Organized sports-based interventions and motor outcomes in children diagnosed with autism spectrum disorder: A systematic review.

AIM: To evaluate the effectiveness of organized sports-based interventions on motor outcomes in children with autism spectrum disorder (ASD).

METHOD: Four databases were searched from inception to November 2025 for randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) reporting motor outcomes of organized sports-based interventions in children with ASD. Risk of bias was evaluated using ROB-2 (Cochrane Risk of Bias Tool, Version Two) for RCTs and ROBINS-I (Risk Of Bias In Non-randomized Studies - of Interventions) for NRCTs.

RESULTS

Eleven studies (six RCTs, five NRCTs) were included and categorized as martial arts (n = 5), aquatic training (n = 2), gymnastics and trampoline (n = 3), and other sports (n = 2); one study was included under both martial arts and aquatic categories. Interventions most consistently improved balance (d = 0.18-4.99), locomotor skills (d = 0.63-2.02), total motor scores (d = 0.61-3.90), and object control skills (d = 1.10-3.83), with effects predominantly moderate to large across martial arts and aquatic training. Risk of bias was high in five RCTs and of some concern in one; among NRCTs, four were serious risk and one critical risk.

INTERPRETATION: Organized sports-based interventions may improve gross motor skills in children with ASD, with martial arts and aquatic training demonstrating the most consistent benefits; however, overall certainty of evidence is limited, and higher-quality studies are needed.