The effects of progressive resistance training on lower limb strength in adolescents with cerebral palsy: A systematic review and meta-analysis

Abstract

Background

Cerebral palsy (CP) is a leading cause of physical disability in children, characterized by impaired motor function and muscle weakness. Progressive resistance training (PRT) has emerged as a potential strategy for improving lower limb strength, though the existing evidence remains inconsistent.

Objective

To assess the impact of PRT on lower limb muscle strength in youth with CP, compared to control or alternative interventions.

Methods

This study systematically reviewed randomized controlled trials (RCTs) following PRISMA guidelines. Six RCTs involving 232 participants with CP (ages 8–25 years, GMFCS levels I-III) were included in the quantitative meta-analysis. Standardized mean differences (Hedges’ g) were calculated using a random-effects model. Risk of bias was assessed using the Cochrane RoB 2 tool, and evidence certainty was evaluated using GRADE framework.

Results

PRT significantly improved lower limb muscle strength compared to controls (Hedges’ g = 0.46, 95% CI [0.26-0.66], p < 0.001) with low-to-moderate heterogeneity (I² = 25.6%). Evidence certainty was rated as MODERATE. Subgroup analyses suggested potentially larger effects for gym-based interventions and participants with GMFCS II-III. Sensitivity analyses confirmed result robustness. No serious adverse events were reported.

Conclusion

PRT effectively enhances lower limb strength in youth (8–25 years) with CP, particularly under structured, supervised conditions. Further research is needed to clarify its long-term functional and psychosocial benefits.