Efficacy of aerobic exercise on the functioning and quality of life of children and adolescents with cerebral palsy: A systematic review and meta-analysis.

Aim: To investigate the efficacy of aerobic exercise on the functioning (participation, activities, and body functions and structures) and quality of life (QoL) of children and adolescents with cerebral palsy (CP).

Method: A systematic review with meta-analysis was performed. A comprehensive search of articles was performed using the electronic databases Embase, PubMed, PEDro, and CINAHL. Methodological quality and certainty of evidence were evaluated with the PEDro and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) scales respectively. The effects of aerobic exercise on functioning were assessed using meta-analytic techniques. However, given the broad nature of outcomes related to functioning and QoL, different instruments can be used to measure them; this made it impossible to synthesize results in a meta-analysis for some of the outcomes.

Results: Fifteen randomized controlled trials with 414 participants with CP were included. Analysis of the methodological quality of the studies revealed a low risk of bias. The effect of aerobic exercise compared to usual care or other interventions was significant for aerobic capacity (standardized mean difference [SMD] = 0.81; 95% confidence interval [CI] = 0.16-1.47; p < 0.002; I  = 68%), gross motor function (SMD = 0.70; 95% = CI 0.21-1.19; p = 0.005; I  = 49%), mobility (SMD = 0.53; 95% CI = 0.05-1.05; p = 0.03; I  = 27%), balance, and participation (SMD = 0.74; 95% CI = 0.10-1.39; p = 0.02; I  = 0%). Aerobic exercise was not effective for muscle strength, spasticity, gait parameters, and QoL (p > 0.05). The certainty of evidence for most comparisons was moderate to low.

Interpretation: This review provides the most up-to-date evidence on the efficacy of aerobic exercise on the functioning and QoL of children and adolescents with CP.

What This Paper Adds: Aerobic exercise improves gross motor function but not gait parameters in cerebral palsy (CP). It improves participation but not quality of life in children and adolescents with CP. It is more effective than usual care or other interventions in improving mobility, aerobic capacity, and balance in CP. It is no more effective than usual care or other interventions in improving muscle strength and spasticity.