Injury prevention is a necessary consideration when training para-athletes owing to their increased risk for overuse injuries, joint strain, and muscular imbalances. Understanding an athlete’s movement patterns and limitations based on their disability is key when developing an effective training plan. Correcting muscle imbalance if present and optimizing the sport-specific kinetic chain will help improve an athlete’s performance and prevent injury. Athletes may use closed kinetic chain exercises to achieve this goal, given the promotion of agonist and antagonist muscle groups working simultaneously, promoting joint stability. Another way to prevent and treat overuse injuries is by using eccentric strength training or controlled muscle lengthening. Eccentric strength training further strengthens the muscle and has unique benefits for the health of ligaments and tendons, increasing muscle control, coordination, and performance. Stretching is also an essential consideration in warm-ups and injury prevention. Dynamic stretching has been shown to improve performance, improve blood flow, and help warm up muscles before a workout. Examples include walking lunges, arm circles, and high knees. Static and passive stretching are also beneficial but should typically be reserved for after a workout when the muscles are already warmed up because of the increased intensity of the stretch. It may be used to cool down and aid in reducing muscle tension. Examples of active stretching include hamstring and quadriceps stretching. Partner stretching or using a band would be considered passive stretching.

Strength training for para-athletes follows similar principles to training a non-disabled athlete, including manipulating FITT (frequency, intensity, time, and type of workout) to introduce overload and growth. However, it may require some adjustment in terms of exercise selection, intensity, volume, and equipment for the para-athlete. Exercises should be chosen based on the athlete’s disability and sport. For example, for athletes that operate on a wheelchair level: core stability, chest, back, arms, and shoulder strength would be the focus, in addition to performing sport-specific drills. Every athlete has a different starting point based on their prior experience and disability. Gradual progression of strength training should be introduced, first focusing on the athlete’s form before increasing weight to allow appropriate physical adaptations to occur. It is also essential to consider the nature of the sport the athlete is playing. If it is an endurance sport, one may focus on lighter weight with increased repetitions compared with a sport with more explosive movements, where the speed of the repetition may need to be adjusted. For sports reliant on power and strength, a lower repetition range may be used at higher weights.

Proper conditioning training helps improve an individual’s stamina and prepares them for the demands of their sport. Aerobic training will better suit athletes if they require more endurance for their sport. Some aerobic activities for wheelchair sports may include rowing or arm cycling. If an athlete requires more explosive movements, anaerobic training will better suit the needs of the individual, such as high-intensity interval training workouts or wheelchair sprints. A good measurement to determine the intensity of training is by using heart rate zones.

Heart zone training is beneficial in gauging and adjusting the intensity of a workout. This assists in targeting specific goals, including fat loss, improving cardiovascular health, and endurance training. For aerobic or zone 3 training, athletes exercise at 70% to 80% of their maximum heart rate. For anaerobic training, an athlete needs to exercise with a heart rate of 80% to 90% of their maximum heart rate. This zone improves the efficiency of working out and helps train endurance during explosive movements. Another benefit of using heart rate zones is to prevent overtraining. It is a good way to gauge active recovery, specifically in zone 2 (50%–60% of maximum heart rate). This training method further individualizes workouts, meeting athletes at different fitness levels to ensure gradual training progression.

Periodization is a method often used to structure training to allow for appropriate progression and to enable athletes to peak during the competitive season while allowing enough time for recovery. A traditional periodization cycle generally includes three key phases: macrocycles, mesocycles, and microcycles. The macrocycle is the long-term plan, typically spanning a year, identifying general performance objectives. The mesocycles are medium-term phases, often lasting several months.

Mesophases are usually split into a build-up phase (preseason), a maintenance/fine-tuning phase (competitive season), and a recovery phase (postseason). Microcycles are the shortest cycles, usually lasting a week, and they provide the day-to-day structure of training, focusing on the goal of the mesocycle the athlete is in. Given para-athletes’ unique physiologic challenges, extensive planning of periodization phases for para-athletes is crucial. Complexity and individualization increase because of varying levels and types of disability ( Table 1 ). There are various categories of disability, including sensory, mobility, and intellectual impairments. The degree and type of disability need to be considered when evaluating how it may affect the athlete’s performance, given the sport’s physical demands. An example of tailoring a program to an athlete’s disability may be incorporating more balance and stability training for athletes with visual impairments. Periodization also allows for appropriate recovery time for the athlete. For example, athletes with below-the-knee amputations often expend more energy on their prosthetics, which, in turn, may require more recovery time. Therefore, more recovery days may be incorporated when planning the microphases of periodization. Allowing time for psychological support should also be considered when working with para-athletes. Many para-athletes face mental health challenges owing to stigmas or struggle to adapt to their condition. Thus, making time for athletes to work with sports psychologists throughout training is a factor to consider in helping develop mental resilience and coping mechanisms and supporting the psychosocial needs of the athlete.

By identifying an athlete’s unique physical and mental demands, periodization can help optimize an athlete’s performance while reducing the risks of training overload. Periodization allows for a comprehensive and individualized approach that considers all aspects of the para-athlete’s performance.

Sports-specific training for Paralympic swimming should focus on targeted swimming movements. This includes, but is not limited to, the start and turn, postural control in the water, and the muscles involved in the kick and pull of the stroke. Findings on the effectiveness of dry-land resistance training programs in Paralympic swimmers indicate that dry-land resistance training yields substantial improvements that corresponded with both improvements in dive starts and trial performances.

Understanding the athlete’s classification in the sport is also an important aspect of Paralympic swimming training. Maximizing training efforts to reduce drag and maximize speed and efficiency can be more beneficial for swimmers in the lowest swimming class, as they have been shown to experience the highest passive drag, and vice versa.

Wheelchair tennis training should encourage skill developments in agility, speed, and precision with a focus on the unique mobility demands of a wheelchair. In a study examining the heart rate response and court-movement variables during wheelchair tennis matches, high performance-ranked players were able to push further and faster than low performance-ranked players. Training athletes’ upper-body extremities, with a focus on endurance, may, in turn, make players more capable of responding to sudden ball movements, and keep up with the physical demands of competitive match play.

As previously discussed in the section on Technology, wheelchair configuration is also an important aspect of athletic performance. Certain configurations of a wheelchair, such as seat positioning, rear wheel camber, wheel size, or hand rim configurations, have been shown to elevate the physiologic demands of the athlete in the wheelchair. Other configurations have been associated with either an increased risk of injury on the court or a favorable performance. Consideration of these factors should be an integral part of an individualized training configuration.