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Objective (1) To synthesise the available evidence on the clinical effectiveness of home-based physical exercise interventions in improving aerobic capacity, functional capacity, muscle strength and quality of life in children and adolescents with chronic diseases, as well as to evaluate their feasibility; and (2) to assess the reporting quality of these interventions using the Consensus on Exercise Reporting Template, with the aim of identifying gaps in methodological transparency that may limit reproducibility and scalability.Design Systematic review and meta-analysis.Data sources Medline (via PubMed), Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), SportDiscus and CINAHL database (via EBSCOhost) were searched until 31 December 2025.Eligibility criteria Eligible studies included intervention designs (randomised controlled trials (RCTs), non-randomised trials and before–after studies) that evaluated home-based physical exercise interventions in children and adolescents with chronic diseases. Studies were required to include a comparator (eg, centre-based interventions, alternative home-based interventions, such as motor imagery, constraint-induced movement therapy or hand-arm bimanual intensive therapy or no intervention) or to report within-group (baseline-to-follow-up) comparisons. Outcomes of interest were aerobic capacity, functional capacity, muscle strength and quality of life.Results A total of 81 studies were included, comprising 2923 children and adolescents. The most frequently represented conditions were cerebral palsy (n=26; 32.1%), cystic fibrosis (n=10; 12.3%) and idiopathic arthritis (n=8; 9.8%). Of the 45 RCTs identified, 19 met the criteria for inclusion in the meta-analysis. Home-based physical exercise interventions were effective in increasing aerobic capacity (p<0.0001; standardised mean differences: 0.53; 95% CI 0.32 to 0.74) compared with the control group. No significant differences were observed between home-based interventions and control conditions for functional capacity or quality of life. However, functional capacity gains are similar when comparing centre-based and home-based approaches. A meta-analysis of muscle strength could not be performed due to insufficient data. Adherence to home-based physical exercise interventions was higher than 80% in 27 of the 50 studies that reported this information. Most studies reported no adverse events of home-based physical exercise interventions, with few studies reporting only mild adverse effects (eg, muscle soreness, stiffness and fatigue).Conclusions Our meta-analysis of randomised controlled trials comparing home-based interventions with control conditions suggests that home-based physical exercise is feasible and improves aerobic capacity, but does not confer significant benefits for functional capacity, muscle strength or quality of life in children and adolescents with chronic diseases. Suboptimal reporting quality, risk of bias and inconsistent adherence/safety data necessitate cautious interpretation.PROSPERO registration number CRD42022330567.