# Effects of exercise on anxiety and psychiatric comorbidities in children with autism spectrum disorder: a systematic review and meta-analysis

## TL;DR

Exercise, especially aerobic, significantly reduces anxiety and improves symptoms in children with autism.

## Contribution

This is the first meta-analysis showing aerobic exercise as an effective non-drug treatment for anxiety in children with autism.

## Key findings

- Aerobic exercise reduced anxiety more than other types (effect size -1.18).
- Exercise also improved core autism symptoms and ADHD-related attention issues.
- Results for sleep improvements were inconclusive due to varied study outcomes.

## Abstract

Anxiety disorders affect nearly 40%–50% of children with autism spectrum disorder (ASD). While exercise benefits motor skills, its efficacy in modulating affective symptoms remains under-synthesized. This meta-analysis evaluated the effects of exercise on anxiety and co-occurring symptoms in pediatric ASD.

We analyzed data from 12 randomized controlled trials (RCTs) involving 482 participants. A three-level random effects model was utilized to account for effect size dependencies. Subgroup analyses examined the exercise modality and intensity.

Exercise significantly reduced comorbid anxiety (Hedges’ g = −0.68, p < 0.001). Notably, aerobic exercise demonstrated the most substantial anxiolytic effect (g = −1.18), outperforming other modalities. Improvements were also observed in the core ASD symptoms (g = −0.56) and attention-deficit/hyperactivity disorder (ADHD)-related attention deficits (g = −0.48). The effects on sleep were inconclusive due to heterogeneity.

Exercise, particularly aerobic interventions, serves as a potent non-pharmacological strategy for the management of anxiety and affective dysregulation in children with ASD. These findings support the integration of aerobic exercise into clinical treatment plans to improve emotional wellbeing.

https://www.crd.york.ac.uk/prospero/, identifier CRD420251157119.

Mechanistic diagram or graphical abstract illustrating how exercise interventions promote improvements in the core and co-occurring symptoms in children with autism spectrum disorder (ASD).Conceptual model illustrating exercise-induced neuroplasticity in autism spectrum disorder (ASD). Panel (a) shows aerobic and rhythmic exercises impacting anxiety and attention networks, respectively, and core ASD symptoms. Panel (b) presents meta-analytic effect sizes for anxiety, core ASD, ADHD symptoms, and sleep outcomes. Panel (c) depicts exercise factors like BDNF and dopamine influencing synaptic modulation and network integration.

Mechanistic diagram or graphical abstract illustrating how exercise interventions promote improvements in the core and co-occurring symptoms in children with autism spectrum disorder (ASD).