Evaluating the short and long-term changes experienced by people with physical impairments who undertake supervised sports training

The intervention each participant will be receving is performance-focused sports training through the ParaSTART (service) program at The University of Queensland and delivered by accredited exercise physiologists or physiotherapists who are part of the ParaSTART service and research team. This study will follow a single-case experimental design (SCED) methodology meaning there will be two 16-week periods where the participants will receive the intervention, with shorter periods (5-weeks) of rest in following each intervention phase where the intervention is withdrawn. Below is an outline of the two components which make up the performance-focused sports training intervention. • Sports-Specific Training: Participants engage in land-based (indoor or outdoor) or aquatic sports aligned with their individual physical capabilities and interests. Training focuses on performance determinants such as speed, endurance, and strength and may include activities such as swimming, wheelchair racing, cycling, and seated throwing. • Strength and Conditioning: Gym-based strength training is prescribed to improve sport-specific performance and enhance physical capabilities. Multiple exercise modalities will be utilised to train strength, fitness, balance, coordination, proprioception, hypertrophy and fine/gross motor planning and execution. Examples of strength and conditioning exercises which might be prescribed to the participant during the intervention include chest fly, overhead press, seated row, lat pulldown, lateral raises, tricep pushdown, bicep curls, rotational throws, medicine ball throws, palloff press amongst others. Each of these exercises also have the capacity to be modified to increase difficulty or place emphasis differently depending on the needs of each participant. During each 16-week intervention period of the SCED, participants will be asked to complete 2 x 60-90 minute sport specific training sessions and 1 x 60 minute gym-based training session. It will be intended that the training components of each session will be completed at an intensity of 7-9/10 rating of perceived exertion (RPE), however this can and will be modified depending on day to day presentation of a participant. These sessions will be delivered either individually or in a group with other participants, depending on participant preferences, availability or what is planned for the session. It is intended that all sessions will be completed face-to-face on The University of Queensland St Lucia campus and all required euipment and facilities (e.g. pool, gym/gym equipment, athletics track, sporting equipment) is located and exists within The University of Queensland. Due to the nature of the population being investigated (individuals with neuromusculoskeletal high support needs impairments) there is a high incidence and severity of comorbidities (e.g. intellectual impairment, seizure disorders etc) leading to heterogeneity among participants. As an example, participants may be primarily diagnosed with the same impairment and severity (e.g. spastic quadriplegia, gross motor function classification system 4) but be extremely different on clinical presentation, therefore needing the intervention entirely individualised to their capacities and abilities. A second layer of this is the different sports each participant may choose to participate in. Each sport will have its own specific needs and requirements to improve performance and therefore interventions will be different across participants involved in different sports. When the participant begins, there will be a familirisation period where they can sample sports and various exercises/movements. Accredited exercise physiologists or physiotherpaists, in conjunction with the participant, will then determine from observing how they move and what sport they want to participate in to determine what exercise modality is most appropriate for the participant to ensure they are training to the best of their ability and achieving increased performance, which is the intent of performance-focused sports training. After each training session the prescribed session will be reassessed and modifcations will be made to clinically progress/regress the sessions depending on factors such as participant fatigue, how well they handled the exercises and what they need to work towards skill/technique wise in their sport. This will follow the principles of progressive overload in exercise to ensure continued and steady progression is being made. Intervention adherence will be monitored as a single case experimental design relies upon consistent intervention adherence to ensure a complete data set it achieved and can therefore be used to infer that the changes observed are due to the intervention. It will be initially advertised to participants that they are expeicted to attend at least 80% of their prescribed sessions. This adherence rate will be noted by the accredited exercise physiologists and physioltherapists delivering the intervention.