PURPOSE: Evaluate effectiveness of active exercise interventions for improving gross motor activity/participation of school-aged, ambulant/semi-ambulant children with cerebral palsy (CP). METHOD: A systematic review was conducted following PRISMA guidelines. Five databases were searched for papers including school-aged children with CP, participating in active, exercise interventions with gross motor outcomes measured at the activity/participation level. Interventions with previous systematic reviews were excluded (eg, hippotherapy). Evidence level and conduct were examined by two raters. RESULTS: Seven interventions (34 studies) met criteria. All studies reported on gross motor function, however, a limited number investigated participation outcomes. Strong positive evidence was available for gross motor activity training (n = 6, evidence level II to IV), and gross motor activity training with progressive resistance exercise plus additional physiotherapy (n = 3, all evidence level II). Moderate positive evidence exists for gross motor activity training plus additional physiotherapy (n = 2, all evidence level II) and physical fitness training (n = 4, evidence level II to V). Weak positive evidence was available for modified sport (n = 3, evidence level IV to V) and non-immersive virtual reality (n = 12, evidence level II to V). There was strong evidence against gross motor activity training plus progressive resistance exercise without additional physiotherapy (n = 4, all evidence level II). INTERPRETATION: Active, performance-focused exercise with variable practice opportunities improves gross motor function in ambulant/semi-ambulant children with CP.

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