['To compare physical activity levels (PALs) of free-living adults with chronic paraplegia with World Health Organization recommendations and to compare energy expenditure between persons with complete vs. incomplete paraplegia.', 'Twenty-seven euthyroid adults (17 men and 10 women) with paraplegia (12.5 +/- 9.5 years since onset; 17 with complete lesions and 10 with incomplete lesions) participated in this cross-sectional study. Resting metabolic rate was measured by indirect calorimetry and total daily energy expenditure (TDEE) by heart rate monitoring. PAL was calculated as TDEE/resting metabolic rate. Total body water was measured by deuterium dilution and fat-free mass (FFM) and fat mass (FM) by calculation (FFM = total body water/0.732; FM = weight - FFM). Obesity was defined using the following percentage FM cutoffs: men 18 to 40 years >22% and 41 to 60 years >25%; and women 18 to 40 years >35% and 41 to 60 years >38%.', 'Nineteen subjects (70.4%; 13 men and six women) were obese. Fifteen subjects (56%) engaged in structured physical activity 1.46 +/- 0.85 times during the observation period for a mean of 49.4 +/- 31.0 minutes per session. Despite this, mean PAL of the group was 1.56 +/- 0.34, indicative of limited physical activity. TDEE was 24.6% lower in subjects with complete paraplegia (2072 +/- 505 vs. 2582 +/- 852 kcal/d, p = 0.0372).'] Are physical activity levels low in free-living adults with chronic paraplegia?