Abstract
BACKGROUND: Physical exercise may confer benefits on cognitive function and quality of life in children with autism spectrum disorder (ASD). However, the evidence has not been co mprehensively synthesized. This study aimed to investigate the effect of exercise intervention on cognitive function and quality of life with ASD, and provide evidence to support the scientific use of exercise interventions in practice. METHODS: We systematically searched major databases from inception to November 2023 for randomized trials and observational studies examining exercise interventions in children with ASD. Mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random-effects models. Heterogeneity was assessed using the I2 statistic. Risk of bias was evaluated with the Cochrane tool. RESULTS: Fourteenth studies were included. Meta-analysis of 8 randomized trials found a small but significant effect of exercise on social communication (MD: 1.42, 95% CI: 0.21 to 2.6322, p = 0.02, I2 = 29%). The effect on social cognition was also significant (MD: 1.99, 95% CI: 0.18 to 3.80, p = 0.03, I2 = 0%). Influential analysis identified 2 studies as outliers. Leave-one-out analysis showed meta-analysis conclusions were robust. The included studies consistently demonstrated benefits of exercise on sleep, behavioral aspects, motor skills, quality of life, and other outcomes. CONCLUSIONS: This meta-analysis provides evidence that exercise interventions may improve core symptoms and functional outcomes in children with ASD. However, small sample sizes and heterogeneity indicate cautious interpretation. Further adequately powered trials are needed to establish optimal exercise programs for managing ASD.