Effectiveness of exercise interventions on gross motor skills in children with autism spectrum disorder: a systematic review and meta-analysis

TL;DR

Exercise, especially land-based sports, significantly improves motor skills in children with autism, with medium-duration programs being most effective.

Contribution

This study provides the first systematic review and meta-analysis comparing different exercise types and dosages for motor skill improvement in children with ASD.

Findings

Exercise interventions significantly improved balance, locomotor, and object control skills in children with ASD.

Land-based sports showed the most consistent improvements across all skill domains.

Medium-duration programs (≤1440 minutes) were more effective than high-duration ones for most motor skills.

Abstract

To systematically evaluate the effectiveness of different exercise interventions on gross motor skills in children with Autism Spectrum Disorder (ASD) and to compare the effects of different exercise types and intervention dosages through subgroup analysis.

We systematically searched randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) investigating the effects of exercise interventions on gross motor skills in children with ASD across PubMed, Web of Science, EBSCO, ProQuest, CNKI, and Wanfang Data databases from their inception until September 20, 2025. Two researchers independently performed literature screening, data extraction, and quality assessment of the included studies using the Cochrane Risk of Bias tool. Meta-analysis was conducted using RevMan 5.4 software with a random-effects model, and effect sizes were expressed as standardized mean difference (SMD) with 95% confidence intervals (CI).

A total of 16 studies involving 493 children with ASD were included. Meta-analysis results indicated that exercise interventions significantly improved balance skills (SMD = 0.85, 95% CI [0.54, 1.16]), locomotor skills (SMD = 0.81, 95% CI [0.51, 1.11]), and object control skills (SMD = 0.86, 95% CI [0.65, 1.07]) in children with ASD, with all effect sizes being large (all P < 0.00001). Subgroup analysis showed that Land-based sports significantly improved all three skill domains (all P < 0.00001), whereas Aquatic sports and technically-assisted sports mostly failed to reach statistical significance. Regarding intervention dosage, medium-duration programs (total duration ≤1440 minutes) significantly improved all three skill domains (all P < 0.0001), while high-duration programs (>1440 minutes) only showed a significant effect on object control skills (SMD = 0.75, P = 0.003).

Exercise interventions, particularly structured Land-based sports, are effective methods for improving gross motor skills in children with ASD. A medium-dosage regimen with a total intervention duration of ≤1440 minutes (approximately 8–12 weeks) appears to be the key window for optimal benefits. Prioritizing this regimen in clinical rehabilitation and educational practice is recommended.

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251185572.

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