ABSTRACT This systematic review evaluates the effect of exercise on pediatric chronic pain in: (a) pre-post-test comparisons and RCTs, and (b) longitudinal actigraphy studies in children’s free-living environments. Following the PRISMA guidelines, 15 studies met inclusion criteria. Although preliminary results suggest exercise may be related to decreased pain, the overall effect of exercise on chronic pain remains inconclusive due to low methodological quality and high risk of bias. Therefore, results underscore the need for future RCTs that examine aerobic exercise and chronic pain. Further, increased sample sizes would allow for future examinations of moderators or indirect paths between exercise and pain.