Study design/Methods: Literature review. Papers were selected from a literature search of both the Medline and Current Contents data bases and through extensive cross checking of references from the author's personal ®les. Objectives: To evaluate the evidence for a reduced level of HDL-C in individuals with spinal cord injury and to discuss physiologic and behavioral factors that may be responsible for the observed reduction, with emphasis on the role of physical activity. Results/Conclusions: The evidence presented suggests that HDL-C may be lower in persons with SCI; however, the available data should be interpreted cautiously due to lack of control for important confounding factors such as smoking, alcohol consumption and physical activity. Results suggest a potential association between increased physical activity and increased HDL-C in persons with SCI. However, the mode, frequency, intensity and duration of activity and the physiologic mechanism responsible for this association have yet to be clearly elucidated.