Table I.
Characteristics of studies included in the meta-analysis
| Study | Country | Sample size, n | Mean age, years | Males, % | Disease status | Measurement tool | Intervention | Control | Outcomes | Follow-up, months |
|---|---|---|---|---|---|---|---|---|---|---|
| Dodd et al. 2003 (29) | Australia | 21 | 13.0 | 47.6 | GMFCS levels I-III | ICF and GMFM | Resistance training | Normal activities | Gross motor function: 69.0 vs 75.3; gait speed: 0.8 m/s vs 0.84 m/s; muscle strength: 33.1 vs 25.5 | 6.0 |
| Engsberg et al. 2006 (30) | USA | 12 | 9.9 | 25.0 | GMFCS levels I-III | GMFM | Resistance training | No strength training | Gross motor function: 69.0 vs 71.4; gait speed: 0.91 m/s vs 0.79 m/s | 3.0 |
| Unger et al. 2006 (31) | South Africa | 37 | 16.0 | 61.3 | GMFCS levels I-III | Three-dimensional gait analysis | Resistance training | Normal school and therapy programme | Gait speed: 1.119 m/s vs 1.17 m/s | 2.0 |
| Liao et al. 2007 (32) | China | 20 | 7.4 | 60.0 | GMFCS levels I, II | GMFM | Resistance training | Regular physiotherapy programme | Gross motor function: 82.7 vs 80.6; gait speed: 1.012 m/s vs 0.98 m/s; muscle strength: 6.1 vs 6.2 | 1.5 |
| Seniorou et al. 2007 (33) | UK | 20 | 12.5 | 50.0 | GMFCS levels I-III | GMFM | Resistance training | Identical programme performed with no weights | Gross motor function: 55.6 vs 60.8; gait speed: 0.3 m/s vs 0.3 m/s; muscle strength: 1.3 vs 1.2 | 6.0 |
| Unnithan et al. 2007 (34) | Greece | 13 | 15.8 | 30.8 | GMFCS levels I-III | GMFM | Mixed training | Normal physical therapy | Gross motor function: 33.85 vs 30.76 | 3.0 |
| Verschuren et al. 2007 (35) | The Netherlands | 68 | 12.2 | 64.7 | GMFCS levels I, II | GMFM | Mixed training | Usual care | Gross motor function: 87.24 vs 90.11; muscle strength: 37.44 vs 38.48 | 12.0 |
| Lee et al. 2008 (36) | Korea | 17 | 6.3 | 58.8 | GMFCS levels II, III | GMFM | Resistance training | Conventional physiotherapy | Gross motor function: 62.7 vs 61.4; gait speed: 0.746 m/s vs 0.68 m/s; muscle strength: 13.2 vs 14.1 | 2.6 |
| Fowler et al. 2010 (37) | USA | 62 | 11.4 | 46.8 | GMFCS levels I-III | GMFM | Aerobic training | No cycling | Gross motor function: 70.8 vs 69.3; gait speed: 1.133 m/s vs 1.04 m/s; muscle strength: 0.89 kg vs 0.86 kg | 3.0 |
| Reid et al. 2010 (38) | Australia | 14 | 11.0 | 42.9 | GMFCS levels I-III | Biodex dynamometer | Resistance training | Normal activity | Muscle strength: 184.71 vs 211.81 | 1.5 |
| Scholtes et al. 2010 (39) | The Netherlands | 51 | 10.4 | 56.9 | GMFCS levels I-III | GMFM | Resistance training | Conventional physiotherapy programme | Gross motor function: 76.1 vs 73.1; gait speed: 1.03 m/s vs 1.07 m/s; muscle strength: 5.39 vs 4.48 | 4.0 |
| Gharib et al. 2011 (40) | Egypt | 30 | 11.6 | 53.3 | GMFCS level II | The Biodex Gait Trainer 2TM | Aerobic training | Identical programme performed with physical therapy exercise | Gait speed: 0.67 m/s vs 0.63 m/s | 3.0 |
| Johnston et al. 2011 (41) | USA | 34 | 9.5 | 53.8 | GMFCS levels II-IV | GMFM | Aerobic training | Strengthening exercise | Gross motor function: 63.3 vs 60.1; gait speed: 0.62 m/s vs 0.50 m/s; muscle strength: 3.58 vs 3.80 | 4.0 |
| Smania et al. 2011 (42) | Italy | 18 | 13.3 | 55.6 | GMFCS levels I-IV | WeeFIM | Aerobic training | Usual physiotherapy | Gait speed: 0.97 m/s vs 0.82 m/s | 1.5 |
| Olama et al. 2011 (43) | Egypt | 30 | 13.7 | 60.0 | NA | Bruininks- Oseretsity test | Aerobic training | Both groups received an exercise programme | Gross motor function: 44.09 vs 46.69; muscle strength: 29.50 vs 30.15 | 6.0 |
| Pandey et al. 2011 (44) | India | 18 | NA | 61.1 | NA | Lateral step up test | Resistance training | None were allowed to attend physiotherapy | Gait speed: 0.70 m/s vs 0.60 m/s; muscle strength: 6.3 vs 2.67 | 1.0 |
| Chrysagis et al. 2012 (45) | Greece | 22 | 16.0 | 59.1 | GMFCS levels I-III | GMFM | Aerobic training | Conventional physiotherapy | Gross motor function: 71.67 vs 65.13; gait speed: 0.997 m/s vs 0.78 m/s | 3.0 |
| Bryant et al. 2013 (46) | UK | 35 | 13.8 | 40.0 | GMFCS levels IV and V | GMFM | Aerobic exercise | Usual physiotherapy | Gross motor function: 1.87 vs 0.20 | 4.0 |
| Chen et al. 2013 (47) | China | 30 | 8.6 | 66.7 | GMFCS levels I-II | GMFM | Aerobic training | General physical activity at home | Gross motor function: 84.2 vs 81.0; muscle strength: 1.63 kg vs 1.35 kg | 3.0 |
| Mattern- Baxter et al. 2013 (48) | USA | 12 | 1.8 | 66.7 | GMFCS levels I-II | GMFM | Aerobic training | Weekly scheduled physiotherapy sessions | Gross motor function: 16.9 vs 13.89; gait speed: 0.699 m/s vs 2.40 m/s | 4.0 |
| Lee et al. 2015 (49) | Korea | 26 | 6.5 | 50.0 | GMFCS levels I-III | GMFM | Resistance training | General neurodevelopmental treatment | Gross motor function: 81.9 vs 81.3 | 1.5 |
| Mitchell et al. 2016 (50) | Australia | 101 | 11.8 | 51.5 | GMFCS levels I-II | 6MWT | Mixed training | Usual care | Muscle strength: 63.5 vs 46.8 | 5.0 |
| Cleary et al. 2017 (51) | Australia | 19 | 13.8 | 52.6 | GMFCS levels I-III | 6MWT | Aerobic training | Social/art activities | Muscle strength: 52.2 vs 24.7 | 5.0 |
| Peungsuwan et al. 2017 (52) | Thailand | 15 | 13.3 | 53.3 | GMFCS levels I-III | 6MWT | Resistance training | Usual care | Gait speed: 1.11 m/s vs 0.99 m/s; muscle strength: 11.13 vs 8.43 | 2.0 |
| Gibson et al. 2018 (53) | Australia | 42 | 12.5 | 64.3 | GMFCS levels I-III | GAS | Aerobic training | Usual care | Muscle strength: 25.6 vs 16.5 | 3.0 |
| Fosdahl et al. 2019 (54) | Norway | 37 | 10.2 | 56.8 | GMFCS levels I-II | 6MWT | Resistance training | Usual care | Gait speed: 1.04 m/s vs 1.03 m/s | 8.0 |
| Kara et al. 2019 (55) | Turkey | 30 | 11.5 | 46.7 | GMFCS levels I-III | GMFM | Resistance training | Usual care | Gross motor function: 97.22 vs 95.83; muscle strength: 4.94 vs 5.82 | 3.0 |
6MWT: Six-Minute Walk Test; GAS: Goal Attainment Scaling; GMFCS: Gross Motor Function Classification System; GMFM: Gross Motor Function Measure; ICF: International Classification of Functioning, Disability and Health; NA: not available; WeeFIM: Functional Independence Measure for Children.