Newswise — Physical training for an extreme sporting event can decrease feelings of helplessness in individuals with chronic disability as long as four months after the event’s completion, according to a new study presented this week at the Association of Academic Physiatrists Annual Meeting in Orlando.

Could training for and completing a highly challenging handcycling mountain time trial event improve helplessness in people with a chronic disability? This new study assessed the impact of extreme sports training and to identify factors associated with this positive change in helplessness. Researchers from the University Medical Center Groningen were involved in the study’s design and data collection, while researchers from the University of Alabama at Birmingham performed the data analysis.

“Uncontrollable factors that accompany a chronic disability can cause feelings of helplessness in some individuals. Consequently, they may be less likely to engage in health-promoting behaviors which can result in poorer overall health,” said Ingrid Kouwijzer, MD, MSc, a human movement scientist in Research and Development at Heliomare Rehabilitation Center in the Netherlands, and the study’s co-author. “Fortunately, this can be reversed by interventions targeted at decreasing helplessness, such as adaptive sports participation. Clinicians should encourage their patients with chronic disability to engage in physical activity and provide resources for adaptive sports participation in their community.”

Each year, 12 rehabilitation centers form teams of former patients to participate in the annual HandbikeBattle, a highly challenging handcycling event held in the mountains of Austria. Participants engage in strenuous training to compete and reach the finish line, making them good subjects for this study, said Dr. Kouwijzer.

“From previous studies, we know that handcycling is physiologically more efficient and is less straining on the shoulders compared to wheelchair propulsion, which makes it an ideal training mode for wheelchair users,” said Dr. Kouwijzer. “The HandbikeBattle event was created in the Netherlands by rehabilitation professionals to initiate an active lifestyle by means of handcycling with peers and to push the participant’s physical and mental boundaries. The training period is free-living, which means that some guidance is provided by the rehabilitation centers, but no specific training regime is provided by the researchers. The rationale is that participants are encouraged to start training and become aware of the potential benefits of this active lifestyle.” The assumption is that participants will be self-motivated to participate in sports long term, she said.

Individuals with chronic disability, including 150 with spinal cord injury or spina bifida and 70 with other conditions, participated in the current study. They completed five months of free-living handcycling training followed by a 20.2-kilometer mountain time trial conducted at almost 1000 meters of elevation in Austria. Researchers measured helplessness using the Illness Cognition Questionnaire and assessed the responses before training, immediately after five months of training (just before the event), and four months after the event. Helplessness was measured as the sum score of six responses with a range of 6 to 24. Higher scores meant greater helplessness. The researchers then assessed how scores changed from before to just after completion of the training program, and from just before to four months after the challenging event. The study also examined associations between score changes and participant characteristics before training, such as sex, age, handcycling classification, disability duration, body-mass index, peak power output, mental health and self-efficacy.

Participants’ helplessness decreased from their pre-training to post-training periods. These effects did not change from the post-training period to the post time-trial follow-up. Improvements in helplessness between pre- and post-training periods were associated with having poor mental health and high self-efficacy at the start of the training, the study found.

Previous studies using data from the HandbikeBattle have shown that training for the event improves participants’ fitness, including a 17% increase in peak power output, and health parameters, such as body-mass index (BMI) also improve, said Dr. Kouwijzer. This new study’s findings also show that challenging training for the Handbikebattle yields strongly positive results in physical fitness for these individuals.



The Association of Academic Physiatrists (AAP) is a professional society with a mission to create the future of academic physiatry through mentorship, leadership, and discovery. Its members are leading physicians, researchers, educators and in-training physiatrists from 35 countries. The AAP holds an Annual Meeting, produces a leading medical journal in rehabilitation: AJPM&R, and leads a variety of programs and activities that support and enhance academic physiatry. On March 4-9, 2020, the AAP is hosting the ISPRM World Congress in Orlando, Florida. To learn more about the association, the specialty of physiatry and the World Congress, visit and follow us on Twitter at @AAPhysiatrists.

Meeting Link: ISPRM 2020, March 2020