Objective To systematically review the effects of the early childhood physical activity program (ECPAP) on gross motor skill (GMS) in preschool children. Methods We searched Web of Science, PubMed, Cochrane Library, EBSCO SPORTDiscus with Full Text, CNKI, WanFangData and VIP databases to collect randomized controlled trails (RCT) about ECPAP for improving GMS in preschool children from the establishment of the database to August 8, 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4.1 and Stata 15.0 software. Results A total of 18 studies including 1 141 children in experimental group and 1 135 children in control group were included. The results of meta-analysis showed that after ECPAP, the GMS (SMD=1.96, 95%CI 1.44 to 2.49), locomotor skills (SMD=1.15, 95%CI 0.83 to 1.46) and manipulative skills (SMD=1.25, 95%CI 0.84 to 1.65) of the experimental group were significantly better than those of the control group (P<0.05). Conclusion ECPAC is considered to significantly promote the GMS of preschool children. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.