The main alterations associated with cerebral palsy (CP) include impairments in body functions and structures, activity limitations and participation restrictions. Thus, the health of individuals with CP can be affected in all domains of the International Classification of Functioning, Disability and Health (ICF). Aerobic exercise showed beneficial results for this population. Most studies report its benefits on body structures and functions; however, the results regarding activity and participation are less explored. The literature does not have comprehensive systematic reviews addressing the benefits of aerobic exercise for individuals with CP in the three domains of the ICF.

To investigate the effectiveness of aerobic exercise on the functionality of children and adolescents with (CP). The effectiveness of aerobic exercise on quality of life (QoL) was verified secondarily.

A systematic review with meta-analysis was conducted, taking into account the recommendations of the Report Items Referenced for Systematic Reviews and Meta-analyses (PRISMA) statement. An extensive search for articles was carried out in the electronic databases PubMed, PEDro, Embase and CINAHL. This systematic review was registered in the PROSPERO International Prospective Registry (nr. CRD42021251361). The methodological quality and certainty of the evidence were assessed using the PEDro and GRADE scales (Evaluation Rating, Development and Evaluation of Recommendations). The effects of aerobic exercise were investigated with meta-analytical techniques.

15 randomized controlled clinical trials (RCTs) were included, with 414 participants. As for the methodological quality, a low risk of bias was revealed. Aerobic exercise was effective in improving aerobic capacity (standardized mean difference [SMD] = 0.81; 95% confidence interval [CI] = 0.16–1.47; p < 0.002; I2 = 68%), gross motor function (SMD = 0.70; 95% = CI 0.21–1.19; p = 0.005; I2 = 49%), mobility (SMD = 0.53; 95% CI = 0.05–1.05; p = 0.03; I2 = 27%), balance (p < 0.05), and participation (SMD = 0.74; 95% CI = 0.10–1.39; p = 0.02; I2 = 0%). Aerobic exercise did not prove to be more effective in terms of muscle strength, spasticity, gait parameters and QoL (p > 0.05). The certainty of evidence for most comparisons was moderate to low.

The results show that aerobic exercise improves aerobic capacity, gross motor function, mobility, balance, and participation, but it did not show significant effects on muscle strength, spasticity, gait parameters and quality of life. The certainty of the evidence was moderate to low. Given the small sample size, heterogeneity may be underestimated, leading to uncertainties regarding effect estimates. New RCTs involving larger samples are needed for definitive conclusions to be reached.

Clinicians should cautiously replicate this intervention, as new studies with larger sample sizes and quality must be conducted.