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The effects of active upper-limb versus passive lower-limb exercise on quality of life among individuals with motor-complete spinal cord injury


Study design

Multi-centre randomized clinical trial.


(1) compare the effects of arm-cycle ergometry (ACET) and body weight supported treadmill training (BWSTT) on quality of life (QOL) and intermediary variables in individuals with spinal cord injury (SCI); (2) examine correlations between baseline measures, and changes in physical activity, QOL, and intermediaries.


Hospital-based research institutes (Vancouver, Toronto) and University-based exercise program (Hamilton).


35 participants with motor-complete SCI above T6 completed baseline assessments of physical activity, life satisfaction, independence, autonomy, positive and negative affect, and pain. Twenty-eight participants were randomized to 72 sessions of ACET (n = 14) or BWSTT (n = 14) with measures repeated following 36 sessions, 72 sessions, and 6-months post-intervention.


Neither intervention significantly impacted QOL. Pain was reduced in ACET compared to BWSTT (interaction effect p = 0.022) and was significantly less at 72 sessions vs. baseline in the ACET group (p = 0.009). At baseline, QOL was positively correlated with independence, autonomy, and positive affect and negatively correlated with negative affect (all p < 0.05). Following BWSTT, changes in moderate-vigorous physical activity correlated with changes in QOL (r = 0.87, p = 0.010). Following ACET, changes in autonomy and independence were positively correlated with changes in QOL (both r > 0.64, p < 0.048).


Contrary to previous studies, there was no benefit of either intervention on measures of QOL. The social context of exercise may be important for improving QOL. However, individuals may benefit more from active (ACET) than passive (BWSTT) exercise modalities through reduced pain. Exercise interventions that improve autonomy and independence may lead to improvements in QOL.

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Fig. 1: SF-36 pain construct (range 0–100) at each time point for each intervention.

Data availability

The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.


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The authors would like to thank all study participants and volunteers who assisted with BWSTT. We would also like to thank Dr. Jasmin K. Ma for help with data collection as well as Dr. Joan Ubeda Colomer and Athena Ginis for assistance with data entry.


The CHOICES study was funded by a project grant from the Canadian Institutes of Health Research with the funding reference number (TCA 118348). Collection of questionnaire data was supported by the Canadian Disability Participation Project which is funded by the Social Sciences and Humanities Research Council of Canada (grant no. 895-2013-1021). AVK holds the Endowed Chair in Spinal Cord Rehabilitation Research, Department of Medicine, UBC. KAMG holds the Reichwald Family Southern Medical Program Chair in Preventive Medicine.

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Authors and Affiliations



CMG acquired data, interpreted results, and drafted the manuscript for important intellectual content. ARS developed and implemented the questionnaire administration protocol, and drafted the measurement section. AVK conceived of and designed the work that led to the submission and revised the manuscript for important intellectual content. KAMG conceived of and designed the work that led to the submission, interpreted results, and revised the manuscript for important intellectual content. All authors approved the final version and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Cameron M. Gee.

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The authors declare no competing interests.

Ethics statement

We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research. Ethics approval was received from the University of British Columbia (H12-02945-11), McMaster University (12-672) and Toronto Rehabilitation Institute – University Health Network (12-5797).

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Gee, C.M., Sinden, A.R., Krassioukov, A.V. et al. The effects of active upper-limb versus passive lower-limb exercise on quality of life among individuals with motor-complete spinal cord injury. Spinal Cord 60, 805–811 (2022).

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