Ellapen Terry J, Hammill Henriëtte V, Swanepoel Mariette, Strydom Gert L
School of Biokinetics Recreation and Sport, Physical Activity Sport and Recreation (PhASRec), North-West University, South Africa.
Afr J Disabil. 2017 Sep 8;6:337. doi: 10.4102/ajod.v6i0.337. eCollection 2017.
There are approximately 1 billion people living with chronic lower limb disability, many of whom are wheelchair users.
Review cardiometabolic and neuromuscular risk profiles of wheelchair users, benefits of regular exercise and the causes of neuromuscular upper limb and hip injuries that hinder regular adherence.
Literature published between 2013 and 2017 was adopted according to the standard practices for systematic reviews (PRISMA) through Crossref Metadata and Google Scholar searches. Individual paper quality was evaluated using a modified Downs and Black Appraisal Scale.
The literature search identified 16 600 papers which were excluded if they were non-English, non-peer-reviewed or published before 2013. Finally, 25 papers were accepted, indicating that sedentary wheelchair users have poor cardiometabolic risk profiles (PCMRP) because of a lack of physical activity, limiting their quality of life, characterised by low self-esteem, social isolation and depression. Their predominant mode of physical activity is through upper limb exercises, which not only improves their cardiometabolic risk profiles but also precipitates neuromuscular upper limb overuse injuries. The primary cause of upper limb injuries was attributed to poor wheelchair propulsion related to incorrect chair setup and poor cardiorespiratory fitness.
Wheelchair users have a high body mass index, body fat percentage and serum lipid, cholesterol and blood glucose concentrations. Empirical investigations illustrate exercise improves their PCMRP and cardiorespiratory fitness levels. Although literature encourages regular exercise, none discusses the need to individualise chair setup in order to eliminate wheelchair pathomechanics and upper limb neuromuscular injuries. Wheelchair users must be encouraged to consult a biokineticist or physiotherapist to review their wheelchair setup so as to eliminate possible incorrect manual wheelchair propulsion biomechanics and consequent overuse injuries.
全球约有10亿人患有慢性下肢残疾，其中许多人需要使用轮椅。
综述轮椅使用者的心脏代谢和神经肌肉风险状况、定期锻炼的益处以及阻碍他们定期坚持锻炼的上肢和髋部神经肌肉损伤的原因。
根据系统评价的标准方法（PRISMA），通过CrossRef元数据和谷歌学术搜索，采用2013年至2017年发表的文献。使用改良的唐斯和布莱克评估量表评估每篇论文的质量。
文献检索共识别出16600篇论文，如果论文是非英文的、未经同行评审的或2013年以前发表的，则予以排除。最终，25篇论文被纳入，结果表明久坐的轮椅使用者由于缺乏体育活动，心脏代谢风险状况较差（PCMRP），这限制了他们的生活质量，其特点是自尊心低、社会孤立和抑郁。他们主要的体育活动方式是上肢锻炼，这不仅改善了他们的心脏代谢风险状况，还引发了上肢神经肌肉过度使用损伤。上肢损伤的主要原因是轮椅推进不当，这与轮椅设置不正确和心肺适能差有关。
轮椅使用者的体重指数、体脂百分比以及血清脂质、胆固醇和血糖浓度都很高。实证研究表明，锻炼可改善他们的PCMRP和心肺适能水平。虽然文献鼓励定期锻炼，但没有一篇讨论个性化轮椅设置以消除轮椅病理力学和上肢神经肌肉损伤的必要性。必须鼓励轮椅使用者咨询生物动力学专家或物理治疗师，以检查他们的轮椅设置，从而消除可能不正确的手动轮椅推进生物力学以及随之而来的过度使用损伤。
