Background: Individuals with spinal cord injury (SCI) have increased rates of glucose intolerance,
insulin insensitivity, and type II diabetes caused mainly by the deconditioning of paralyzed muscle. The purpose
of this systematic review was to determine the effectiveness of locomotor training in individuals with SCI on
blood glucose control.
Methods: We searched studies on locomotor training for individuals with SCI with outcomes of glucose, insulin,
or outcomes that could change glucose handling (i.e. increases in muscle mass, shifts in muscle fiber type composition,
changes in transport proteins, or enzymes involved in glucose metabolism) in PubMed and EMBASE.
Results: Eleven studies (10 with incomplete SCI; 1 with complete SCI) were included in our review. Locomotor
training included body weight supported treadmill training (BWSTT) with manual or robotic assistance, with and
without functional electrical stimulation (FES), or involved FES-assisted over ground training. Six months of
locomotor training in individuals with SCI resulted in significant decreases in glucose (15%) and insulin (33%)
areas under the curve during oral glucose tolerance tests. Two to twelve months of locomotor training reversed
some of the muscle atrophy - with muscle being the site of most glucose consumption, this is important for glucose
control. Training also increased capacity for glucose storage, enzymes involved in glucose phosphorylation
(hexokinase) and oxidation (citrate synthase), and glucose transport proteins (GLUT-4). Fiber type composition
shifted to a slower fiber type, which favors glucose handling. There were no effects on fat mass.
Conclusion: Locomotor training in individuals with SCI (generally an incomplete injury) increases capacity to
handle glucose and results in muscular changes that should reduce the risk of type II diabetes.