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Overall and Modality-Specific Exercise Doses for Motor Skill Improvement in Cerebral Palsy: A Systematic Review and Bayesian Network Dose-Response Meta-Analysis

pediatrics
rehabilitation
sports-medicine

Abstract

Objective: To examine the nonlinear dose–response of overall and modality-specific exercise interventions on motor skill improvement in children and adolescents with cerebral palsy (CP) using a Bayesian model-based network meta-analysis.

Methods: RCTs involving participants aged ≤18 years with CP were retrieved from five databases (PubMed, Embase, Web of Science, Cochrane Library, SPORTDiscus; up to Aug 10, 2025). Gross motor function (GMFM-66/88) was the main outcome. Exercise dose was standardized as METs·min/week, and nonlinear MBNMA estimated overall and modality-specific effects. Quality and certainty were evaluated using PEDro and GRADE.

Results: Twenty RCTs were included. Most applied aerobic exercise, body control, or resistance training. The mean PEDro score was 6.7, indicating moderate–high quality. Overall, exercise improved GMFM with a small-to-moderate effect (SMD = 0.295; 95% CrI 0.016–0.613). The dose–response showed an inverted U-shape, peaking near 560 METs·min/week, with stable gains between 330–560. By modality, body control training yielded the most consistent improvements at ~330 METs·min/week (SMD = 0.313; 95% CrI 0.014–0.666), while aerobic and resistance training showed smaller, less stable effects that declined at higher doses. Evidence certainty was moderate, with minimal publication bias.

Conclusion: Exercise improved motor function in children with cerebral palsy, with optimal benefits at 330–560 METs·min/week. Body control training around 330 METs·min/week produced the most stable gains, whereas aerobic and resistance training declined at higher doses. These findings highlight the importance of defining effective dose ranges; larger multicenter RCTs with standardized dose reporting are needed to refine clinical guidelines.

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