The effects of aquatic exercises on body functions, activity and participation in children and adolescents with cerebral palsy: a systematic review

Introduction: Aquatic exercises may benefit children and adolescents with cerebral palsy (CP). Nevertheless, there are few studies about the efficacy and safety of those interventions for this population. Therefore, the objective of this study was to perform a systematic review of the effects of aquatic interventions in children and adolescents with CP, considering outcomes related to the body structure, function, activity, and participation; based on the World Health Organization International Classification of Functioning, Disability and Health framework (ICF). Methods: We searched for experimental or quasi-experimental studies about aquatic exercises’ effects on children and adolescents with CP. We used the databases PubMed/MEDLINE, CINAHL, Scielo, LILACS, SPORTDiscus, Cochrane Reviews, Trials, and PEDro, from January 1st, 2011, to December 31st, 2020. In addition, the risk of bias was assessed with the PEDro tool. Results: 10 randomized clinical trials and five quasi-experimental studies were included. The focus was on aerobic activities in children with spastic CP, mainly classified as levels I to III in the Gross Motor Function Classification System (GMFCS), outcomes related to structure and function, and activity. Thirteen studies reported positive effects, but the methodological quality was low. Discussion: Aquatic exercise programs are feasible and demonstrate a positive effect on this population. There is a need for studies of better methodological quality, including children classified as GMFCS V and outcomes based on the domain of participation.