Play, physical activity, and exercise interventions for behavioral and social outcomes in autism spectrum disorder: a narrative review
Article information
Abstract
Autism spectrum disorder (ASD) is characterized by persistent difficulties in social communication and interaction, alongside restricted and repetitive patterns of behavior. Growing evidence suggests that play, physical activity (PA), and exercise may contribute to improvements in behavioral regulation and social functioning in individuals with ASD. However, findings across studies remain heterogeneous with respect to intervention type, intensity, and targeted outcomes, making it challenging to draw unified conclusions. This narrative review aimed to synthesize and discuss existing literatures on play-based, PA, and exercise interventions targeting behavioral and social outcomes in individuals with ASD. Overall, the literature indicated that PA and exercise programs—particularly those incorporating social interaction, task-oriented play, or group-based formats—were associated with meaningful improvements in both sociobehavioral domains. Potential mechanisms underlying these effects included enhanced executive functioning, improved self-regulation, neurobiological adaptations, and increased opportunities for social learning. Nevertheless, variability in study design, outcome measures, and methodological quality limits the generalizability of findings. Future research should prioritize well-designed trials with standardized outcome measures and clearly defined intervention parameters to strengthen the evidence base and inform clinical and educational practice.
INTRODUCTION
Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by persistent deficits in social communication and interaction (Oberman and Kaufmann, 2020), accompanied by restricted and repetitive patterns of behavior that can substantially impair daily functioning and quality of life across the lifespan (Lord et al., 2018). Beyond core social impairments, individuals with ASD frequently present with behavioral challenges such as stereotyped movements, hyperactivity, emotional dysregulation, and reduced adaptive functioning, which often limit participation in educational, recreational, and community-based activities (Kanne and Mazurek, 2011).
Although pharmacological treatments may alleviate certain associated symptoms, including irritability and inattention, their effects on social functioning are limited, and concerns regarding adverse side effects remain (Fung et al., 2016). Consequently, increasing attention has been directed toward nonpharmacological and lifestyle-based interventions that align with rehabilitation and health promotion paradigms (Figueiredo Godoy et al., 2025), particularly those that can be implemented safely and sustainably across developmental stages (Yu and Jee, 2020).
Play, physical activity (PA), and structured exercise interventions have emerged as promising approaches for improving behavioral and social outcomes in individuals with ASD (Shahane et al., 2024). Play is a form of voluntary activity primarily driven by enjoyment, whereas PA encompasses all bodily movements that increase energy expenditure. Exercise represents a structured and planned subset of PA specifically designed to improve physical fitness and health (Pellegrini and Smith, 1998). Play-based interventions emphasize intrinsic motivation, enjoyment, and social engagement, which are particularly relevant for fostering peer interaction and communication skills in children with ASD (Gibson et al., 2021). Similarly, PA and exercise programs—ranging from unstructured movement to structured aerobic or resistance training—have been associated with improvements in behavioral regulation, attention, and reductions in stereotypic behaviors (Bremer et al., 2016; Healy et al., 2018; Pan et al., 2017). Importantly, group-based and socially embedded intervention formats may provide naturalistic opportunities for social learning, cooperation, and reciprocal interaction (Oriel et al., 2011).
From a mechanistic perspective, PA may influence sociobehavioral functioning in ASD through multiple pathways, including enhancements in executive function, improved self-regulation, and modulation of arousal levels (Tse et al., 2024). Neurobiological adaptations, such as changes in neurotransmitter systems and increased neurotrophic factor expression, have also been proposed as potential mechanisms underlying these benefits (Diamond, 2013; Hillman et al., 2008). These mechanisms are consistent with broader evidence demonstrating the role of PA in supporting cognitive, emotional, and psychosocial health in children and adolescents (Biddle and Asare, 2011).
Despite a growing body of research, findings related to play, PA, and exercise interventions in ASD remain heterogeneous due to variations in intervention type, intensity, duration, participant characteristics, and outcome measures. While several systematic reviews and meta-analyses have examined specific modalities or outcomes, an integrative narrative synthesis that situates play-based, PA, and exercise interventions within a unified sociobehavioral framework remains limited. Therefore, the purpose of this narrative review was to synthesize and critically discuss literature examining the effects of play, PA, and exercise interventions on behavioral and social outcomes in individuals with ASD. By organizing evidence according to intervention characteristics, outcome domains, and proposed mechanisms, this review tried to provide a clinically relevant overview to inform future research directions and exercise-based rehabilitation practice.
MATERIALS AND METHODS
Study design
This study conducted a narrative review and synthesis of existing evidence influencing the play, PA, and exercise interventions on behavioral and social outcomes in ASD. The narrative review adopted in this study differs from a systematic review in that it does not apply strictly standardized procedures for research questions, literature search, study selection, or data analysis (Siddaway et al., 2019). Instead, it is a descriptive form of review that interprets and synthesizes existing studies to provide a coherent and integrative overview of a specific topic. This approach allows for the incorporation of expert perspectives, theoretical frameworks, and clarification of research trends; however, it is inherently limited by a lower level of evidence compared with systematic reviews (Busti Ceccarelli et al., 2020). Nevertheless, this narrative review was deemed appropriate for the present study because interventions involving play, PA, and exercise in individuals with ASD are highly heterogeneous in terms of intervention type, intensity, duration, and outcome measures, which make quantitative synthesis and meta-analysis difficult.
Study selection and data extraction
A comprehensive literature search was conducted independently by two reviewers across PubMed, Web of Science, Scopus, and Google Scholar from database inception through February 3, 2026. The search strategy combined controlled indexing terms and free-text keywords, including autism spectrum disorder, play, physical activity, exercise, behavior, and social interaction.
Inclusion and exclusion criteria
Studies were eligible for inclusion if they examined play-based, PA, or exercise interventions in participants under 18 years of age and met the predefined inclusion criteria. Peer-reviewed studies published in English were considered, with an emphasis on intervention-based research involving children and adolescents with ASD. The identified literature was narratively synthesized and organized according to outcome domains (behavioral and social outcomes) and intervention characteristics (play-based, PA, and exercise). Methodological heterogeneity and potential sources of bias were considered in the interpretation of findings. In addition, studies that reported autism-related behavioral or social outcome measures—such as assessments of social communication, behavioral characteristics, or autism severity—were preferentially examined to ensure relevance to the core outcomes of interest. Multiple study designs were eligible for inclusion, and these considerations were applied flexibly to align with the narrative review approach.
Studies were not considered central to this narrative review if they focused exclusively on adult populations with ASD or on individuals with developmental disorders other than ASD without separate reporting for ASD participants. Research examining non-exercise-based interventions, such as purely pharmacological or behavioral therapies, was also not emphasized. In addition, studies that did not report behavioral or social outcomes relevant to ASD, including those limited to physiological or biomechanical outcomes without linkage to autism-related functioning, were deprioritized. Case reports, conference abstracts, editorials, and non–peer-reviewed articles were likewise not a primary focus, as they provide limited empirical detail for interpreting intervention effects. These exclusion considerations were applied pragmatically to maintain thematic coherence rather than to enforce strict methodological boundaries.
Quality assessment of included studies
Because this was a narrative review, no standardized quality appraisal instrument was used. Instead, methodological rigor was evaluated descriptively by considering study design characteristics, the clarity of intervention descriptions, and whether validated outcome measures were employed (Baethge et al., 2019).
Research analysis and presentation method
Findings from the included studies were compared and synthesized descriptively, with attention to similarities and differences in intervention characteristics, outcome domains, and reported effects. Instead of conducting quantitative synthesis, the analysis emphasized the identification of common themes, contrasting results, and plausible mechanisms underlying behavioral and social outcomes in children with ASD.
Ethical considerations
As this study was based exclusively on previously published literature and did not involve human participants or animals, ethical approval was not required.
RESULTS
Literature search and screening process
Fig. 1 illustrates the stepwise literature search and study selection process undertaken in this review. Records were initially identified through comprehensive searches of major databases. Prior to screening, duplicate records and records deemed ineligible by automated tools or other predefined criteria were removed. The remaining records were screened based on titles and abstracts, and studies that did not meet the research topic or inclusion criteria were excluded. Full-text retrieval was subsequently attempted for studies considered potentially eligible; however, some reports were excluded due to the unavailability of full-text access. Full-text articles that could be retrieved were then assessed for eligibility according to the predefined inclusion criteria. Studies were excluded at this stage if they were non-human studies, conference abstracts, editorials, commentaries, or letters, single-case studies, or if their primary outcome measures were not sufficiently aligned with the objectives of the present review. Ultimately, this narrative review included 18 primary studies, with three additional reports originating from these studies also considered in the analysis.
Narrative overview of literature identification.
Clinical characteristics of ASD relevant to exercise-based interventions
As shown in Table 1, Healy et al. (2018) provided robust evidence supporting the effectiveness of PA interventions for youth with ASD through a comprehensive meta-analysis. By synthesizing data from 29 studies comprising 30 independent samples (total N=1,009), the authors demonstrated that PA interventions were associated with a moderate effect size (Hedges’ g=0.62) across multiple outcome domains. This finding indicates that, on average, children and adolescents with ASD who participated in PA interventions showed meaningful improvements compared with control conditions. Importantly, the beneficial effects of PA were not limited to a single functional domain. Improvements were observed across behavioral, social, cognitive, and motor outcomes, highlighting the multidimensional impact of PA interventions in ASD. From a clinical perspective, these findings are particularly relevant given that core features of ASD—such as difficulties in behavioral regulation and social engagement—are often resistant to pharmacological treatment alone. The results suggest that PA may serve as a viable complementary intervention capable of addressing both core and associated ASD symptoms. They also reported substantial heterogeneity among included studies, reflecting variability in intervention type, intensity, duration, and outcome measures. Rather than undermining the validity of the findings, this heterogeneity underscores the flexible and adaptable nature of PA in real-world clinical and educational settings. The observed variability supports the view that PA can be implemented in diverse formats while still yielding beneficial outcomes for youth with ASD. The findings of Healy et al. (2018) reinforce the clinical relevance of PA as a rehabilitation-oriented intervention for ASD. The moderate effect size, coupled with consistent improvements across behavioral and social domains, provides a strong empirical rationale for incorporating PA and exercise into multidisciplinary intervention frameworks aimed at improving functional outcomes in children and adolescents with ASD.
Clinical characteristics and behavioral outcomes relevant to exercise-based interventions in autism spectrum disorder
Behavioral outcomes following exercise interventions in ASD
As also shown in Table 1, Bremer et al. (2016) systematically reviewed the effects of exercise interventions on behavioral outcomes in children and youth with ASD, providing focused evidence on the role of PA in behavioral regulation. According to the included studies, exercise interventions were consistently associated with reductions in maladaptive behaviors, particularly stereotypic and repetitive behaviors. These improvements were most frequently observed following aerobic exercise protocols, suggesting that activities involving sustained movement may exert beneficial effects on behavioral control. In addition to reductions in problematic behaviors, several studies reviewed by Bremer et al. (2016) reported improvements in attention and on-task behavior following exercise participation. These findings indicate that exercise may function as an effective preparatory strategy to support learning and structured activities in children and youth with ASD. The review also highlighted decreases in hyperactivity and overall behavioral instability in response to exercise interventions, although the magnitude and consistency of these effects varied across studies. Importantly, Bremer et al. (2016) emphasized that behavioral benefits were influenced by intervention characteristics, including exercise intensity, duration, and structure, as well as individual participant differences. Despite this heterogeneity, the overall pattern of findings supports the potential of exercise as a complementary, nonpharmacological intervention for improving behavioral outcomes in ASD.
Social outcomes following exercise and PA interventions in ASD
Recent meta-analytic evidence consistently supports the beneficial effects of exercise and PA interventions on social functioning in children with ASD. Hou et al. (2024), using a network meta-analysis framework, demonstrated that exercise interventions significantly improved social interaction outcomes compared with control conditions. Importantly, their analysis suggested that interventions incorporating structured and socially interactive components were particularly effective, highlighting the relevance of program design in maximizing social benefits. Similarly, Qi et al. (2024) reported that PA interventions were associated with meaningful improvements in social communication impairments in children with ASD. Their meta-analysis showed that regular participation in PA led to enhanced social responsiveness and communication-related behaviors, indicating that exercise may positively influence core social deficits rather than only peripheral functional outcomes. These findings reinforce the role of PA as a viable intervention strategy for addressing social communication challenges in ASD. Koh (2024) further extended this evidence by demonstrating that physical exercise interventions exerted a significant positive effect on social skills, including cooperation, social engagement, and interaction with peers. The meta-analytic results emphasized that exercise-based programs delivered in structured or group-based formats yielded more pronounced social skill improvements, suggesting that social exposure embedded within PA contexts may facilitate social learning processes. Consistent with these findings, Wang et al. (2025) conducted a systematic review and meta-analysis of randomized controlled trials and reported that physical exercise interventions produced significant improvements in social outcomes, alongside benefits in behavioral and motor domains. Notably, the authors highlighted that social gains were evident across diverse exercise modalities, supporting the generalizability of exercise-based approaches in improving social functioning in children with ASD. These meta-analytic findings provide converging evidence that exercise and PA interventions contribute to meaningful improvements in social interaction, communication, and social skills in children with ASD as shown in Table 2. Although heterogeneity across intervention types, intensities, and outcome measures was evident, the overall pattern of results underscores the clinical relevance of incorporating exercise-based strategies into multidisciplinary intervention frameworks targeting social functioning in ASD.
Meta-analytic evidence on social outcomes following exercise and physical activity interventions in children with autism spectrum disorder
Social outcomes of play-based interventions in children with ASD
Evidence from recent reviews and intervention studies indicates that play-based interventions are effective in enhancing social interaction and communication skills in children with ASD. Dijkstra-de Neijs et al. (2023) systematically reviewed play-based interventions involving children with ASD and, in some cases, their parents, and reported consistent improvements in social engagement, joint attention, and reciprocal interaction. The review highlighted that play contexts emphasizing shared goals and active participation were particularly effective in promoting social responsiveness. Complementing these findings, López-Nieto et al. (2022) conducted a scoping review and identified a wide range of play-based intervention approaches, including symbolic play, cooperative play, and parent-mediated play programs. Across the reviewed studies, improvements were commonly reported in social communication, turn-taking, and peer interaction. Although methodological heterogeneity was substantial, the overall pattern suggested that play-based interventions provide developmentally appropriate and motivating contexts for fostering social skills in children with ASD. Gibson et al. (2021) further examined play-based interventions targeting social and communication development in young children with ASD aged 2–8 years. Their scoping review demonstrated that early play-based approaches were associated with gains in social initiation, shared attention, and communicative behaviors. The authors emphasized that interventions embedded within naturalistic play environments may support generalization of social skills to everyday settings. At the individual study level, Henning et al. (2016) reported findings from a pilot play-based intervention involving children with ASD and their typically developing peers. The intervention led to observable improvements in the quality and frequency of social play interactions, including increased cooperative play and sustained peer engagement. These results provide preliminary empirical support for the use of inclusive, peer-mediated play-based interventions to enhance social participation in children with ASD. The findings across systematic reviews, scoping reviews, and pilot intervention studies consistently indicate that play-based interventions positively influence social interaction and communication outcomes in children with ASD as shown in Table 3. Despite variability in intervention structure and outcome measures, play-based approaches appear to be particularly well suited for addressing social deficits by leveraging intrinsic motivation, shared enjoyment, and naturalistic social contexts.
Evidence on social outcomes of play-based interventions in children with autism spectrum disorder
Effects of exergaming on executive function and related outcomes in children with ASD
Emerging evidence suggests that exergaming, which integrates PA with interactive digital environments, may offer a unique intervention modality for improving executive function and related behavioral outcomes in children with ASD. Hilton et al. (2014) conducted a pilot study demonstrating that participation in an exergaming program was associated with improvements in executive functioning domains, including attention control and cognitive flexibility, alongside gains in motor skills. These findings indicated that exergaming may simultaneously engage cognitive and motor systems, supporting functional improvements relevant to daily behavior. Building on this preliminary evidence, Rafiei Milajerdi et al. (2021) compared the effects of traditional PA and exergaming interventions in children with ASD. Both intervention modalities resulted in significant improvements in executive functions and motor performance; however, exergaming was particularly effective in enhancing cognitive outcomes related to inhibitory control and working memory. The authors suggested that the interactive and feedback-rich nature of exergaming may promote sustained engagement and higher cognitive demands, thereby facilitating executive function development. At the synthesis level, Fang et al. (2019) systematically reviewed studies examining the effects of exergaming on physical and cognitive functions in individuals with ASD. Through the included studies, exergaming interventions were consistently associated with improvements in cognitive functioning, particularly executive processes, as well as motor abilities.
Although methodological heterogeneity and small sample sizes limited definitive conclusions, the review highlighted exergaming as a promising and engaging alternative to conventional exercise interventions for individuals with ASD. More recently, Kou et al. (2024) conducted a systematic review and meta-analysis evaluating the effects of exergaming on executive function and motor ability in children. Their meta-analytic findings demonstrated significant positive effects of exergaming on executive function, with concurrent improvements in motor performance. These results provide stronger quantitative support for the role of exergaming in enhancing executive control processes, which are closely linked to behavioral regulation and adaptive functioning in children with ASD. Collectively, evidence from pilot studies, comparative trials, systematic reviews, and meta-analyses indicates that exergaming interventions contribute to meaningful improvements in executive function and motor abilities in children with ASD as shown in Table 4. Given the established association between executive functioning and behavioral regulation, these findings suggest that exergaming may indirectly support behavioral and social outcomes by enhancing cognitive control mechanisms. Furthermore, the motivating and interactive characteristics of exergaming may facilitate adherence and engagement, underscoring its potential utility as a rehabilitation-oriented intervention within multidisciplinary programs for ASD.
Evidence on the effects of exergaming on executive function and related outcomes in children with autism spectrum disorder
Effects of sport-based exercise on motor and social outcomes in children with ASD
Recent evidence indicates that sport-based exercise interventions incorporating structured rules, sensory input, and social interaction can positively influence both motor and social skill development in children with ASD. Wen and Wu (2025) examined the effects of sensory integration-based sports training and reported significant improvements in motor coordination as well as social skills, including peer interaction and cooperative behaviors. Their findings suggest that integrating sensory processing demands within sports activities may enhance both motor performance and social engagement, which are often interrelated challenges in children with ASD. Complementing this individual intervention evidence, González-Devesa et al. (2025) systematically reviewed randomized controlled trials evaluating mini-basketball programs for preschool and school-aged children with ASD. The review demonstrated that participation in structured basketball-based interventions was associated with consistent improvements in social skills, such as teamwork, communication, and adherence to social rules, alongside gains in motor competence. Importantly, the authors highlighted that the structured and rule-governed nature of mini-basketball provided repeated opportunities for social interaction, turn-taking, and cooperative play, which are essential components of social skill acquisition. These findings suggest that sport-based exercise interventions, particularly those incorporating sensory integration and team-based elements, may offer a dual benefit for children with ASD by simultaneously targeting motor development and social functioning as shown in Table 5. The structured yet dynamic context of sports appears to facilitate social learning while maintaining engagement and motivation, supporting the inclusion of sport-based programs within exercise rehabilitation frameworks for ASD.
Evidence on the effects of sport-based exercise interventions on motor and social outcomes in children with autism spectrum disorder
PA, executive function, and behavioral-social outcomes in ASD
Meta-analytic evidence indicates that PA interventions exert meaningful effects on functional outcomes in youth with ASD. Healy et al. (2018) demonstrated that participation in PA was associated with a moderate overall effect across multiple domains, including behavioral, social, cognitive, and motor outcomes. Importantly, these improvements were observed across diverse intervention formats, suggesting that PA represents a flexible and broadly applicable intervention strategy for youth with ASD. The beneficial effects of PA on behavioral and social functioning may be partially explained by its influence on executive functions. Executive functions—encompassing inhibitory control, working memory, and cognitive flexibility—are fundamental for goal-directed behavior, emotional regulation, and social interaction (Diamond, 2013). Deficits in these cognitive processes are commonly observed in individuals with ASD and are closely linked to behavioral dysregulation and social difficulties. Diamond (2015) further emphasized that physical exercise can enhance executive functions most effectively when it involves cognitive engagement, goal setting, and adaptive decision-making, rather than repetitive movement alone. Such cognitively demanding physical activities may strengthen neural networks supporting self-regulation and attentional control, thereby facilitating improvements in behavior and social engagement. This framework aligns with findings from Healy et al. (2018), suggesting that PA interventions incorporating cognitive and social components may yield more pronounced functional benefits in youth with ASD. Collectively, these findings suggest that PA may improve behavioral and social outcomes in ASD by enhancing executive function (Table 6). From an exercise rehabilitation perspective, interventions combining physical and cognitive demands may be especially effective for addressing ASD-related behavioral and social challenges.
Evidence linking physical activity, executive function, and behavioral-social outcomes in youth with autism spectrum disorder
DISCUSSION
This narrative review synthesized current evidence on play, PA, and exercise interventions targeting behavioral and social outcomes in children with ASD. The findings indicate that movement-based interventions constitute a promising and versatile nonpharmacological approach for addressing core and associated difficulties in ASD. Across diverse intervention modalities—including general PA, structured exercise, play-based programs, exergaming, and sport-based training—consistent improvements were observed in behavioral regulation, social interaction, and related functional domains. Because the functional roles of play, PA, and exercise differ by developmental stage or ages in ASD (Rafiei Milajerdi et al., 2021), this review focused on above interventions and excluded studies involving adults, for whom structured exercise and daily PA are more relevant.
Behavioral dysregulation, such as hyperactivity, inattention, and stereotypic behaviors, represents a significant barrier to learning and social participation in children with ASD. Evidence from systematic reviews and meta-analyses suggests that PA and exercise interventions are associated with meaningful reductions in maladaptive behaviors and improvements in attention and on-task behavior (Bremer et al., 2016; Healy et al., 2018). These behavioral benefits appear particularly pronounced following aerobic or moderate-to-vigorous PA, supporting the role of exercise in modulating arousal levels and enhancing self-regulatory capacity. Importantly, the behavioral effects of exercise are not limited to immediate post-exercise periods. Several studies suggest that repeated participation in structured PA may contribute to more sustained improvements in behavioral stability, although the magnitude and persistence of effects vary depending on intervention characteristics and individual differences. This variability underscores the importance of tailoring exercise programs to the needs and capacities of children with ASD rather than adopting a one-size-fits-all approach (Stasolla et al., 2024).
Beyond behavioral regulation, social communication and interaction deficits are central features of ASD and are closely linked to long-term functional outcomes. Recent meta-analytic evidence consistently demonstrates that PA and exercise interventions positively influence social interaction, social communication, and social skills in children with ASD (Hou et al., 2024; Koh, 2024; Qi et al., 2024; Wang et al., 2025). Notably, interventions delivered in group-based or socially embedded contexts appear particularly effective, suggesting that the social structure inherent in many physical activities may facilitate social learning. Play-based interventions further strengthen this evidence by highlighting the importance of intrinsic motivation and naturalistic interaction. Systematic and scoping reviews indicate that play-oriented approaches improve joint attention, reciprocal interaction, and peer engagement, especially in younger children (Dijkstra-de Neijs et al., 2023; Gibson et al., 2021; López-Nieto et al., 2022). Pilot studies involving typically developing peers also demonstrate that inclusive play-based interventions can enhance the quality and frequency of social play, reinforcing the ecological validity of play as a medium for social skill development (Henning et al., 2016).
A central mechanism linking PA to behavioral and social outcomes in ASD appears to be executive function. Executive functions—including inhibitory control, working memory, and cognitive flexibility—are critical for goal-directed behavior, emotional regulation, and social interaction, yet are frequently impaired in children with ASD (Diamond, 2013). Meta-analytic findings indicate that PA interventions yield improvements across cognitive domains, suggesting that enhancements in executive function may mediate downstream behavioral and social benefits (Healy et al., 2018). Diamond (2015) further emphasized that exercise interventions are most effective for executive function when they involve cognitive engagement, strategic decision-making, and adaptive responses rather than repetitive movement alone. This perspective provides a theoretical framework for understanding why interventions such as exergaming and sport-based training may be particularly beneficial. Exergaming integrates physical exertion with cognitive demands and immediate feedback, and evidence from pilot studies, systematic reviews, and meta-analyses indicates significant improvements in executive function and motor abilities following exergaming interventions (Fang et al., 2019; Hilton et al., 2014; Kou et al., 2024; Rafiei Milajerdi et al., 2021). Given the close association between executive functioning and behavioral regulation (Fang et al., 2019), these findings suggest an indirect pathway through which exergaming may support behavioral and social adaptation in ASD.
Sport-based exercise interventions represent another promising avenue for enhancing both motor and social functioning (Shahane et al., 2024). Sensory integration-based sports training has been shown to improve motor coordination and social skills, highlighting the interconnected nature of sensory processing, movement, and social engagement in children with ASD (Wen and Wu, 2025). Similarly, systematic reviews of mini-basketball programs demonstrate consistent improvements in teamwork, communication, and adherence to social rules among preschool and school-aged children with ASD (González-Devesa et al., 2025). The structured, rule-governed, and cooperative nature of sports may provide repeated and meaningful opportunities for social interaction while maintaining high levels of motivation and engagement.
From a rehabilitation perspective, the findings of this narrative review support the integration of play, PA, and exercise into multidisciplinary intervention frameworks for ASD. Unlike pharmacological treatments, which often target associated symptoms and may produce adverse effects, movement-based interventions are generally safe, adaptable, and scalable across clinical, educational, and community settings (Torres et al., 2025). Moreover, the diversity of effective intervention formats allows practitioners to select approaches that align with individual preferences, developmental stages, and contextual constraints. Importantly, the observed heterogeneity across studies should not be interpreted solely as a limitation but rather as evidence of the flexibility and broad applicability of movement-based interventions. The challenge for future practice lies in identifying optimal combinations of intensity, structure, and social-cognitive demands to maximize functional outcomes.
Several limitations should be acknowledged. As a narrative review, this study did not apply formal quality assessment or risk-of-bias tools, and conclusions are based on interpretive synthesis rather than quantitative pooling. In addition, considerable heterogeneity in intervention design, outcome measures, and participant characteristics limits direct comparison across studies. Future research should prioritize well-designed randomized controlled trials with standardized outcome measures and longer follow-up periods to clarify the sustainability of behavioral and social gains. Further investigation into mediating mechanisms—particularly executive function and self-regulation—is warranted. Studies employing mediation analyses and neurocognitive measures may help elucidate how different types of PA exert their effects. Finally, greater attention should be given to implementation research, examining how exercise-based interventions can be effectively integrated into real-world clinical and educational environments.
In conclusion, evidence synthesized in this narrative review indicates that play, PA, and exercise interventions contribute meaningfully to improvements in behavioral and social outcomes in children with ASD. These benefits appear to be mediated, at least in part, by enhancements in executive functioning and are reinforced by structured social interaction embedded within movement-based contexts. The findings support the role of exercise-based interventions as a core component of rehabilitation-oriented approaches for ASD.
Notes
CONFLICT OF INTEREST
No potential conflict of interest relevant to this article was reported.
ACKNOWLEDGMENTS
The authors received no financial support for this article.