linda J. Valent
  4. Nutrition and Dietetics, The Hague University of Applied Sciences, The Hague, The Netherlands

    • Marjolein Baauw
  5. Rehabilitation Center Rijndam, Rotterdam, The Netherlands

    • Rogier Broeksteeg


  1. Search for Sonja de Groot in:

  2. Search for Ingrid Kouwijzer in:

  3. Search for Marjolein Baauw in:

  4. Search for Rogier Broeksteeg in:

  5. Search for Linda J. Valent in:


  1. HandbikeBattle

    Conflict of interest

    The authors declare that they have no conflict of interest.

    Statement of ethics

    The study was approved by the Local Ethical Committee of the Center for Human Movement Sciences, University Medical Center Groningen, the Netherlands. All participants voluntary signed an informed consent form after they were given information about the testing procedures. The study was registered in the Dutch Trial Register (, NTR6586).

    Corresponding author

    Correspondence to Sonja de Groot.

    HandbikeBattle group name

    HandbikeBattle group name

    Bram van Gemeren, Rehabilitation center Het Roessingh, Enschede, The Netherlands

    Mark van de Mijll Dekker, Rehabilitation center Heliomare, Wijk aan Zee, The Netherlands

    Karin Postma, Rehabilitation Center Rijndam, Rotterdam, The Netherlands

    Linda van Vliet, Reade center for rehabilitation & rheumatology, Amsterdam, The Netherlands

    Misha Metsaars, Libra Rehabilitation & Audiology, location Blixembosch, Eindhoven, The Netherlands

    Eric Helmantel, University Medical Center Groningen, Location Beatrixoord, Haren, The Netherlands

    Lise Wilders, Sint Maartenskliniek, Nijmegen, The Netherlands

    Maremka Zwinkels, Rehabilitation center De Hoogstraat, Utrecht, The Netherlands

    Paul Grandjean, Rehabilitation center Adelante, Hoensbroek, The Netherlands

    Selma Overbeek, Rehabilitation center Tolbrug, Den Bosch, The Netherlands

    About this article

    Publication history