Abstract
OBJECTIVE: This systematic review and meta-analysis evaluated the effects of various physical activities on executive function (EF) and its components-inhibition, working memory, and cognitive flexibility-in children with ASD. METHODS: Six databases (Cochrane Library, PubMed, Embase, Web of Science, ScienceDirect, CBMdisc) were searched from inception to December 2025. Additional studies were identified through reference list screening. We used RevMan 5.4 and the GRADE framework to assess risk of bias and quality grades, and Stata 18 to generate forest and funnel plots for data analysis. RESULTS: Fourteen RCTs met the inclusion criteria. Physical activity resulted in at least moderate improvements in EF and all subdomains. Notably, FMS training administered four times per week for 18 weeks produced a large effect on EF [SMD = 2.62, 95% CI = 1.50-3.74]. In comparison, digital motion-sensing games showed the largest effects on inhibition [SMD = 1.38, 95% CI = 0.52-2.25], working memory [SMD = 0.89, 95% CI = 0.08-1.70], and cognitive flexibility [SMD = 0.88, 95% CI = 0.36-1.39]. A protocol of 15 min per session, two to three sessions per week for 18 weeks, achieved at least moderate improvements in inhibition and cognitive flexibility, while working memory showed a large effect by eight weeks. CONCLUSIONS: FMS training conducted four times per week for 18 weeks provides the greatest overall benefit. Fifteen-minute digital motion-sensing game sessions, two to three times per week for 18 weeks, are most effective for improving inhibition and cognitive flexibility, and working-memory improvements are observable within four weeks. Further research with larger sample sizes is recommended. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251130511, PROSPERO CRD420251130511.