Monitoring the Internal Training Load and Surrogate Measures in a Senior Female Paralympic Athlete with Spinal Cord Injury: A Case Study

Mirna Clemente, Marilis Dallarmi Miguel, Darlan França Ciesielski Junior, Tabea Epp Kuster Alves, Tiago Volpi Braz, Louryana Padilha Campos, Luciana Gibbert, Sandro Jose Ribeiro Bonatto, Luiz Claudio Fernandes, Larissa Junqueira Gatto, Christian Burmeister Schonhofen, Obdulio Gomes Miguel


Purpose: Paralympic Games were started originally for therapeutic reasons; nowadays they demonstrate the characteristics of high-performance sports. The surrogate measures (e.g., sleeping habits) and the internal training load (ITL) measures are strongly associated and are used to monitor performance in sport. This study aimed to understand whether the relationship between internal training load and surrogate measures, observed over a 16-week period, would be beneficial or otherwise in the case of a senior female Paralympic athlete with spinal cord injury, who was training to compete in table tennis at the Parapan American Games in Lima. 

Method: This case study evaluated the surrogate measures through the Heart Rate Variability measure, the Wisconsin Upper Respiratory Symptom Survey and the Pittsburgh Sleep Quality Index and assessed their relationship with the internal training load.

Results: The data demonstrated that during the monitoring period the athlete presented minimal fluctuations in the Heart Rate Variability measure, the Wisconsin Upper Respiratory Symptom Survey and the Pittsburgh Sleep Index. Significance was considered at p< 0.05.

Conclusion and Implication: Contrary to the athlete`s age and physical condition, the data demonstrated some gains towards her success in the sporting competition. A new approach in monitoring internal training load associated with surrogate measures is necessary. It could prove to be a good strategy for implementation in competition training routines for Paralympic athletes to reach their individual goals.


Paralympic sport; spinal cord injury; training programme; senior athletes

Full Text:



Barrett B, Brown R, Mundt M, Safdar N, Dye L, Maberry R, Alt J (2005). The Wisconsin upper respiratory symptom survey is responsive, reliable, and valid. Journal of Clinical Epidemiology; 58(6): 609-617. PMid:15878475 PMCid:PMC7119015

Blume K, Körber N, Hoffmann D, Wolfarth B (2018). Training load, immune status, and clinical outcomes in young athletes: A controlled, prospective, longitudinal study. Frontiers in Physiology; 9(Mar): 1-15. PMid:29628891 PMCid:PMC5876235

Buchheit M (2014), Monitoring Training Status with HR Measures: Do all roads lead to Rome? Frontiers in Physiology, 5(February): 1-19.

Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ (1989). The Pittsburgh sleep quality index - A new instrument for assessing sleep in psychiatric practice and research. Psychiatry Research; 28(2): 193-213.

Debien PB, Mancini M, Coimbra DR, de Freitas DGS, Miranda R, Bara Filho MGB (2018). Monitoring training load, recovery, and performance of Brazilian professional volleyball players during a season. International Journal of Sports Physiology and Performance; 13(9): 1182-1189. PMid:29584530

Eaker ED, Chesebro JH, Sacks FM, Wenger NK, Whisnant JP, Winston M, Staff AHA (1993). Cardiovascular disease in women. AHA Medical/Scientific Statement Special Report Circulation; 88(4): 1999-2009. PMid:8403349

Esco MR, Williford HN, Flatt AA, Freeborn TJ, Nakamura FY (2018). Ultra-shortened time-domain HRV parameters at rest and following exercise in athletes: An alternative to frequency computation of sympathovagal balance. European Journal of Applied Physiology; 118(1): 175-184. PMid:29128939

Foster C (1998). Monitoring training in athletes with reference to overtraining syndrome. Medicine and Science in Sports and Exercise; 30(7): 1164-1168. PMid:9662690

Gagnier JJ, Kienle G, Altman DG, Moher D, Sox H, Riley D, Tugwell P (2013). The CARE guidelines: Consensus-based clinical case reporting guideline development. Headache; 53(10): 1541-1547. PMid:24266334

Gleeson,M, Bishop N, Oliveira M, McCauley T, Tauler P, Muhamad S (2012). Respiratory infection risk in athletes: Association with antigen-stimulated IL-10 production and salivary IgA secretion. Scandinavian Journal of Medicine and Science in Sports; 22(3): 410-417. PMid:21385218

Groff DG, Lundberg NR, Zabriskie RB (2009). Influence of adapted sport on quality of life: Perceptions of athletes with cerebral palsy. Disability and Rehabilitation; 31(4): 318-326. PMid:18608427

Halson SL (2008). Nutrition, sleep and recovery. European Journal of Sport Science; 8(2): 119-126.

Hoshikawa M, Uchida S, Hirano Y (2018). A subjective assessment of the prevalence and factors associated with poor sleep quality amongst elite Japanese athletes. Sports Medicine; Open4(1): 10. PMid:29484576 PMCid:PMC5826912

Impellizzeri FM, Marcora SM, Coutts AJ (2019). Internal and external training load: 15 years on. International Journal of Sports Physiology and Performance; 14(2): 270-273. PMid:30614348

Kenttä G, Hassmén P (1998). Overtraining and recovery - A conceptual model. Sports Medicine; 26(1): 1-16. PMid:9739537

Kinne S, Patrick D, Doyle DL (2004). Prevalence of secondary conditions among people with disabilities. American Journal of Public Health; 94(3): 443-445. PMid:14998811 PMCid:PMC1448273

Mah CD, Kezirian EJ, Marcello BM, Dement WC (2018). Poor sleep quality and insufficient sleep of a collegiate student-athlete population. Sleep Health; 4(3): 251-257. PMid:29776619

Marques R, Gutierrez G, Almeida M (2014). Media approach to paralympic sports: Brazilian athletes standpoint. Movimento; 20(3): 989-1015.

Paschoal M, Volanti, Pires C, Fernandes F (2006). Variabilidade da freqüência cardíaca em diferentes faixas etárias. Revista Brasileira de Fisioterapia; 10(4): 413-419.

Reland S, Ville N, Wong S, Senhadjis L, Carr F (2004). Does the level of chronic physical activity alter heart rate variability in healthy older women. Clinical Science; 107(1): 29-35. PMid:14979870

Rodrigues JA, Yamane AC, Gonçalves TCP, Kalva-Filho C, Papoti M, Júnior CRB (2019). Fed and fasted states on heart rate variability, hemodynamic heart rate and blood pressure in adults submitted to moderate aerobic exercise. IJC Heart and Vasculature; 23: 100378. PMid:31193402 PMCid:PMC6527814

Winnick JP (2004). Educação Física e esportes adaptados. 3rd Edition, Barueri, SP: Manole


Copyright (c) 2020 Marilis Dallarmi Miguel, Darlan França Ciesielski Junior, Tabea Epp Kuster Alves, Tiago Volpi Braz, Louryana Padilha Campos, Luciana Gibbert, Gabriel Kircher Fragomeni, Sandro Jose Ribeiro Bonatto, Luiz Claudio Fernandes, Obdulio Gomes Miguel

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Supported by:


© Disability, CBR & Inclusive Development