Exercise interventions for health outcomes in children with autism spectrum disorder: An umbrella review of meta-analyses of clinical trials

Exercise interventions have gained widespread acceptance due to their cost-effectiveness, ease of implementation, and low incidence of negative effects. However, the overall effects of exercise interventions on the health outcomes of children with autism are not evaluated systematically. To evaluate the effect of exercise interventions on behavioral, motorial, and psychosocial health outcomes in autistic children, as well as to determine the quality of evidence for each outcome. We conducted an umbrella review of meta-analyses investigating the associations between exercise interventions and health outcomes in autistic children from inception to November 27, 2024. Following exercise interventions, maladaptive behavior [standardized mean difference (SMD): -0.73; 95% confidence interval (95% CI): -0.71, -0.03] showed a substantial improvement. However, no discernible impact on stereotyped behavior (SMD: 0.09; 95% CI: -0.30, 0.48) was observed. Sensitivity analysis revealed that all overall effect sizes indicated statistically significant differences, even though the reanalysis of meta-analyses showed no significant effectiveness of exercise interventions on social communication (SMD: -0.09; 95% CI: -0.61, 0.43), social skill (SMD = -0.22; 95% CI: -0.99, 0.54), social function (SMD = 2.64; 95% CI: -0.10, 5.39), and motor skills (SMD: 0.71; 95% CI: -0.97, 2.39). Exercise interventions are suggested to improve maladaptive behaviors and may help with social communication, social skills, social function, and motor skills. The evidence for the effectiveness of exercise interventions in reducing stereotyped behaviors is weak, but it still merits investigation. We need more carefully planned randomized controlled studies.