J Autism Dev Disord. 2026 Jun 24. doi: 10.1007/s10803-026-07403-3. Online ahead of print.
ABSTRACT
PURPOSE: To examine the impact of physical exercise on motor skills in children with autism spectrum disorders (ASD).
METHODS: This study followed PRISMA guidelines (PROSPERO: CRD42024600538). Six databases (Embase, Engineering Village, OVID, PubMed, Scopus, and Web of Science) were searched through October 30, 2025.
INCLUSION CRITERIA: children ≤ 12 years with ASD; randomized controlled trials (RCTs); physical exercise interventions; motor skills outcomes measured via standardized instruments (BOT-2, TGMD-2, PDMS-2, ADS-3, MABC). Two independent reviewers performed study selection and data extraction. Risk of bias was assessed using Cochrane ROB 2.0; evidence quality via GRADE. Statistical analysis used R 4.4.3, calculating standardized mean differences (SMDs) with 95% confidence intervals (CIs). Random-effects models were applied when I² ≥ 50%.
RESULTS: Ten RCTs (256 children; mean age 6.91 ± 2.51 years) were included. Physical exercise significantly improved total motor skills (SMD = 1.58, 95%CI: 1.15-2.00, p < 0.0000), locomotion (SMD = 1.34, 95%CI: 0.98-1.70, p < 0.00001), object control (SMD = 1.37, 95%CI: 1.02-1.72, p < 0.00001), and balance (SMD = 1.73, 95%CI: 0.82-2.65, p = 0.0002). Publication bias was detected for total motor skills and balance. Meta-regression showed that intervention frequency positively correlated with balance improvement (p = 0.022), while duration negatively correlated (p = 0.002).
CONCLUSION: Physical exercise significantly improves motor skills in children with ASD. Meta-regression indicates that frequency is a positive moderator for balance gains, but prolonged duration shows diminishing returns due to adaptation plateaus. Age and session length did not affect the protocol, so it remained flexible.
PMID:42340634 | DOI:10.1007/s10803-026-07403-3
