Aquatic Compared With Land-Based Exercises on Gross Motor Function of Children/Adolescents With Cerebral Palsy: A Systematic Review With Meta-Analysis

Aim: This study aimed to compare gross motor function between aquatic- and land-based exercises in children and adolescents with cerebral palsy (CP).

Methods: The authors conducted an electronic search of nine databases from their inception to 21 November 2024 (PROSPERO registration: CRD42020194121). Inclusion criteria were randomized controlled trials involving aquatic-based exercises for children and adolescents with CP, assessing gross motor function using standardized scales or tests. Three authors independently extracted data using a predetermined Excel form. The risk of bias was assessed with the PEDro scale. The body of evidence was synthesized using the GRADE approach. Meta-analysis was conducted using the Revman 5.3 program.

Results: A total of 369 children aged 2-18 years from 15 studies were included. Most participants were ambulatory and classified as having spastic hemiparetic or diparetic CP. The majority of studies had a high risk of bias and small sample sizes. Aquatic-based exercises were categorized as aquatic physical therapy, Halliwick, swimming exercises, gait training and exercises. Low-quality evidence indicated that aquatic physical therapy resulted in higher gross motor function than land-based exercises (SMD = 0.47, n = 93, 4 trials, I² = 5%, p = 0.03), with a small effect size. No significant differences were found for Halliwick or swimming exercises.

Interpretation: There is low-quality evidence, because of high risk of bias, imprecision and inconsistency, suggesting that aquatic-based exercises are comparable with land-based exercises. Future research should focus on well-designed interventions with adequate sample sizes to compare the combination of aquatic- and land-based therapies with land-based therapy alone.