BJSM - 2026-05-22 - Journal Article
Effectiveness and feasibility of home-based physical exercise interventions for children and adolescents with chronic diseases: a systematic review and meta-analysis.
Sieczkowska SM, Coimbra DR, Infante Smaira F, Mazzolani BC, Paticcié G, Astley C, Iraha A, Roschel H, Peçanha T, Gualano B
Topics
Key Takeaway
Home-based exercise improves aerobic capacity (SMD 0.53, 95% CI 0.32–0.74) in children and adolescents with chronic diseases, but confers no significant benefit over controls for functional capacity or quality of life.
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Summary
This systematic review and meta-analysis evaluated home-based physical exercise interventions across children and adolescents with chronic diseases (predominantly CP 32.1%, cystic fibrosis 12.3%, idiopathic arthritis 9.8%), pooling 19 RCTs for quantitative analysis. Home-based exercise produced a moderate effect on aerobic capacity (SMD 0.53) versus controls, but showed no significant advantage for functional capacity or quality of life; functional capacity outcomes were equivalent when home-based was compared directly to centre-based programs. Adherence exceeded 80% in 27 of 50 reporting studies, and adverse events were predominantly mild.
Key Limitation
Heterogeneity across disease types, exercise modalities, and outcome measurement tools limits the clinical specificity of pooled effect sizes and prevents disease-specific practice recommendations.
Original Abstract
OBJECTIVE
(1) To synthesise the available evidence on the clinical effectiveness of home-based physical exercise interventions in improving aerobic capacity, functional capacity, muscle strength and quality of life in children and adolescents with chronic diseases, as well as to evaluate their feasibility; and (2) to assess the reporting quality of these interventions using the Consensus on Exercise Reporting Template, with the aim of identifying gaps in methodological transparency that may limit reproducibility and scalability.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
Medline (via PubMed), Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), SportDiscus and CINAHL database (via EBSCOhost) were searched until 31 December 2025.
ELIGIBILITY CRITERIA
Eligible studies included intervention designs (randomised controlled trials (RCTs), non-randomised trials and before-after studies) that evaluated home-based physical exercise interventions in children and adolescents with chronic diseases. Studies were required to include a comparator (eg, centre-based interventions, alternative home-based interventions, such as motor imagery, constraint-induced movement therapy or hand-arm bimanual intensive therapy or no intervention) or to report within-group (baseline-to-follow-up) comparisons. Outcomes of interest were aerobic capacity, functional capacity, muscle strength and quality of life.
RESULTS
A total of 81 studies were included, comprising 2923 children and adolescents. The most frequently represented conditions were cerebral palsy (n=26; 32.1%), cystic fibrosis (n=10; 12.3%) and idiopathic arthritis (n=8; 9.8%). Of the 45 RCTs identified, 19 met the criteria for inclusion in the meta-analysis. Home-based physical exercise interventions were effective in increasing aerobic capacity (p<0.0001; standardised mean differences: 0.53; 95% CI 0.32 to 0.74) compared with the control group. No significant differences were observed between home-based interventions and control conditions for functional capacity or quality of life. However, functional capacity gains are similar when comparing centre-based and home-based approaches. A meta-analysis of muscle strength could not be performed due to insufficient data. Adherence to home-based physical exercise interventions was higher than 80% in 27 of the 50 studies that reported this information. Most studies reported no adverse events of home-based physical exercise interventions, with few studies reporting only mild adverse effects (eg, muscle soreness, stiffness and fatigue).
CONCLUSIONS
Our meta-analysis of randomised controlled trials comparing home-based interventions with control conditions suggests that home-based physical exercise is feasible and improves aerobic capacity, but does not confer significant benefits for functional capacity, muscle strength or quality of life in children and adolescents with chronic diseases. Suboptimal reporting quality, risk of bias and inconsistent adherence/safety data necessitate cautious interpretation.
PROSPERO REGISTRATION NUMBER
CRD42022330567.