Scand J Med Sci Sports 2010: 20: 638–643
doi: 10.1111/j.1600-0838.2009.00934.x
Relationship between aerobic and anaerobic parameters and
functional classification in wheelchair basketball players
C. A. B. de Lira, R. L. Vancini, F. C. Minozzo, B. S. Sousa, J. P. Dubas, M. S. Andrade, L. L. Steinberg, A. C. da Silva
Department of Physiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
Corresponding author: Claudio Andre Barbosa de Lira, Department of Physiology, Universidade Federal de São Paulo
(UNIFESP), Rua Botucatu, 862, 51 andar, 04023-062, São Paulo, SP, Brazil. Tel: 155 11 5576 4513, Fax: 155 11 5571
0171, E-mail: claudio.andre@unifesp.br
Accepted for publication 15 January 2009
Participation in sports for individuals with disabilities
continues to gain popularity. In order to provide fair and
equitable competition among persons with different disabil-
ities and functional capacity, a separate functional classifi-
cation system has been devised for each sport. The aims of
the present study were to evaluate aerobic and anaerobic
performance of wheelchair basketball athletes and verify a
correlation with the International Wheelchair Basketball
Federation functional classification system. For this, 17
highly trained male Brazilian basketball wheelchair athletes
(25.4  4.4 years) from the national team who had taken
part in the Athens 2004 Paralympic Games were assessed.
These athletes were submitted to cardiopulmonary exercise
Participation in regular physical activity is consid-
ered to be an essential part of the rehabilitation
process among individuals with chronic disabilities
(Booth & Grogono, 1998; Bhambhani, 2002) and
there has been a tremendous growth in competitive
sport for those with disabilities (Bhambhani, 2002).
Thus, there is an increase in the number of publica-
tions involving physical exercise and the disabled
(Jacobs & Nash, 2004; De Groot et al., 2008; Wright
et al., 2008).
In order to provide fair and equitable competition
among persons with different disabilities and diverse
functional potential, separate functional classifica-
tion systems have been devised for each sport. In
wheelchair basketball, the functional classification
system is based mainly on the competence of the
classifier in recognizing a player’s physical ability in
executing fundamental movements through field test-
ing and game observation. These movements include
trunk stability, sitting balance and trunk movement
in the horizontal, frontal and sagittal planes, such as
pushing and handling the wheelchair, dribbling and
passing, shooting and rebounding the ball. Under
this system, players are assigned a score of 1.0
(minimal functional potential) to 4.5 points (maximal
638
& 2009 John Wiley & Sons A/S
testing and Wingate-like 30-s sprint test using upper limbs.
The present study demonstrated that the functional classi-
fication score correlated with relative (r 5 0.90; Po0.0001)
and absolute peak power (r 5 0.50; P 5 0.0353) and abso-
lute mean power (r 5 0.93; Po0.0001) obtained from the
Wingate-like
. 30-s sprint test and also correlated . with
absolute VO2 peak (r 5 0.68; P 5 0.0026) and VO2 at
ventilatory threshold (r 5 0.71; P 5 0.0014), measured on
cardiopulmonary exercise testing. Therefore, our findings
support the functional classification created to classify
athletes’ functional capability on the court, which also
correlated with aerobic and anaerobic performance para-
meters of the elite wheelchair basketball players.
functional potential) on an ordinal scale according to
the extent of their physical ability, balance and
maneuverability in the wheelchair. In addition,
half-point classes, i.e., 1.5, 2.5, 3.5 and 4.5, are used
if the player functionally blends characteristics, spe-
cific criteria or the volume of action of two classes
(Strohkendl, 1984, 1985).
The International Wheelchair Basketball Federa-
tion (IWBF) applies the four-class Player Classifica-
tion System for Wheelchair Basketball at all
international events (IWBF, 2008): a team is allowed
to field players at any time with a total of points not
greater than 14 (IWBF, 2008).
The validity of the player classification system has
been examined on a national level through field-test
analysis (Hedrick & Brasile, 1996; Vanlandewijck,
1997) and field performance analysis (Vanlandewijck
et al., 1995; Molik & Kosmol, 2001). In 2004,
Vanlandewijck et al. validated the classification sys-
tem on an international level, studying the class
dependency of field performance in elite male wheel-
chair athletes. These authors demonstrated a clear
relationship between the functional classification
attributed to elite athletes and their sport-specific
performance. It was concluded that the Player Clas-

sification System for Wheelchair Basketball reflects
the differences present in the performance of the elite
male players. However, there is little data on a
possible correlation between aerobic and anaerobic
responses to physical exercise and functional classi-
fication (van der Woude et al., 1997, 2002; Vanlan-
dewijck et al., 2004). Aerobic and anaerobic
responses to physical exercise depend on gender,
training status and functionality. Considering that
individuals with chronic disabilities differ signifi-
cantly in functionality, a possible correlation be-
tween both aerobic and anaerobic performance in
standardized exercise tests and functional classifica-
tion in terms of classification should be considered.
Evaluation of aerobic and anaerobic performance
can be used to analyze the functioning of cardiovas-
cular, respiratory and neuromuscular systems, pro-
viding a global assessment of the integrative
physiological responses and probable relationship
with functional capability. Therefore, we hypothe-
sized that the Player Classification System for Wheel-
chair Basketball reflects the differences present in the
physiological responses to exercise of elite male
players. The purposes of the present study were to
evaluate aerobic and anaerobic responses of wheel-
chair basketball Brazilian athletes and verify a pos-
sible correlation with the IWBF functional
classification system.
Methods
Participants
Seventeen highly trained male Brazilian basketball wheelchair
athletes from the national team, who had participated in the
Athens 2004 Paralympic Games, took part in this study.
Participants’ height and weight were measured to the nearest
0.1 kg and 0.1 cm, respectively. Their mean (SD) body weight,
height and age were 63.9 (15.4) kg, 166.8 (18.7) cm and 25.4
(4.4) years, respectively. Medical examination identified seven
participants with traumatic paraplegic lesion, eight partici-
pants who had suffered poliomyelitis and two with lower limb
amputation. The high variability in the height and weight was
a consequence of the presence of these two individuals in our
sample (Table 1). The general characteristics of the partici-
pants are shown in Table 1. Informed consent was obtained
through the teams’ coaches/managers who were informed
about the aims and methods of all tests at the management
meeting organized by the Brazilian Paralympic Committee.
The injury functional classification of these participants ran-
ged from 1.0 to 4.5, with class 1.0 having the least mobility and
Table 1. Characteristics of the participants
Variable Mean SD
Age (years) 25.4 4.4
Body mass (kg) 63.9 15.4
Height (cm) 166.8 18.7
Wheelchair basketball training (years) 9.7 3.7
SD, standard deviation.
Wheelchair basketball
class 4.5 having the most mobility, based on the functional
assessment of athletes with disability according to the IWBF
Player Classification System. In this study, two athletes were
classified with 1.0 point, one with 1.5 points, four with 2.0
points, three with 2.5 points, two with 3.0 points, one with 3.5
points, two with 4.0 points and two with 4.5 points. All
athletes trained about three times a week at 2.5 h/session.
Our University Ethics Committee approved all protocols.
Experimental procedure
Each participant reported to the laboratory on two separate
occasions. During the first session, cardiopulmonary exercise
testing was administrated to determine . the ventilatory thresh-
old (VT) and peak oxygen uptake (VO2 peak). On the second
visit, participants performed a Wingate-like 30-s sprint test for
upper limbs. At least 24 h separated the laboratory visits. All
participants were instructed to refrain from eating 2 h before
any visit to the laboratory, to abstain from caffeine, alcohol
and strenuous physical activity on each test day and to always
wear shorts, T-shirt and gym shoes. The temperature and
relative humidity of air in the testing laboratory ranged from
21 1C to 23 1C and 55% to 65%, respectively.
Before exercise testing, participants were given a standar-
dized set of instructions explaining the tests. On completion of
these preliminary procedures, each of them was submitted to
cardiopulmonary exercise testing in a wheelchair mounted on
a motorized treadmill (Trackmaster, Newton, Kansas, USA).
The schedule of this test consisted of 5 min warm-up at 7 km/h,
then adjusting the initial speed to 8 km/h, followed by pro-
gressive increases of the treadmill speed at a rate of 1 km/h
every minute until exhaustion, with the treadmill always set at
1% grade. During the exercise testing, participants were
verbally encouraged to exercise for as long as possible.
Respiratory gas samples were analyzed breath-to-breath using
a gas analyzer (K4b2-Cosmed, Rome, Italy). Before each test,
the gas analyzers were calibrated using gas of a known
concentration (White Martins, Säo Paulo, Brazil) and the
flowmeter was calibrated using a 3-L syringe (Hans Rudolph
Inc., Shawnee, Kansas, USA). Heart rate (HR) was recorded
using a HR monitor (Polar Electronics, Kempele, Finland).
The following
. data (average of 20 s) were obtained: oxygen
uptake (VO2, mL/min, Standard Temperature . and Pressure,
Dry-STPD), carbon dioxide production (VCO2, mL/min, .
STPD), respiratory exchange ratio, minute ventilation (VE,
L/min, Standard Temperature and Pressure, Saturated -
BTPS), respiratory
. . rate (f, .bpm),
. ventilatory equivalent for
O2 and CO2 (VE/VO2 and VE/VCO2), expired fraction of O2
and
. CO2 (FEO2 and FECO2, %), HR (bpm) and oxygen . . pulse
(VO2/HR, mL/beat). VT . .was estimated when VE/VO2 and
FEO2 increased while VE/VCO2 and FECO2 remained stable.
VT is a method of assessing aerobic fitness, defined as a
disproportional ventilatory response to the body’s oxygen
consumption during increased exercise intensity. This phe-
nomenon may result from a greater contribution of the
anaerobic glycolytic pathway, i.e., more lactate and protons
(H1) start to appear in the blood (Skinner & McLellan, 1980).
The excess protons combine with bicarbonate (HCO3 ), which
buffers acid and forms water and carbon dioxide (CO2). An
Range increase in carbon dioxide stimulates specific chemoreceptors,
which in turn signal the inspiratory center to increase ventila-
18–34 tion disproportional to the body’s oxygen demand (Wasser-
45–100 man & Mcilroy, 1964; Wasserman et al., 1973; Wasserman &
114–192 Koike, 1992). VT was determined independently by three
4–17 experienced investigators. If agreement of two out of three
investigators was not achieved, VT was determined by con-
sensus.
639
de Lira et al.
The second visit to the laboratory was used to apply Table 4 summarizes the data concerning the relation-
Wingate-like 30-s sprint tests. This test was performed in a ship between cardiopulmonary exercise testing re-
calibrated, electromagnetically braked arm crank ergometer sults and functional classification in wheelchair
(Cybex MET-300; Cybex, Ronkonkoma, New York, USA).
During the 10-min warm-up period in which participants basketball players.
. Positive correlations were de-
practiced with the ergometer, they were asked to perform tected with VO2 (L/min) in VT and maximal exercise
three all-out 5-s sprints on the command of the investigator. and with VO2/HR in VT.
Following this warm-up period, participants rested quietly for Table 5 shows the data concerning the relationship
5 min. The athletes were then instructed to begin unloaded between Wingate-like 30-s sprint test, with upper
pedaling 10 s before beginning the test. Again, on the com-
mand of the investigator, each participant was instructed to limb results, and functional classification in wheel-
accelerate maximally against no load. Then, isokinetic resis- chair basketball players. Positive correlations were
tance was applied until the end of the 30-s period test. Verbal detected with PPa (W), PPr (W/kg) and MPa (W).
encouragement was provided throughout the period.
The following data (average of 5 s) were obtained: absolute Table 3. Wingate-like 30-s sprint test indices of wheelchair basketball
peak power (PPa) and relative peak power (PPr), the highest
players (n 5 17)
power obtained during the test; absolute mean power (MPa) and
relative mean power (MPr), the average power obtained during Variable Mean SD Range
the test; and fatigue index (FI). PPr and MPr were expressed in
Watt/kg. The FI was calculated as the absolute difference PPa (W) 396.5 128.2 261–651
between the highest and the lowest power output obtained in PPr (W/kg) 6.3 1.4 3.5–6.8
the sprint test and was expressed as percentage. MPa (W) 304.4 94.3 161–487
MPr (W/kg) 4.8 1.1 2.7–6.4
FI (%) 50 11 30–75
Statistical analysis
SD, standard deviation; PPa, absolute peak power; PPr, relative peak
Results are presented as mean  standard deviation (SD). power; MPa, absolute mean power; MPr, relative mean power; FI, fatigue
Distribution analysis was performed using the Kolmogorov– index.
Smirnov test. Spearman’s correlation was used to establish the
relationship between variables obtained from incremental
maximal exercise test and Wingate-like 30-s sprint test. Statis- Table 4. Correlation coefficients between metabolic parameters obtained
tical analysis was conducted using the GRAPH PAD PRISM SOFT- in cardiopulmonary exercise testing and functional classification system
WARE (GraphPad Software, San Diego, California, USA). The
score (n 5 17)
level of significance for all statistical procedures was Po5%.
Variables Spearman’s r P

Results At .ventilatory threshold

. 2 (L/min)
VO 0.71* 0.0014
Data for progressive exercise testing are shown in VO2. (mL/kg/min) 0.10 0.7050
% VO2 peak 0.20 0.4455
Table 2. Table 3 summarizes data concerning per- HR (bpm) 0.32 0.2066
formance during the sprint test with upper limbs. %
. HRmax 0.29 0.2533
VO2/HR (mL/beat) 0.45 0.0673
Table 2. Metabolic parameters obtained in cardiopulmonary exercise
Velocity (km/h) 0.11 0.6750
Maximal
. exercise
testing (n 5 17) VO 0.68*
. 2 (L/min) 0.0026
Variable Mean SD Range VO2 (mL/kg/min) 0.02 0.9473
HR
. (bpm) 0.07 0.7836
VO2/HR (mL/beat) 0.63* 0.0068
At .ventilatory threshold
Velocity (km/h) 0.14 0.5885
. 2 (L/min)
VO 1.35 0.31 0.78–1.96
VO2. (mL/kg/min) 20.9 4.1 14.9–31.0 · ·
VO2, oxygen uptake; HR, heart rate; VO2/HR, oxygen pulse.
% VO2 peak 68.5 10.8 50.4–91.7
HR (bpm) 144.1 20.3 98–179 *Significant correlation.
% HRmax 77.7 9.3 61.7–93.2
%
. predicted HRmax 74.3 10.3 50.5–92.3
VO2/HR (mL/beat) 8.8 2.0 5.7–13.7 Table 5. Correlation coefficients between Wingate-like 30-s sprint test
Velocity (km/h) 10.1 1.2 8–13 indices and functional classification system score (n 5 17)
Maximal
. exercise
VO
. 2 (L/min) 1.92 0.37 1.25–2.62 Variables Spearman’s r P
VO2 (mL/kg/min) 30.8 6.1 23.82–46.78
HR (bpm) 185.5 12.7 148–203 PPa (W) 0.90* o0.0001
%
. predicted HRmax 95.6 6.2 76.3–103.1 PPr (W/kg) 0.50* 0.0353
VO2/HR (mL/beat) 10.8 2.1 6.7–15.4 MPa (W) 0.93* o0.0001
Velocity
. . (km/h) 14.2 1.5 12–17 MPr (W/kg) 0.41 0.1065
VCO2/VO2 1.38 0.12 1.11–1.54 FI (%) 0.20 0.4360
· ·
SD, standard deviation; VO2, oxygen uptake; HR, heart rate; VO2/HR, PPa, absolute peak power; PPr, relative peak power; MPa, absolute mean
· · ·
oxygen pulse; VCO2, carbon dioxide production; VCO2/VO2, respiratory power; MPr, relative mean power; FI, fatigue index.
exchange ratio. *Significant correlation.

640

Discussion
The purpose of this study was to determine whether
physiological responses are correlated with the
IWBF functional classification system. We found
that variables obtained from the Wingate-like . 30-s
sprint. test with upper limbs and also with VO2 peak
and VO2 at VT obtained on cardiopulmonary ex-
ercise testing are correlated with the IWBF func-
tional classification system.
There has been controversy concerning the use of
functional vs physiological classification systems.
The major criticism of the current functional schemes
is its lack of scientific basis. A limited number of
studies have either examined the relationship be-
tween athletes’ classification and physiological pro-
file, e.g., anaerobic power, aerobic and anaerobic
capacity and strength or the relationship between
athletes’ classification and athletic performance
(Vanlandewijck & Chappel, 1996; Vanlandewijck
et al., 2004).
The ability of the wheelchair athletes is influenced
by cardiorespiratory fitness, anaerobic fitness and
upper limb coordination.
. The worse the sequel, the
more limited the VO2 peak tends to be (Coutts et al.,
1983; Goosey et al., 2000). According to Booth and
Grogono (1998), autonomic nervous system dysfunc-
tion in athletes with high thoracic- or cervical-level
spinal cord injury and also those with neuronal
impairment caused by polio virus (Mulder, 1995)
reduce the ability of their cardiovascular and other
systems to respond to exercise demands, particularly
in quadriplegic athletes, which will be limited
owing to loss of the reflex redistribution of blood
to working muscles and diminished sympathetic
control of HR and myocardial contractility. Exercis-
ing muscles thus become more dependent on anae-
robic metabolism to meet energy demands. In
addition, individuals who are confined to wheel-
chairs demonstrate decreases in lean tissue, with
associated increases in body fat and extracellular
fluid (Shephard, 1988).
Active wheelchair athletes will typically attempt to
compensate for any muscle loss from their lower
limbs through hypertrophy of the arms and the
shoulders (Shephard, 1988). Subsequently, as ex-
pected, there
. are two positive correlations: first
between VO2 peak and. the functional classification
and second between VO2 at VT and functional
classification. One possible explanation is that the
higher the functional classification score, the . higher
the lean tissue. It is likely that the relative VO2 peak
did not correlate because, as in cycling or rowing,
participants do not need to carry their own body
weight. In addition, cardiorespiratory fitness is not a
determinant for basketball (Sallet et al., 2005) or
wheelchair basketball because these sports are char-
Wheelchair basketball
acterized by intense and intermittent movements.
However, because. of the heterogeneity of the sample,
the absolute VO2. peak is not the best means of
representing the VO2 peak. Perhaps allometric ana-
lyses would have contributed to our results but this
approach remains debated for both able-bodied
(Batterham et al., 1999) and disabled individuals
(Goosey-Tolfrey et al., 2003).
For these reasons, physiological response to ex-
ercise in disabled people has particularities compared
with able-bodied individuals. Although the training
principles may be similar across many wheelchair
sports, those employed by the able-bodied athlete
may not be directly transferable to the wheelchair
athlete (Coutts & McKenzie, 1995; Campbell et al.,
1997; Vinet et al., 1997; Tolfrey et al., 2001; Goosey-
Tolfrey & Tolfrey, 2004). Wheelchair athletes have
unique physiological responses during upper limb
exercise as a result of vascular insufficiency of the
lower limbs and adrenergic dysfunction. In contrast
to this, Vanlandewijck et al. (1994) showed that
maximal aerobic power is dependent on the func-
tional ability, at least when comparing class I wheel-
chair basketball athletes to class IV (less disabled).
Notwithstanding this, when we analyzed the asso-
ciation between anaerobic variables and functional
classification, we found a relationship with PPa and
MPa, both indicators of anaerobic fitness. Even
when the variables had been normalized, we verified
that the correlation between PPr and functional
classification remained. These associations were ex-
pected because wheelchair basketball is characterized
by high intensity and intermittent activity and places
high demands on the players, mainly under the
anaerobic system of energy production (Coutts,
1992). Accordingly, Coutts (1990) showed that
wheelchair basketball players have lower aerobic
capacity than wheelchair track athletes.
The results presented in this study are in agreement
with studies on anaerobic performance in exercise
tests among wheelchair athletes, showing that func-
tional classification has an impact on performance.
van der Woude et al. (1997) studied 67 elite wheel-
chair athletes and found that anaerobic power out-
put showed higher values with increasing functional
classification for male athletes. In the same context,
Vanlandewijck et al. (2004) described a relationship
between functional classification and field perfor-
mance in elite female wheelchair basketball players
through game analysis at an international level. This
study showed that high-scoring players performed
better than low-scoring players for the majority of
variables linked to the quality of game performance.
Anaerobic responses are important in various
sports disciplines. Moreover, many daily activities
are considered to be of short duration and are
suggested to be anaerobic in nature (Hjeltnes &
641
 de Lira et al.
Vokac, 1979; Janssen et al., 1994). Anaerobic per-
formance of wheelchair users and athletes has been
studied to a limited extent, involving rather small and
heterogeneous participant groups (Coutts & Stogryn,
1987; Lees & Arthur, 1988; Veeger et al., 1991, 1992;
Janssen et al., 1993; Dallmeijer et al., 1994). More-
over, different experimental approaches are used to
study anaerobic performance in wheelchair-confined
populations (Coutts & Stogryn, 1987; Lees & Arthur,
1988; Veeger et al., 1992; Dallmeijer et al., 1994).
In summary, the functional classification system
provides athletes having different disabilities with an
option to compete with and against each other.
Although many medical and sports classification
systems exist, there are few concerns over the validity
of these systems.
Our findings support and strengthen the impor-
tance of the functional classification system created
to classify athletes’ physical capabilities in executing
basketball movements on court. The athletes’ func-
tional classification was correlated with aerobic and
anaerobic parameters for performance. Therefore,
these measurements could be used together with the
IWBF criteria to complement this classification sys-
tem and ensure fair and equitable competition
among athletes.
Perspectives
Providing an optimal functional classification system
for individuals with disabilities remains a challenge.
The
. current study
. has shown that PPa, PPr, MPa,
VO2 peak and VO2 at VT correlated with the func-
tional classification score used by the IWBF. Never-
theless, we cannot neglect that the best result
obtained by an athlete depends on his effort. The
athlete can execute a submaximal test yielding a
minor functional classification score.
Key words: wheelchair athlete, athletes with disabil-
ities, exercise physiology, exercise, functional classifi-
cation, aerobic and anaerobic profile.
Acknowledgements
We are grateful to the Directors of the Brazilian Paralympic
Committee and Brazilian Ministry of Sport (Rede CENESP).
We would also like to thank all the athletes who volunteered
their time to participate in this study.
C. A. B. de Lira had a fellowship from the Coordenação
de Aperfeiçoamento de Pessoal de Nı́vel Superior (CAPES-
Brazil). R. L. Vancini had a fellowship from the Conselho
Nacional de Desenvolvimento Cientı́fico e Tecnológico
(CNPq-Brazil).

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