Relationship between physical strain during standardised ADL tasks and physical capacity in men with spinal cord injuries

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Abstract
To describe physical strain during activities of daily living (ADL), 44 men with spinal cord injuries (C4-L5) performed a set of standardised tasks. The physical strain was defined as the highest heart rate response expressed as a percentage of the individual heart rate reserve (%HRR). The physical strain averaged over the subjects who performed all tasks (n = 24) was (mean ± SD): 20.2 ± 7.2 %HRR (washing hands), 20.4 ± 7.3 %HRR (passing a side-hung door), 28.8 ± 10.8 %HRR (transfer to a toilet), 31.2 ± 13.1 %HRR (ascending an 8 cm curb), 33.9 ± 12.0 %HRR (transfer to a shower seat), 35.1 ± 10.5 %HRR (transfer to bed), 36.4 ± 13.3 %HRR (preparing lunch), 37.1 ± 12.0 %HRR (washing up), 38.7 ± 14.9 %HRR (ascending a ramp), 39.8 ± 15.6 %HRR (transfer to a shower wheelchair), 41.4 ± 12.1 %HRR (changing sheets), and 45.9 ± 10.4 %HRR (entering a car). Physical strain could be notably high, but large variations among subjects were present. During all tasks, subjects with tetraplegia had significantly higher levels of strain than subjects with low (T6-L5) lesions. Physical strain was inversely related to parameters of physical capacity: isometric strength (r: -0.34 to -0.72), sprint power (r: —0.34 to -0.69), peak oxygen uptake (r: -0.41 to -0.81) and maximal power output (r: -0.52 to -0.82). Parameters of physical capacity were better predictors of physical strain than was the lesion level, and explained 37-71% of the variance in strain during ADL. It was also concluded that the method used in this study provides a quantitative and objective estimation of physical strain and may therefore be a useful tool to identify task difficulty during rehabilitation and to evaluate the results of task and physical training on the physical strain during ADL.