Efficacy of functional training on cardiorespiratory fitness in individuals with cerebral palsy: A systematic review

Abstract

Aim To determine the efficacy of functional training on cardiorespiratory fitness in individuals with cerebral palsy (CP). Method Randomized controlled trials involving individuals with CP who had functional training interventions, which also reported cardiorespiratory fitness outcomes, were included in this systematic review. Two independent reviewers searched PubMed, MEDLINE, Embase, CENTRAL, Web of Science, and CINAHL up to February 2025, and selected studies and extracted data. Study quality was assessed using the Cochrane Risk of Bias 2 tool. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation system. Mean differences and standard mean differences with 95% confidence intervals (CIs) were calculated. Results From 594 papers, 11 randomized controlled trials (n = 387, mean ages 5 years 10 months-20 years 6 months, Gross Motor Function Classification Systems levels I-IV) were included. Functional training had statistically and clinically significant effects on the 6-minute walk test (mean difference = 30.91; 95% CI = 28.34-33.48; p < 0.001) and Physiological Cost Index (mean difference = -0.16; 95% CI = -0.20 to -0.13; p < 0.001). No effect was found for gait speed or the timed stair test. Interpretation Functional training has the potential to improve functional exercise capacity in individuals with CP. Given the significant impact of cardiorespiratory problems on the morbidity and mortality of individuals with CP, integrating cardiorespiratory parameters into functional training programmes may contribute to long-term health benefits.