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Para-athletics race. Closeup view of leading athlete during a race on the track.

Para sport has grown substantially in the past decades with increases in athlete participation as well as training intensities and sport performance (Patricios & Webborn, 2021; Fagher et coll., 2016). Yet, there is still limited research to help inform practice, especially concerning sport physiology and health in Para athletes (Gee et coll., 2021).

Recently, more dedicated research around Para sport training has improved. However, some aspects of health and wellbeing are not well understood, including how fatigue and recovery is managed, despite high incidences of injuries and illness among elite Para athletes (Harrington et coll., 2021; Fagher et coll., 2022a).

This blog shares findings from our research, which explored how Para sport practitioners manage recovery with their athletes. We interviewed experienced sport practitioners working with elite Para athletes across North America regarding the challenges and successes they had experienced with their athletes. We chose to interview a variety of professionals to ensure a balanced perspective, including coaches, physiologists, physicians, dieticians, rehabilitative therapists and a mental performance trainer.

Our interviews revealed clear themes about athlete recovery in Para sport, which are highlighted below:

1. Prioritize the simple concepts

Practitioners all shared the perspective that ensuring quality rest and proper nutrition are key to keeping athletes healthy and prepared. They emphasized that if athletes were rested and ate well, adaptations from training improved. This idea is not unique to Para athletes, but practitioners discussed the ways in which some Para athletes struggle to get good rest and nutrition.

For instance, some athletes with visual impairment have altered responses to light which may impact their sleep cycles. Some athletes might have sleep disturbances because of muscle spasms or chronic pain. Recent research looked at sleep habits in a large group of Swedish elite Para athletes and found that 60% reported sleeping 7 hours a night or less (Fagher et coll., 2022b). Further, given differences in digestion and appetite, particularly in athletes with spinal cord injuries, practitioners suggested focusing on the basics of simply eating enough.

Thus, if working with Para athletes of any level, remember to ask them about sleep and nutrition, and provide support accordingly.

2. Get to know the whole athlete

Para-alpine skier going down the hill.Many sport practitioners highlighted the importance of establishing quality relationships with the Para athletes with whom they worked. They emphasized that using self-report tools (for example, questionnaires or single questions where the athlete can rate their feelings or state of well-being) improved decision-making about how to adjust training and determine recovery needs.

Beyond this, practitioners spoke about the importance of listening to and learning from an athlete’s lived experience, to get to know them as a person. Practitioners noted that spending time building relationships with Para athletes also helped to reduce unnecessary assumptions about disability, ultimately improving performance goals and maintaining better overall athlete health. The experts we interviewed stressed how a shift in expertise is required when working with Para athletes, allowing for more guidance from the athlete, trusting their judgment and knowledge of their body.

When working with Para athletes, remember that time, effort, and intimacy are required to appropriately understand each individual’s history with both their sport and disability.

3. Recognize diversity of experiences

The diversity of experiences among Para athlete populations is greater than mainstream athletes for a few reasons. First, there are a variety of different impairment types, as well as diversity within each impairment type. Second, each Para athlete has a unique individual lived experience, with both sport and disability. For example, athletes who have acquired an impairment later in life will have a different experience than those who experience a congenital impairment. We can consider the duration of time for which an athlete has lived with their impairment as their “impairment age.” This idea of impairment age matters to how you work and plan recovery in Para athletes. Some athletes might be navigating a newly changed body as well as adjustments in their daily lifestyle, while some Para athletes have significant years of dedicated training and therefore have a better understanding of training and recovery principles.

4. Think about musculoskeletal factors

The sport practitioners we interviewed all highlighted that muscle mass (amount of muscle), muscular imbalances (for example, different muscle function in one arm compared to the other), and muscle spasticity (increased muscle tone or stiffness) all influenced decision making for Para athletes. Muscle mass is an important consideration specifically with regard to athletes with high-lesion spinal cord injuries who may be recruiting all of their available functional muscle mass to meet activity demands. Understanding this, practitioners realized that longer rest intervals within training or between sessions may be needed to allow ample recovery time. Similarly, understanding muscle mass availability for each athlete is essential for proper programming of a training session, where less muscle mass may demand longer rest between work bouts and modification to the overall training session duration or number of sets, reps, or intervals completed.

Practitioners also highlighted that prescribing intensity of work and progression of training should be done carefully to avoid overtaxing the working muscles (especially in athletes who have smaller amounts of functional muscle). For athletes experiencing spasticity, increased muscle tone and stiffness can be exacerbated post-exercise, altering the rate of recovery post-exercise. When working with Para athletes, adding regular self-care strategies like massage and stretching into their training regimen to account for these musculoskeletal factors can be paramount to the quality and time duration of recovery.

5. Consider their activities of daily living

Lastly, sport practitioners discussed additional physical and mental stresses that many Para athletes accumulate in their daily lives outside of training, especially when more effort is required to navigate environments with reduced accessibility. This is particularly important for athletes with less functional muscle mass, where activities of daily living simply require more time, planning and overall energy. This cumulatively impacts how much true rest an athlete can get, especially when combined with training, therefore imposing greater total stress which can lead to chronic fatigue or risk of overuse injuries.

Injury prevention is critical since sport injuries can be especially detrimental among Para athletes, impacting their ability to train and making daily activities more challenging (Thompson & Vanlandewijck, 2021). One practitioner summarized by saying that the overall training program should include daily living stress as a factor in the overall training load. Working with athletes to explore strategies that reduce daily living stress is important to enhance recovery and preparedness to train and compete.

Concluding thoughts

We hope we have illuminated important aspects to consider when working with Para athletes. Overall, making sure to support athletes in their non-training hours will have positive results in training and competition. Given the unique lived experience that each athlete has, remember to listen to them and make decisions collectively based on their feedback. Health and training concerns among Para athletes vary, but regularly monitoring athlete health can help understand individual needs and prevent injury or illness (Fagher et coll., 2022c). Finally, ensuring that the basics of adequate sleep and nutrition are addressed is fundamental to preparing athletes to train and compete.


About the Author(s)

Sara W. Szabo, BKin is a Master of Science student and member of the Athlete Health Lab in the Faculty of Kinesiology, Sport and Recreation at the University of Alberta. Her research focuses on women’s health in endurance athletes as well as sport participation in youth, and individuals with disabilities.

Michael Kennedy, Ph.D., CSEP-CEP® is the director of the Athlete Health Lab and an Associate Professor of Sport Science in the Faculty of Kinesiology, Sport and Recreation at the University of Alberta. His research has focused on factors which influence athlete health and performance.

References

Gee, C. M., Lacroix, M. A., Stellingwerff, T., Gavel, E. H., Logan-Sprenger, H. M., & West, C. (2021). Physiological considerations to support Podium performance in Para-Athletes.Frontiers in Rehabilitation Sciences, 2(84).

Fagher, K., Kunorozva, L., Badenhorst, M., Derman, W., Kissick, J., Verhagen, E., … & Lexell, (2022a). Safe and Healthy Para sport project (SHAPE): a study protocol of a complex intervention within Para sport.BMJ open sport & exercise medicine,8(3).

Fagher, K., Dahlström, Ö., & Lexell, J. (2022b). Mental health, sleep and pain in elite Para athletes and the association with injury and illness‐a prospective study. PM&R.

Fagher, K., Badenhorst, M., Kunorozva, L., Derman, W., & Lexell, J. (2022c). “It gives me a wake up call” – It is time to implement athlete health monitoring within the Para sport context. Scandinavian Journal of Medicine & Science in Sports.

Harrington, S. E., McQueeney, S., & Fearing, M. (2021). Understanding injury and injury prevention in para sport athletes. Journal of sport rehabilitation30(7), 1053-1059.

Patricios, J., & Webborn, N. (2021). Prioritising Para athlete care. British Journal of Sports Medicine55(10), 529-530.

 

Thompson, W. R., & Vanlandewijck, Y. C. (2021). Perspectives on research conducted at the

Paralympic Games. Disability and Rehabilitation43(24), 3503-3514.


The information presented in SIRC blogs and SIRCuit articles is accurate and reliable as of the date of publication. Developments that occur after the date of publication may impact the current accuracy of the information presented in a previously published blog or article.