While upper body training is effective for improving aerobic fitness and muscle strength after spinal cord injury (SCI), activity-based therapies (ABT) intended to activate the paralysed extremities have been reported to promote neurological improvement. We investigated the effectiveness of intensive ABT compared with upper body training for people with SCI.

One hundred and sixteen participants (C2-T12, AIS A-D) were recruited from six SCI units in Australia and New Zealand, and randomised to experimental or control groups. Experimental participants received a 12-week ABT program including locomotor training, functional electrical stimulation-assisted leg cycling, and trunk and lower extremity exercises, while control group participants undertook upper body strength and aerobic fitness training. The primary outcome measure was the ASIA motor scores for upper and lower extremities.

One hundred and three participants completed the interventions and were included in the primary analysis. Mean (SD) upper extremity motor scores for experimental (n=49) and control (n=54) groups were 41.45 (12.11) and 39.39 (11.94), respectively, with an adjusted mean between-group difference of −0.039 (95% CI: −1.12 to 1.04). Mean (SD) lower extremity motor scores were 12.51 (17) and 10.24 (17.19) for experimental and control groups, with an adjusted mean between-group difference of 0.895 (95% CI: −0.48 to 2.27). There were 15 serious adverse events within each group, but only one of these was related to the experimental intervention (bilateral femoral condyle and tibial plateau subchondral fractures).

Activity-based therapy did not lead to greater improvements in ASIA motor scores compared to upper body training.