Handcyclists with the most significant impairment, typically a high-level spinal cord injury affecting arms, trunk and legs (tetraplegia).
The H1–H5 classes are for athletes who power a handcycle with their arms. H1 riders compete lying back in a recumbent handcycle and have the greatest activity limitation — usually a cervical (neck-level) spinal cord injury affecting the hands, arms, trunk and legs. With no trunk control and limited arm and hand function, H1 is the most impaired handcycle class.