Effectiveness of aerobic exercise on motor function and functional capacity in children and adolescents with neuromuscular diseases: a systematic review and meta-analysis

Abstract

Purpose To evaluate the effectiveness of aerobic exercise, alone or combined with other modalities, on motor function and functional capacity in children and adolescents with neuromuscular diseases (NMDs).Materials and methods A systematic review and meta-analysis were conducted (CRD420251110784). Five databases were searched up to September 2025. Randomized and non-randomized trials assessing aerobic exercise in children/adolescents with NMDs were included. Risk of bias and certainty of evidence were assessed using RoB2, ROBINS-I, and GRADE. Random-effects meta-analyses estimated standardized mean differences (SMD) and 95% confidence intervals (CI).Results Eleven studies (227 participants) were included. Aerobic exercise showed no significant effect on motor function (SMD = 0.15, 95% CI: −0.10 to 0.40, I2=0%) but produced moderate improvements in functional capacity (SMD = 0.51, 95% CI: 0.03 to 0.99, I2=78%). Subgroup analyses suggested non-significant effects for sessions <40 min (SMD = 0.83) and combined aerobic plus strength training (SMD = 0.74). Sensitivity analyses showed one study disproportionately influenced results; excluding high-risk studies yielded SMD = 0.36 (I2=0%). GRADE indicated low certainty for motor function and very low certainty for functional capacity.Conclusions Aerobic exercise is safe and may improve functional capacity but not motor function in pediatric NMDs. Evidence is limited and needs for cautious interpretation and high-quality trials to inform clinical practice.