OBJECTIVE: To evaluate the impact of lifestyle and behavioral interventions on anthropometric indices and body composition in individuals with spinal cord injury (SCI). DATA SOURCES: MEDLINE, EMBASE, Web of Science, and Cochrane Library were searched from inception to January 22, 2024. STUDY SELECTION: Randomized clinical trials (RCTs), non-randomized clinical trials and pre-post studies on the effectiveness of lifestyle and/or behavioral interventions in improving body composition (including body mass index, waist circumference, fat mass and lean mass) were eligible. DATA EXTRACTION: Study design characteristics, number of participants, interventions/controls characteristics, and outcomes were extracted. DATA SYNTHESIS: Sixty-one interventional studies were included in the systematic review, among which five RCTs contributed to meta-analysis. Exercise, alone or combined with functional electrical stimulation (FES), supplements, or educational sessions, was the most studied intervention across the identified studies, accounting for 75% of studies. Exercise regimen compared to the usual activities yielded a decrease in BMI (MD -0.38 kg/m2 (95% CI -0.57 to -0.19, I2 0%, pq 0.45)) and waist circumference (MD -2.93 cm (95% CI -3.98 to -1.88, I2 0%, pq 0.59)). No significant differences were observed when comparing changes in total body fat percentage nor lean body mass between the two groups. Exercise with FES and testosterone, exercise and personalized diet, high protein diet, and alpha-lipoic acid supplementation were mapped as other potentially beneficial interventions, while studies targeting behavioral changes were inconclusive. CONCLUSION: Exercise-based interventions alone or combined with FES or standardized/personalized dietary regimens show promise as effective strategies for improving anthropometric indices and body composition among individuals with SCI, emphasizing the potential benefit of weight management programme. The present findings may not be applicable to individuals with high SCI lesion. Further research to evaluate the effectiveness of a more complex lifestyle and / or behavioral interventions in individuals with SCI is warranted.

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