Intervention on Bone Health in Wheelchair Users

Inclusion Criteria: * BMD Z-score of the spine ≤ 0 SD * primary aid for mobility being a manual wheelchair, i.e. ≥50% of the time * 18-60 Y * congenital (i.e., CP, spina bifida, dysmelia, hip dysplasia) and acquired disabilities (i.e., SCI, amputation) * non-progressive impairment, and in the case of SCI; ≥ 2 years since time of injury * ability to perform key exercises (e.g., overhead press) Exclusion Criteria: * injury acquired \<2 Y ago * change in health and/or medication within the last 3 months * fractures affecting measured sites or contraindicating strength testing/training * menopausal, pregnancy or planned pregnancy during the study period * language or cognitive barriers affecting the ability to understand all aspects of the study * • patients with progressive neurological disease, serious or uncontrollable epilepsy, endocrine diseases (including diabetes mellitus type 1 or 2, thyroid disorders, calcium homeostasis disorders and metabolic bone disease, pituitary gland disorder, sex hormone disorders), cancer, serious mental disorder, or comorbid medical conditions affecting either a) nutritional function: i.e., malabsorption problems due to previous surgery in the gastrointestinal tract, inflammatory bowel disease, coeliac disease, eating disorders, chronic pancreatitis, liver or kidney disease (those that cannot convert vitamin D to its active form in the body), other conditions affecting vitamin D or calcium absorption; b) musculoskeletal system: i.e., congeni…