The effects of exercise training on cardiometabolic health in adults with spinal cord injury: a systematic review and meta-analysis

Spinal cord injury (SCI) is associated with increased cardiometabolic health risks that may be mitigated through exercise training, although this association requires further elucidation. Therefore, the aim of the present meta-analysis was to investigate the effects of exercise training on cardiometabolic health markers in adults with SCI. A comprehensive search was conducted in three primary databases (PubMed, Web of Science, and Scopus) from inception to January 2025 to identify original studies investigating the effects of exercise training on glycemic markers, lipid profiles, blood pressure, and inflammatory markers in adults with SCI. Standardized mean differences (SMD) or weighted mean differences (WMD) with 95% confidence intervals (CIs) were determined. Twenty-nine studies, including randomized controlled trials (RCTs) and non-RCT designs, involving 502 participants with SCI, with durations of injury ranging from less than 1 to 22 years, were included in the meta-analysis. Overall, exercise training exhibited significantly larger decreases in fasting glucose [WMD: -0.15 mmol/L], insulin [SMD: -0.50], insulin resistance [SMD: -0.56], total cholesterol [WMD: -0.15 mmol/L], triglycerides [WMD: -0.15 mmol/L], diastolic blood pressure (DBP) [WMD: -2.31 mmHg], interleukin-6 [SMD: -0.75], tumor necrosis factor-alpha [SMD: -0.48], and C-reactive protein [SMD: -0.36], and significantly larger increases in high-density lipoprotein [WMD: 0.03 mmol/L], but did not differentially affect low-density lipoprotein or systolic blood pressure (SBP). Based on subgroup analyses, upper body-aerobic and high intensity interval training, and exercise without electrical stimulation (ES), appeared to be more effective for improving glycemic markers, whereas upper body resistance training and exercise without ES demonstrated greater effectiveness for improving lipid profiles. Exercise training is effective for reducing glycemic and pro-inflammatory markers, and for improving lipid profiles in adults with SCI. Moreover, exercise training decreased DBP, but not SBP, with uncertainty regarding whether the decreases in DBP are positive in this population. This is an important result, and may represent a potentially important clinical consideration. Further research is needed to determine the long-term clinical effects and whether adverse cardiovascular events are reduced or health outcomes are improved in adults with SCI.