OBJECTIVE: To assess the influence of a home-based exercise intervention on indices of health-related quality of life (HRQOL) in persons with spinal cord injury (SCI). DESIGN: This was a randomized controlled trial (HOMEX-SCI; ISRCTN57096451). After baseline laboratory testing and a week of free-living physical activity monitoring, eligible participants were randomly assigned (2:1 allocation ratio) to a home-based moderate-intensity upper-body exercise intervention (INT, n = 13), or a lifestyle maintenance control group (CON, n = 8), for 6 weeks. SETTING: Home-based with short laboratory visits immediately before and after the intervention/control period. PARTICIPANTS: Twenty-one inactive participants with chronic (> 1 year) SCI (injury level range T4 to L5). INTERVENTION: Participants assigned to the exercise intervention group (INT) completed 4x45 min moderate-intensity (60 to 65% peak oxygen uptake (VO2peak)) arm-crank exercise per week for 6 weeks. Participants assigned to the control group (CON) were asked to maintain their habitual physical activity behaviour. MAIN OUTCOME MEASURES: Secondary outcome measures were assessed, including physical and emotional component scores (PCS and MCS) of health-related quality of life (SF-36), fatigue, global fatigue (FSS) and shoulder pain index (WUSPI). Cardiorespiratory fitness (CRF), objectively measured habitual moderate-to-vigorous physical activity (MVPA) and exercise self-efficacy (ESE) were also assessed at baseline and follow-up. RESULTS: Changes in the PCS (p = 0.017) of the SF-36, ESE (p = 0.011) and FSS (p = 0.036) were significantly different between the two groups, with moderate to large effect sizes (d = 0.75 to 1.37). Various HRQOL outcomes demonstrated 'likely' to 'very likely' positive inferences in favour of the INT group following the 6-week exercise intervention. Changes in ESE were significantly (p < 0.01) associated with changes in PCS (r = 0.62) and MCS (r = 0.71), FSS (r = -0.71) and global fatigue (r = 0.57). CONCLUSIONS: A 6-week upper-body exercise intervention improved indices of HRQOL in persons with SCI. Improvements were associated with increases in ESE. While this intervention demonstrated a positive impact on perceived physical functioning, future interventions should aim to support social and mental functioning and exercise maintenance.

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