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Physical exercise training may increase cardiorespiratory fitness in people with spinal cord injury

This systematic review of 17 randomized controlled trials (505 participants) found that physical exercise training may increase cardiorespiratory fitness (CRF) in people with spinal cord injury (SCI), with a standardized mean difference of 0.48 (95% CI 0.18 to 0.77) compared to no intervention. However, the certainty of evidence is low due to high risk of bias in most studies, and effects on other outcomes (functional fitness, quality of life, depression, anxiety, adverse events) are very unclear.

Last updated: Aug 29, 2026•0 RCTs•1 Meta-analyses•📖 Read as article →

Evidence Score

Evidence Score53/100
Human RCT☆☆☆☆☆
Meta-analysis★★★☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. Physical exercise training to increase cardiorespiratory fitness in people with spinal cord injury.

meta

Ilha J, Glinsky JV, Chu J, Bye EA, Tweedy SM, Harvey LA · The Cochrane database of systematic reviews (2026)

Participants: 505
Duration: 6 weeks to 9 months (short-term <6 weeks, long-term >6 weeks)
Intervention: Planned and structured physical exercise training (e.g., hand cycling, rowing, wheelchair propulsion, robotic gait training, walking/running, mixed gym equipment) with specified type, intensity, frequency, and duration, compared to no intervention
Outcome: Cardiorespiratory fitness (CRF), functional fitness, quality of life, depression and anxiety, adverse events, perceived exertion, independence, physical activity levels, fatigue, sleep quality
Effect Size: SMD = 0.48 (95% CI 0.18 to 0.77) for CRF
Population: People with spinal cord injury (SCI)

Result: This systematic review of 17 randomized controlled trials (505 participants) found that physical exercise training may increase cardiorespiratory fitness (CRF) in people with spinal cord injury (SCI), with a standardized mean difference of 0.48 (95% CI 0.18 to 0.77) compared to no intervention. However, the certainty of evidence is low due to high risk of bias in most studies, and effects on other outcomes (functional fitness, quality of life, depression, anxiety, adverse events) are very unclear.

PubMed: 42663176DOI: 10.1002/14651858.CD014476.pub2

Mechanism Graph

Exercise training stimulates cardiovascular and muscular adaptations
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Improved oxygen uptake and cardiac output
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Enhanced peripheral muscle oxidative capacity
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Result: Increased cardiorespiratory fitness

Limitations

  • ⚠96% of studies rated as high risk of bias using Cochrane RoB 2 tool
  • ⚠Very small number of studies for most outcomes, leading to imprecise estimates and wide confidence intervals spanning zero
  • ⚠Only one study examined long-term effects (>6 weeks), limiting generalizability

Frequently Asked Questions

Does physical exercise training improve cardiorespiratory fitness in people with spinal cord injury?▼

Yes, the review found a moderate effect (SMD 0.48) suggesting exercise may increase CRF, but the evidence is low certainty due to risk of bias.

What types of exercise were included in the review?▼

Exercises included hand cycling, rowing, wheelchair propulsion, robotic gait training, walking/running, and mixed gym equipment, with sessions 2-5 times per week for 30 minutes to 2 hours.

How certain is the evidence for other outcomes like quality of life or depression?▼

The evidence is very unclear for these outcomes because few studies reported them, and the confidence intervals were wide and crossed zero, meaning no definitive effect.

Are there any harms associated with exercise training in SCI?▼

Adverse events were reported in only one study, and the risk ratio was 1.30 (95% CI 0.32 to 5.26), indicating it is unclear whether exercise increases adverse events.

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References

  1. 1.Ilha J, Glinsky JV, Chu J, Bye EA, Tweedy SM, Harvey LA. "Physical exercise training to increase cardiorespiratory fitness in people with spinal cord injury.." The Cochrane database of systematic reviews, 2026. PMID: 42663176 DOI: 10.1002/14651858.CD014476.pub2
Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.