Comparison of Two Types of Concurrent Respiratory Resistance Training Devices on Measures of Physiological Performance, Perception of Health-related Quality of Life and Self-efficacy in Wheelchair Rugby Athletes
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The overall objective of this dissertation was to compare the effects of training with two types of concurrent respiratory resistance devices on athletic performance, health-related quality of life, and self-efficacy in wheelchair rugby athletes. Twenty-four male wheelchair rugby athletes were matched by lesion level, completeness of injury, and rugby classification prior to being randomly assigned to one of three groups: 1) Concurrent Pressure Threshold Resistance (CPTR = 8), 2) Concurrent Flow Resistance (CFR = 8), or 3) controls (CON, n = 8). Pre/post-testing included assessment of respiratory function as measured by maximum voluntary ventilation (MVV) and maximum inspiratory pressure (MIP), aerobic capacity as measured by a one-mile time trial test, and Health-Related Quality of Life (HRQoL) as measured by the Short Form-36 version 2™ (SF-36 v2™). In addition, 5 athletes were observed throughout the intervention, completed a General Self-Efficacy (GSE) survey, and participated in in-depth, open-ended interviews with follow-up questions. Sixteen participants completed the study (CPTR=4, CFR =5, CON =7). During pre-testing, manufacturer protocol guidelines were provided in both verbal and written forms to all subjects. Breathing exercises were performed 2-3 times per day for 9 weeks, with CPTR performing 3 sets of 10 and CFR performing 1 set of 10. The Mann-Whitney U rank order revealed significantly greater improvements in speed for CPTR versus CON (<em>p</em> = .038), and in MVV for CFR versus CPTR (<em>p</em> = .027). The standardized effect size was large for change in time (φ = .322), MVV (φ = .138) and MIP (φ = .141), with CPTR experiencing greater improvements in time and MIP, and with CFR experiencing greater improvements in MVV. Significantly greater improvements in bodily pain and vitality were observed for CFR versus CON (<em>p</em> = .038; p=.028, respectively). In addition, the standardized effect size was large for change in bodily pain (η <sup>2</sup> = .304), general health (η <sup>2</sup> = .191), and vitality (η <sup>2</sup> = .326). The large effect size suggests that perhaps statistical significance would have been observed if the sample size had been larger. The results of the qualitative study support some quantitative findings. In that, those athletes who trained with the CPTR device perceived greater improvements in their diaphragm strength, aerobic capacity, and days free from illness. The athletes who trained with CFR experienced less restriction to ventilation during exercise, less bodily pain and more energy. Both the CPTR and CFR devices improved trunk stability. The findings suggest that wheelchair rugby athletes training with a CPTR device may experience greater benefit with regard to their overall physical performance when compared to those training with a CFR device. In summary, 9 weeks of training with a CPTR device appears to improve both cardiorespiratory endurance and respiratory muscular strength, while 9 weeks of training with a CFR device appears to improve respiratory muscular endurance, reduce bodily pain, and enhance vitality for wheelchair rugby athletes. Since wheelchair rugby is performed for prolonged periods at moderate to high intensity, as opposed to maximal intensity, any positive effect that a training device could potentially have on the cardiorespiratory endurance of wheelchair rugby athletes is worthy of consideration. Specifically, with regard to performance, athletes with quadriplegia who train with a CPTR device may receive greater benefits than those training with a CFR device.