Introduction:
To evaluate the effectiveness of the aquatic aerobic exercise training (AqET) on the pulmonary function (PF) and aquatic skills performance in the older children with spastic cerebral palsy (CP). Randomized controlled study.

Methods:
Twenty-eight children, 13–15 years old, with spastic CP were randomly allocated into AqET group (n = 13; received AqET plus traditional Physiotherapy “TPT” program) and control group (n = 15; received TPT only). The PF [including (the forced vital capacity; FVC), (forced expiratory volume in one second; FEV1)] and the aquatic skills performance (including the WOTA mental adaptation score “WMA”, the WOTA skills balance control movement score “WSBM”, the WOTA total score “WTOT”) were evaluated at the beginning and after 12-weeks.

Results:
Post-study results revealed significant increases in the PF, WMA, WSBM, WTOT mean values in both groups. The FEV1% and FVC% mean values and percentages of changes were [84.00% (21.5%), 78.23% (24.56%)] and [(71.13% (6.9%), 62% (7.12%)] for the AqET, and control groups respectively. The WMA, WSBM, WTOT mean scores and percentages of changes were [33.15 (77.01%), 15.46 (643.27%), 48.62, (133.19%)] and [(20.2 (7.59%), 2.27 (23.89%), 22.47 (7.36%) for the AqET, and control groups respectively (p < 0.05). There were significant differences between-groups in the PF and the aquatic skills performance post-study, but in favor of AqET group.

Conclusions:
Children with spastic CP benefit favorably from AqET or TPT programs. The AqET is more beneficial than the TPT in increasing the PF and the aquatic skills performance in older children with spastic CP.