The propulsion, or “pushing”, of a manual wheelchair can be used as a form of exercise. There are multiple approaches to performing such exercise, including simple over-ground pushing (as is used for mobility/locomotion) or the use of devices that allow for stationary pushing. The most common devices are roller systems that the wheelchair’s rear wheels are placed over that allow for power output to be modulated by controlling the amount of rotational resistance on the rollers. Less common are wheelchair-compatible treadmills. These devices are usually large, require different belts than running treadmills, and are often outfitted with catch systems so that users do not roll off the back of the device during use. It should be noted that if a person’s primary means of mobility/locomotion is wheelchair propulsion, the additional repetitions of this approach during exercise are likely to increase the risk for upper extremity overuse injury. Conversely, if the person’s primary means of mobility is an electric wheelchair then there can be a considerable learning effect with wheelchair pushing on a treadmill and/or rollers.
Eight studies were identified that examined the effect of wheelchair propulsion training on cardiorespiratory fitness and/or endurance. There is level 1b evidence from 1 RCT study showing that low-intensity wheelchair propulsion for 2 sessions per week for 16 weeks fails to elicit an increase in cardiorespiratory fitness. Level 2 evidence from two studies (one RCT and one prospective control) shows that increasing exercise intensity, albeit over a shorter 6 to 8 wk training period, does not result in greater improvements in cardiorespiratory fitness compared to lower intensity wheelchair propulsion. Of five pre/post studies, providing weaker evidence, one showed 12 wk of wheelchair propulsion did not ↑ VO2peak while three showed that 4 to 6 wk of wheelchair population can modestly ↑ VO2peak. Results at various evidence levels show similar incongruent findings for the effect of wheelchair propulsion on endurance performance: Level 1b evidence from an RCT shows a benefit only on sprint performance (not endurance), while level 4 evidence from four pre/post studies shows evidence of benefit on endurance. One pre/post study suggests the potential for wheelchair propulsion training to benefit pulmonary function, while two other pre/post studies show no effect of this training.
Van der Scheer et al. (2016) provides Level 1 evidence that 16 wk of 2 day/wk of wheelchair pushing benefits endurance performance but can do so without improving VO2peak.
Hooker and Wells. (1989) provided Level 2 evidence that 8 wk of 3 day/wk of wheelchair pushing can have no effect of VO2peak and POpeak while benefitting some blood lipid measures.
Fauthier et al. provides Level 2 evidence that 6 wk of 3 day/wk of wheelchair pushing can result in no effect on cardiorespiratory fitness or performance.
Keyser et al. (2003) provided Level 4 evidence that 6 – 12 wk of wheelchair pushing benefits POpeak.
Le Foll-de Moro et al. (2005) provided Level 4 evidence that 6 wk of 3 day/wk of wheelchair pushing benefits VO2peak and some measures of pulmonary function.
Bougenot et al. (2003) provided Level 4 evidence that 6 wk of 3 day/wk of wheelchair pushing benefits VO2peak, endurance performance, and some measures of pulmonary function.
Tordi et al. (2001) provided Level 4 evidence that 4 wk of 3day/wk of wheelchair pushing benefits VO2peak and endurance performance.