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. 2022 Apr 7;37(4):335–365. doi: 10.1007/s10654-022-00859-4

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© The Author(s) 2022

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 3 — The illustrative summary of the most important findings of the current systematic review. White: No association observed in the meta-analysis. Dark grey: Results were supported by meta-analysis of cross-sectional studies and RCTs (i.e. glucose homeostasis). Grey: Results were supported by meta-analysis of cross-sectional studies only (i.e. blood lipids). Light grey: Results were significant only in cross-sectional studies but not overall (i.e. pooled estimates were significant only in analyses comparing para-athletes with sedentary individuals with SCI). Letters A-D refer to certainty of evidence as assessed using the GRADE approach: A: high certainty, B: moderate certainty; C: low certainty and D: very low certainty; First letter refers to certainty of evidence from cross-sectional studies, second letter refers to certainty of evidence from RCTs (missing letter for RCTs indicates that association was not supported by evidence form RCTs or that meta-analysis was not performed)