Eligibility Details:
Inclusion Criteria:
1. Men and women, 19 to 70 years
2. Confirmed spinal cord injury C7-T12 motor level, AIS grade A-C who are at least 6
months post-injury and who use a wheelchair as their primary mobility mode
3. Medically stable, able to follow directions
4. Able to provide informed consent.
5. For females of reproductive potential: use of highly effective contraception for at
least 1 month prior to Day 1 and agreement to use such a method during study
participation and for an additional 12 weeks after the end of intervention.
Exclusion Criteria:
1. Upper extremity musculoskeletal conditions (such as advanced rotator cuff pathology or
carpal tunnel syndrome) or neurological disorder preventing arm ergometry
2. Fractures in the upper or lower extremity
3. In accordance with the Endocrine Society and ISSAM Guidelines, we will exclude
individuals with a contraindication for androgen use:
- History of prostate or breast cancer
- Severe lower urinary tract symptoms (IPSS score of > 19)
- Prostate nodule or induration on digital rectal examination (DRE)
- Prostate specific antigen (PSA) > 4 ng/ml or > 3 ng/ml in individuals at high
risk of prostate cancer such as African Americans or those with family history of
prostate cancer in first degree relatives, unless there has been a negative
prostate biopsy within 3 months
- Hematocrit > 48%
4. Conditions that would render exercise and FES unsafe or unfeasible such as severe
autonomic dysreflexia, orthostatic hypotension, exercise-induced hypotension, severe
pressure sores, severe spasticity and severe pain.
5. Body mass index (BMI) > 45 kg/m2
6. Renal dysfunction as indicated by GFR of <50 ml/min, estimated by using the
Modification of Diet in Kidney Disease (MDRD) Study equation, in accordance with
K/DOQI guidelines
7. Use of testosterone or other anabolic therapies, including DHEA and androstenedione,
or rhGH in the preceding 6 months
8. Active cancer requiring therapy and which may limit life expectancy to less than 5
years
9. Psychosis, bipolar disorder, or major untreated depression
10. Dementia (Mini-Mental Status Exam [MMSE] <24)
11. Myocardial infarction (MI) within 3 months of entry
12. ALT and AST > 3 x upper limit of normal
13. Poorly controlled diabetes as indicated by hemoglobin (Hb)-A1c greater than 9.0%
14. Blood thinners such as Coumadin, heparin, rivaroxaban (Xarelto), dabigatran (Pradaxa),
lovenox (subcutaneous heparin), apixaban (Eliquis) (aspirin, plavix and other
anti-platelet agents are allowed)
16. Systolic blood pressure (BP) > 170 or diastolic BP > 100 mm Hg 17. Current grade 2 or
greater pressure ulcers at relevant contact sites 19. Because the safety of nandrolone
decanoate has not been established in pregnancy and lactation, we will exclude pregnant or
lactating women and women of childbearing potential who are unwilling or unable to use a
reliable form of contraception. We will perform a blood test to exclude pregnancy at the
time of enrollment.
20. Participation in a structured exercise program currently or in the past 3 months 21.
Inability or unwillingness to participate in the hybrid exercise training or the
assessments of muscle performance and physical performance