How to use BWA 2.0 for para-athletes
Interview Article – “Body Composition Measurement and Activity Support using BWA cutting mode for para-runners”
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This article from Japan discusses the experience of Shunsuke Itani, a para-runner who competes in the para track and field event, winning bronze in 100 m and silver in the 200 m at the Dubai World Para Athletics Grand Prix 2023. As an athlete, he was always curious about his body composition, as it is important to monitor it in the management of their physical condition, goals, injuries, etc. He believed this was not possible until one of his sponsors, Arrows Lab, asked InBody Japan for help. Starting in 2023, Itani’s body composition has been measured at the Nagoya office.
As a token of gratitude, Itani has added InBody’s logo to his jersey at his own expense, and the Japanese corporation is sponsoring Itani on a regular basis, based on this report.
InBody Japan plans to set up a booth at three conferences related to disability sports and provide corporate sponsorship, to seek markets in the field and provide support for athletes like Itani.
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“How to use BWA 2.0 for para-athletes”
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Shunsuke Itani , who specializes in short-distance events (100m and 200m) in para track and field, is a top para-athlete based in Aichi Prefecture.?Itani holds the Japanese record for the 100m in the T64 (unilateral lower leg amputation and uses a prosthetic leg for competition) competition class, with a time of 11.29 seconds at the Para Athletics Festival held in Aichi Prefecture in April 2023. He broke his own 100m Japanese record.?He also won a bronze medal (100m) and a silver medal (200m) at the Dubai 2023 World Para Athletics Grand Prix held in the United Arab Emirates in February 2023.
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Itani: “I've always loved sports, and played kendo, racing carts, softball, and baseball in elementary, junior high, and high school. I devoted myself to motorsports in college, but I needed money to continue as a racer, so I had to work part-time. I was working in three jobs. Even then, I didn't have enough money, so I borrowed my monthly salary in advance to run. As a result of spending all my time trying to earn money to participate in kart races and continue practicing, I ended up losing money. I couldn't find time to practice, and I felt that it would be difficult to win at this rate. Meanwhile, while riding my bike home from my part-time job, I had an accident and had to have my right leg amputated below the knee.”
Immediately after the accident, he was temporarily unconscious and in a serious condition, and when he woke up, his right ankle was diagnosed as an open comminuted fracture, and he had lost sensation.?Ten days after the accident, his right leg below the knee was amputated, and he was unable to speak a single word to his family or friends due to the emotional shock and pain of the injury.?
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Itani: “While I was in the hospital, many people came to visit me, and I remember that some of my friends cried when they saw my amputated leg, and it made my heart hurt even more because I was sapping everyone's energy.?The smile on my mother's face disappeared from her face, and as I watched her, I began to wonder what I should do.
Therefore, I thought that if I could show people around me that I was trying something, I might be able to bring back their smiles.?With a prosthetic leg, I can walk and continue playing the sports I love.?First, I stopped feeling depressed.?While I was still in the hospital and didn't even have a prosthetic leg, I watched the 100m final race at the Paralympic Games on YouTube and felt like I wanted to run.?I had a genuine admiration for athletes with prosthetic legs.?At that time, it was a faraway world where I just thought it was “cool.” A month and a half after the accident, the prosthetic leg was completed, I was able to undergo rehabilitation, and I felt hopeful and happy that I would be able to walk again.?However, rehabilitation was harder than I had imagined, and there were times when I felt like giving up, thinking, ‘Is it really that difficult to even take the first step?’?The doctor told me that it would take six months before I could walk and a year before I could run, but with the support of those around me, I was able to do my best in rehabilitation, and I was able to walk within two weeks.?I think this is because I have been exposed to various sports since I was a child and have always had confidence in my physical strength.”
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Three months after getting a prosthetic leg, Itani joined a community in Mie Prefecture where people with prosthetic legs gathered to learn about tips and knowledge on how to live with a prosthetic leg.
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Itani participating in the prosthetic leg community.
Itani: “At that time, I still felt somewhat dark, negative, and depressed, and I thought that people with disabilities were like that and that it was the same for other people. However, when I joined the community, this was not the case at all, and I saw everyone from children with prosthetic legs to grandparents running with smiles on their faces. After being discharged from the hospital, I was able to walk with my prosthetic legs, but I never ran. I hadn't been able to run, and it was the moment when my desire to run grew stronger. At that time, I was able to borrow a treadmill and run, and just running with my own legs made me feel so happy and I smiled, realizing how good it felt to run with my own legs.?My mother, who came with me, also smiled, and when I showed the running footage to her friends, they all enjoyed it.?‘If I am so happy just by running, I'm sure I'll be even happier if I can participate in the Paralympics.?As for my mother, I feel embarrassed because her son has a disability, and I feel like I make my friends worry about me because I have a prosthetic leg. If I can participate, I will become a son that everyone can be proud of and become a friend...’ I thought.?That was the moment when my dream of becoming an athlete began to grow within me.”
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However, at that time, the prosthetic legs used in track and field events were very expensive, there were no para track and field instructors, and there was no place for para-athletes to practice, so his life continued to revolve around kart racing.?During that time, he met Juichi Wakisaka, a legend in the racing world, who supported Itani's dream of “trying to compete in para track and field”. ?In 2018, two years after the accident, he began to pursue a full-fledged career. Now he could try track and field.
In May 2018, he won the 100m event at the World Para Athletics (WPA) Beijing Grand Prix, which he competed in for the first time.?She set a new Asian record in the 100m event at the 2019 WPA Paris Grand Prix with a time of 11.47 seconds.?He became the first Japanese to reach the finals in the 100m event at the World Para Athletics Championships.?He broke his personal record (Japanese record) at this year's domestic competition and won a medal at the world competition, quickly growing into a top para-athlete representing Japan.
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BWA measurement inside Arrows Gym
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For many para-athletes, weight is the only indicator they can use for conditioning.?In Itani's case, he loses weight due to overtraining, fatigue, and insufficient food intake, so it is essential to weigh him every morning.
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Itani: “When you lose 1 kg of weight, it would be ideal to know whether your muscle mass is decreasing, whether your body fat is decreasing, and which components are decreasing and in what proportion. After that, I gave up on measuring my body composition. I thought that if my body fat mass had decreased by 1kg, I wouldn't have to worry so much even if I lost 1kg, and it would be easier to do conditioning. Your weight is given as a numerical value, but the breakdown of muscle and body fat is not known, so the only way to determine whether you have gained muscle mass or whether your body fat mass has increased or decreased is by looking in the mirror. Track and Field Athletes must constantly observe and manage their own bodies, but if you rely on your own subjectivity and sensations, I think it will be difficult to move in the right direction. When I met the people at Arrows Lab and underwent a sports checkup, I measured with InBody 470 with Mr. Shoshima.?The amputated limb could not touch the foot electrode, resulting in a measurement error.?I had never measured my body composition since my leg was amputated, and I really wanted to know my body fat percentage, so I asked Mr. Shojima if there was a way to measure my body composition myself, and he decided on InBody BWA.”
* Please refer to?this ?article for additional information.
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From left: Yuki Shojima, Shunsuke Itani (feedback of measurement results)
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Mr. Shojima of Arrows Lab: “I think there is no longer a distinction between the bodies of people with disabilities and those of healthy people, but there are still limited measuring devices that can be used by para-athletes and facilities that can accept them. I wanted to somehow make Itani's wish come true, so I asked Mr. Keuke of InBody if there was a way to measure body composition even with limb loss. Then, he decided to use InBody BWA, which is also used in hospitals. Mr. Itani introduced me to para-athlete support for the first time, so I am still trying to find my way.”
Itani: “I had been playing competitively without having any idea of my own muscle mass or body fat percentage, so when I got my prosthetic legs and was able to quantify my body composition for the first time, it was a great experience. I was so happy and said, ‘I finally got to see it!' I was surprised to see that I had a lot more muscle mass compared to my weight and that my body fat percentage was lower than I had expected. I felt completely different.”
How to utilize the InBody BWA 2.0
The BWA 2.0 allows settings such as chronic disease, area of paralysis, presence of amputation, etc. at the time of measurement as necessary.?If you select "Amputation present", the amputation site will be automatically detected from the impedance information, and the body composition of the amputation site will be presented as 0 in the site-specific information result field.?On the other hand, for whole-body body composition results, the weight reduced by amputation is estimated from the difference between the impedance of the amputated limb and the impedance of the healthy side, and a value that includes the estimated value of the amputated limb is presented.
Impedance is affected by the length of the conductor, but if the measurement distance is shortened due to cutting or other reasons, the impedance will decrease significantly.?A decrease in impedance is interpreted as an increase in body water content (muscle mass).?As a result, when measuring with conventional BIA equipment, not only the muscle mass of the amputated limb is calculated to be abnormally large, but also, depending on the length of the amputated limb, information by region other than the amputated limb and body composition results of the whole body may be calculated. There was a problem that the accuracy decreased.?The BWA 2.0 overcomes these challenges by applying InBody technology that allows impedance to be measured independently for each region.
▲?Itani’s measurement results
① Because the right leg was amputated, the muscle mass, ECW/TBW, body fat mass, and water mass of the right leg are displayed as 0.?The skeletal muscle index, which is calculated by dividing the total muscle mass of the limbs by the square of the height (m), is also displayed as 0.
② The right leg muscle mass is displayed as 0.00 kg. Still, the whole-body muscle mass includes the estimated value of the amputated limb, so the whole-body muscle mass - (right arm muscle mass + left arm muscle mass + trunk muscle mass + left leg muscle mass) It is possible to monitor increases and decreases by using the calculated value as the sum of the remaining part of the right leg and head muscle mass.
Example of Itani: 63.5-(4.18+4.10+31.0+11.03) = 13.19kg. Estimated value of right leg + head muscle mass
③ECW/TBW represents muscle quality and is one of the items that should be checked along with muscle mass.?As time passes after waking up, body water moves to the lower body due to sitting and standing postures, so generally the ECW/TBW of the lower body tends to be higher than the upper body, but Mr. Itani's ECW/TBW of the lower body is low. It is being measured.?This is a characteristic seen in sports that use the lower body a lot, such as track and field, and it is clear that Mr. Itani also has particularly toned muscles in his lower body.
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Utilization of muscle mass by InBody region In track and field, the length and muscle mass of the amputated limb are directly linked to athletic performance.?For this reason, detailed classification charts 1 and 2 have been established?for para competitions to maintain fairness.?In the case of short-distance track and field events, just one second of difference in time between below-knee and above-knee amputation can change the time.?Of course, legs are important in the movement of running, but arms are also important in competitions.?Even in the same 100m event, athletes with arm amputations and athletes with leg amputations compete differently.
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Figure 2. Classification image of athletes with lower limb amputations (using prosthetic legs for competition)
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Itani:“Since my right leg is a prosthesis, I rely on my left leg in my daily life, which inevitably causes me to lose muscle mass in my right thigh. To properly control my prosthetic leg, I have to strengthen my right thigh. It is important to train muscle strength to reduce the difference in muscle strength between the left and right legs, and to maintain as much muscle mass in the right leg as possible.
If you are a healthy person, you can easily measure your body fat percentage at home using a home body composition meter, so you may not find BWA that appealing.?However, for those of us who don't usually measure things, just being able to measure things is a huge benefit.?I'm very happy to be able to see my own body as data, and to be able to see daily changes in numbers.”
Itani: “When I measured with the BWA for the first time, it was at a time when I hadn't fully focused on my body, but I was surprised to see that my body fat mass and body fat percentage were lower than I expected. I imagine that the body fat will be a little lower if you measure it after your body is finished, but when you look at foreign athletes, their bodies are clearly different, so I think they need to reduce their body fat even more. In the future, by continuing to measure InBody, we will be able to understand how the body changes during the season, during the off-season, when you are feeling well, when you are tired, etc., and what changes occur when you change your training or eating habits. I would like to quantify it and see if it exists.?Based on the characteristics of the results that appear depending on the conditions at that time, I think it will be possible to use it for the purpose of injury prevention.?We often hear about muscle mass and body fat percentage indicators that are standards for different athletes and sports, but there are almost no standards or general indicators for para-athletes.?I want to find out what is right within me and what is closest to my best performance.”
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Mr. Shojima of Arrows Lab: “I want to know my physical strength and body composition, but there are no measuring devices or facilities that I can use.” This is one way that my activities can improve the inconvenience felt by para-athletes. I would be happy if this was an opportunity for you. Arrows Labs nationwide are not yet able to accept para-athletes, but InBody can measure body composition even for people with limb loss, so I hope this will help para-athletes in the future. I hope we can take it in a direction where it can be used freely not only by patients in wheelchairs but also by children with prosthetic legs."
▲ Dubai 2023 World Para Athletics Grand Prix race scene
Itani: “Competitively, I'm aiming to win a gold medal at the Asian Games, and to become an athlete who can represent Japan at the 2024 Paris Paralympic Games and compete for a medal. I would be happy if people who have lost their limbs would want to run with a prosthetic leg or exercise. I hope that not only people with disabilities but also many other people with disabilities will be able to help me, as well as para-athletes who take on challenges every day. I hope that seeing them inspires me and gives me a chance to take a step forward.
Para-athletics is still lacking in excitement, so I would like to focus on public awareness activities at events and raise awareness in Japan.?I would like to work to help people find para track and field to be an interesting sport.?Lastly, I am truly grateful to InBody, who developed a device that can measure body composition even with prosthetic legs like mine, and to Mr. Shojima of Arrows Lab, who reached out to me when I was in trouble and had given up.?thank you very much.”
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Please see?the article on Arrows Lab?here.? InBody is used as one of the evaluations of the “sports version medical checkup” that uses full-scale training machines and measurement equipment.