The risks and health hazards of the cardiometabolic syndrome (CMS) are commonly reported in persons with spinal cord injuries (SCIs) and disorders. Overweight/obesity, insulin resistance, hypertension, and dyslipidemia are highly prevalent after SCI. Both the CMS diagnosis and physical deconditioning worsen the prognosis for all-cause cardiovascular disease. Evidence suggests a role for physical activity to address these risks, although intense exercise may be required. A lifestyle plan incorporating both exercise and nutrition represents a preferred approach for health management. Improved surveillance for CMS risks and exercise and nutritional management are essential for the preservation of optimal health and independence.