To investigate the effects of a 6-week indoor hand-bike exercise program on fasting insulin and homeostasis model assessment of insulin resistance (HOMA-IR) levels and physical fitness in people with spinal cord injury (SCI).Randomized controlled trial.National rehabilitation center (outpatient).Participants with SCI (N=15; exercise group: n=8, control group: n=7).This study involved 60-minute exercise sessions on an indoor hand-bike. Participants in the exercise group exercised 3 times per week for 6 weeks.Health parameters (body mass index [BMI], waist circumference, percent body fat, insulin level, and HOMA-IR level) and fitness outcomes (peak oxygen consumption [Vo2peak], shoulder abduction and adduction, shoulder flexion and extension, and elbow flexion and extension).Participation in a 6-week exercise program using an indoor hand-bike significantly decreased BMI (baseline: 22.0±3.7m/kg2 vs postintervention: 21.7±3.5m/kg2, P=.028), fasting insulin (baseline: 5.4±2.9μU/mL vs postintervention: 3.4±1.5μU/mL, P=.036), and HOMA-IR (baseline: 1.0±0.6 vs postintervention: 0.6±0.3, P=.03) levels compared with those in the control group. Furthermore, this training program significantly increased Vo2peak and strength in shoulder abduction, adduction, flexion, and extension and elbow flexion and extension compared with those in the control group.Exercise using an indoor hand-bike appears to be an effective modality to improve body composition, fasting insulin, and HOMA-IR levels and fitness in people with an SCI.