Date: 24, Nov Program & Abstracts. Venue: Wakayama Marina City, Wakayama, Japan. Wakayama Medical University

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1 The International Symposium of Sport Science in Athletes with Spinal Cord Injury in Wakayama, Japan Joint Usage/Research Center of Sports for Persons with Impairments Symposium 2014 Program & Abstracts Date: 24, Nov Venue: Wakayama Marina City, Wakayama, Japan Sponsored by Department of Rehabilitation Medicine, Wakayama Medical University, School of Medicine Joint Usage/Research Center of Sports for persons with impairments Medical Center for Health Promotion and Sports Science Wakayama Medical University

2 Welcome Yoshitaka Okamura, MD and PhD The president of Wakayama Medical University I am very honored to have you here to participate and share in The International Symposium of Sport Science in Athletes with Spinal Cord Injury in Wakayama, Japan. All of speakers, chairs, and audiences are outstanding persons to lead sports science and medicine in persons with spinal cord injury (SCI). In 2009, Dr. Kishio Nanjo, the president of Wakayama Medical University at that time, established Medical Center for Health Promotion and Sports Science and the institute took over research of sports science and medicine in SCI. And in 2013, I am very proud that the Ministry of Education, Culture, Sports, Science and Technology authorized this institute as Joint Usage/Research Center of Sports for persons with impairments. Tokyo Olympic and Paralympic games will be held in 2020 and our institute is being expected to improve performance and health condition in persons with impairments. This symposium was planned as an activity of our center. I should state special thanks for Professor Vicky Goosey-Tolfrey who has mainly arranged this symposium with Professor Fumihiro Tajima of our university. Finally, I believe that Wakayama prefecture is one of the best places in Japan and we have more than two thousand years of history. I am a cardiovascular surgeon and I am proud of Dr. Seishu Hanaoka who performed the first operation for breast cancer under anesthesia in the world. There are nice sightseeing places, outstanding foods and kind people in Wakayama. Please study hard and enjoy here.

3 Statement Professor Vicky Goosey-Tolfrey and Professor Fumihiro Tajima Sport science and sport medicine can help to improve daily activities and performance. In patients and athletes with SCI, few specialized research groups around the world are investigating issues related to applied physiology, nutrition, coaching and sports management in these unique population groups. The outcomes of these various research areas represent the foundation for evidence-based support to improve daily activities, athletic performance and quality of life in SCI. To use the existing knowledge more efficiently, it seems important to offer researchers an opportunity to meet across different research strands. In this way, scientific data can be presented and experiences exchanged on an interdisciplinary level. We believe that the discussions in this meeting will not only benefit persons with disabilities but also able-bodied persons and the research community. In light of the Tokyo Olympic and Paralympic Games in 2020, we propose to conduct a mini-symposium in Wakayama, Japan. The committee of the mini-symposium will invite a number of experts in the field to provide an opportunity to develop sports science and sport medicine. We further aim to strengthen the collaborative links and deepen the friendship between these researchers. スポーツ 医 科 学 は アスリートの 競 技 パフォーマンスの 向 上 に 不 可 欠 な 分 野 であることはも ちろんのこと 全 ての 人 にとっても 生 活 の 質 の 改 善 に 寄 与 するものである 脊 髄 損 傷 患 者 や アスリートに 対 しては 応 用 生 理 学 栄 養 学 コーチング スポーツマネ ージメントなど 様 々な 分 野 で 研 究 が 行 われてきたが それぞれの 分 野 としては 少 数 の 専 門 的 なグループとなっているきらいがある つまり これらの 成 果 から 得 られた 科 学 的 根 拠 により 脊 髄 損 傷 者 の 生 活 運 動 能 力 QOL を 改 善 させる 支 援 が 個 別 に 行 われてきたため 今 までは 総 合 的 な 発 展 に 乏 しかった 側 面 がある これまで 得 られた 多 くの 知 見 をより 効 果 的 に 活 用 するためには これら 様 々な 分 野 の 研 究 者 達 が 一 堂 に 会 し 各 々の 持 つ 科 学 的 データを 基 に 活 発 な 議 論 意 見 交 換 を 行 う 場 が 必 要 であ り そういった 意 味 で 本 シンポジウムの 開 催 は 障 害 者 だけでなく 健 常 者 や 各 研 究 団 体 にと っても 有 益 なものであると 考 える 2020 年 に 東 京 オリンピック パラリンピック 大 会 の 開 催 を 控 える 今 障 害 者 スポーツ 医 科 学 発 展 のため 国 内 外 から 各 分 野 の 専 門 家 を 招 き 本 学 において 障 害 者 スポーツ 医 科 学 に 関 する 国 際 シンポジウムを 開 催 することは 意 義 深 いものであり 本 シンポジウムを 通 じて 大 いに 議 論 を 深 め また 研 究 者 間 の 連 携 を 強 化 したい

4 Program 8:30 Reception 9:00 Opening Ceremony MC:Toshihito Mitsui Medical Center for Health Promotion and Sports Science, Wakayama Medical University Opening Remarks Dr. Tetsuo Suyama Trustee, Japanese Para-Sports Association Promotion Committee, Joint Usage/Research Center of Sports for Persons with Impairments 9:10 ~ 10:10 Special Lecture Chair: Dr. Tetsuo Suyama LectureⅠ Sport Medicine and Science for Top Athlete in Japan (9:10-9:30) Dr. Takashi Kawahara Director General, Japan Institute of Sports Sciences Management Committee, Joint Usage/Research Center of Sports for Persons with Impairments LectureⅡ Sports Medicine agenda of the Paralympic Movement (9:30-10:10) Dr. Peter Van de Vliet Medical & Scientific Director, International Paralympic Committee 10:10 ~ 11:00 Keynote Presentation Chair: Professor Fumihiro Tajima Testing wheelchair sportspersons: Methodological considerations Prof. Vicky Goosey-Tolfrey The Peter Harrison Centre for Disability Sport, School of sport, Exercise and Health Sciences, Loughborough University Prof. Thomas Janssen Amsterdam Rehabilitation Research Center Reade, VU University Amsterdam Dr. Christof Leicht Research assistant in Sport Science, The Peter Harrison Centre for Disability Sport, School of sport, Exercise and Health Sciences, Loughborough University 11:00 ~ 11:10 Break 11:10 ~ 12:30 Lecture Chair: Professor Vicky Goosey-Tolfrey LectureⅠ Activating paralyzed muscle: The role of FES for health benefits (11:10-12:10) Prof. Thomas Janssen Amsterdam Rehabilitation Research Center Reade, VU University Amsterdam

5 LectureⅡ Introducing our research activities (12:10-12:30) Prof. Fumihiro Tajima Director of medical center for health Promotion and Sport Science, Wakayama Medical University Department of Rehabilitation Medicine, Wakayama Medical University, School of Medicine 12:30 ~ 13:40 Lunch and Poster session 13:40 ~ 15:40 Lecture Chair: Professor Thomas Janssen LectureⅢ A team approach: Collaborations in SCI Research (13:40-14:40) Prof. Vicky Goosey-Tolfrey The Peter Harrison Centre for Disability Sport, School of sport, Exercise and Health Sciences, Loughborough University LectureⅣ Quality of life in persons with SCI: The importance of stories (14:40-15:40) Dr. Brett Smith Reader in Qualitative Health Research The Peter Harrison Centre for Disability Sport, School of sport, Exercise and Health Sciences, Loughborough University 15:40 ~ 15:50 Break 15:50 ~ 17:50 Lecture Chair: Dr. Tomoyuki Ito LectureⅤ Performance enhancement: Cardiorespiratory function and other techniques (15:50-16:50) Dr. Christopher West Postdoctoral Fellow Autonomic Research Unit, ICORD- spinal cord injury Research Center of UBC Faculty of Medicine and Vancouver Coastal Health Research Institute, Blusson Spinal Cord Center at Vancouver General Hospital LectureⅥ Immune function and exercise special considerations in wheelchair-dependent (16:50-17:50) populations Dr. Christof Leicht Research assistant in Sport Science, The Peter Harrison Centre for Disability Sport, School of sport, Exercise and Health Sciences, Loughborough University 17:50 ~ 18:00 Closing Remarks Dr. Yoshitaka Okamura President of Wakayama Medical University 18:05 Scheduled Finish

6 Special Lecture 特 別 講 演

7 Dr. Takeshi Kawahara Brief summary of career 1976 Graduated Medical School, University of Tokyo 1979 Cardiologist, Tokyo University Hospital 1985 Lecturer, College of Arts & Sciences, University of Tokyo 1989 Associate Professor, College of Arts & Sciences, University of Tokyo 1994 Associate Professor, Graduate School of Arts & Sciences, University of Tokyo 1999 Director, Preparation for Japan Institute of Sports Sciences (JISS) 2001 Director of Sport Medicine, JISS 2005 General Director of Research Departments, JISS 2014 Director General, Japan Institute of Sports Sciences Board Member of Japanese Olympic Committee Participated Olympic Game in Seoul, Barcelona, Lilehammer, Atlanta, Nagano and Sydeny as a Japanese Delegation Doctor. Sport Medicine and Science for Top Athlete in Japan Nowadays support of sport medicine and science is essential for elite athletes to win international competitions. Many countries have national training center and sport science institute. Japan institute of Sports Sciences (JISS) established in 2001 for elite athletes, have research facilities, medical care facilities, training facilities, restaurant and accommodation in one building. Experienced experts of sport medicine treat sport injuries and illness of top-level athletes in the medical clinic. Medical clinic include internal medicine, orthopedics, dentistry, gynecology, ophthalmology, otolaryngology, dermatology, athletic rehabilitation, psychological counseling and nutritional counseling. We provide comprehensive support to national team of each sport by sport medicine physiology, biomechanics, nutrition, psychology, and technology. JISS was not responsible for Paralympic athletes before but starts to support Paralympic athletes this year.

8 Dr. Peter Van de Vliet Dr. Peter Van de Vliet is Medical & Scientific Director of the International Paralympic Committee (IPC), with office in Bonn, Germany, since October His portfolio includes classification, anti-doping, medical services, sports sciences and equipment. Dr. Van de Vliet, Belgian citizen, holds a Ph.D. in Physiotherapy and Motor Rehabilitation from the Katholieke Universiteit Leuven, Belgium, on the theme of Exercise in Clinical Depression. Prior to taking the position in the IPC, he was commercial agent in mobility devices for persons with a disability, and later worked as researcher at the Leuven University with particular interest in Paralympic classification and psychosocial determinants of sports-participation in athletes with a disability. He was member of the Belgian Paralympic Team for Atlanta 2006 (Athletics Coach) and Athens 2004 (Wheelchair Rugby Team Manager), and member of the Belgian Paralympic Committee Elite Athlete Sport Counseling Group. He also was Chef de Mission for numerous Belgian delegations at European and World Championships in IPC Athletics and IWAS Wheelchair Rugby in the period Sports Medicine Agenda of the Paralympic Movement Nowadays, people with impairment participate in high performance as well as in competitive and recreational sport across the world, and sports and physical activity also found its way in rehabilitation. The impact of such programs in early phase of rehabilitation are well documented in literature, including higher employment rates, increased psychological stability and life satisfaction, reduced medical after-care and increased independent living. Sport programmes and opportunities worldwide have increased in scope and number, and sport has become a viable option for individuals with a disability. Sports Medicine evolves in similar fashion. Although commonly established for many years, it is only since the early 21st century that sports medicine has emerged as a distinct entity in paralympic sport, but despite the growing awareness there remains a relative paucity of published research on sports medicine specifically for this athletic population. This presentation will outline some of the common situations that team physicians may encounter when travelling with a team, or that medical services of an organizing committee will need to make provisions for.

9 Keynote Presentation 基 調 講 演

10 Professor Vicky Goosey-Tolfrey, Dr. Christof Leicht and Professor Thomas Janssen Testing wheelchair sportspersons: Methodological considerations The aim of this presentation will be to describe the sports science monitoring model that has been used to provide appropriate sport science support to the sports of Wheelchair Basketball, Wheelchair Tennis and Wheelchair Rugby. This paper will highlight how performances have been monitored and the training implications in order to optimize performance. This will be achieved by describing some of the key areas of these support programmes. Aerobic endurance fitness is important for wheelchair games players - this component of fitness has customarily been evaluated in the laboratory. However, due to the wide range of standardised laboratory protocols and the limited availability of specialised equipment for testing wheelchair-dependent participants, field-based tests have become the preferred option. An obvious advantage of field testing is that large groups of athletes can be tested in less time. Typically, wheelchair basketball coaches have used the 20 m multistage fitness test (MSFT) as it is easy to administer. Issues related to the validity of this test will be discussed along with how wheelchair mobility can be assessed through other tests and other parameters are of notable importance such as acceleration and top speed. Once a physiological profile has been established it is important to understand the sport and the implications for training. The second aspect of the presentation will illustrate how we can relate the laboratory testing to explore the relationship between the blood lactate response to exercise and to identify the sport specific HR training zones and/or the use of Ratings of Perceived Exertion (RPE). Future technologies to understand the on-court movements of wheelchair games play will be briefly highlighted.

11 Lecture 講 演

12 Professor Thomas Janssen In 1988, Thomas Janssen received his master s degree in exercise physiology and functional anatomy from the Faculty of Human Movement Sciences, VU University in Amsterdam. In 1994, he received a PhD degree in Human Movement Sciences on Physical Strain and Physical Capacity of Men with Spinal Cord Injuries. Between 1994 and 1998 he was a visiting scientist at and associate director of the Institute for Rehabilitation Research and Medicine, Wright State University School of Medicine in Dayton, Ohio, USA. Upon returning to the Netherlands, he took an assistant professorship at the VU University, performing rehabilitation research and teaching classes on exercise physiology and rehabilitation. At the same time, he started working as research coordinator of the Rehabilitation Center Amsterdam (current name: Reade). His main research interest lies in the field of exercise physiology and biomechanics applied to rehabilitation and exercise. Most profound research subjects are physical capacity of wheelchair users with a spinal cord injury, electrical stimulation therapy of paralyzed muscles, muscle function, shoulder kinematics and walking ability in patients with stroke, and disability sports. Since 2008 he is professor in rehabilitation research at the VU University. He is currently chair of the Amsterdam Rehabilitation Research Center Reade and scientifically responsible for the Center for Adapted Sports Amsterdam Reade. He has (co-)authored over 140 publications on topics such as exercise and rehabilitation. Activating paralyzed muscle: The role of FES for health benefits As a result of the injury, persons with spinal cord injury (SCI) have motor disorders below the level of the lesion. The resulting paralysis leads to deconditioning of all tissues, including muscle atrophy and poor circulation. This situation can result in several secondary medical complications, such as poor wound healing and pressure ulcers, severely restricting mobility in not only sedentary individuals but also athletes with an SCI. Individuals with SCI predominantly engage in upper-body exercise for health and fitness improvement. Even though this type of exercise is beneficial in many ways, it does not adequately improve the condition and integrity of the paralyzed parts of the body and can therefore not prevent the above-described complications. Moreover, the muscle mass that can be activated in upper-body exercise is relatively small, especially in those with tetraplegia, and therefore not always adequate for improving/maintaining cardiorespiratory fitness or for weight control. Activation of the paralyzed lower-body muscles by using functional electrical stimulation (ES) may be a way to solve some of these problems. As a result of the leg muscle activity, not only the condition of the lower-body can be improved and the risk of secondary complications reduced, but also the cardiorespiratory and metabolic responses can be increased resulting in improved fitness and better weight control. This presentation will illustrate some of the ES-exercise modalities and their effects and the role of ES-exercise for health benefits in athletes with SCI will be discussed.

13 Professor Fumihiro Tajima Dr. Fumihiro Tajima was born in Tokyo, Japan in He graduated from University of Occupational and Environmental Health (UOEH), School of Medicine in He took early part of resident program of rehabilitation medicine for 2 years. At that time, he participated in research team of Oita International Wheelchair Marathon Race and decided to study exercise physiology in persons with impairments. And then he was admitted to postgraduate school of exercise and environmental physiology, UOEH. He studied cardiovascular, renal and endocrine responses during exercise, hypo and hyperbaric conditions, water immersion and head-up tilt in elderly and persons with spinal cord injury. He was promoted to an assistant professor of Rehabilitation medicine in UOEH and moved to State University of New York at Buffalo, as a Buswell fellow. He studied muscle sympathetic nerve activity in humans with stroke, spinal cord injury and cardiac transplantation for 2 years. In 2000, he was elected as the first associate professor of rehabilitation medicine, Hamamatsu Medical University, School of Medicine. He constructed the system of rehabilitation medicine there for 4 years. In 2003, he was selected as a professor and director of rehabilitation medicine, Wakayama Medical University School of Medicine. In 2005, He was selected as a director of Japanese Society of Rehabilitation Medicine. And, he established Nachi-Katsuura Research Center of Sports Medicine and Balneology, in 2008, and Research center of environmental and exercise physiology and sports medicine in In 2011, he was elected as the chairman of annual meeting in Japanese Society of Spinal Cord Injury. In his clinical career, he is a deputy chief of his University Hospital, this year. Next year, he will be the chairman of the 70th annual meeting of Japanese Society of Physical Fitness and Sports Medicine. In his social activities, he is contributing medical check activities in Japanese Paralympic Committee as the chief of the division. Throughout his 30 years career, he has been working as a physician of rehabilitation medicine in several University hospitals and studying exercise and environmental physiology in persons with impairment and contributed medical supports for athletes with impairment. He has published more than 140 papers and 20 books in English and Japanese, and promoted more than 30 specialist physicians, 38 Master of Science, and 18 PhD. He loves fishing, Go and Golf.

14 Introducing our research activities of Joint Usage/Research Center of Sports for Persons with Impairments In Japan, sports activities in persons with impairments (PI) were realized as a part of rehabilitation and/or welfare. Therefore, support and promotion of sports in PI were within jurisdiction of Ministry of Health, Labour and Welfare in Japan, while sports in able bodied persons were controlled by Ministry of Education, Culture, Sports, Science and Technology (MECSST). However, international opinion changed the understanding of sports in PI and Paralympic games should be competition in PI. Therefore, the numbers of medals in Paralympic games in Japan decreased. In 2011, Japanese government changed Sports basic law and sports in PI should be similar to persons with able-bodied. And Sports in PI was within jurisdiction of MECSST in Japan. And MECSST authorized our research center as Joint Usage/Research Center of Sports for Persons with Impairments. However, our institute was designed as a research center and not a training center for PI. If Japanese government would like to increase number of medals in Paralympic games, National training center for PI will have to be established in Japan (Japan Rehabilitation Center should be the best in my opinion), and/or Japan Institute of Sports Science (National Training Center) should include contribution against Paralympic athletes. Our research center focused on exercise and environmental physiology and medical support for PI. I think that our research activities in sports science and medicine in PI are similar to some institutes in Universities around the world, such as The Peter Harrison Centre. Therefore, I strongly hope that we will co-work with them.

15 Professor Vicky Goosey-Tolfrey Vicky Tolfrey is a Professor in Applied Disability Sport and the Director of the Peter Harrison Centre for Disability Sport which is based at Loughborough University. She is a BASES Re-accredited Sport Scientist and has provided applied sport science support to Paralympic athletes since 1994, and has attended the Atlanta 1996, Sydney 2000 Paralympic Games, the Cyprus holding camp for Athens 2004 and the Far East holding camp for Beijing 2008 and the London 2012 Paralympic Games. She acts as a sport science consultant for the Great Britain Wheelchair Rugby Association and Para-triathlon squads over-seeing the delivery of a programme of applied research leading to Rio Additionally, she is a member of the Technical Advisory Group for the English Institute of Sport and the Paralympic Performance Advisory Group for the British Paralympic Association. Vicky received a BASES Award for Good Practice in Applied Sport Science (2005) and was awarded a BASES Fellowship in 2011 for her work in Disability Sport and mentorship of others. Vicky is editor of one of the few scientific international handbooks on sport physiology and biomechanics in adapted sports Wheelchair Sport published by Human Kinetics and has over 100 academic publications on the topic. A team approach: Collaborations in SCI Research The Mission: To improve knowledge about Paralympic sport and to promote the substantial health and quality of life benefits that can be gained through participation in disability sports and physical activity. In the context of rehabilitation medicine and care the restoration and maintenance of mobility and functioning are key objectives in persons with a spinal cord injury. The need for evidence-based rehabilitation practice, improved diagnostics and technological innovation in assistive devices and patient monitoring, all require a systematic and collaborative research effort, now and in the future. It is this, where sport/exercise sciences and rehabilitation sciences and practice meet in local, national and international collaborations or cross-disciplinary staff members work together. The staff of the Peter Harrison Centre for Disability Sport (PHC) of Loughborough University in the UK has a strong position in this multidisciplinary area in terms of expertise, methodology, technology, research input, collaboration and dissemination. Our research has generated impact has grown out of many national and international collaborations. For example work with Prof. van der Woude has enabled us to bridge the divide between rehabilitation sciences and a high performance sporting environment where our expertise lies by sharing knowledge across the exercise continuum. This work now continues with partnerships between the UK and Japan. Moreover, the a research model that includes inter/multi-disciplinary research activities between our staff members from the School of Sport, Exercise and Health Sciences across disciplines will also be discussed (e.g., the work of our Coca-Cola funded fit for life project).

16 Dr. Brett Smith Brett Smith, PhD, leads the psycho-social health and wellbeing strand in the Peter Harrison Centre for Disability Sport at Loughborough University, UK. For over 15 years, and working at the intersection of psychology and sociology, his research has focused on two complementary themes: 1) The psycho-social investigation of disability, health, and wellbeing and 2) The advancement of qualitative methods and narrative theory. This research has resulted in over 100 publications, appearing in leading journals like Health Psychology, Health Psychology Review, Sociology of Health and Illness, and Qualitative Health Research. It has also been disseminated to audiences around the world through over 20 invited keynote presentations, 100 invited talks, and events held by the Wellcome Trust and the UK Houses of Parliament. Brett is Editor of the award winning international journal, Qualitative Research in Sport, Exercise, and Health (QRSEH). He also is associate editor of Psychology of Sport and Exercise, actively serves on eight editorial boards, and is co-author of four books. Currently Brett is co-editing two Handbooks: the International Handbook of Qualitative Methods in Sport and Exercise and the International Handbook on Sport Psychology (2015: Routledge). Quality of life in persons with SCI: The importance of stories Suffering a spinal cord injury (SCI) raises many challenges. One of these is how to have a good quality of life and be fit for life following SCI. The purpose of this presentation is to critically explore how quality of life and being fit for life may be hindered and promoted for people with SCI. This is vital to explore because people with SCI are within the most inactive segment of society that comprises disabled people. First, drawing on empirical data and a recent systematic review with colleagues in the Peter Harrison Centre for Disability Sport, the barriers to and psycho-social benefits of being physically active are highlighted. Drawing on narrative theory, a typology of stories that people tell about physical activity, health and wellbeing are offered. The various types of stories identified are useful as resources for researchers, policy makers, and health care professionals. They can be used to help promote sport and enhance quality of life. The stories are also useful as warning signposts about the possible dangers that lie ahead when people engage in physical activities for certain reasons. The presentation closes with current ideas and evidence about how we might better translate knowledge of all kinds be it psychological, sociological, or physiological - to sporting organizations, health care professionals, and disabled people about sport and physical activity.

17 Dr. Christopher West Christopher West is an Assistant Professor of Kinesiology at the University of British Columbia and a Principal Investigator at the International Collaboration on Repair Discoveries (ICORD). He is a board approved member of the American Spinal injuries Association where he also sits on the Autonomic Standards Committee. His research, which spans the basic-clinical translational spectrum, focuses on understanding mechanisms of cardiovascular decline after spinal cord injury and limitations to exercise performance in this population. He has attended the last 3 Paralympic games along with World Championship events in a research capacity, where he is part of a small team that are investigating whether cardiovascular and autonomic testing should be included into Paralympic sports classification. He has published his work in tier 1 journals for his field including the Journal of Physiology and Medicine and Science in Sport and Exercise. He has taken part in International Symposia and has received numerous awards for his research including the coveted Sam Schmidt/ASIA Sell Fund Young Investigator Award. His research has been funded by numerous national and international funding bodies such as the Canadian Institute for Health Research, Craig Neilsen Foundation, Michael Smith Foundation for Health Research, and the Rick Hansen Institute. Performance enhancement: Cardiorespiratory function and other techniques Alterations in both cardiovascular and respiratory function post spinal cord injury (SCI) are now well described. Recent research has indicated that these alterations in function occur secondary to loss of descending neural control over the cardiovascular end-organs and physical deconditioning. From a cardiovascular standpoint, loss of descending sympathetic control over the heart and blood vessels is arguably one of the most potent changes that occur following high-thoracic or cervical SCI. In these individuals, blood pressure and heart rate (at rest and during exercise) are severely reduced as is the ability to redistribute blood from the abdomen to the skeletal muscles during exercise. This results in a limited stroke volume and cardiac output during exercise which ultimately reduces oxygen delivery to the working muscles. From a respiratory standpoint, loss of volitional control over the accessory muscles of inspiration and the major muscles of expiration alters the mechanics of breathing and reduces ventilatory efficiency during exercise. Together we and others have shown that these impairments in cardiorespiratory function limit exercise performance. During this presentation, I will explore techniques that can be used to enhance cardiorespiratory function during exercise and elevate sports performance. These techniques will include theoretical techniques (anti-gravity suits) as well as practical techniques that can be used during competition (abdominal binding, boosting, pressure stockings, respiratory muscle training).

18 Dr. Christof Leicht Joining the Peter Harrison Centre for Disability Sport at Loughborough University in 2009 from the Swiss Paraplegic Centre, Dr Christof Leicht completed a PhD in Sport Science on Mucosal immune and physiological responses to exercise in wheelchair athletes. In his research capacity, international collaborations include work with Prof. Fumihiro Tajima (Wakayama Medical University, Japan), Prof. Martin Ferguson-Pell (University of Alberta, Canada) and Dr Claudio Perret (Swiss Paraplegic Centre). In the lead-up to London 2012, he was further involved in Paralympic support, particularly in wheelchair basketball, wheelchair rugby, goalball and handcycling. Christof has recently taken up the role as Lecturer in Exercise Physiology at Loughborough University. Immune function and exercise special considerations in wheelchair-dependent populations Apart from motor and sensory function loss, an injury to the spinal cord can cause sympathetic dysfunction, which has been shown to affect immune responses. For example, it could potentially affect mucosal immunity, as salivary glands are innervated by sympathetic nerves. Mucosal immunity is crucial to protect the body from respiratory tract infections, which is relevant in both patient and athletic spinal cord injured populations. Interestingly, despite the disruption of their sympathetic nervous system, some exercise-induced mucosal immune responses in tetraplegic athletes are comparable with findings in able-bodied and paraplegic populations. This provides evidence for the positive impacts of exercise on oral immune function in wheelchair athletes. In able-bodied populations, exercise-induced elevations in interleukin-6 (IL-6) can trigger an acute anti-inflammatory response, which is regarded to reduce chronic low-grade inflammation. This condition is associated with chronic disease, such as cardiovascular disease or diabetes. Even though the highest acute IL-6 increases have been reported following exercise using large muscle groups, the muscle mass used during upper body exercise in both able-bodied and paraplegic populations is sufficient to trigger an IL-6 response. However, the IL-6 response to exercise is blunted in individuals with tetraplegia, who may hence not benefit from the anti-inflammatory effects of exercise. It is likely that sympathetic dysfunction explains some of this blunted response, as catecholamines independently induce IL-6 secretion. However, IL-6 increases in in the absence of catecholamine elevations have been documented. For example, passive elevations of core temperature through hot water immersion can induce both elevations in IL-6 and anti-inflammatory cytokines in tetraplegia. With respect to the cytokine response, hot water immersion may therefore offer an alternative to exercise in individuals with sympathetic dysfunction. Future studies may also look into combining exercise and temperature elements to optimise the anti-inflammatory effect of this intervention.

19 Poster session ポスターセッション

20 Dr. Hideki Arakawa Assistant Professor, Department of Rehabilitation Medicine, Wakayama Medical University Renal function and endocrine responses to arm exercise in persons with spinal cord injury Dr. Ken Kouda Part-time Lecturer, Department of Rehabilitation Medicine, Wakayama Medical University Chief, Department of Rehabilitation Medicine, Nachikatsuura Municipal Hospital Increases of capillary blood pressure in individuals with cervical spinal cord injuries Dr. Yusuke Sasaki Assistant Professor, Department of Rehabilitation Medicine, Wakayama Medical University Plasma Interleukin-6 Response with Paraplegia During a Wheelchair Half-Marathon Race Dr. Yasunori Umemoto Chief, Department of Rehabilitation Medicine, Kansai Electric Power Hospital Arm crank ergometer exercise at 60% of maximum oxygen consumption increases IL-6 in persons with spinal cord injuries

21 Dr. Motohiko Banno Assistant Professor, Department of Rehabilitation Medicine, Wakayama Medical University Wheelchair half marathon race increases natural killer cell activity in persons with cervical spinal cord injury Dr. Sumiko Shiba Physical Therapist, Assistant Professor, Department of Physical Therapy, Konan women s Medical University Longitudinal Changes in Physical Capacity Over 20 Years in Athletes With Spinal Cord Injury Mr. Tokio Kinoshita Physical Therapist, Department of Rehabilitation Medicine, Wakayama Medical University Activation of Interleukin 6 during Wheelchair Basketball game in Persons Spinal Cord Injury Mr. Takamasa Hashizaki Physical Therapist, Department of Rehabilitation Medicine, Wakayama Medical University Serum IL-6 levels after heat stress in persons with cervical cord injury

22 Note Wakayama Medical University

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