OBJECTIVE: To investigate the effects of a six-week indoor hand-bike exercise program on fasting insulin and homeostasis model assessment of insulin resistance (HOMA-IR) levels and physical fitness in people with spinal cord injury (SCI). DESIGN: Randomized controlled trial. SETTING: National rehabilitation center (outpatient). PARTICIPANTS: Fifteen participants with SCI (exercise group: eight, control group: seven). INTERVENTIONS: This study involved 60-minute exercise sessions on an indoor hand-bike. Participants in the exercise group exercised three times per week for six weeks. MAIN OUTCOME MEASURES: Health parameters (body mass index (BMI), waist circumference, percent body fat, insulin level, and HOMA-IR level) and fitness outcomes (peak oxygen consumption (VO2peak), shoulder abduction and adduction, shoulder flexion and extension, elbow flexion and extension). RESULTS: Participation in a six-week exercise program using an indoor hand-bike significantly decreased BMI (baseline 22.0 +/- 3.7 m/kg2 versus post-intervention 21.7 +/- 3.5 m/kg2, p = 0.028), fasting insulin (baseline 5.4 +/- 2.9 muU/ml versus post-intervention 3.4 +/- 1.5 muU/ml, p = 0.036), and HOMA-IR (baseline 1.0 +/- 0.6 versus post-intervention 0.6 +/- 0.3, p = 0.030) levels compared to those in the control group. Furthermore, this training program significantly increased VO2peak and strength in shoulder abduction, adduction, flexion and extension, and elbow flexion and extension compared to those in the control group. CONCLUSIONS: Exercise using an indoor hand-bike appears to be an effective modality to improve body composition, fasting insulin and HOMA-IR levels, and fitness in people with a SCI.

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