OBJECTIVE: Evaluate the effects of following the physical activity guidelines (PAG) for adults with spinal cord injury (SCI) for 16-weeks. DESIGN: Randomized controlled trial. SETTING: Community exercise program. PARTICIPANTS: Twenty-three individuals with SCI (NLI C3 to T11, AIS A to C, YPI 12.0 +/- 9.9 years, age 41.4 +/- 11.6 years). INTERVENTIONS: Participants were randomized into PAG training (n = 12) or active control (CON; n = 11) groups. PAG training involved >= 20 min of moderate-vigorous aerobic exercise (RPE 3 to 6 on 10-point scale) and 3x10 reps of upper-body strengthening exercises (50 to 70% 1RM) 2x/wk. The CON group maintained existing physical activity levels with no guidance on training intensity. OUTCOME MEASURES: Outcome measures were obtained pre- and post-intervention. Vascular health indicators included arterial stiffness via carotid distensibility and pulse wave velocity, and endothelial function via flow-mediated-dilation (FMD). Fasted blood samples were analyzed for markers of cardiovascular disease (CVD) risk. Body composition was assessed via anthropometrics and with dual-energy x-ray absorptiometry. RESULTS: Twenty-one individuals completed the intervention (PAG = 12; COn = 9). Group-by-time interactions were observed for whole-body mass (p = 0.03), whole-body fat (p = 0.04), visceral adipose tissue (p = 0.04), and carotid artery distensibility (p = 0.05), suggesting maintained body composition and carotid stiffness in the PAG group concurrent with declines in the CON group. No changes were found in any other outcome measure. CONCLUSIONS: While 16-weeks of adherence to the PAG in adults with SCI is insufficient to improve many markers of CVD risk, it may prevent declines in others. The PAG should continue to be promoted as a means to increase physical fitness and maintain body composition in individuals with SCI, but changes may be needed to achieve other health outcomes.

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