Effectiveness of therapeutic exercise programs on balance and gait in children and adolescents with unilateral cerebral palsy: A systematic review and meta-analysis of randomized controlled trials

Abstract

Objective

Unilateral cerebral palsy causes motor impairments affecting upper and lower limbs; compromising balance and gait. Although therapeutic exercise is commonly used, heterogeneity in interventions and outcomes hinders interpretation. This systematic review evaluated the effects of exercise programs on balance and gait in children and adolescents with unilateral cerebral palsy.

Data Sources

Searches were conducted in PubMed, Cochrane CENTRAL, PEDro, SPORTDiscus, and Scopus from inception to January 2026. Reference lists of eligible studies were also screened.

Methods

Randomized controlled trials including participants aged 2–18 years with unilateral cerebral palsy, assessing exercise programs targeting balance or gait were eligible. Independent reviewer pairs conducted screening, data extraction, and risk-of-bias assessments, resolving disagreements with a third reviewer. Standardized mean differences (SMD) were pooled using a random-effects model. Subgroup, sensitivity, and meta-regression analyses were performed. Certainty of evidence was rated with GRADE.

Results

Thirteen trials were included. Exercise programs produced a significant moderate effect on balance (SMD = 0.61; 95% CI: 0.38 to 0.83; I² = 0.003%). The pooled effect on gait was moderate (SMD = 0.51; 95% CI: −0.22 to 1.23) but not significant, with high heterogeneity (I² = 91.1%). Subgroup analyses suggested larger effects with non-plyometric training for balance and with plyometric training for gait. Meta-regression indicated a positive dose–response relationship for balance.

Conclusion

Therapeutic exercise programs improve balance in youths with unilateral cerebral palsy with evidence of a dose–response effect. Effects on gait remain uncertain. Structured balance-focused interventions should be integrated into rehabilitation programs.