Sports and physical activity interventions in autism spectrum disorder: a systematic literature review and meta-analysis

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Background: Physical activity (PA) interventions have been explored as a means of improving motor, social, executive, behavioural, and psychosocial outcomes in children and adolescents with autism spectrum disorder (ASD). However, variability in study designs and methodological quality raises questions about the consistency and reliability of reported effects. Methods: A systematic review and meta-analysis were conducted, including studies published between 2019 and 2025. Eighteen studies met the inclusion criteria for qualitative synthesis, and twelve were included in the meta-analysis using a random-effects model. Effect sizes were calculated and pooled across outcome domains. Risk of bias was assessed, and additional analyses were conducted to examine heterogeneity and potential publication bias. Results: ≈ 1.28), but substantial heterogeneity across study designs, intervention types, and sample characteristics was observed. Subgroup analyses indicated variation in effects across intervention types and participant groups, though findings were not consistently stable. Risk-of-bias assessments identified several methodological limitations, and publication bias analyses suggested possible asymmetry. These factors indicate that the magnitude of the pooled effect size may be overestimated. Conclusion: PA interventions show promise for supporting multidomain development in children and adolescents with ASD. However, the certainty of evidence ranges from low to moderate, and findings should be interpreted cautiously. Future research should prioritise rigorous study designs, larger samples, and consistent reporting of intervention fidelity and long-term outcomes to strengthen the evidence base.

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