Comparative efficacy of various physical activity interventions on individuals with autism spectrum disorder: a...

Physical activity is a promising non-pharmacological intervention for individuals with autism spectrum disorder (ASD), but the most effective intervention regimen remains unclear. This study aimed to compare and rank the effects of different types and doses of physical activity on social communication, stereotyped behaviors, and motor skills in individuals with ASD, thereby providing theoretical guidance for physical activity-based interventions.

We searched Web of Science, PubMed, Embase, Cochrane Central Register of Controlled Trials, SPORTDiscus, PsycInfo and CNKI from inception to December 2025. Randomized controlled trials, quasi-experimental studies, and controlled studies evaluating the effects of various physical activity interventions on social communication, stereotyped behaviors, or motor skills in individuals with ASD were included. Pairwise analyses and network meta-analyses were conducted using a random effects model.

A total of 45 studies involving 1479 participants were included. The results showed that martial arts had the highest possibility of producing the best effects on social communication (SMD = -0.84, 95% CI : -1.31,-0.37), and team ball sports were most likely to be the most effective in reducing stereotyped behaviors (SMD = -1.39, 95% CI: -2.09,-0.68), while mind-body exercise was identified as the most effective physical activity for improving motor skills (SMD = 2.10, 95% CI: 0.45, 3.75). Additionally, for social communication, the best effects were observed with a frequency of 3-4 times per week (SMD = -0.90, 95% CI: -1.34, -0.45), session duration of ≤45 minutes (SMD = -0.67, 95% CI: -0.91, -0.43), and an intervention period of more than 12 weeks (SMD = -0.93, 95% CI: -1.18, -0.68). For stereotyped behaviors, the best effects were observed with a frequency of ≥5 times per week (SMD = -1.40, 95% CI: -2.15, -0.65), session duration of ≤45 minutes (SMD = -0.60, 95% CI: -1.10, -0.10), whereas no statistically significant effects were observed for intervention period; For motor skills, the best effects were associated with a frequency of 3-4 times per week (SMD = 2.02, 95% CI: 0.92, 3.12), session duration of＞60 minutes (SMD = 4.35, 95% CI: 1.44,7.26), and a period of ≤8 weeks (SMD = 2.41, 95% CI: 0.90, 3.91).

Martial arts appear to be the most effective intervention for improving social communication, and team ball sports are likely to be the most effective for reducing stereotyped behaviors, whereas mind-body exercises may be the most beneficial for enhancing motor skills in individuals with ASD. In addition, for social communication, the most favorable outcomes were associated with a frequency of 3-4 sessions per week, session duration of ≤45 minutes, and an intervention period of >12 weeks. For stereotyped behaviors, the best effects were observed with a frequency of ≥5 times per week, session duration of ≤45 minutes, however, no statistically significant effects were observed for intervention period. Regarding motor skills, the best effects were found with a frequency of 3-4 times per week, session duration of > 60 minutes, and an intervention period of ≤8 weeks.