Efforts to treat obesity in childhood and adolescence would benefit from a greater understanding of evidence-based strategies to modify physical activity behaviour. A systematic review was conducted to examine the impact of child and adolescent obesity treatment interventions on physical activity. Studies included were randomized controlled trials or controlled trials, with overweight and obese youth (aged < 18 years), which reported statistical analysis of free-living physical activity at pretreatment and post-treatment. Two independent reviewers assessed each study for methodological quality. Seventeen child and three adolescent studies were retrieved, half of which were conducted in the USA. Studies were characterized by small samples of limited cultural and economic diversity. Fifteen studies reported an increase in at least one physical activity outcome at post-test or follow-up. Overall, study quality was rated as low (child median score = 3/10, range = 0–9; adolescent median score = 3/10, range = 2–5) with three child studies classified as high quality (6/10). Research evaluating the effect of child and adolescent obesity treatment trials on physical activity is limited in both quantity and quality. Studies testing innovative, theoretically driven treatment approaches that use robust methodologies are required to better understand generalizable approaches for promoting physical activity participation among obese youth.