Background: Cerebral palsy (CP) is associated with progressive atrophy and secondary sarcopenia. This systematic review aimed to evaluate the effects of progressive resistance training and explore the synergistic potential of targeted nutritional supplementation (based on evidence from aging and other muscle atrophy conditions) on sarcopenia and muscle morphology in CP.

Methods: A comprehensive search was conducted across PubMed, Web of Science, Scopus, and PEDro databases for articles published between 2005 and 2026. Studies assessing training interventions in CP and nutritional supplementation in atrophy and sarcopenia conditions were included. Methodological quality was appraised using the Downs and Black checklist.

Findings: Among the 15 included studies, progressive resistance training led to increased muscle strength and thickness. However, structural morphological changes occur more slowly, and the initial increase in cross-sectional area is primarily due to tissue swelling (edema). Empirical evidence from other populations (such as older adults) confirms that supplementation with protein and creatine can overcome anabolic resistance to significantly augment muscle protein synthesis.

Conclusion: The combination of power-based functional training and targeted supplementation (especially leucine and creatine) holds substantial potential for counteracting sarcopenia in CP. Nevertheless, due to the extrapolation of evidence from other conditions, the overall certainty of evidence is low to very low, highlighting the necessity for direct clinical trials in this population.