Does physical exercise training improve heart and lung function (cardiorespiratory fitness) in people with spinal cord injury?

Key messages

• Physical exercise training may help increase heart and lung function (cardiorespiratory fitness) in people with spinal cord injury up to 6 weeks after training stopped.

• The effects of physical exercise training are unclear on the ability to perform everyday activities, well-being, mood, and any unwanted effects.

• In the future, researchers should focus on large, well-designed studies that address issues that are important to people with spinal cord injury.

What is a spinal cord injury?

The spinal cord is a bundle of nerves and fibres that runs from the brain down the centre of the spine. It carries signals between the brain and parts of the body. A spinal cord injury (as a result of an accident or medical condition) disrupts these signals. This can cause loss of muscle function or movement (paralysis) or weakness, loss of feeling, and issues with basic body functions like bladder and bowel control, sexual function, and blood pressure regulation. The exact location of the injury determines how much of the body is affected. Injuries in the neck can affect the whole body; injuries in the back may only affect the trunk and legs. People with spinal cord injury find everyday tasks and movement difficult. Some need a wheelchair to move about and rely on help from others for daily tasks.

What is cardiorespiratory fitness?

Cardiorespiratory fitness is how well your heart, lungs, and blood vessels work together to supply oxygen to your body during physical activities. The benefits of good cardiorespiratory fitness on general health, daily life, mood and well-being are widely accepted for non-disabled people, but can be challenging to achieve in people who find it hard or impossible to move their limbs. However, people with spinal cord injury may also benefit from good cardiovascular fitness, meaning they could lead more active lives with more independence and better well-being.

What did we want to find out?

We wanted to know whether physical exercise training (compared to no training) improved cardiorespiratory fitness in people with spinal cord injury. We also looked at its effects on:

• functional fitness (the ability to perform daily activities, like push a wheelchair or walk a certain distance);

• well-being:

• mood (depression and anxiety); and

• unwanted effects due to training, such as death, hospitalisation, falls, stroke or heart attack, pain, or injury.

What did we do?

We searched for studies that compared physical exercise training to no training in adults with spinal cord injury. They could have had their injury for any length of time, and it could be from any cause. Training could last for any time and be of any intensity but had to be planned, structured and repetitive, and intended to improve cardiorespiratory fitness. It could include cycling, rowing, walking or swimming. It could take place in hospital, in the community or at home.

We compared and summarised the results of the studies and rated our confidence in the evidence, based on factors such as the design and size of studies.

What did we find?

We found 17 studies with a total of 505 people. There were between 10 and 68 people in each study, with a mix of neck and back injuries. They had an average age of 27 to 57 years, and 71% were men. Twelve studies took place in Europe or North America. Training sessions:

• focused on arms only or arms and legs

• typically consisted of using an arm ergometer (stationary arm bike), rowing, wheelchair propulsion, robotic gait training (machine-based, supported walking)

• happened two to five times a week

• ran for between 6 weeks and 9 months, and

• lasted between 30 minutes and 2 hours.

All studies examined the effects of physical exercise up to six weeks after the training had stopped (short-term) and only one study for longer than 6 weeks (long-term).

In the short-term, physical exercise training may help improve cardiorespiratory fitness in people with spinal cord injury (15 studies, 337 participants).

It is unclear whether physical exercise training:

• increases functional fitness (3 studies, 67 people)

• improves well-being (2 studies, 49 people)

• reduces depression and anxiety (1 study, 23 people)

• increases unwanted events (4 studies, 141 people)

What are the limitations of the evidence?

Our confidence in the evidence is low or very low for several reasons. Most studies were small and not high quality. For example, many studies failed to present all the data that they collected, failed to provide a plan at the start of the study on how they would analyse the data, and failed to keep most of the participants in the study. Few studies included our most important points of interest for this review.

How up to date is this evidence?

The evidence is current to 9 December 2025.