Wheelchair athlete surrounded by electric energy

Boosting Performance: The Surprising Edge in Tetraplegic Athletes?

Lena Kashyap in Health & Wellness December 2025 • 4 min read.

"Unintentional Autonomic Dysreflexia and its Impact on Exercise Performance in Wheelchair Rugby"

Autonomic dysreflexia (AD) is a potentially life-threatening condition unique to individuals with spinal cord injury (SCI) above the sixth thoracic spinal level. AD is characterized by a sudden increase in blood pressure, and it results from afferent stimuli below the level of the injury that excites sympathetic preganglionic neurons and triggers systemic vasoconstriction. It can also be accompanied by other symptoms such as bradycardia, excessive sweating, anxiety, blurred vision, and headache.

During exercise, AD can inadvertently activate sympathetic circuitry below the level of injury, which is otherwise dormant due to the interruption of descending sympathetic spinal pathways. This phenomenon is sometimes termed 'boosting'. While boosting can enhance performance, it's officially prohibited by the International Paralympic Committee due to its inherent risks.

While the dangers are well-documented, athletes have been known to intentionally induce AD to improve their performance. This article explores a case of unintentional boosting during a field-based exercise test in an elite wheelchair rugby athlete, shedding light on the immediate effects and potential implications for athletes with tetraplegia.

How Does Autonomic Dysreflexia Affect Athletic Performance?

Wheelchair athlete surrounded by electric energy

A recent case study examined an elite male wheelchair rugby athlete with a chronic SCI (C6 motor-complete, sensory-incomplete). The athlete participated in two 20 × 20 m repeated sprint field tests on consecutive days, a standard part of their training regime. During the 13th sprint on the second day, the athlete unintentionally experienced AD due to bladder overdistension, triggering a series of physiological responses.

The data collected during this incident revealed several key insights:

Elevated Heart Rate: The athlete's average heart rate during sprints 14-20 (when boosted) was significantly higher (141 ± 4 bpm) compared to before boosting (116 ± 7 bpm) and the corresponding sprints on the first day (120 ± 1 bpm).
Improved Sprint Times: The average time to complete the 20 m sprints when boosted was faster (6.70 ± 0.05 s) compared to the corresponding sprints on the first day (6.87 ± 0.05 s).
Subjective Perception: Ratings of Perceived Exertion (RPE) initially dropped at the onset of AD but returned to previous levels after the final sprint when the heart rate decreased.

These findings suggest that AD can lead to immediate improvements in both cardiovascular response and sprint performance. The sudden increase in heart rate and the ability to maintain faster sprint times highlight the potential benefits—and risks—associated with boosting.

The Ethical and Practical Implications for Athletes and Regulators

This case report underscores the complex relationship between AD and athletic performance in individuals with SCI. While boosting can offer a competitive edge, it carries inherent risks and is banned by the IPC. The challenge lies in effectively testing and regulating intentional boosting during competitions, as well as ensuring the safety and well-being of athletes. Further research is needed to fully understand the long-term effects of boosting and to develop strategies that promote fair and safe competition for all athletes.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1249/mss.0000000000001738, Alternate LINK

Title: Effect Of Unintentional Boosting On Exercise Performance In A Tetraplegic Athlete

Subject: Physical Therapy, Sports Therapy and Rehabilitation

Journal: Medicine & Science in Sports & Exercise

Publisher: Ovid Technologies (Wolters Kluwer Health)

Authors: Cameron M. Gee, Melissa A. Lacroix, Christopher R. West

Published: 2018-12-01

Everything You Need To Know

What is Autonomic Dysreflexia (AD) and why is it relevant to athletes with spinal cord injuries?

Autonomic Dysreflexia (AD) is a potentially life-threatening condition that primarily affects individuals with spinal cord injuries (SCI) above the T6 spinal level. It's characterized by a sudden and dangerous increase in blood pressure, triggered by stimuli below the level of the injury. In athletes, AD can occur unintentionally ('boosting') during exercise, sometimes leading to enhanced performance. The condition occurs because the spinal cord injury disrupts the normal communication between the brain and the body, leading to an exaggerated response of the autonomic nervous system to stimuli below the injury site.

How does 'boosting' through Autonomic Dysreflexia (AD) impact the performance of a wheelchair rugby athlete?

In the context of the elite wheelchair rugby athlete, 'boosting' through Autonomic Dysreflexia (AD) demonstrated significant physiological and performance benefits. During the 20m sprint tests, the athlete showed an increased heart rate during sprints. Moreover, the athlete experienced improved sprint times during the sprints performed while in AD, suggesting enhanced cardiovascular response. However, it's crucial to recognize the risks associated with boosting, including the potential for serious health complications due to the sudden blood pressure surge.

What are the key physiological changes observed in an athlete experiencing Autonomic Dysreflexia during exercise?

In the case of the wheelchair rugby athlete, several key physiological changes were observed. There was a noticeable elevation in heart rate, with the average heart rate during boosted sprints being significantly higher than before or on the first day. Sprint times improved, indicating a faster completion of the 20m sprints when AD was present. Despite the physiological stress, the athlete's Rating of Perceived Exertion (RPE) initially dropped at the onset of AD but returned to previous levels after the final sprint when the heart rate decreased, suggesting a complex interplay of factors during the boosted state.

Why is 'boosting' prohibited by the International Paralympic Committee (IPC), and what are the ethical considerations?

The International Paralympic Committee (IPC) prohibits 'boosting' due to the significant health risks associated with Autonomic Dysreflexia (AD). The sudden and uncontrolled increase in blood pressure can lead to severe complications, including stroke. Ethical considerations revolve around the fairness of competition and the safety of athletes. While 'boosting' can enhance performance, it creates an uneven playing field and prioritizes competitive advantage over athlete well-being. Regulators face the challenge of effectively testing for and preventing intentional boosting while ensuring athlete safety.

Beyond performance enhancement, what are the long-term implications and areas for future research regarding Autonomic Dysreflexia and its impact on athletes with spinal cord injuries?

While the immediate effects of Autonomic Dysreflexia (AD) on athletic performance can be observed, there is a need for further research to understand the long-term implications. Studies should investigate the potential cumulative impact of repeated episodes of AD on cardiovascular health and overall well-being. Furthermore, research is needed to develop effective strategies for managing AD during exercise, including preventative measures and safe protocols for athletes with spinal cord injuries. This includes methods for detecting intentional boosting and ensuring fair and safe competition. Ultimately, the goal is to balance performance enhancement with the paramount importance of athlete health and safety.