What should patients with SCI and osteoporosis of the lower limbs avoid during training?

• A. High-intensity upper-body exercises only
• B. Max intensity in lower limbs (especially strength testing)
• C. Long slow cardio in lower limbs
• D. No exercise at all in any limb

Answer: (B)

In osteoporosis of the lower limbs, bones become fragile and can't tolerate large peak forces without risk of fracture. After spinal cord injury, there’s often accelerated bone loss in the legs, so pushing the lower limbs to maximum intensity—especially during strength testing—greatly raises the chance of a fracture. The safest approach during training is to avoid maximal loading in the lower limbs and instead use controlled, submaximal resistance and progressive loading, with emphasis on safety and technique. Upper-body high-intensity work isn’t inherently ruled out, and longer low‑impact activities can be incorporated carefully, but the key precaution for the lower limbs is to avoid maximum-intensity efforts that could overload osteoporotic bones.