Effects of exercise interventions on executive function in autism spectrum disorder: a three-level meta-analytic...

This study aimed to use a three-level meta-analysis to examine the effects of exercise interventions on executive function (EF) in children and adolescents with autism spectrum disorder (ASD), and to explore the relationship between exercise dose and intervention effects through subgroup analyses.

A systematic search was conducted in Web of Science, PubMed, Embase, and the Cochrane Library from database inception to November 17, 2025. All included studies were randomized controlled trials. A three-level random-effects model was applied to integrate multiple dependent effect sizes. Hedges' g was used to calculate effect sizes, and negative values indicated improvements in EF following exercise interventions. Study quality was assessed using the PEDro scale, and publication bias was evaluated using Egger's regression and the trim-and-fill method.

Seventeen studies involving 626 participants were included. Exercise interventions produced a moderate and significant improvement in EF (g = -0.34, p < 0.0001) with low heterogeneity (Q = 50.42, p =0.268). Subgroup analyses showed that only intervention duration significantly moderated the effects, with programs lasting ≥10 weeks yielding the greatest benefits.

Exercise interventions significantly improve EF in children and adolescents with ASD, with the largest effect sizes observed in interventions lasting ≥10 weeks. Further large-scale studies are needed to clarify dose-response relationships and inform optimal exercise prescriptions. This meta-analysis was designed and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines.

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251236112.