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Article

Assessment of Health-Related Behaviors and Physical Activity of Wheelchair Fencers

by
Dariusz Boguszewski
1,* and
Katarzyna Łuczak
2
1
Department of Individual Sports, University of Physical Education in Warsaw, 00-968 Warszawa, Poland
2
Department of Rehabilitation, Medical University of Warsaw, 02-097 Warszawa, Poland
*
Author to whom correspondence should be addressed.
Appl. Sci. 2025, 15(3), 1507; https://doi.org/10.3390/app15031507
Submission received: 6 December 2024 / Revised: 23 January 2025 / Accepted: 31 January 2025 / Published: 1 February 2025
(This article belongs to the Special Issue Athletes Performance and Analysis in Combat Sports and Martial Arts: Second Edition)
Versions Notes

Abstract

:
Background. Sports for people with disabilities were developed to be the final stage and continuation of rehabilitation, and their main purpose was for therapeutic value. The purpose of this study was to assess the physical activity and selected health behaviors of people with disabilities involved in wheelchair fencing. Materials and Methods. The study included 89 people with disabilities. The first group (n = 42) consisted of parafencers participating in the Kiliński’s Sabre Wheelchair Fencing World Cup. The control group was 47 people with disabilities who were non-athletes. The main research tools were the Health Behaviors Inventory (HBI) and the International Physical Activity Questionnaire (IPAQ). Results. The athletes’ health behaviors, assessed using the HBI, showed significant differences between the two study groups. Wheelchair fencers were more attentive to eating habits, preventive behaviors, and health practices and had more favorable mental attitudes. In the fencers’ overall physical activity over the past seven days, differences were observed between those who trained competitively and non-athletes. The differences were statistically significant. Conclusions. Fencers were characterized by significantly higher levels of health behavior. This may indicate the intellectualization of the training process and the transfer of the desired behavior to everyday life.

1. Introduction

Disabled people have the same needs as the non-disabled. Disability causes a high number of difficulties, including limitations of functioning in personal, social, and professional life. There are also additional needs resulting from disability at the level of medical, psychological, professional, social, and welfare due to the choice of a specific lifestyle and way of rehabilitation. Sports for people with disabilities were developed to be the final stage and continuation of rehabilitation, and their main purpose was for therapeutic value. They are currently growing in popularity. Technology to support specific dysfunctions is also developing rapidly, making it possible to expand the groups of people adapted to practicing sports. A major influence on the change in the approach to the process of improving people with disabilities has been the use of sports forms in rehabilitation, especially from mainly hospital-based solutions for community and social rehabilitation [1].
Physical activity prevents the development of many diseases of both body and mind. Regular exercise can reduce the risk of premature death from cardiovascular disease by more than 50% (especially the risk of death from heart attack). Physically active people, both men and women, have about 20–30% lower risk of ischemic and hemorrhagic stroke. In people with high levels of physical activity, long-term studies have found reductions in cancer death rates in the range of 25–30%. Regular exercise is also critical in the prevention and treatment of overweight and obesity. Physical activity benefits mental performance and is a protective factor against memory disorders. Exercise reduces the incidence of depression and the risk of dementia due to cerebrovascular disease [2,3,4,5]. The consequences of hypokinesia, or insufficient physical activity, also include muscle atrophy and a reduction in muscle strength and endurance, which result in poorer human functional capabilities. Current WHO guidelines on physical activity for children and adolescents with disabilities call for devoting at least 60 min a day to moderate to vigorous activity, mainly aerobic. Guidelines for adults with disabilities recommend performing at least 150 to 300 min of moderate-intensity aerobic physical activity, at least 75 to 150 min of high-intensity aerobic physical activity, or an equivalent combination of the two training intensities throughout the week. Adults should also perform muscle-strengthening exercises involving all major muscle groups two or more days a week [6]. It is also important to take care of other elements of a healthy lifestyle, such as diet, sleep, and mental conditioning, in addition to regular activity.
Parafencing is a sport for people using wheelchairs. These may be people with physical disabilities such as limb amputations, spinal cord injuries, or neurological diseases that impair the musculoskeletal system. Parafencing is one of the most popular sports for people with disabilities. However, there are not many scientific articles about it. The physiological and biomechanical aspects of training of wheelchair fencers have been the most studied [7,8,9,10,11]. Not many works show topics connected with lifestyle and social rehabilitation [12,13]. Therefore, the main aim of this study is to recognize the level of selected health-related behaviors and physical activity in people with disabilities involved in wheelchair fencing.

2. Materials and Methods

The study included 94 people with disabilities. The first group (the study group, n = 42) consisted of parafencers participating in the Kiliński’s Sabre Wheelchair Fencing World Cup (Warsaw, Poland, 8–12 July 2023). The players represented Poland, Georgia, Hungary, France, Italy, the UK, Ukraine, Kuwait, South Korea, Hong Kong, Philippines, China, India, and Brazil. The participants were aged 19 to 48 years. There were high-performance athletes in parafencing—Paralympic medalists, World Championships medalists, European and Asian Championships medalists, and World Cups medalists. The causes of their disabilities were conditions recognized by the International Fencing Federation in sports categories A and B [14,15]. For comparison purposes, we used a control group of 52 people with disabilities who were non-athletes (Table 1). There were 16 women and 26 men in the group of athletes. The average training experience was 8.39 years (±3.89), and it was higher for men than for women (Table 2). People’s participation in the study was voluntary and anonymous.
The survey was conducted in the form of a traditional survey using a face-to-face auditory method. The survey was available in Polish and English. Questions included in the survey concerned the demographics of the respondents, the experience of chronic pain, injuries and their treatment, and subsequent rehabilitation and its effectiveness. The main research tools were the Health Behaviors Inventory by Zygfryd Juczyński and the International Physical Activity Questionnaire [16,17].
The Health Behaviors Inventory (HBI) was developed by Zygfryd Juczyński. It is used to assess selected lifestyle elements. The questionnaire contains 24 items. The questions concern the four basic categories of health behaviors: proper nutrition habits (the kind and quality of consumed food), preventing behaviors (complying with the principles of preventing civilization diseases, possessing and obtaining information on one’s health and disease), positive psychical attitude (avoiding negative emotions, tension, and stress), health practices (everyday habits, such as being physically active, sleep, recreation). Each category contains 6 statements describing lifestyle. Each statement is rated on a scale of 1–5, where 1 means almost never, and 5 means almost always. The obtained overall result allows for conventional classification of the studied persons as those of the low 24–77 points, average 78–91, or high 92–120 level of health behaviors [16].
The International Physical Activity Questionnaire–Short Version (modified, adapted for wheelchair users with disabilities) [17,18] consists of four independent parts and contains accurate information about physical activity. With this information, it is possible to determine an estimate of the level of intense and moderate physical activity and locomotion-related activity. A conversion factor in MET (Metabolic Equivalent of Work–minutes/week) units is used to estimate the degree of activity. The participants are classified based on their level of physical activity into one of three groups: high physical activity (score greater than or equal to 1500 MET in minutes/week), sufficient physical activity (score between 600 and 1500 MET), and insufficient physical activity (if the participants did not participate in any physical activity or their score did not meet the conditions to qualify for the group at a sufficient level) [17]. The questionnaire was adapted by changing the word “walking” to “moving by own muscles e.g., in wheelchair” [18].
The research related to human use has complied with all the relevant national regulations and institutional policies and has followed the tenets of the Declaration of Helsinki. The study was approved by the Research Ethics Committee of the Józef Pilsudski University of Physical Education in Warsaw (No. SKE 01-38/2023, 16.06.2023).
After analyzing the data, they were exported to Statistica 12 software (TIBCO software, 12.0.4, Santa Clara, CA, USA). Due to the lack of normal distribution of the data, as verified by the Shapiro–Wilk test, further analyses of differences between groups were conducted using the Mann–Whitney U test. The relationships between particular variables were determined by means of Spearman’s rho correlation analysis. The minimal statistical significance was set at p ≤ 0.05.

3. Results

3.1. Health-Related Behaviors

Table 3 presents the results of the Health Behaviors Inventory performed by athletes and non-athletes. The athletes’ health behaviors showed significant differences between the two study groups. Wheelchair fencers were more attentive to eating habits, preventive behaviors, and health practices and had more favorable mental attitudes. Differences were statistically significant in all categories (Table 3).
In the first group (athletes), 21 people had a high level of health-related behaviors: 17—average level and 4—low level. The proportion was the opposite in the group of non-athletes: only 7 people met the requirements of a high level of health-related behaviors, while 12 were at an average level and 31 were at a low level.
Table 4 presents the results of the Health Behaviors Inventory performed by fencers—women and men. The health behaviors of female and male athletes showed statistically significant differences in favor of women. Both men and women similarly emphasized preventive behavior and a positive mental attitude. However, women scored higher in every category, with significant differences found in the categories of eating habits and health practices (Table 4). There were 10 women and 11 men with high levels of health behaviors.
Table 5 presents the results of the Health Behaviors Inventory performed by athletes from Asia and Europe. Fencers from Europe and Asia differed significantly in their health behaviors. European athletes scored significantly higher in the categories of eating habits and preventive behaviors. Scores in the mental attitude category were very similar between participants from the two continents (Table 5).

3.2. Physical Activity

Table 6 presents the results of the International Physical Activity Questionnaire performed by athletes and non-athletes. The analysis shows differences in physical activity levels according to intensity in athletes and non-athletes. The values obtained in MET were significantly higher in the group of wheelchair fencers only in the aspect of intensive physical activity. Analysis of daily locomotion showed that people who do not practice competitive sports are more involved in locomotion than athletes. Moderate physical activity was similar in both groups. After summing the MET values to estimate the fencers’ overall physical activity over the past seven days, differences were observed between those who trained competitively and non-athletes. The differences were statistically significant (Table 6).
All athletes (n = 42) met the requirements of a high physical activity level. In the control group, there were 21 people in the high level, 11 in the sufficient level, and 20 in the insufficient level of physical activity.
Table 7 presents the results of the International Physical Activity Questionnaire performed by athletes—women and men. The analysis showed no statistically significant differences in the levels of physical activity between male and female wheelchair fencers. Women scored slightly higher in the category of intense physical activity (Table 7).
Table 8 presents the results of the International Physical Activity Questionnaire performed by athletes from Asia and Europe. Asian athletes had higher levels of total physical activity, but the difference was not significant (p = 195). The largest yet statistically insignificant differences occurred in the category of intense physical activity. In the locomotion category, values were similar (Table 8).

3.3. Correlations

Table 9 presents the Spearman’s rho correlation [r] between health behaviors measured by the Health Behaviors Inventory and BMI, immobility, physical activity (measured by IPAQ), training experience, self-esteem of health, and self-esteem of physical fitness. Significant negative correlations were observed between health behaviors (measured by the Health Behaviors Inventory) and BMI, and time spent without physical activity. In the case of BMI, these correlations were particularly true for women and, in the case of time at immobility, for men. Positive correlations were found between health behaviors and self-assessment of health and self-assessment of physical fitness (Table 9).
Table 10 presents the Spearman’s rho correlation [r] between physical activity measured by the International Physical Activity Questionnaire and BMI, immobility, training experience, and training frequency. Strong positive correlations were found between total physical activity and training experience, while negative correlations were observed for activity and immobility. There were positive correlations between physical activity and training experience and training frequency in women, and physical activity and BMI and training experience in men (Table 10).

4. Discussion

Wheelchair fencing is a good example of comprehensive physical rehabilitation. Fencing training alone and tournaments and fights in front of an audience shape the athlete’s prowess, self-confidence, and abilities. The sport helps break down barriers and teaches self-discipline and determination [9,19]. Fencing helps develop all motor abilities, such as speed, strength, balance, motor coordination, flexibility, and endurance. Therefore, the benefits of the sport are also observed in everyday life and related activities [12]. The sport can be started at any age, beginning in early childhood, so that in clubs and at training sessions, players can meet other enthusiasts to establish and improve social contacts, meet people in similar life situations, and take example from others who have gone through problems related to their disability [12]. People with musculoskeletal dysfunctions who engage in physical activity are very often active professionals who strive to develop the fitness and capabilities of their bodies and also try to climb the career ladder [20,21,22].
The research conducted as part of the present study aimed to determine the physical activity of wheelchair fencers and assess their health behaviors. For this purpose, the author’s questionnaire and Juczyński’s modified IPAQ and Health Behaviors Inventory questionnaire were used. Based on the results, it can be concluded that competitive athletes are distinguished by a higher level of intense physical activity than non-athletes and that wheelchair fencing athletes are characterized by a higher level of physical activity than non-athletes. Similar findings have also been reported by other authors of studies on other Paralympic and Olympic sports [23,24,25,26,27,28]. There were also sex-related differences in the results. In the categories of moderate physical activity and locomotion, higher values were obtained by males; only in the aspect of intensive physical activity was a slightly higher score recorded in females.
The results of comparing the physical activity levels of athletes from Europe and Asia show much higher levels of the intensive and moderate physical activity categories in Asian athletes. In terms of locomotion, values were comparable between continents. Unfortunately, no studies on similar problems were found.
Research conducted with the help of Juczyński’s Health Behaviors Inventory showed substantially higher awareness of health behavior in the population of athletes than non-athletes. This may indicate the educational role of training and the participants’ awareness and concern for their health and the prevention of health problems. Athletes were more likely to pay attention and attach importance to dietary habits, preventive behaviors, mental attitudes, and health practices [26,27]. The difference in health behavior scores is also evident when comparing sexes, where higher values in the study group of athletes were received by women. Authors of other studies have come to similar conclusions [22,27].
When comparing the values of health behaviors of Asian and European athletes, one can see significantly higher values in the categories of eating habits, preventive behaviors, and health practices in European athletes. Only in the mental attitude category do the results differ slightly. This may be due to cultural and nutritional differences between the continents. More and more processed foods are sold in Asia [29].
The limitation of the study is the small size of the group of wheelchair fencers with disabilities. Especially for the analysis of subgroups, this does not allow far-reaching conclusions to be drawn. There are also not many published studies on this population. Most available studies have been conducted on rugby players and basketball players. Therefore, we compared results with them and with young adults [30,31,32,33]. There is a need to conduct multicenter studies on larger groups to eliminate this limitation.
There are not many studies connected with healthy practices in Paralympic athletes. Burns et al. conducted open-ended, semi-structured, face-to-face interviews with ten World, Olympic, and Paralympic champion athletes. Four dominant issues emerged: psychological attributes, interpersonal relationships, performance strategies, and lifestyle practices. The most important, in the opinion of the athletes, was psychological skills [34]. Maden et al. evaluated nutrient intakes and supplement use in Paralympic athletes (with physical disabilities). Athletes generally met able-bodied recommendations for macronutrients. Commonly consumed supplements were vitamin D, protein powder, sports bars, and sports drinks. An analysis of diet and supplement use within this population shows several micronutrient deficiencies and irregular use of specific supplements [35]. Calheiros et al. showed the association between quality of life and healthy lifestyle of wheelchair handball athletes. The results suggest that the practice of adapted sports can exert an important influence on the quality of life and lifestyle of people with physical disabilities [36]. Similar conclusions can be drawn from studies on parafencers.
The drawback of the study was its subjectivity. However, publicly available and widely reported questionnaires—the Health Behaviors Inventory and the International Physical Activity Questionnaire—were used. The solution could be to use additional research tools, such as mobile applications. Research into lifestyle and physical activity certainly should be continued. Information on current trends in healthy behaviors in disabled people will allow for the implementation of actions that activate them.
The present study can be a good starting point for research on disabled fencers both inside and outside the country due to the large community of people practicing the sport worldwide and the large-scale competitions that are organized for them. Also, a comparison of physical activity and health behavior of athletes between countries and continents would yield interesting insights and show the influence of culture on the above values, among other things. Future research could be extended to other groups of disabled athletes. More advanced, objective tools, such as accelerometers, could also be used.

5. Conclusions

Fencers were characterized by significantly higher levels of health-related behaviors. This may indicate the educational value of the training process and the transfer of the desired behavior to everyday life. Athletes practicing adapted sports were characterized by higher levels of physical activity. Promoting rehabilitation through sports can affect not only the physical rehabilitation of the disabled but also social and vocational rehabilitation.
A study conducted among wheelchair fencers showed that sex has an impact on the level of health behaviors, with significantly higher results obtained by women compared to men, which is consistent with other studies on these problems. Better results concerning athletes’ health behaviors were recorded in European populations. Only in the mental attitude category were the results comparable. This phenomenon certainly requires further scientific exploration.

Author Contributions

Conceptualization, D.B.; methodology, D.B.; software, D.B.; validation, D.B.; formal analysis, D.B.; investigation, D.B. and K.Ł.; resources, D.B. and K.Ł.; data curation, D.B. and K.Ł.; writing—original draft preparation, D.B.; writing—review and editing, D.B.; visualization, D.B.; supervision, D.B.; project administration, D.B.; funding acquisition, D.B. All authors have read and agreed to the published version of the manuscript.

Funding

The study are financed from the Subsidy of the Rector of the University of Physical Education in Warsaw intended for scientific activities (Polish Ministry od Education and Science Subsidy)–University Research Project no. 4 at Józef Piłsudski University of Physical Education in Warsaw: The effectiveness of methods and tools supporting sports training, post-exercise recovery and prevention of musculoskeletal injuries in athletes.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Research Ethics Committee of the Józef Pilsudski University of Physical Education in Warsaw (No. SKE 01-38/2023, 26.06.2023).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The original contributions presented in this study are included in the article. Further inquiries can be directed to the corresponding author.

Acknowledgments

We would like to acknowledge all athletes who were participants in this research project.

Conflicts of Interest

The authors declare no conflicts of interest.

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Table 1. Characteristics of examined people (mean value ± standard deviation).
Table 1. Characteristics of examined people (mean value ± standard deviation).
GroupWomenMenAge [Years]Body Mass [kg]Body Height [cm]
Athletes162628.17 ± 5.5870.83 ± 13.36172.69 ± 9.89
Non-athletes84434.04 ± 9.4871.82 ± 8.38176.42 ± 6.79
Table 2. Characteristics of examined athletes (mean value ± standard deviation).
Table 2. Characteristics of examined athletes (mean value ± standard deviation).
GenderAge [Years]Body Mass [kg]Body Height [cm]Training Experience [Years]
Women27.38 ± 6.2959.00 ± 8.96163.77 ± 6.175.81 ± 3.64
Men28.65 ± 5.1777.65 ± 10.42177.95 ± 7.648.48 ± 4.44
Table 3. Health Behaviors Inventory results of athletes and non-athletes (mean value ± standard deviation). Differences measured by Mann–Whitney U test.
Table 3. Health Behaviors Inventory results of athletes and non-athletes (mean value ± standard deviation). Differences measured by Mann–Whitney U test.
GroupNutrition HabitsProphylactic BehaviorPositive AttitudeHealthy
Practices		Health-Related Behaviors–Sum
Athletes3.71 ± 0.563.68 ± 0.474.13 ± 0.473.69 ± 0.5591.26 ± 10.01
Non-athletes2.86 ± 0.712.91 ± 0.653.52 ± 0.663.38 ± 0.6576.08 ± 13.52
Differences [p]0.0000.0000.0000.0140.000
Table 4. Health Behaviors Inventory results of athletes—women and men (mean value ± standard deviation). Differences measured by Mann–Whitney U test.
Table 4. Health Behaviors Inventory results of athletes—women and men (mean value ± standard deviation). Differences measured by Mann–Whitney U test.
GroupNutrition HabitsProphylactic BehaviorPositive AttitudeHealthy
Practices		Health-Related Behaviors–Sum
Women3.92 ± 0.353.81 ± 0.384.23 ± 0.483.95 ± 0.3195.44 ± 6.79
Men3.58 ± 0.633.60 ± 0.504.07 ± 0.463.54 ± 0.6188.69 ± 10.89
Differences [p]0.0300.1240.2980.0070.018
Table 5. Health Behaviors Inventory results of athletes from Europe and Asia (mean value ± standard deviation). Differences measured by Mann–Whitney U test.
Table 5. Health Behaviors Inventory results of athletes from Europe and Asia (mean value ± standard deviation). Differences measured by Mann–Whitney U test.
GroupNutrition HabitsProphylactic BehaviorPositive AttitudeHealthy
Practices		Health-Related Behaviors–Sum
Asia3.52 ± 0.643.48 ± 0.454.12 ± 0.513.57 ± 0.4788.17 ± 11.02
Europe3.89 ± 0.373.81 ± 0.414.08 ± 0.433.83 ± 0.3793.68 ± 7.15
Differences [p]0.0370.0200.8050.1220.044
Table 6. International Physical Activity Questionnaire results of examined people (mean value ± standard deviation). Differences measured by Mann–Whitney U test.
Table 6. International Physical Activity Questionnaire results of examined people (mean value ± standard deviation). Differences measured by Mann–Whitney U test.
GroupVigorous
Physical Activity [MET min/week]		Moderate
Physical Activity [MET min/week]		Locomotion [MET min/week]Sum [MET min/week]
Athletes4177.14 ± 2584.91925.71 ± 758.271389.54 ± 825.436492.39 ± 2872.87
Non-athletes1236.00 ± 1042.611302.00 ± 943.782554.76 ± 2195.095030.85 ± 3679.32
Differences [p]0.0000.1110.0090.048
Table 7. International Physical Activity Questionnaire results of athletes—women and men (mean value ± standard deviation). Differences measured by Mann–Whitney U test.
Table 7. International Physical Activity Questionnaire results of athletes—women and men (mean value ± standard deviation). Differences measured by Mann–Whitney U test.
GroupVigorous
Physical Activity [MET min/week]		Moderate
Physical Activity [MET min/week]		Locomotion [MET min/week]Sum [MET min/week]
Women4395.00 ± 2333.02832.50 ± 548.981225.13 ± 762.476452.63 ± 2683.13
Men4043.08 ± 2764.641010.77 ± 856.091490.71 ± 860.656544.56 ± 3061.02
Differences [p]0.6610.5270.3040.919
Table 8. International Physical Activity Questionnaire results of athletes from Europe and Asia (mean value ± standard deviation). Differences measured by Mann–Whitney U test.
Table 8. International Physical Activity Questionnaire results of athletes from Europe and Asia (mean value ± standard deviation). Differences measured by Mann–Whitney U test.
GroupVigorous
Physical Activity [MET min/week]		Moderate
Physical Activity [MET min/week]		Locomotion [MET min/week]Sum [MET min/week]
Asia4853.33 ± 3055.521073.33 ± 830.001397.00 ± 799.177123.67 ± 3526.89
Europe3766.96 ± 1691.55746.09 ± 524.541426.89 ± 754.335939.93 ± 2157.19
Differences [p]0.2220.3140.9090.195
Table 9. Spearman’s rho correlation [r] between health behaviors and chosen data; * p < 0.05, ** p < 0.01.
Table 9. Spearman’s rho correlation [r] between health behaviors and chosen data; * p < 0.05, ** p < 0.01.
GroupBMIImmobilityPhysical ActivityTraining ExperienceSelf-Esteem of HealthSelf-Esteem of Physical Fitness
All−0.308 *−0.316 *0.2030.1530.396 **0.319 *
Women−0.614 **0.0550.1550.2850.3840.269
Men−0.073−0.494 **0.3020.1240.464 *0.221
Table 10. Spearman’s rho correlation [r] between physical activity and chosen data; * p < 0.05, ** p < 0.01, *** p < 0.001.
Table 10. Spearman’s rho correlation [r] between physical activity and chosen data; * p < 0.05, ** p < 0.01, *** p < 0.001.
GroupBMIImmobilityTraining ExperienceTraining Frequency
All−0.192−0.340 *0.497 ***0.279
Women−0.220−0.501 *0.628 **0.488 *
Men−0.404 *−0.2170.413 *0.170
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Boguszewski, D.; Łuczak, K. Assessment of Health-Related Behaviors and Physical Activity of Wheelchair Fencers. Appl. Sci. 2025, 15, 1507. https://doi.org/10.3390/app15031507

AMA Style

Boguszewski D, Łuczak K. Assessment of Health-Related Behaviors and Physical Activity of Wheelchair Fencers. Applied Sciences. 2025; 15(3):1507. https://doi.org/10.3390/app15031507

Chicago/Turabian Style

Boguszewski, Dariusz, and Katarzyna Łuczak. 2025. "Assessment of Health-Related Behaviors and Physical Activity of Wheelchair Fencers" Applied Sciences 15, no. 3: 1507. https://doi.org/10.3390/app15031507

APA Style

Boguszewski, D., & Łuczak, K. (2025). Assessment of Health-Related Behaviors and Physical Activity of Wheelchair Fencers. Applied Sciences, 15(3), 1507. https://doi.org/10.3390/app15031507

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