Physical inactivity in individuals with spinal cord injury (SCI) has been suggested to be an important determinant of increased cardiometabolic disease (CMD) risk. However, it remains unclear whether physically active SCI individuals as compared to inactive or less active individuals have truly better cardiometabolic risk profile. We aimed to systematically review and quantify the association between engagement in regular physical activity and/or exercise interventions and CMD risk factors in individuals with SCI. Four medical databases were searched and studies were included if they were clinical trials or observational studies conducted in adult individuals with SCI and provided information of interest. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was applied to rate the certainty of evidence. Of 5816 unique citations, 11 randomized clinical trials, 3 non-randomized trial and 32 cross-sectional studies comprising more than 5500 SCI individuals were included in the systematic review. In meta-analysis of RCTs and based on evidence of moderate certainty, physical activity in comparison to control intervention was associated with: (i) better glucose homeostasis profile [WMD of glucose, insulin and Assessment of Insulin Resistance (HOMA-IR) were − 3.26 mg/dl (95% CI − 5.12 to − 1.39), − 3.19 μU/ml (95% CI − 3.96 to − 2.43)] and − 0.47 (95% CI − 0.60 to − 0.35), respectively], and (ii) improved cardiorespiratory fitness [WMD of relative and absolute oxygen uptake relative (VO₂) were 4.53 ml/kg/min (95% CI 3.11, 5.96) and 0.26 L/min (95% CI 0.21, 0.32) respectively]. No differences were observed in blood pressure, heart rate and lipids (based on evidence of low/moderate certainty). In meta-analysis of cross-sectional studies and based on the evidence of very low to low certainty, glucose [WMD − 3.25 mg/dl (95% CI − 5.36, − 1.14)], insulin [− 2.12 μU/ml (95% CI − 4.21 to − 0.03)] and total cholesterol [WMD − 6.72 mg/dl (95% CI − 13.09, − 0.34)] were lower and HDL [WMD 3.86 mg/dl (95% CI 0.66, 7.05)] and catalase [0.07 UgHb-1 (95% CI 0.03, 0.11)] were higher in physically active SCI individuals in comparison to reference groups. Based on limited number of cross-sectional studies, better parameters of systolic and diastolic cardiac function and lower carotid intima media thickness were found in physically active groups. Methodologically sound clinical trials and prospective observational studies are required to further elaborate the impact of different physical activity prescriptions alone or in combination with other life-style interventions on CMD risk factors in SCI individuals.

脊髓损伤 (SCI) 患者缺乏身体活动被认为是心脏代谢疾病 (CMD) 风险增加的重要决定因素。然而，目前尚不清楚体育锻炼的 SCI 个体与不活动或活动较少的个体相比是否真正具有更好的心脏代谢风险状况。我们的目的是系统地回顾和量化 SCI 患者定期进行体力活动和/或运动干预与 CMD 危险因素之间的关联。检索了四个医学数据库，并纳入了在成人 SCI 患者中进行的临床试验或观察性研究，并提供了感兴趣的信息。采用建议评估、制定和评价分级（GRADE）方法来评估证据的确定性。在 5816 篇独特引用中，系统评价纳入了 11 项随机临床试验、3 项非随机试验和 32 项横断面研究，其中包括超过 5500 名 SCI 个体。在随机对照试验的荟萃分析中，基于中等确定性的证据，与对照干预相比，体力活动与：（i）更好的葡萄糖稳态曲线[葡萄糖、胰岛素的 WMD 和胰岛素抵抗评估（HOMA-IR）为 -分别为 3.26 mg/dl（95% CI − 5.12 至 − 1.39）、− 3.19 μU/ml（95% CI − 3.96 至 − 2.43）] 和 − 0.47（95% CI − 0.60 至 − 0.35）]，和（ ii) 改善心肺健康[相对和绝对摄氧量相对 (VO ₂ ) 的 WMD 分别为 4.53 ml/kg/min (95% CI 3.11, 5.96) 和 0.26 L/min (95% CI 0.21, 0.32)]。血压、心率和血脂没有观察到差异（基于低/中确定性的证据）。 在横断面研究的荟萃分析中，基于极低至低确定性的证据，葡萄糖[WMD − 3.25 mg/dl (95% CI − 5.36, − 1.14)]、胰岛素[− 2.12 μU/ml (95 % CI − 4.21 至 − 0.03)] 和总胆固醇 [WMD − 6.72 mg/dl (95% CI − 13.09, − 0.34)] 较低，HDL [WMD 3.86 mg/dl (95% CI 0.66, 7.05)] 和与参考组相比，体力活跃的 SCI 个体的过氧化氢酶 [0.07 UgHb-1 (95% CI 0.03, 0.11)] 较高。基于有限数量的横断面研究，发现体力活动组的心脏收缩和舒张功能参数更好，颈动脉内膜中层厚度更低。需要进行方法学上合理的临床试验和前瞻性观察研究，以进一步阐明不同的身体活动处方单独或与其他生活方式干预措施相结合对 SCI 个体 CMD 危险因素的影响。