Commentary 2.p65

Manual wheelchair propulsion is a straining form of ambulation, both for the cardio-respiratory as well as the musculo-skeletal system. Wheelchair locomotion implies arm work in every other activity in daily life. Compared to leg work, wheelchair arm work is much less efficient and more straining, and subsequently leads to a lower work capacity. Underlying pathology may further influence performance capacity, as is illustrated by Mukherjee et al in the comparison of wheelchair dependent subjects with non-wheelchair users in this issue. In addition, hand rim wheelchair propulsion the most common form of manual wheelchair ambulation in the western world is overall a very inefficient mode of exercise due to the coupling/decoupling of the hand to the rim, the execution of the movement partly outside the visual field. In hand rim wheelchair locomotion task load and physical work capacity therefore often seem out-off balance.