|Year : 2016 | Volume
| Issue : 3 | Page : 163-167
Benefits of physical activity for autism spectrum disorders: A systematic review
Abdulrahman Mohammed Alhowikan
Department of Physiology, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
|Date of Web Publication||28-Sep-2016|
Dr. Abdulrahman Mohammed Alhowikan
Department of Physiology, Faculty of Medicine, King Saud University, PO Box 2925, Riyadh 11461
The purpose of this systematic review was to collect and synthesize evidence from the studies of physical activity (PA)-based interventions for children and adolescents with autism spectrum disorders (ASDs). Systematic search procedures identified 11 studies meeting predetermined inclusion criteria. These studies were evaluated in terms of the following: (a) participant characteristics, (b) type of exercise, and (c) outcomes. Across the corpus of studies, the preliminary search identified 47 studies and exercise was implemented with 115 male (76%) and 36 female (23%) with ASD, aged 4-19 years. A variety of exercise activities were employed (e.g., skating, jogging, horse and bike riding). Following the exercise interventions, decreases in stereotypy, aggression, off-task behavior, improved objective sleep on nights. There is a clear need for further systematic research to develop the way in which exercise prescription provided and increase the sample size those participate in PA. In conclusion, PA reduces stereotypy or self-stimulatory behavior and increases participation in more PAs.
فوائد المجهود البدنى للذين يعانون من الاضطرابات المصاحبة لاضطرابات التوحد..
الغرض من هذه المراجعة المرجعية جمع وتجميع الأدلة من الدراسات عن النشاط البدني (PA) فى ألأطفال والمراهقين الذين يعانون من اضطرابات التوحد. وحددت إجراءات البحث إحدى عشرة دراسة تلبي المعايير المحددة سلفا. تم تقييم هذه الدراسات من حيث ما يلي:
(أ) خصائص المشاركين، (ب) نوع التمارين الرياضية، و (ج) النتائج.
عبر إجراءات البحث الأولية تم تحديد 47 دراسة وتم فبها تنفيذ التمارين فى 115 من الذكور (76٪) و 36 من الإناث (23٪) يعانون من التوحد، وقد تراوحت أعمارهم بين 4-19 سنة. تم توظيف مجموعة متنوعة من الأنشطة العملية (على سبيل المثال، التزلج، الركض، ركوب الخيل والدراجة). بعد الممارسة ،لوحظ انخفاض في الرتابة، السلوك العدواني، كما لوحظ تحسن النوم ليلا. هناك حاجة واضحة لمزيد من البحث المنهجي لتطوير الطريقة التي تمارس بها الأنشطة البدنية المقدمة وزيادة حجم العينة المشاركة في فى مثل هذه الدراسات. وفي الختام، بناءا على نتائج هذا البحث أن النشاط البدني يقلل السلوك النمطي ويحفز النفس ويزيد من المشاركة في المزيد من الأنشطة البدنية.
Keywords: Autism Spectrum Disorder, children and adolescents, health benefits, physical activity
|How to cite this article:|
Alhowikan AM. Benefits of physical activity for autism spectrum disorders: A systematic review. Saudi J Sports Med 2016;16:163-7
|How to cite this URL:|
Alhowikan AM. Benefits of physical activity for autism spectrum disorders: A systematic review. Saudi J Sports Med [serial online] 2016 [cited 2020 Jan 20];16:163-7. Available from: http://www.sjosm.org/text.asp?2016/16/3/163/187558
| Introduction|| |
Autism is a disorder affecting brain function. It is characterized by impairments in social orientation, communication and repetitive or restricted patterns of interests or behaviors appearing during the first 3 years of life with the onset from birth or gradually in a regressive process. The disorder affects approximately four times more boys than girls. ,
Many health organizations and scientific associations agreed that physical activity (PA) provides fundamental health benefits for children and youth, , and recommend a daily moderate-to-vigorous PA for at least 60 min.  Children and youth with disability are deemed to be at greater risk of obesity due to lower levels of PA.  Furthermore, initial evidence suggests that PA levels for children with autism spectrum disorders (ASDs) are lower than normal healthy children and they live sedentary lifestyle, which places them at higher risk of noncommunicable disease. 
Participation in PA may be challenging for individuals with autism because of reasons such as peer and social integration difficulties, communication breakdowns. Furthermore, children with autism cannot play with peers and participate in team sports and various sports activities.  Lack of interest or motivation to exercise may also make it difficult for a child with ASD to comply with daily PA recommendations. However, in order to enhance PA of autism, various types of strategies or interventions must be developed.  Once the children with autism engage in a new PA, they need time to become familiar with physical environment, adaptation with sport hall or playing field, with other children and the teacher. Therefore, it is much better to schedule all PAs in quiet noncrowded place. 
Individuals with ASD are more likely to have difficulties with balance, postural stability, gait, joint flexibility, and movement speed. ,, These disorder in motor abilities may reduce chance to participate in PA.
To support the evidence-based practice in this important area, we provide a systematic update literature review information to increase the exercise behavior of individuals with ASD.
The aims of this review are to guide and inform practitioners for benefits of PA for individuals with ASD and to use exercise to improve the physical and psychological health of individuals with ASD.
| Materials and Methods|| |
This study presents a systematic review of research examining the effects of PA on the health of children's with ASD. Each identified study that met predetermined inclusion criteria was analyzed and summarized in terms of: (a) participant characteristics, (b) exercise behavior taught, and (c) outcomes. Literature search was conducted using the following online databases ISI Web of Knowledge, ProQuest, PubMed, and MEDLINE Full Text. In addition, we searched the references of published studies manually. Publication year was restricted; it is covered the period from April 2012 to July 2016 and limited to studies written in English. On all databases, the keywords "exercise," "fitness," "aerobic," "physical exercise," "swimming," "walk," "jogging," and "physical activity" were paired with "autism," "ASD/Autism Spectrum Disorder," and "Asperger," (e.g., exercise plus autism).
Studies included in the current review met three criteria: (1) they had to include children or adolescents with an ASD diagnosis (i.e., age = 4-19 years); (2) the study involve some kind of physical exercise, measured PA as an independent variable, and articulated how PA was measured; and (3) the study examined the effects of PA on children or adolescents with ASD. The search yielded a total of 11 studies meeting all four inclusion criteria.
| Results|| |
The preliminary search identified 47 studies. Eleven studies investigating the effects of exercise on ASD were summarized in [Table 1]. One-hundred and fifteen (76%) of the participants were male and thirty-six (23%) were female. The age ranges 4-19.
|Table 1: Study outcomes assessed, type of physical activity implemented, and key findings for all reviewed studies|
Click here to view
Exercise behaviors list in [Table 1] showing that, in two studies participants engaged in bike riding exercises. Exercises used in only one study each included swimming, horseback riding, aerobic jogging, roller-skating, karate techniques training, and aerobic exercises, plyometric training.
The outcomes of reviewed studies illustrated that all of the reviewed studies reported improvements in either behavior (e.g., decrease negative behaviors, and in improving positive stereotypy), sleep (e.g., improved quality of sleep on nights immediately following the training), social relation (e.g., reduction in their communication deficit), or improve movement skills (e.g., improvements in balance, motor development, skating skills, and karate techniques).
| Discussion|| |
PA provides long-term health benefits for everyone;  however, people with disabilities face barriers to PA, both in the built and social atmospheres.  It is overlooked in people with severe disabilities  including those with ASD.
In the present review, we provide an update on the effects of PA and exercise on ASD, clarify the benefits of PA for adolescents and children with ASD, and to learn from previous experiments - the best method that encourage ASD to participate in PA.
The strongest evidence from the current review supports the benefits of PA related to; improve social relation with surrounding community, significant improvements in emotional and social functioning motor development enhancing motor skill (MS) proficiency, physical fitness and decreases in repetitive, stereotyped, and self-injurious behaviors. Despite lower levels of representation in the literature, social-emotional effects of PA also yielded relatively large effects.  And clearly from previous studies, the most common behavioral improvement associated with increases in exercise was reduced stereotypy or self-stimulatory behavior, which was reported in many studies. ,,
As we mentioned earlier that exercise may produce positive changes in behavior (e.g., stereotypy). However, the mechanism of action for these improvements is not clear. Possible explanation for decreases in negative behavior is that fatigue resulting from exercise leads to a decrease in all behaviors, Rosenthal-Malek and Mitchell  taught five children with ASD to exercise around a gymnasium for 20 min. Following jogging exercise they found that negative self-stimulatory behavior in the classroom and a community work place was substantially decreased, which could be explained by fatigue. Other reason that may contribute to reductions in stereotypy is the stimulation obtained via exercise may be similar to that obtained via stereotypy for some children. Stereotypic behaviors (e.g., body rocking, arm flapping, and spinning in circles) are often hypothesized to occur because the behavior itself produces pleasant feeling for ASD.
The existing literature shows minimal evidence of increases in cognitive performance for ASD, which may related to the lack of reviews of literature that focused on this aspect.
Researchers have identified that individuals with ASD move differently from their typically developing counterparts, and they often have poorer MSs,  thus participation in PA is often a challenge for people with autism because of poor MSs, low motivation,  and individual PAs may be more appealing to ASD.  However, several studies on children with ASD ,, have found improvements in MSs following long-term PA intervention. And some group games can increase MSs, communication ability, and help improve social interaction skills. 
Autisms are unable to successfully communicate and interact with others, which restricted them from participating in group sports activities and socialization with peers,  so PA such as karate techniques leads to statistically significant reduction in their communication deficit.  However, children with ASD may not be able to participate in activities that rely heavily on communication, such as basketball or soccer. 
Insufficient sleep can result in daytime sleepiness, learning problems, and behavioral issues such as hyperactivity. Research shows that sleep disturbance occurs in 44-83% of ASD children; such as difficulty falling asleep, restless sleep, and frequent wakening.  Kalak et al.  reported improvement in the quality of sleep among adolescents following 3 weeks of morning jogging, compared with controls groups. Obviously, more vigorous exercise led to objectively improved sleep,  and that adult regular exercisers, irrespective of the time of the day at which they exercised, reported better quality of sleep. 
Negative behavior in ASD appears in several forms for many reasons. In addition, any action performed by a child which is not in line with the norms and expectation of people living in the society. More clearly, when an individual's behavior is not in line with the norms of the community, the response he receives may chastise him for his inappropriate behavior, but he may also receive no feedback at all, which is itself also a kind of negative feedback.  However, performing regular PA reduces negative behavior of children with autism such as stereotypies and increased positive behaviors, such as time on required tasks.  And more vigorous sessions of PA have further amplified positive behavior change in comparison to sessions of light or moderate PA. ,,
Research has also demonstrated that increased aerobic exercise can significantly decrease the frequency and habitual of negative, self-stimulating behaviors that are common among individuals with autism, while not decreasing other positive behaviors such as body rocking, spinning, head-nodding, hand flapping, object-tapping, and light gazing that have been shown to interfere with positive social behavior and learning, , and it can discourage aggressive and self-injurious behavior and improving attention span,  and engaging in regular PA has the potential to improve general emotional well-being. 
Despite the useful findings of current review, some limitations still exist due to lack of research studies that exploratory the way in which exercise prescription were sampled and analyzed. Moreover, small sample size may influence the accuracy of result. In view of the above limitations, we believe that future research should attempt to identify possible changes in these aspects of ASD following PA interventions. Moreover, health beneficial should be assessed more precisely, in ways that allow examination of changes in level, trend, and variability before and after exercise prescription.
| Conclusion|| |
To sum up the healthy benefits of PAs on the adolescent and children with ASD, it can be observed from the reduction of stereotypy or self-stimulatory behavior and increases participation in more PAs.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Belmonte MK, Allen G, Beckel-Mitchener A, Boulanger LM, Carper RA, Webb SJ. Autism and abnormal development of brain connectivity. J Neurosci 2004;24:9228-31.
Rapin I, Tuchman RF. Autism: Definition, neurobiology, screening, diagnosis. Pediatr Clin North Am 2008;55:1129-46, viii.
Tremblay MS, Warburton DE, Janssen I, Paterson DH, Latimer AE, Rhodes RE, et al.
New Canadian physical activity guidelines. Appl Physiol Nutr Metab 2011;36:36-46.
Sallis JF, Patrick K. Physical activity guidelines for adolescents: Consensus statement. Pediatr Exerc Sci 1994;6:302.
Maïano C. Prevalence and risk factors of overweight and obesity among children and adolescents with intellectual disabilities. Obes Rev 2011;12:189-97.
Draheim CC, Williams DP, McCubbin JA. Prevalence of physical inactivity and recommended physical activity in community-based adults with mental retardation. Ment Retard 2002;40:436-44.
Block ME, Block VE, Halliday P. What Is autism? Teach Elem Phys Educ 2006;17:7-11.
Yanardað M, Ýlker Y, Özgen A. Approaches to the teaching exercise and sports for the children with autism. Int J Early Child Spec Educ 2010;2:214-30.
Groft-Jones M, Block ME. Strategies for teaching children with autism in physical education. Teach Elem Phys Educ 2006;17:25-8.
Jansiewicz EM, Goldberg MC, Newschaffer CJ, Denckla MB, Landa R, Mostofsky SH. Motor signs distinguish children with high functioning autism and Asperger′s syndrome from controls. J Autism Dev Disord 2006;36:613-21.
Minshew NJ, Sung K, Jones BL, Furman JM. Underdevelopment of the postural control system in autism. Neurology 2004;63:2056-61.
Page J, Boucher J. Motor impairments in children with autistic disorder. Child Lang Teach Ther 1998;14:233-59.
Pan CY, Chu CH, Tsai CL, Sung MC, Huang CY, Ma WY. The impacts of physical activity intervention on physical and cognitive outcomes in children with autism spectrum disorder. Autism 2016. pii: 1362361316633562.
Jull S, Mirenda P. Effects of a staff training program on community instructors′ ability to teach swimming skills to children with autism. J Posit Behav Interv 2015;18:29-40.
Obrusnikova I, Bibik JM. Effects of canines on physical activity of children with autism. Res Q Exerc Sport 2014;85:A82.
Bahrami F, Movahedi A, Marandi SM, Sorensen C. The effect of karate techniques training on communication deficit of children with autism spectrum disorders. J Autism Dev Disord 2016;46:978-86.
Ringenbach SD, Lichtsinn KC, Holzapfel SD. Assisted cycling therapy (ACT) improves inhibition in adolescents with autism spectrum disorder. J Intellect Dev Disabil 2015;40:376-87.
Sarol H, Çimen Z. The effects of adapted recreational physical activity on the life quality of individuals with autism. Anthropologist 2015;21:522-7.
Casey AF, Quenneville-Himbeault G, Normore A, Davis H, Martell SG. A therapeutic skating intervention for children with autism spectrum disorder. Pediatr Phys Ther 2015;27:170-7.
Brand S, Jossen S, Holsboer-Trachsler E, Pühse U, Gerber M. Impact of aerobic exercise on sleep and motor skills in children with autism spectrum disorders - A pilot study. Neuropsychiatr Dis Treat 2015;11:1911-20.
Lanning BA, Baier ME, Ivey-Hatz J, Krenek N, Tubbs JD. Effects of equine assisted activities on autism spectrum disorder. J Autism Dev Disord 2014;44:1897-907.
Mays MN. Using antecedent aerobic exercise to decrease stereotypic behavior in children with autism. Georgia State University; 2013.
Magnusson JE, Cobham C, McLeod R. Beneficial effects of clinical exercise rehabilitation for children and adolescents with autism spectrum disorder (ASD). J Exerc Physiol 2012;15:71-9.
U.S. Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 1996.
Kirchner CE, Gerber EG, Smith BC. Designed to deter. Community barriers to physical activity for people with visual or motor impairments. Am J Prev Med 2008;34:349-52.
Ellis DN, Cress PJ, Spellman CR. Using timers and lap counters to promote self-management of independent exercise in adolescents with mental retardation. Educ Train Ment Retard 1992;27:51-9.
Pan CY. Age, social engagement, and physical activity in children with autism spectrum disorders. Res Autism Spectr Disord 2009;3:22-31.
Yilmaz I, Yanarda M, Birkan B, Bumin G. Effects of swimming training on physical fitness and water orientation in autism. Pediatr Int 2004;46:624-6.
Prupas A, Reid G. Effects of exercise frequency on stereotypic behaviors of children with developmental disabilities. Educ Train Ment Retard Dev Disabil 2001;1:196-206.
Elliott RO Jr., Dobbin AR, Rose GD, Soper HV. Vigorous, aerobic exercise versus general motor training activities: Effects on maladaptive and stereotypic behaviors of adults with both autism and mental retardation. J Autism Dev Disord 1994;24:565-76.
Rosenthal-Malek A, Mitchell S. Brief report: The effects of exercise on the self-stimulatory behaviors and positive responding of adolescents with autism. J Autism Dev Disord 1997;27:193-202.
Berkeley SL, Zittel LL, Pitney LV, Nichols SE. Locomotor and object control skills of children diagnosed with autism. Adapt Phys Activ Q 2001;18:405-16.
Levinson LJ, Reid G. Patterns of physical activity among youngsters with developmental disabilities Cahper Journal 1991;57:24-8.
Todd T, Reid G. Increasing physical activity in individuals with autism. Focus Autism Other Dev Disabl 2006;21:167-76.
Bremer E, Balogh R, Lloyd M. Effectiveness of a fundamental motor skill intervention for 4-year-old children with autism spectrum disorder: A pilot study. Autism 2015;19:980-91.
MacDonald M, Esposito P, Hauck J, Jeong I, Hornyak J, Argento A, et al
. Bicycle training for youth with Down syndrome and autism spectrum disorders. Focus Autism Other Dev Disabl 2012;27:12-21.
Pan CY. Effects of water exercise swimming program on aquatic skills and social behaviors in children with autism spectrum disorders. Autism 2010;14:9-28.
Rogers L, Hemmeter ML, Wolery M. Using a constant time delay procedure to teach foundational swimming skills to children with autism. Topics Early Child Spec Educ 2010;30:102-11.
Provost B, Heimerl S, Lopez BR. Levels of gross and fine motor development in young children with autism spectrum disorder. Phys Occup Ther Pediatr 2007;27:21-36.
Reid G, O Connor J. The autism spectrum disorders: Activity selection, assessment, and program organization-Part II. palaestra-macomb illinois 2003;19:20-27.
Gail Williams P, Sears LL, Allard A. Sleep problems in children with autism. J Sleep Res 2004;13:265-8.
Kalak N, Gerber M, Kirov R, Mikoteit T, Yordanova J, Pühse U, et al.
Daily morning running for 3 weeks improved sleep and psychological functioning in healthy adolescents compared with controls. J Adolesc Health 2012;51:615-22.
Brand S, Kalak N, Gerber M, Kirov R, Pühse U, Holsboer-Trachsler E. High self-perceived exercise exertion before bedtime is associated with greater objectively assessed sleep efficiency. Sleep Med 2014;15:1031-6.
Buman MP, Phillips BA, Youngstedt SD, Kline CE, Hirshkowitz M. Does nighttime exercise really disturb sleep? Results from the 2013 National Sleep Foundation Sleep in America Poll. Sleep Med 2014;15:755-61.
Zurcher LA. Social Roles: Conformity, Conflict, and Creativity. Beverly Hills: Sage Publications, Inc.; 1983.
Levinson LJ, Reid G. The effects of exercise intensity on the stereotypic behaviors of individuals with autism. Adapted Physical Activity Quarterly 1993;10:255-68.
Lang R, Koegel LK, Ashbaugh K, Regester A, Ence W, Smith W. Physical exercise and individuals with autism spectrum disorders: A systematic review. Res Autism Spectr Disord 2010;4:565-76.
Petrus C, Adamson SR, Block L, Einarson SJ, Sharifnejad M, Harris SR. Effects of exercise interventions on stereotypic behaviours in children with autism spectrum disorder. Physiother Can 2008;60:134-45.
McGimsey JF, Favell JE. The effects of increased physical exercise on disruptive behavior in retarded persons. J Autism Dev Disord 1988;18:167-79.