The effects of exercise intervention on children with developmental coordination disorder: a systematic review and network meta-analysis of randomized controlled trials

Background: Motor interventions are widely used to improve motor function in children with developmental coordination disorder (DCD), but their relative efficacy across key functional domains remains unclear. This network meta-analysis aimed to compare the effects of integrated training (IT), task-oriented training (TOT), and process-oriented training (POT). Methods: Randomized controlled trials (RCTs) published between January 2000 and January 2026 were systematically retrieved from multiple databases following PRISMA 2020 and PRISMA-NMA reporting standards. Multiple validated motor assessment tools were harmonized for pooled analysis. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated, and interventions were ranked using the surface under the cumulative ranking curve (SUCRA). Subgroup and sensitivity analyses were performed. Results: Twenty RCTs (n = 1,867) were included. All three interventions were associated with significant improvements in motor function outcomes. TOT showed the largest estimated effect on overall motor function (SMD = 2. 30, 95% CI: 0. 42 to 4. 18) and achieved the highest SUCRA ranking (55. 3%). IT achieved the highest SUCRA rankings for balance (SMD = -1. 93, 95% CI: -3. 10 to -0. 76; SUCRA = 78. 3%) and manual dexterity (SMD = -2. 11, 95% CI: -4. 12 to -0. 10; SUCRA = 71. 5%). For aiming and catching, IT (SMD = -3. 90, 95% CI: -7. 51 to -0. 29) and POT (SMD = -3. 83, 95% CI: -7. 48 to -0. 18) showed significant improvements, whereas TOT did not demonstrate a significant effect. Interventions lasting more than 8 weeks were associated with greater effects (P = 0. 001), while age was not a significant moderator (P = 0. 577). Sensitivity analyses supported the robustness of the overall findings, although significant small-study effects were observed for several outcomes; incomplete blinding and substantial cross-study heterogeneity may inflate pooled effect sizes. Conclusion: The available evidence suggests that motor interventions may improve motor function in children with DCD, with potentially different benefits across functional domains. TOT achieved the highest ranking probability for overall motor function, whereas IT achieved the highest rankings for balance and manual dexterity. In addition, both IT and POT were associated with significant improvements in aiming and catching ability. Longer intervention durations were associated with larger effect sizes. However, due to small-study effects, limited direct head-to-head comparisons, sparse network connectivity, and the inherent uncertainty of indirect comparisons, the present findings and SUCRA-based rankings should be interpreted with caution. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420261346625.