Background <p>This study aimed to evaluate the impact of exercise interventions on physical recovery among paediatric cancer patients and survivors. Given the challenges these individuals face, enhancing physical fitness is crucial for improving overall health outcomes and quality of life.</p> Methods <p>A meta-analysis was conducted, including 16 randomised controlled trials that examined various outcomes: VO₂ peak, handgrip strength, the 6-minute walk test (6MWT), Timed Up and Go (TUG), Timed Up and Down Stairs (TUDS), body mass index (BMI), and fat mass. Statistical analyses included calculation of weighted mean differences (WMD) and assessment of heterogeneity using the I² statistic.</p> Results <p>A total of 16 studies were included. Significant positive effects were observed for the 6MWT (WMD = 54.83, 95% CI: 22.04 to 87.62, <i>p</i> = 0.001; I² = 32.6%) and TUDS (WMD = -1.02, 95% CI: -1.88 to -0.16, <i>p</i> = 0.02; I² = 49.3%), indicating improvements in cardiorespiratory fitness and physical function. No statistically significant effects were found for VO₂ peak (WMD = 1.74, 95% CI: -0.03 to 3.52, <i>p</i> = 0.054), handgrip strength (WMD = 0.50, 95% CI: -2.62 to 3.62, <i>p</i> = 0.75; I² = 73.8%), TUG (WMD = -0.33, 95% CI: -1.01 to 0.36, <i>p</i> = 0.348; I² = 85.5%), BMI, or fat mass. Subgroup analyses revealed differing patterns between current patients and survivors, though differences were not statistically significant. Sensitivity analyses confirmed the robustness of findings for the 6MWT and TUDS.</p> Conclusions <p>Exercise appears to improve cardiorespiratory fitness and physical function in paediatric cancer patients and survivors. However, study heterogeneity and small sample sizes warrant caution. Future research with standardised interventions and larger sample sizes is needed to establish more definitive evidence.</p>