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Purpose To test the hypothesis that aerobic fitness is inversely related to the risk of atherosclerotic cardiovascular disease (ACVD) in athletes with locomotor impairments deriving from health conditions, such as spinal cord injury (SCI), lower limb amputation, cerebral palsy, poliomyelitis, and other health conditions different from the previous ones. Methods A total of 68 male athletes who competed in either summer or winter Paralympic games were divided in two health conditions groups (35 with SCI, mean age 37.2 ± 8.0 years, and 33 with different health conditions, mean age 37.8 ± 9.9 years) and in four sport type groups (skill, power, intermittent—mixed metabolism—and endurance). They were evaluated through anthropometric and blood pressure measurements, laboratory blood tests, and graded cardiopulmonary maximal arm cranking exercise test, with oxygen uptake peak ( V O 2peak ) measurement. Cardiovascular risk profile was assessed in each athlete. Results The prevalence of ACVD-risk factors in the overall population was 20.6% for hypertension; 47% and 55.9% for high values of total and LDL cholesterol, respectively; 22.1% for reduce glucose tolerance; and 8.8% for obesity. No difference was found between athletes with and without SCI, while the prevalence of obesity was significantly higher in those practicing skill sports (22.7%,  p  = 0.035), which was the sport type group with Paralympic athletes with the lowest  V O 2peak  (22.5 ± 5.70 ml kg −1  min −1 ).  V O 2peak  was lower in athletes with SCI than those with different health conditions (28.6 ± 10.0 vs 33.6 ± 8.9 ml kg −1  min −1  p  = 0.03), and in those with 3–4 risk factors (19.09 ± 5.34 ml kg −1  min −1 ) than those with 2 risk factors (27.1 ± 5.50 ml kg −1  min −1 ), 1 risk factor (31.6 ± 8.55 ml kg −1  min −1 ), or none (36.4 ± 8.76 ml kg −1  min −1 ) ( p  &lt; 0.001). Conclusions The present study suggests that having higher  V O 2peak  seems to offer greater protection against ACVD in individuals with a locomotor impairment. Prescribing physical exercise at an intensity similar to that of endurance and intermittent sports should become a fundamental tool to promote health among people with a locomotor impairment.

Aerobic fitness is a potential crucial factor in protecting paralympic athletes with locomotor impairments from atherosclerotic cardiovascular risk