In the summer 2021 issue of The Spin, we told you about the impressive work that a cross-disciplinary team of ICORD researchers have done to create the aROW and aSKI—two revolutionary adaptations for the very popular, commercially-available Concept2 rowing and ski ergometers that allow them to be used by people with disabilities without leaving their wheelchairs.
For decades, the only readily-available indoor cardio workout option for wheelchair users has been the handcycle ergometer. The aROW and aSKI offer long-needed alternatives—they’re safer from a repetitive injury standpoint, they’re a lot more interesting and engaging to use, and they offer a superior workout, which is born out by research.
These clever adaptations are the result of a team effort by like-minded ICORD researchers—Dr. Carolyn Sparrey, Dr. Jaimie Borisoff, Dr. Bonita Sawatzky, Dr. Ben Mortenson, Dr. Andrea Bundon, Dr. James Laskin, and Johanne Mattie. The devices on their own are amazing enough. But what’s also incredible is that the research team has done much more than simply invent—they’ve been steadfastly committed from the outset to get SCI BC peers (and wheelchair users around the world) using them in their own communities and even their homes.
aROW vs. aSKI
The aROW is an adaptation for the popular Concept2 rowing ergometer. The arm provides adjustable chest and lap supports to stabilize users while exercising from a wheelchair. The user wheels onto the base platform and secures the wheelchair brakes. The lap pad is slid into position and lowered until it comfortably restrains the upper thighs. At this point, anyone with full trunk strength can begin exercising. If your injury is higher level, you would attach the optional chest pad to the lap pad assembly, and adjust the height as required before beginning your workout.
The aSKI is an adaptation for the popular Concept2 ski ergometer. The lap pad can be adjusted to stabilize wheelchair users no matter how tall they sit in their chair, or the size of their chair, allowing them to optimize their workout. The user wheels into position and sets the wheelchair locks. The aSKI lap pad is then swung into position and lowered until it comfortably restrains the upper thighs. At this point, the user can begin to exercise with the cross country motion.
From Humble Beginnings
“This has really been an evolving project,” explains Sparrey, an engineer and associate professor at SFU’s School of Mechatronic Systems Engineering who really got the ball rolling a few years ago. “It was initially driven by a request from Trevor Greene, an injured Canadian forces veteran, for an adaptive rowing solution—he was a high performance rower before his injury and wanted to have the chance to row again. With a student engineering club at SFU, we turned Trevor’s ask into a student design competition. More than 80 students from across the lower mainland participated. It really highlighted the drive that many engineers have to impact the world and make things better, and made me realize this could be bigger than a solution for just one person.”
But that revelation also made it clear to Sparrey that it would take a team effort to make it a reality.
“Through my decades of ICORD research seminars and activities, I had heard experts like Jaimie, Bonnie and Ben talk about user experience, barriers to participation, and the need for accessible exercise,” she says. “I had previously worked with Jaimie on other projects, and Bonnie and I share an office at ICORD, so we started having conversations and ended up finding like-minded and passionate people through our network of ICORD collaborators to make this possible. I think as a team we saw a need and opportunity and realized that together we could actually have impact, which is exciting, rewarding and why most of us go into research in the first place—to answer interesting questions that matter in the real world.”
With the collaboration of like-minded researchers established and committed to the concept, the team got to work refining the initial aROW prototype. Over the last couple of years, aROW improvements have included a gas spring lock to improve securement and release of the lap pad, a new handle design to increase row stroke range of motion, removal of the Concept2 foot pads so the user is closer to the control screen and positioning is more intuitive, a modified chest pad arm and linkage to improve fit and usability, an improved chest pad with a pivoting attachment for increased comfort and usability, and a shortened wooden base with a tapered edge for easier access.
Meanwhile, the team was busy transferring the entire concept from aROW to the aSKI, which has enjoyed many of the same improvements during the refinement process.
Crucial to the refinement process was consumer engagement and feedback from SCI BC peers.
“A key part of the success of this project was the willingness of people with SCI to engage with us and really share their experiences and opinions, and be open to trying new things—even the first prototypes,” says Sparrey. “While we have people on the research team with lived experience, the needs of people with different stages and severity of injury vary. Having input from a diverse group of people has been essential to the evolution of these designs to make sure they are as broadly usable as possible.”
Sparrey says refinement of both models continues today, but adds the team is close to finalizing the designs.
aROW: Research is Confirming the Benefits
Since the aROW adaptation for the commercially-available Concept2 rowing machine was created a few years ago, a steady progression of fitness-minded SCI BC peers have tried it at PARC and other community gyms—and have raved about the workout it provides. Among their observations is that they believe it provides a superior cardio workout to more traditional workout machines like handcycle ergometers, and that it’s a lot more enjoyable to use as well.
Now, the researchers involved in developing the aROW are starting to confirm these benefits through rigorous scientific studies.
Earlier this year, ICORD researchers Drs. Bonnie Sawatzky, Ben Mortenson, Jaimie Borisoff and Carolyn Sparrey, along with Dr. James Laskin of the University of Montana and UBC medical students Brandon Herrington and Kevin Choi, published a study titled Acute physiological comparison of sub-maximal exercise on a novel adapted rowing machine and arm crank ergometry in people with a spinal cord injury in the journal Spinal Cord.
The primary goal of this study was to compare VO2 max in people with SCI during exercise using the aROW and the handcycle ergometer. VO2 max refers to the maximum amount of oxygen that an individual can utilize during intense or maximal exercise. The higher the VO2 values, the more intense exercise is in terms of challenging one’s heart, lungs, and metabolism.
“We wanted to see if our approach to allowing a different style of exercise also gives a good cardio workout,” says Sawatzky, an ICORD principal investigator and UBC associate professor who is the study’s lead investigator.
Fourteen adults with SCI took part in the study. The aROW, with its adjustable frame and support pads for thighs and chest, can be used by power and manual chair users, so participants with varying levels of SCI and trunk stability were recruited. After an orientation session, participants were tested on the arm ergometer and the aROW on two separate days. On each day, participants began with a warm-up on the selected machine, and then exercised for five minutes each at self-selected low and moderate workloads. Metabolic data, such as VO2 and heart rate, along with perceived physical exertion (how hard you feel like your body is working), were recorded during each session.
The most important finding of the study was that participants reached a much higher VO2 using the aROW than they did on the handcycle ergometer.
“The main takeaway was that rowing does give as good as a workout and actually increases the energy output,” says Sawatzky. She and her colleagues believe that the reason for this is that rowing relies heavily on the larger, posterior shoulder muscles.
“When you use larger muscles, you require a greater oxygen load to use these muscle groups,” she explains. “Thus, this exercise pumps more oxygen through your system and may potentially allow an equal workout, cardiovascularly-speaking, with a shorter duration than what might be required on another piece of equipment.”
Participants also reported that exercising on the aROW felt harder than exercising on the handcycle ergometer—but that was viewed positively rather than negatively.
“We were surprised how many of the participants enjoyed the increased workout and just doing a different motion,” says Sawatzky.
She adds that the study had limitations. The sample size was relatively small, and the participants were likely more active than the general population of people with SCI. Participants exercised on each machine for only five minutes in order to prevent potential overuse injuries, including skin shearing. These limitations mean that more research is needed to confirm the benefits.
“We need to do an exercise intervention study over time to see if it actually does improve fitness more than other methods,” says Sawatzky. “For the moment, we’re currently doing an intervention study where the participant gets an aROW combined with a smaller, less expensive commercial rowing machine (Sunny Health & Fitness Rowing Machine) in their home to use as often as they wish, without going to a gym for eight weeks. Then they get a pass to a gym for eight weeks to use a Concept2 aROW, plus all the other gym equipment. We’re comparing the enjoyability and feasibility of doing it at home versus going to a gym. We’re also measuring cardio fitness and muscle strength plus a few other quality of life measures.”
The team is also planning to include aSKI, the system that adapts the Concept2 ski machine for people with SCI.
“We want to study all these styles of adapted ergometers to see which ones will have more uptake,” says Sawatzky. “The size and space issues are important. A qualitative study is being done to include perceptions of the aSKI and aROW.”
Here at SCI BC, we’re following this line of research closely—more effective and enjoyable exercise options for home and the gym can only be good news for SCI BC peers, particularly at a time when other research is making it clear how important exercise is for health and quality of life. For help getting more fit, see the Evidence-Based Physical Activity Guidelines for Adults with SCI (sciguidelines.ubc.ca).
From Lab to Real Life
As impressive as the aROW and aSKI are, the willingness of Sparrey and her collaborators to take on the considerable challenge of actually making them available for people to use is perhaps even more laudable. Throughout the history of invention, so many innovations have fallen by the wayside because of a lack of a champion—consider, for example, the electric car, which played second fiddle to combustion engine cars for more than a century before Elon Musk brought them to the forefront through sheer tenacity.
From the outset, all of the design team’s efforts and funding requests emphasized that moving the aROW and aSKI out of the lab into real life use was a high priority. The effort has paid off: at the time of writing, the team has built 18 of each machine, which have been donated to 14 community facilities, including nine community gym facilities in BC.
“We’re planning to deploy two more aROW and aSKI systems, including hopefully a set out to collaborators in Nova Scotia,” says Sparrey. “Here in BC, with most facilities back to regular operations after a few years of pandemic closures, it’s likely that many of the BC SCI community can now actually access one of our machines.”
Additionally, both designs have been made open source so that individuals could build their own, or have one built for them. You can see the plans and other resources at the project website.
“Making an aROW or aSKI requires a workshop and a bit of skill, but it’s something that a local tech college or a group like Tetra could do,” says Sparrey. “However, we’re realizing that many people would like to just be able to buy a complete system instead of trying to find people to build it for them. So we’re exploring partnerships and collaborations that could help make that happen Neil Squire, Tetra and others have been approached to hopefully find a way to make transition this to a sustainable and broadly available solution, although we don’t have any formal agreements yet.”
Naturally, achieving the momentum to see these devices find a way into SCI peers homes or community gyms across Canada and even around the world requires more than simply making or promoting them. “We’re always eager to make more systems, but we’re also looking at how to make this a sustainable venture—making systems as part of a research study is different than being able to sustain and support systems longer term,” explains Sparrey. “What happens when a system needs a replacement part, or there are new users that need an orientation to the machines? We’re getting inquiries from people around the world on accessing these systems and building their own. We’re exploring different ways to enhance accessibility and sustainability, such as commercialization or engaging non-profit partners, but we also want to stick to the spirit of the project and make sure that these systems are available broadly. Moving out of the research and development space brings new complexity to the project, including things like product liability that we’re starting to explore. We’re also now working on home versions of the system that have a lower cost and are smaller. Finally, we’re looking at whether similar approaches to adaptive exercise could be used for older adults with mobility limitations. In conclusion, lots more work to do.”
It’s quite extraordinary, and even more so when you consider that the design team members are simultaneously working on research that quantifies the benefits of these machines (not to mention other research streams).
“We’re starting to scheme about the next phase of this research to measure benefits over a longer term trial, but we’re waiting to finalize the home aROW design so that we can include an aspect of assessing the community gym participation versus home exercise in the outcome measures,” says Sparrey. “We certainly want to be looking at muscle mass, trunk stability and cardiovascular health as part of this larger study, as there’s lots of evidence that higher intensity (HIT) exercise like that afforded by the aROW and aSKI can have benefits above baseline cardio exercise. Also, the community gym versus home rower will help us look at how exercise and community engagement affect mental health and wellbeing of people with SCI.”
Credit Where Credit’s Due
As explained above, Sparrey is grateful for the ongoing involvement of SCI BC peers for their efforts to bring the aROW and aSKI to the place they’re now at. However, she adds, none of it would have happened without the exceptional financial support provided by US-based Craig H. Neilsen Foundation (which, we’ll add, has also supported SCI BC’s efforts during the COVID-19 pandemic).
Founded by the late Craig Neilsen, an American entrepreneur who became a quadriplegic as the result of a car crash, the Foundation is the largest private funder of SCI research, rehabilitation, clinical training, and programmatic support in the U.S. and Canada
“The Craig H. Neilsen Foundation has been a huge supporter of this project and has now supported another team in the US to build and deploy aROWs in South Carolina,” says Sparrey. “I think the foundation has found a great balance in their funding programs between supporting fundamental research and activities that directly impact the community. With our project, we have benefited from the foundation’s Creating Opportunity and Independence grants, which has allowed us to both conduct research and get systems into the community.”
Sparrey is also grateful for ICORD Seed Grants, which are supported by the Rick Hansen Foundation. “These have been essential for us to come together as a team and get early results to show Craig H. Neilsen Foundation that our proposed projects are feasible,” she says.
She also acknowledges the efforts of the many UBC OT students, biomedical engineering students, medical students, and ICORD Indigenous summer students who have contributed. “The students’ input, ability to work directly with participants, and unique perspectives on barriers and opportunities has expanded the project to be richer and more focused on the end user experience.”
She saves her final thanks for her colleagues for sharing her passion.
“We have such a fantastic and brilliant team of collaborators who really like working together, and value and respect the range of knowledge each team member brings to the project.”
Where to Find and Use the aROW or aSKI in British Columbia
Note: List below updated in December 2022
- Grandview Community Centre, Surrey
- Newton Recreation Centre, Surrey
- Champlain Heights Community Centre, Vancouver
- Creekside Fitness Centre, Vancouver
- Delbrook Community Recreations Centre, North Vancouver
- MOVE Adapted Fitness and Rehabilitation Society, Victoria
- Parkinson Recreation Centre, Kelowna
- Physical Activity Research Centre (PARC), Vancouver
- Raincity Boxing Studio, Richmond
To find more accessible fitness centres and equipment in your community, call our InfoLine toll-free from 9 am – 5 pm, Monday to Friday at 1-800-689-2477 or email info@sci-bc.ca.
This article was originally published in the Winter 2022 issue of The Spin. Read more stories from this issue, including:
- Clinical Trial Enrollment
- A Peer’s Musical Achievement
- Canada’s Universal Health Care Program
And more!
