Effects of exercise on anxiety and psychiatric comorbidities in children with autism spectrum disorder: a systematic review and meta-analysis.

Abstract

<h4>Background</h4>Anxiety disorders affect nearly 40%-50% of children with autism spectrum disorder (ASD). While exercise benefits motor skills, its efficacy in modulating affective symptoms remains under-synthesized. This meta-analysis evaluated the effects of exercise on anxiety and co-occurring symptoms in pediatric ASD.<h4>Methods</h4>We analyzed data from 12 randomized controlled trials (RCTs) involving 482 participants. A three-level random effects model was utilized to account for effect size dependencies. Subgroup analyses examined the exercise modality and intensity.<h4>Results</h4>Exercise significantly reduced comorbid anxiety (Hedges' <i>g</i> = -0.68, <i>p</i> < 0.001). Notably, aerobic exercise demonstrated the most substantial anxiolytic effect (<i>g</i> = -1.18), outperforming other modalities. Improvements were also observed in the core ASD symptoms (<i>g</i> = -0.56) and attention-deficit/hyperactivity disorder (ADHD)-related attention deficits (<i>g</i> = -0.48). The effects on sleep were inconclusive due to heterogeneity.<h4>Conclusions</h4>Exercise, particularly aerobic interventions, serves as a potent non-pharmacological strategy for the management of anxiety and affective dysregulation in children with ASD. These findings support the integration of aerobic exercise into clinical treatment plans to improve emotional wellbeing.<h4>Systematic review registration</h4>https://www.crd.york.ac.uk/prospero/, identifier CRD420251157119.