Physical Activity Interventions for Children and Adolescents With Autism: A Second-Order Meta-Analysis

Previous meta-analyses of physical activity interventions for children and adolescents with autism spectrum disorder (ASD) have reported variable effect sizes and substantial heterogeneity, potentially reflecting differences in included primary studies, intervention characteristics, outcome domains, and analytic approaches. This second-order meta-analysis aimed to synthesize existing meta-analytic evidence on the effects of physical activity interventions across developmental domains in children and adolescents with ASD and to examine potential moderators of these effects.

Thirty-four first-order meta-analyses were included for synthesis. Statistical analyses, including subgroup analyses and meta-regression, were conducted to examine intervention effects and moderators.

Physical activity interventions were associated with significant positive effects in children and adolescents with ASD, with an adjusted effect size of g = 0.58. Significant positive effects were observed across developmental domains; motor skills and sleep quality showed the largest effects, whereas executive function and cognitive outcomes showed relatively modest effects. Outdoor activities and ball sports showed larger pooled effects than other intervention types, whereas water-based exercise, dance, and expressive movement did not show statistically significant effects in this analysis. Meta-regression indicated that intervention effects increased progressively with publication year.

Physical activity interventions may be promising non-pharmacological approaches for multiple developmental outcomes in ASD youth, particularly motor skills, sleep quality, and emotional-behavioral outcomes. Outdoor activities and ball sports showed larger pooled effects, but further research is needed to confirm their consistent superiority across outcomes. The positive association between publication year and effect size warrants investigation, reflecting changes in intervention design, study quality, or publication trends.