OBJECTIVE: To evaluate the effectiveness of a community-based structured exercise program, compared with usual care, in enhancing physical, functional, and psychological outcomes for ambulatory individuals with spinal cord injury (SCI). DESIGN: Randomized controlled trial comparing exercise group with usual care group. SETTING: One university-affiliated rehabilitation hospital. PARTICIPANTS: Fifty-seven participants with chronic SCI who could walk more than 10 m. INTERVENTIONS: A supervised 20-session program focusing on flexibility, aerobic, and strengthening exercises was provided over 8 weeks for the exercise group, whereas the usual care group maintained their regular daily exercise routines. MAIN OUTCOME MEASURES: Primary outcome included 6-minute walk test, and secondary outcomes assessed EuroQol-5 Dimensions 5-Level, Spinal Cord Independence Measure III, Berg Balance Scale, Timed Up and Go, grip strength, 30-second sit-to-stand test, sit and reach test, Beck Anxiety Inventory, Beck Depression Inventory, and bioelectrical impedance analysis. RESULTS: The 51 participants were allocated to intervention (n = 36) and usual care (n = 15) groups, consisting of 34 males and 17 females (average age 59.78 +/- 13.19y). The participants included 24 with cervical, 17 with thoracic, 8 with lumbar, and 2 with sacral lesions, with all participants having motor incomplete injuries. The exercise group showed significant improvement compared with the usual care group in the 6-minute walk test by 49.80 m (95% confidence interval (CI) 13.04 to 86.55), Berg Balance Scale scores by 3.50 (95% CI 0.96 to 6.03), 30-second sit-to-stand by 2.38 (95% CI 0.29 to 4.47), and sit and reach test by 3.89 cm (95% CI 0.96 to 6.82). The adherence rate was remarkably high at 89.6%, suggesting the feasibility of community exercise programs for this population. However, no significant changes were observed in psychological and quality-of-life measures. CONCLUSIONS: Community-based structured exercise programs have been shown to be both feasible and effective in improving walking capacity, balance, lower extremity strength, and flexibility in ambulatory individuals with SCI.

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