Effects of Exercise Interventions on Stereotypic Behaviours in Children with Autism Spectrum Disorder
Open accessAbstract
Purpose: The purpose of this systematic review was to synthesize evidence from studies examining the effect of exercise interventions on stereotypic behaviours in children with autism spectrum disorder (ASD). Methods: Only exercise-related physical therapy (PT) interventions were included. A multifaceted search strategy identified studies published between 1980 and 2007. Quality was assessed using the American Academy of Cerebral Palsy and Developmental Medicine (AACPDM) Study Quality Scale, the Clinical Relevance Tool for Case Studies, and the Quality, Rigour or Evaluative Criteria tool. Results: Seven studies (1982–2003) met our inclusion criteria; four of these used single-subject research designs, two were group studies, and one was a case study. Ages and behavioural characteristics of the children (N = 25) varied among the studies. Levels of evidence ranged from II to V (of a possible I–V). Study quality scores ranged from 2 to 5 (range: 0 to 7); mean = 3.9, mode = 5. Few studies in this area of PT practice have been published, and those identified scored low levels of rigour on the AACPDM criteria. Conclusions: Research suggests that exercise provides short-term reductions of stereotypic behaviours in children with ASD. Future research with stronger evidence levels, greater rigour, and longer-term outcome assessment is required to determine specific exercise parameters.
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The relationship between exercise and cognition in the neurodevelopmental population appears to be less clear, with ASD studies focusing more on behavioural symptoms compared to ADHD studies that specifically examine EF.
“Unlike in the literature from the general population, however, the relationship between exercise and cognition in the neurodevelopmental population appears to be less clear, with studies on ASD samples focusing more on behavioural symptoms (e.g., Petrus et al. 2008;Sowa and Meulenbroek 2012) compared to ADHD studies that specifically examine EF (e.g., Chang et al. 2012b;Smith et al. 2013).”
From A meta-analytic review of the efficacy of physical exercise interventions on cognition in individuals with autism spectrum disorder and ADHD (2016) · cites this paper as Petrus et al. 2008
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“Previous studies have revealed that participation in physical activity positively affects various developmental areas of children with ASD (Healy et al., 2018; Petrus et al., 2008).”
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“Numerous systematic reviews and meta-analyses (e.g., Bremer et al., 2016; Lang et al., 2010; Petrus et al., 2008; Sorensen and Zarrett, 2014; Sowa and Meulenbroek, 2012), report upon the positive impact of physical activity on a range of variables for autistic individuals, yet the smaller sample…”
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“Neuroprotective effects of exercise on various brain insults are well documented (Kim et al., 2011; Lang et al., 2010; Petrus et al., 2008).”
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“Neuroprotective effects of exercise on various brain insults are well documented (Kim et al., 2011; Lang et al., 2010; Petrus et al., 2008; Seo et al., 2013).”
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“Overall, results suggest that the protocol was welltolerated by the children with ASD without ID; another important finding as the tolerability of an intervention can differ for subgroups with ASD (Petrus et al., 2008).”
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“They also support previous studies that found physical exercise to improve cognitive processes in children and adolescents with ASD [46,47].”
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“Several studies (Ferreira et al., 2019; Huang et al., 2020; Petrus et al., 2008; Tarr et al., 2020; Teh et al., 2021) also reported the positive effects of physical activity on alleviating stereotyped behaviors in individuals with ASD.”
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“Studies have indicated that exercise bene fi ts social interaction de fi cits (13) and can reduce stereotyped behaviors in children and adolescents with autism (14, 15).”
BackgroundAydemir, U. (2025) · JMIR Human Factors · doi:10.2196/71119 · Cited by 24 · see citing works
“Participation in physical activity provides many benefits to children with ASD in terms of physical and mental health [9-11].”
Cho, H.-S., Kim, T.-W., Ji, E., Park, H.-S., Shin, M., & Baek, S. (2016) · Journal of Exercise Rehabilitation · doi:10.12965/jer.1632696.348 · Cited by 22 · see citing works
“Exercise may attenuate neurological impairments in various neuropsychiatric disorders, including autism (Kim et al., 2013; Petrus et al., 2008).”
BackgroundBenefits of physical activity for autism spectrum disorders: A systematic review
Alhowikan, A. M. (2016) · Saudi Journal of Sports Medicine · doi:10.4103/1319-6308.187558 · Cited by 21 · see citing works
Yue, Y., Xu, P., Liu, Z., Sun, X., Su, J., Du, H., Chen, L., Ash, R. T., Smirnakis, S. M., Simha, R., et al. (2021) · Science Advances · doi:10.1126/sciadv.abf7467 · Cited by 20 · see citing works
Stimulation of vagus nerve for patients with disorders of consciousness: a systematic review
Dong, X., Tang, Y., Zhou, Y., & Feng, Z. (2023) · Frontiers in Neuroscience · doi:10.3389/fnins.2023.1257378 · Cited by 19 · see citing works
“The evaluation of the articles’ quality was conducted using the American Academy of Cerebral Palsy and Developmental Medicine (AACPDM) Study Quality Scale (Petrus et al., 2008) (refer to Table 2), the Clinical Relevance Tool for Case Studies, and the Quality, Rigor or Evaluative Criteria tool.”
MethodKasner, M., Reid, G., & MacDonald, C. D. (2012) · Research in Autism · doi:10.1016/j.rasd.2012.02.001 · Cited by 17 · see citing works
“Lang et al. (2010) conducted a systematic review of research on the impact of exercise on a variety of behaviors of individuals with ASD while Petrus et al. (2008) restricted their review to the exercise effect on stereotypic behaviors.”
BackgroundYessick, A., Haegele, J. A., Zhu, X., & Bobzien, J. (2019) · Advances in Neurodevelopmental Disorders · doi:10.1007/s41252-019-00139-5 · Cited by 19 · see citing works
Sabet, N., Abadi, B., Moslemizadeh, A., Rajizadeh, M. A., Arabzadeh, F., Shahrbabaki, S. S. V., Soltani, Z., Rafie, F., & Bashiri, H. (2023) · Heliyon · doi:10.1016/j.heliyon.2023.e20641 · Cited by 17 · see citing works
“Moreover, it has been shown that physical exercise can enrich memory deficits and social behavior complications and decreases hyperactivity in autism [49 – 51].”
BackgroundEffect of whole body vibration on stereotypy of young children with autism
Bressel, E., Gibbons, M. W., & Samaha, A. (2011) · BMJ Case Reports · doi:10.1136/bcr.02.2011.3834 · Cited by 8 · see citing works
“11 Regarding vigorous exercise, Kern et al 12 observed that 15 min of jogging around a large open fi eld at a ‘mildly strenuous’ pace produced a systemic decrease in stereotypy whereas 15 min of playing with a ball resulted in some stereotypies decreasing and some increasing after the intervention.”
On the Playing Field to Improve: A Goal for Autism
Vetri, L., & Roccella, M. (2020) · Medicina · doi:10.3390/medicina56110585 · Cited by 18 · see citing works
“5) [11,12] 9 weeks peer-mediated intervention accuracy of soccer skills quantitative measures Barak et al.”
BackgroundTse, A. C. Y., Lee, P. H., Zhang, J., & Lai, E. W. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-020944 · Cited by 16 · see citing works
“The total of 24 sessions was selected based on previous studies involving jogging in this population.(45) 46 Each intervention session will be conducted in the morning by a trained research assistant and student helpers.”
MethodAn Evaluation of the Effects of Antecedent Exercise Type on Stereotypic Behaviors
Lee, J., Vargo, K. K., & Porretta, D. L. (2018) · Journal of Developmental and Physical Disabilities · doi:10.1007/s10882-018-9593-1 · Cited by 14 · see citing works
Duffy, L. J., Baluch, B., Welland, S., & Raman, E. (2017) · Journal of Exercise Rehabilitation · doi:10.12965/jer.1734960.480 · Cited by 14 · see citing works
“…exercise may lead to the reduction of aggressive behaviour (Allison et al., 1991; Gabler-Halle et al.; 1993; Yell, 1988) and reduce stereotyped and self-injurious behaviour (Bachman and Fuqua, 1983; Baumeister and MacLean, 1984; Elliot et al., 1994; Petrus et al., 2008; Prupas and Reid, 2001).”
BackgroundZhu, Y., Li, X., & Du, Z. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1626831 · Cited by 14 · see citing works
Estrategias de actividad física planificada en autismo: revisión sistemática
Fessia, G., Contini, L., Astorino, F., & Manni, D. (2018) · Revista de Salud Pública · doi:10.15446/rsap.v20n3.63040 · Cited by 14 · see citing works
Tse, A. C. Y., LIU, V. H. L., & Lee, P. H. (2020) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000002525 · Cited by 13 · see citing works
Social Learning Through Structured Exercise for Students with Autism Spectrum Disorders
Habib, K., Montreuil, T. C., & Bertone, A. (2018) · Review Journal of Autism and Developmental Disorders · doi:10.1007/s40489-018-0139-3 · Cited by 13 · see citing works
Dance therapy in autism: a case report
Teixeira-Machado, L. (2022) · LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) · doi:10.6084/m9.figshare.20015371 · Cited by 12 · see citing works
Lourenço, C., Esteves, D., Corredeira, R., & Seabra, A. (2016) · Revista Brasileira de Educação Especial · doi:10.1590/s1413-65382216000100004 · Cited by 12 · see citing works
Khanzadeh, A. A. H., & Imankhah, F. (2017) · Practice in Clinical Psychology · doi:10.29252/nirp.jpcp.5.4.251 · Cited by 10 · see citing works
Plaza‐Díaz, J., Radar, A. M., Baig, A. T., Leyba, M. F., Costabel, M. M., Zavala-Crichton, J. P., Sanchez‐Martinez, J., MacKenzie, A., & Solis‐Urra, P. (2022) · Children · doi:10.3390/children9121834 · Cited by 11 · see citing works
“[74], as well as reducing deficits in social interaction and executive function (particularly”
BackgroundThe Impact of a Rock Climbing Program for Adolescents with Autism Spectrum Disorder: A Pilot Study
Oriel, K. N., Kanupka, J. W., Fuehrer, A. T., Klumpp, K. M., Stoltz, K. N., Willey, D. W., & Decvalcante, M. L. (2018) · International Journal of Kinesiology in Higher Education · doi:10.1080/24711616.2018.1425601 · Cited by 9 · see citing works
“Petrus et al. (2008), determined that increased workout intensity in adolescents with ASD leads to the majority of the short-term social changes observed, such as decreased self-stimulatory and stereotypic behaviors.”
BackgroundThe Effects of Physical Activity on Engagement in Young Children with Autism Spectrum Disorder
Harbin, S. G., Davis, C. A., Sandall, S. R., & Fettig, A. (2021) · Early Childhood Education Journal · doi:10.1007/s10643-021-01272-4 · Cited by 7 · see citing works
Cui, X., & Wang, S. (2024) · International Journal of Mental Health Promotion · doi:10.32604/ijmhp.2023.030135 · Cited by 8 · see citing works
“Although there are relevant data to support their effectiveness [6 – 8], they ignore the advantages and abilities of children with autism in some aspects.”
Creating Entrepreneurial and Innovative Fundraising Opportunities Through Service-Learning
Meaney, K. S., Liu, T., & Duke, L. M. (2016) · Kinesiology Review · doi:10.1123/kr.2016-0024 · Cited by 8 · see citing works
Боднар, І., & Hamade, A. (2019) · Pedagogics psychology medical-biological problems of physical training and sports · doi:10.15561/18189172.2019.0302 · Cited by 8 · see citing works
“Among the meta-studies there are several which analyzed the level of PA [26], examined effects of various means on PA on cognitive performance and stereotyped behavior [27, 28, 29, 30] of children with ASD.”
BackgroundKetcheson, L. R., Pitchford, E. A., Wentz, C. F., & Loetzner, F. (2023) · Disability and health journal · doi:10.1016/j.dhjo.2023.101538 · Cited by 7 · see citing works
Esentürk, O. K., & Yarımkaya, E. (2020) · Ankara Üniversitesi Eğitim Bilimleri Fakültesi Özel Eğitim Dergisi · doi:10.21565/ozelegitimdergisi.686849 · Cited by 7 · see citing works
Prescription of Exercise Programs for Individuals with Autism Spectrum Disorder: Systematic Review
Ataíde, S. S., Ferreira, J. P., & Campos, M. J. (2024) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-024-06566-1 · Cited by 6 · see citing works
“…often selected because they are accessible and adaptable to the different levels of functionality in ASD, making them more feasible for a broad spectrum of abilities (Bremer et al., 2016; Lang et al., 2010; Petrus et al., 2008; Sowa & Meulenbroek, 2012; Srinivasan et al., 2014; Tan et al., 2016).”
Goldman, K. J., DeLeon, I. G., Schieber, E., Weinsztok, S. C., & Nicolini, G. (2021) · Behavioral Interventions · doi:10.1002/bin.1812 · Cited by 6 · see citing works
Fairburn, D. J., Baiamonte, B. A., Gray, B. E., Hernandez, K. A., Horton, J. R., & Hollander, D. B. (2021) · Behavioural Brain Research · doi:10.1016/j.bbr.2021.113727 · Cited by 6 · see citing works
Li, L., Wang, A. T., Fang, Q., & Moosbrugger, M. E. (2023) · JMIR Research Protocols · doi:10.2196/40383 · Cited by 6 · see citing works
“Physical exercise– and motor skill–related interventions, such as aerobic exercise, resistance training, and aquatic activities, were mostly adopted in the clinical practice [32,34,41-56].”
BackgroundInfluentialEvans, P., Golla, S., & Morris, M. A. (2014) · Elsevier eBooks · doi:10.1016/b978-0-12-410529-4.00018-8 · Cited by 6 · see citing works
Treadmill Exercise Improves Stereotypical Behaviors in Autistic Rats
Alipour, V., Shabani, R., Zarrindast, M., Rahmani-Nia, F., & Nasehi, M. (2022) · Galen Medical Journal · doi:10.31661/gmj.v11i.1990 · Cited by 5 · see citing works
“Previous studies have also evaluated the impact of physical activity and exercise interventions on individuals with ASD [13, 14], resulting in positive outcomes.”
BackgroundOTİZMLİ ÇOCUKLARDA TEMEL HAREKET EĞİTİMİNİN FİZİKSEL UYGUNLUK PARAMETRELERİ ÜZERİNE ETKİSİ
Kara, E., BEYAZOĞLU, G., & Uysal, E. (2019) · Ankara Üniversitesi Beden Eğitimi ve Spor Yüksekokulu SPORMETRE Beden Eğitimi ve Spor Bilimleri Dergisi · doi:10.33689/spormetre.503317 · Cited by 5 · see citing works
“Otizm, günümüzde çocukları etkileyen en yaygın nörolojik bozukluk ve en yaygın gelişimsel engellerden biri olarak kabul edilmektedir; otizm çocuk populasyonunda kanser, diyabet, ayrık omurga ve down sendromundan daha yaygındır (Petrus et al., 2008; Filipek et al., 1999).”
Mademtzi, M. (2016) · University of Birmingham Institutional Research Archive (University of Birmingham) · Cited by 4 · see citing works
Parsons, K., Payne, S., Bhaska, L., Wallace, J., & Holt, N. (2025) · Psychology of Sport And Exercise · doi:10.1016/j.psychsport.2025.102867 · Cited by 3 · see citing works
Children and Teens With Autism Spectrum Disorder
Tovin, M. M. (2013) · Strength and conditioning journal · doi:10.1519/ssc.0b013e3182919fab · Cited by 3 · see citing works
“There is additional evidence that children with ASD experience other positive effects from exercise, including improved motor function and exercise capacity (35), reduced self-stimulatory behaviors such as rocking, spinning, and hand flapping (34,40,47), and improved selfesteem, mood, and attention (32,36).”
BackgroundAkter, R., Urme, N. A., Hossain, K. M. A., Hossain, T., Ahammad, S., Yeasmin, M. H., Hossain, M. Z., Parvin, R., Hossain, M. S., & Zahid, M. A. (2023) · PLoS ONE · doi:10.1371/journal.pone.0292326 · Cited by 3 · see citing works
Bhagwasia, H., & Kaur, B. (2022) · Physiotherapy - The Journal of Indian Association of Physiotherapists · doi:10.4103/pjiap.pjiap_40_22 · Cited by 3 · see citing works
Li, Y., Qi, Y., Yang, Y., & Zhang, R. X. (2026) · Medicine · doi:10.1097/md.0000000000047186 · Cited by 2 · see citing works
“[39,40] Macoun used game-based cognitive training with children with ASD and found it to be effective in improving executive functioning in children with ASD, with a significant transfer effect.”
Helal, E. (2018) · International Journal of Psychology & Behavior Analysis · doi:10.15344/2455-3867/2018/152 · Cited by 1 · see citing works
“This result matches the results of other studies [53,46-50], which concluded the importance of early intervention to treat behavioral problems and disorders using behavioral therapy.”
ResultJiu Jitsu como instrumento de tratamento para crianças com Transtorno do Espectro Autista
Lima, L. S., do Amaral, M. F., Fontes, V. A. M., Couto, C. R., Almohalha, L., & Santos, S. P. (2021) · Revista Brasileira de Educação Física e Esporte · doi:10.11606/issn.1981-4690.v35i4p191-202 · Cited by 2 · see citing works
Lourenço, C., Esteves, D., & Pinheiro, M. D. O. (2023) · IntechOpen eBooks · doi:10.5772/intechopen.106399 · Cited by 2 · see citing works
Ratcliff, K., Hilton, C. L., Fingerhut, P. E., Jin, Y., & Hong, I. (2023) · Occupational Therapy In Health Care · doi:10.1080/07380577.2023.2243513 · Cited by 2 · see citing works
“Autistic children are often less likely to enjoy and participate in physical activities than non-autistic children (Cotman, et al., 2007; Eversole, et al., 2016; Hilton, et al., 2008; MacDonald, et al., 2011; Petrus, et al., 2008).”
Using antecedent aerobic exercise to decrease stereotypic behavior in children with autism
Mays, M. N. M. (2022) · Digital Archive @ GSU · doi:10.57709/4851623 · Cited by 2 · see citing works
Elliott, N. A. (2016) · University of Birmingham Institutional Research Archive (University of Birmingham) · Cited by 2 · see citing works
Benson, S. (2017) · Libraries and Cultural Resources (University of Calgary) · doi:10.11575/prism/24915 · Cited by 2 · see citing works
Survey of Sensory Diet Use Among California Occupational Therapy Practitioners
Peterson, M., Hunt, A., & White, E. (2018) · doi:10.33015/dominican.edu/2018.ot.10 · Cited by 2 · see citing works
“Various populations have shown substantial benefits of physical activity to regulate one’s mood, behavior, and sensory processing (Petrus et al., 2008; Watling & Dietz, 2007; Bass, Duchowny, & Llabre, 2009).”
BackgroundInclusion Strategies: A Trampoline Program For Children With Autism Spectrum DisorderPreprint
Lourenço, C., & Esteves, D. (2021) · Research Square · doi:10.21203/rs.3.rs-798851/v1 · Cited by 2 · see citing works
TRANSTORNOS INVASIVOS DE DESENVOLVIMENTO NO AUTISMO E SÍNDROME DE ASPERGER: UMA REVISÃO SISTEMÁTICA
Haas, P., de Paiva, K. M., Corrêa, V. P., Gonzáles, A. I., Besen, E., Moreira, E., & da Cunha, J. (2020) · Revista Brasileira de Ciência e Movimento · doi:10.31501/rbcm.v28i2.10624 · Cited by 1 · see citing works
- Authors
- Petrus, C., Adamson, S. R., Block, L., Einarson, S. J., Sharifnejad, M., & Harris, S. R.
- Affiliations
- University of British Columbia (CA)
- Corresponding author
- Harris, Susan R.
- Venue
- Physiotherapy Canada
- Published
- 2008-04
- Volume
- 60
- Issue
- 2
- Pages
- 134-145
- ISSN
- 0300-0508 (ISSN-L)
- 1708-8313
- PMC
- PMC2792819
- OpenAlex
- W2134528830
- Cited by
- 147
- References
- 26
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 12 · 2023: 14 · 2022: 12 · 2021: 15 · 2020: 10 · 2019: 10 · 2018: 14 · 2017: 8 · 2016: 11 · 2015: 9 · 2014: 2 · 2013: 7 · 2012: 4
- FWCI
- 0.86
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Physiotherapy Canada (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of British Columbia
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Health Sciences › Medicine › Psychiatry and Mental health › Cerebral Palsy and Movement Disorders
- Keywords
- autism spectrum disorder, stereotypy, exercise intervention, physiotherapy, children, study quality
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