Effectiveness of Physical Exercises on the Functional Performance, Cognitive Function, and Quality of Life of Children and Adolescents with Cerebral Palsy: A Systematic Review and Meta-Analysis

A bstract Background: Cerebral palsy (CP) presents challenges in motor function, cognition, and quality of life (QoL) in children and adolescents. Physical exercise is widely recommended, yet its overall effectiveness remains unclear. Objective: To evaluate the effects of physical exercise on functional performance, cognitive function, and QoL in children and adolescents with CP. Materials and Methods: A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eight databases (CINAHL, Cochrane Library, EMBASE, AMED, MEDLINE, PsycINFO, EMCARE, and PubMed) were searched up to June 30, 2024. Randomized controlled trials (RCTs) of aerobic and/or resistance exercise in participants of <18 years with CP were included. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. Meta-analyses were performed with a random-effects model, generating standardized mean differences (SMD) for continuous outcomes. Heterogeneity was evaluated using I 2 statistics. Results: Twelve RCTs with 396 participants met eligibility. Adherence to interventions was high (89.5–96.3%). Meta-analysis found no significant improvements in Gross Motor Function (GMF) (SMD = −0.48, P = 0.55), spasticity (SM = 0.19, P = 0.82), or muscle strength (SMD = 0.12, P = 0.48). Narrative synthesis indicated potential benefits for QoL and cognitive outcomes, including motor function, autonomy, emotional well-being, and attention. Subgroup and sensitivity analyses by the GMF Classification System (GMFCS) levels, exercise type, and risk of bias showed no significant group differences. Small sample sizes across studies may limit confidence in these findings. Conclusion: Physical exercise did not significantly improve motor or strength outcomes but showed potential benefits for QoL and cognition. Larger, rigorously designed trials are needed to establish evidence-based physiotherapy guidelines for CP rehabilitation. Protocol registration at INPLASY (ID: INPLASY202250023).