Background: The objective of this study was to verify the long-term effects of exercise on energy expenditure and body composition in individuals with spinal cord injury (SCI), as very little information is available on this population under free-living conditions. Methods: Free-living energy expenditure and body composition using doubly labeled water (DLW) was measured in 13 individuals with SCI, subdivided in 2 groups: (1) sedentary (SED; N = 7) and (2) regularly engaged in any exercise program, for at least 150 min緫-1 (EXE; N = 6). Results: The total daily energy expenditure (TDEE) was significantly higher in the EXE group (33 ᠴ.5 kcal竧-1礡y-1) if compared with SED group (27 ᠴ.3 kcal竧-1礡y-1). The percentage of body fat was significantly higher in SED group than in EXE group (38 ᠶ% and 28 ᠹ%). Conclusion: Our findings revealed that, despite the severity of SCI, the actual ACSM's guidelines for weight management for healthy adults exercise could significantly increase TDEE and BMR and improve body composition in individuals who regularly perform exercise. However, the EXE group still showed a high percentage of body fat, suggesting that a more specific approach might be considered (ie, increased intensity or volume, or combining with a diet program).