Case Report: Training Monitoring and Performance Development of a Triathlete With Spinal Cord Injury and Chronic Myeloid Leukemia During a Paralympic Cycle

Introduction: Paratriathlon has increasingly gained popularity as it allows competition for athletes with various physical impairments. The wheelchair category stands out since competing in swimming, handcycling and wheelchair racing entails substantial demands on the upper extremities that may cause overuse injuries. Hence, knowledge on exercise testing and training is needed to avoid overuse injuries and improve performance. The limited number of elite athletes, individual conditions and a need for long-term investigations justify the use of single-case designs. To gain practical insights, we describe the training, performance and experiences throughout a multi-year exposure of an elite triathlete with spinal cord injury (SCI) and recent diagnosis of chronic myeloid leukemia (CML) who aims to qualify for the Paralympic Games.
Case Presentation/Methods: A 30-year-old wheelchair athlete with a ten-year experience in wheelchair basketball contacted our university for guidance regarding testing and training in paratriathlon. Laboratory and field tests were modified from protocols used for testing able-bodied athletes to examine his abilities in all disciplines. In handcycling, incremental tests were used to determine the power corresponding to a lactate concentration of 4 mmol·l-1 (POBLA) and all-out sprint tests were applied to calculate maximal lactate accumulation rate (V̇Lamax) as a measure of glycolytic capabilities. From 2017 to 2020, training was systematically monitored by means of heart rate and ratings of perceived exertion to quantify training load (TL) and intensity distribution (TID).
Results: From 2016 to 2019, the athlete was placed within the top ten at European and World Championships. From 2017 to 2019, TL increased from 414 to 604 h and demonstrated a shift in TID from 77-17-6% to 88-8-4%. In this period, POBLA increased from 101 to 158 W and V̇Lamax decreased from 0.56 to 0.36 mmol·l-1·s-1. In 2020, soon after he received CML-diagnosis, TL, TID and POBLA were 317 h, 94-5-1%, and 108 W, respectively.
Discussion: Results indicate that reducing work duration allows to execute and adapt to more (intense) training which, in turn, requires corresponding sponsorship. Strength training and physiotherapy seem to be helpful since the upper-extremities are highly involved. Increased volumes at low-intensity are assumed to increase POBLA and decrease V̇Lamax over time. CML treatment and side-effects drastically decreased TL, intensity and performance which ultimately hindered a qualification for Tokyo 2020/21. Medical, financial, logistical and time-based challenges have to be considered for training and performance development in the wheelchair category.