The effect of exercise on cardiometabolic risk factors in adults with chronic spinal cord injury: A systematic review

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Objective To determine the effects of exercise on individual cardiometabolic syndrome (CMS) risk factors in adults with chronic spinal cord injury (SCI). Data sources English language searches of PubMed, Web of Science, EMBASE, and Scopus (01/01/1970 to 31/07/2019). Study Selection Articles were included if they met the following criteria: (1) original articles with statistical analysis, (2) participants were adults with a SCI sustained ≥ 1-year ago, (3) exercise intervention duration ≥ 2 weeks, and (4) included any CMS risk factor as an outcome. Data Extraction The methodological quality of articles was assessed using the Downs and Black score. Data Synthesis Sixty-five studies were included for the final analysis, including nine studies classified as high quality (≥66%), 35 studies classified as fair quality (50-66%), and 21 studies classified as low quality (<50%). Improvements in waist circumference (4/6 studies) and markers of hepatic insulin sensitivity (4/5 studies) were reported following upper-body aerobic exercise training, but no improvements in fasting glucose (8/8 studies), lipid profile (6/8 studies), systolic (8/9 studies) or diastolic blood pressure (9/9 studies) were observed. Improvements in markers of peripheral insulin sensitivity (5/6 studies) were observed following functional electrical stimulation (FES)-cycling. Improvements in lipid profile (4/5 studies) were observed following upper-body resistance training (RT) (with or without aerobic exercise). No consistent improvements in CMS risk factors were observed following assisted ambulation, FES-hybrid, FES-rowing, and FES-RT. Conclusions Upper-body aerobic exercise training (>75% maximum heart rate) appears to improve waist circumference and hepatic insulin sensitivity, but appears insufficient for improving fasting glucose, lipid profile, or resting blood pressure. The addition of RT to upper-body aerobic exercise may elicit favourable changes in the lipid profile. More high-quality studies are needed to confirm if FES-cycling is effective at improving peripheral insulin sensitivity.
Original languageEnglish
JournalArchives of Physical Medicine and Rehabilitation
Early online date20 May 2020
Publication statusE-pub ahead of print - 20 May 2020


  • spinal cord injuries, exercise therapy, metabolic diseases


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