Spinal cord injury leads to two dramatic changes: not only is there loss of muscle function and a large amount of muscle, but also susceptibility to inactivity related diseases, such as obesity, insulin resistance, type II diabetes, and coronary heart disease, increases.¹ Previously, one of the major problems and causes of death for people with spinal cord injuries was infection, but recently, coronary heart disease has become more prominent. The possibilities for exercise in people with spinal cord injuries are limited to either performing voluntary exercise with non-paralysed muscle groups—for example, arm exercises, especially in the paraplegic—or subjecting themselves to electrically induced exercise through stimulation of motor nerves either with surface electrodes or after implantation of electrodes.

Whereas voluntary arm exercise can provide a …