Martinez, Katherine

Background: Physical inactivity is highly prevalent among individuals with spinal cord injury (SCI), contributing to secondary health conditions and reduced quality of life (QOL). Objectives: To examine the independent associations between adherence to SCI cardiorespiratory fitness guidelines and health and psychosocial outcomes, while controlling for relevant covariates. Method: We conducted a multisite, cross-sectional study of adults with traumatic SCI stratified by self-reported leisure-time physical activity: no activity (28%), some activity (41%), and met guidelines (26%). Multivariable regression models analyzed associations between physical activity (PA) group and outcomes of hospitalization, self-perceived health, resilience (SCI-QOL Resilience), pain, depression (PHQ-8), QOL (SWLS), and social integration (CHART-SF). Results: The study included 361 participants (no activity, 28%; some activity, 41%; met guidelines, 26%). Meeting PA guidelines was associated with better self-perceived health (odds ratio [OR] 2.79, P < .001) and higher resilience (β = 1.78, P = .04) compared to the No Activity group. However, hospitalization risk was unexpectedly higher for both the Some Activity (risk ratio [RR] 1.93, P = .005) and Met Guidelines (RR 1.75, P = .03) groups. After adjusting for covariates, PA was not significantly associated with pain, depression, QOL, or social integration; instead, higher income was consistently associated with better outcomes in these domains. Conclusion: Adherence to SCI exercise guidelines is associated with enhanced self-perceived health and resilience. However, PA alone was not associated with broader psychosocial outcomes in this model, where socioeconomic factors such as income appeared to play a significant explanatory role.