Effects of exercise interventions on fundamental motor skills in children and adolescents with autism spectrum disorder: a meta-analysis with meta-regression analyses of randomized controlled trials
Abstract
The objective of this study was to systematically evaluate the effects of exercise interventions on fundamental motor skills (FMS) in children and adolescents with autism spectrum disorder (ASD) and determine whether distinct FMS domains demonstrate differential responses to exercise dosage and intervention characteristics. A comprehensive search of PubMed, the Cochrane Library, Embase, and Web of Science up to July 2026 identified 31 RCTs. Standardized mean differences were calculated to evaluate the effects of exercise interventions on object control, locomotor, and stability skills. Subgroup and meta-regression analyses examined the effects of intervention characteristics and exercise dosage, while sensitivity analyses and risk of bias assessments evaluated the robustness of the findings. Exercise interventions significantly improved all three dimensions of FMS in children and adolescents with ASD: Object control skills (OCS) (Hedges’ g = 1.13, 95% CI: 0.67 to 1.59), Locomotor skills (LMS) (Hedges’ g = 1.19, 95% CI: 0.87 to 1.51), and Stability skills (SS) (Hedges’ g = 1.08, 95% CI: 0.68 to 1.49). Further analyses revealed domain-specific responses to exercise dosage. Longer exercise session time was associated with greater improvements in OCS, supported by both subgroup analyses and meta-regression. For LMS, greater effects were observed with three sessions per week and interventions lasting ≤ 10 weeks in subgroup analyses, although these findings were not confirmed by meta-regression. No significant dose-related associations were identified for SS. Exercise interventions improve OCS, LMS, and SS in children and adolescents with ASD. Different FMS domains may show distinct responses to exercise dosage, suggesting that future exercise programs may need to consider the specific characteristics of targeted motor domains. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251139963 , identifier CRD420251139963.