April 2021 Issue

Focus on Fitness: Benefits of Exercise for Autism
By Jennifer Van Pelt, MA
Today’s Dietitian
Vol. 23, No. 4, P. 52

Evidence of physical activity’s perks for ASD continues to emerge.

April is National Autism Awareness Month. Since Today’s Dietitian’s last published article on exercise and autism in 2016, numerous research studies have been published and results continue to support the benefits of exercise for those with autism spectrum disorder (ASD). Considered a neurodevelopmental disorder because symptoms appear between 18 months and 3 years of age, ASD is an “umbrella diagnosis” that includes multiple disorders, including autistic disorder, childhood disintegrative disorder, Asperger syndrome, and pervasive developmental disorder-not otherwise specified. ASD is characterized by difficulties with communication and social interactions, repetitive behaviors, and challenges with functioning in school, work, and other life activities.

According to the Centers for Disease Control and Prevention, approximately 1 in 54 children in the United States has been diagnosed with ASD. Boys are four times more likely to be diagnosed with ASD; 1 in 34 boys have ASD, compared with 1 in 144 girls. ASD may be accompanied by other disabilities and medical conditions. Approximately one-third of children with ASD also have an intellectual disability that presents challenges to daily functioning. More than 50% of children with ASD have chronic sleep issues. An estimated 7% of children and 26% of adults with ASD have depression, while about 11% to 40% of children and teens with ASD have anxiety disorders. Children, teens, and adults with ASD are more likely to have overweight or obesity.1 Medication side effects, sedentary lifestyle related to electronic device use, motor skill limitations, and use of food to reinforce behavior/response can exacerbate weight gain in children and adolescents with ASD.

Exercise is essential for minimizing the likelihood of obesity and overweight—and their associated comorbidities (eg, CVD, diabetes)—in those with ASD. In addition, regular exercise can help reduce anxiety and depression, as well as improve sleep quality. Several research studies conducted over the last 20 years have confirmed that exercise has additional benefits in ASD, including improving motor skills, decreasing stereotypy (eg, repetitive movements such as hand flapping and rocking), reducing aggression, and improving social skills and school-related functioning. Although the exact mechanisms by which exercise positively affects ASD behaviors aren’t fully understood, neuropsychological studies suggest that exercise can increase the production of nerve growth factor and fibroblast growth factor-2, the volume of hippocampal tissue, and the stimulation of certain nerve-signaling pathways, thereby reducing some ASD symptoms.2

Evidence-Based Practices
Research published in the last year has validated earlier studies and added to the evidence base supporting the benefits of exercise for those with ASD, as well as helped to determine the types of exercise that might be most beneficial and accessible. Studies reporting positive results for children and teens with ASD include the following:

• A March 2020 meta-analysis of 12 studies of physical activity and exercise found significant improvements in social interaction skills, communication ability, and motor skills of children and adolescents with ASD who were regularly physically active. Exercise and physical activity in the studies included karate and kata training, table tennis, horseback riding, tai chi, outdoor activities, sports-based games, water exercise, and trampoline exercise. Improvements resulted from continuous activity/exercise performed 30 to 90 minutes per session, four to seven times weekly, for four to 24 weeks. Some activities, such as table tennis and outdoor activities, were performed more frequently per week. Greater improvements were associated with longer-term partipation.3

• A November 2020 study found that after a randomized controlled 12-week trial of organized jogging sessions, significant improvements in emotional regulation and reduced behavioral problems were observed in children with ASD aged 8 to 12.4

• Another November 2020 study found that in a randomized controlled six-week trial of a yoga-based program, children aged 8 to 12 showed significant improvement in overall control, reduced sleep problems, and improved ability to communicate and analyze emotions.5

Few recent studies address the benefits of exercise for adults with ASD. A March 2020 systematic review of five studies of the benefits of dance reported that practicing dance not only helped with body awareness and fitness but also positively influenced empathy, emotional expression, psychological well-being, and social skills for adults with ASD.6

Survey and epidemiologic research have found that those with ASD are significantly less active than their peers.2 Barriers to exercise include the lack of appropriate exercise programs, motor skill and coordination limitations, medication side effects, caregiver availability and support, and communication difficulties. In addition, capabilities vary widely between individuals with ASD; some may require one-on-one highly modified exercise due to physical limitations, while others may be physically capable but require communication support. Parental and caregiver understanding of the importance of exercise and ongoing support of participation is another critical factor for increasing exercise in the ASD population.

Appropriate exercises and activities that parents and caregivers can provide or facilitate include the following, all of which can be adapted for a range of ASD needs:

• bicycling—stationary or outdoor cycle or adapted bicycle;
• jogging/walking on a treadmill, indoor/outdoor track, appropriate outdoor trails;
• activities with balls or other equipment to improve coordination, such as kicking, dribbling, passing to another, bouncing and catching, throwing, racket or bat, golf, frisbee golf;
• martial arts;
• dancing;
• horseback riding, modified as needed;
• certain programs and activities at indoor fitness/recreational facilities;
• swimming or other water exercise; and
• yoga.

Organized fitness programs specifically designed for the ASD population may be available in some communities or at some fitness or dance facilities, especially for children and teens. Dedicated adult programs, however, aren’t as common and are an area of need for adults with ASD. For those interested in becoming more involved in exercise for clients with ASD, specialized certifications recently have been introduced, including the Autism Exercise Specialist certification endorsed by the American College of Sports Medicine (autismexercisespecialist.com) and the Autism Fitness Certification, which has been approved by two leading fitness certification organizations, and the National Council for Therapeutic Recreation Certification (autismfitness.com/certification). For motivation and tracking of exercise, an app called ExerciseBuddy, designed to support fitness and related behavior for those with ASD, may be helpful.

— Jennifer Van Pelt, MA, is a certified group fitness instructor and health care researcher in the Lancaster, Pennsylvania, area.


1. Autism statistics and facts. Autism Speaks website. https://www.autismspeaks.org/autism-statistics

2. Chen Z, Lan W, Yang G, et al. Exercise intervention in treatment of neuropsychological diseases: a review. Front Psychol. 2020;11:569206.

3. Huang J, Du C, Liu J, Tan G. Meta-analysis on intervention effects of physical activities on children and adolescents with autism. Int J Environ Res Public Health. 2020;17(6):1950.

4. Tse ACY. Brief report: impact of a physical exercise intervention on emotion regulation and behavioral functioning in children with autism spectrum disorder. J Autism Dev Disord. 2020;50(11):4191-4198.

5. Tanksale R, Sofronoff K, Sheffield J, Gilmour J. Evaluating the effects of a yoga-based program integrated with third-wave cognitive behavioral therapy components on self-regulation in children on the autism spectrum: a pilot randomized controlled trial [published online November 25, 2020]. Autism. doi: 10.1177/1362361320974841.

6. DeJesus BM, Oliveira RC, de Carvalho FO, de Jesus Mari J, Arida RM, Teixeira-Machado L. Dance promotes positive benefits for negative symptoms in autism spectrum disorder (ASD): a systematic review. Complement Ther Med. 2020;49:102299.