QUESTION: What is the effect of exercise on reducing impairment and increasing activity in the rehabilitation of people with upper limb fractures? DESIGN: Systematic review of controlled trials. PARTICIPANTS: Adults following an upper limb fracture. INTERVENTION: Any exercise therapy program, including trials where exercise was delivered to both groups providing there was an expectation of different amounts of exercise. OUTCOME MEASURES: Body structure and function, and activity limitations. RESULTS: 13 relevant trials involving 781 participants with an upper limb fracture were identified. 12 of the 13 trials included exercise of different duration and administration in both intervention and comparison groups. In support of the role of exercise there is evidence that: exercise and advice compared to no intervention reduce pain and improve upper limb activity in the short term after distal radius fracture; starting exercise earlier after conservatively managed proximal humeral fractures can reduce pain and improve shoulder activity; and physiotherapy that included supervised exercise and home exercise increased wrist movement after distal radius fracture when compared to home exercise alone. There is contrary evidence from two trials one after distal radius fracture and one after proximal humeral fracture that a home exercise program was superior to a supervised plus home exercise program. Only a single meta-analysis was conducted due to clinical heterogeneity and a lack of common outcome measures among the included trials. CONCLUSION: There is evidence to support the role of specific exercise regimens in reducing impairments and improving upper limb function following specific upper limb fractures.