Effects of Physical Exercise on Motor Skills in Children With Autism Spectrum Disorder: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

PURPOSE: To examine the impact of physical exercise on motor skills in children with autism spectrum disorders (ASD).

METHODS

This study followed PRISMA guidelines (PROSPERO: CRD42024600538). Six databases (Embase, Engineering Village, OVID, PubMed, Scopus, and Web of Science) were searched through October 30, 2025.

INCLUSION CRITERIA: children ≤ 12 years with ASD; randomized controlled trials (RCTs); physical exercise interventions; motor skills outcomes measured via standardized instruments (BOT-2, TGMD-2, PDMS-2, ADS-3, MABC). Two independent reviewers performed study selection and data extraction. Risk of bias was assessed using Cochrane ROB 2.0; evidence quality via GRADE. Statistical analysis used R 4.4.3, calculating standardized mean differences (SMDs) with 95% confidence intervals (CIs). Random-effects models were applied when I² ≥ 50%.

RESULTS

Ten RCTs (256 children; mean age 6.91 ± 2.51 years) were included. Physical exercise significantly improved total motor skills (SMD = 1.58, 95%CI: 1.15-2.00, p < 0.0000), locomotion (SMD = 1.34, 95%CI: 0.98-1.70, p < 0.00001), object control (SMD = 1.37, 95%CI: 1.02-1.72, p < 0.00001), and balance (SMD = 1.73, 95%CI: 0.82-2.65, p = 0.0002). Publication bias was detected for total motor skills and balance. Meta-regression showed that intervention frequency positively correlated with balance improvement (p = 0.022), while duration negatively correlated (p = 0.002).

CONCLUSION

Physical exercise significantly improves motor skills in children with ASD. Meta-regression indicates that frequency is a positive moderator for balance gains, but prolonged duration shows diminishing returns due to adaptation plateaus. Age and session length did not affect the protocol, so it remained flexible.