Evaluation of Changes in Physical Fitness and Body Composition Following a Tailored Judo Intervention and Nutritional Counseling in Children and Adolescents With Autism Spectrum Disorder: A Study Incorporating Blood Morphology and Genetic Polymorphism Analysis.
Phase: NA
Conditions: ASD, Autism Spectrum Disorder, Autism Spectrum Disorder High-Functioning, Autism Spectrum
Sponsor: Poznan University of Physical Education

27/06/2024 
General information 
Protocol title: The Effects of Tailored Judo Training and Nutritional Counseling on 
Physical Fitness and Body Composition in Children With Autism: A Study Including 
Blood Morphology and Genetic Analysis 
Name and address of the funder: Poznań University of Physical Education, Królowej 
Jadwigi 27/39, 61-871 Poznań  
Name and title of the investigator(s) who is (are) responsible for conducting the research: 
Adam Prokopczyk, PhD 
Name and address technical department institutions involved in the research: Department of 
Sport and Defence Education, Poznań University of Physical Education, Poznań, Poland 
 
Rationale & background information  
To date, despite ongoing research, no effective pharmacological therapy has been discovered 
to reduce the symptoms of autism. However, it has been demonstrated that therapy should focus 
on environmental variables. Research shows that through exploration and imitation during 
maturation, interactions with the social and physical environment enable cognitive and motor 
development, as well as the learning process (Serrada-Tejeda, Santos-del-Riego et al., 2021; 
Wang, Wang et al., 2023). For individuals with Autism Spectrum Disorder (ASD) to function 
correctly, various therapies are essential, including pedagogical, behavioral, speech, and 
developmental interventions. Much contemporary scientific research focuses on identifying 
forms of physical activity that yield positive effects for neurodivergent individuals. It has been 
shown that children and adolescents with ASD experience motor difficulties, such as abnormal 
gait, irregular muscle tone, balance problems, and poor motor control (Gueity-Rodrigueaza, 
Ogonowska-Słodownik et al., 2021). Furthermore, they have been noted to be less physically 
active and perform fewer exercises compared to their typically developing peers (Pace & 
Bricout, 2015; Coffeey, Sheehan et al., 2021). 
It is documented that children with ASD should begin sports training immediately after 
diagnosis and participate in physical activities alongside neurotypical peers (Arslan, Ince et al., 
2019), ensuring the proper functioning and development of the cardiometabolic system and 
cardiorespiratory fitness (Pierantozzi & Morales, 2022). Current research indicates that judo 
training, although a contact sport, reduces the intensity of symptoms in individuals with ASD 
(Morales et al., 2022). This suggests that its format can serve as a valuable therapeutic 
intervention. Therefore, this study plans to implement a tailored judo training program as a form 
of therapy for children and adolescents aged 7 to 14. The sessions will be conducted over a 10-
month period in integrated training groups, where individuals with ASD and those without such 
a diagnosis train together. The aim of this program is to analyze the effectiveness of 
environmental adaptation, overcoming resistance to physical contact through a contact sport, 
and performing a comparative analysis of changes in the studied variables between individuals 
with and without ASD. 

The training program will be based on movement games and activities that influence 
psychosocial behavior, peer interaction, and the learning of new motor tasks to expand 
functional abilities. Additionally, it will include comprehensive physical fitness components 
and judo-specific elements (safe falling, movement, applying and escaping holds, body 
rotations, unbalancing/kuzushi, etc.). Sessions will take place twice a week for 60 minutes. The 
program will include 50 children and adolescents (aged 7–14) with a diagnosed ASD, 
possessing at least functional communication skills and no diagnosed aphasia, and a control 
group of 50 individuals without any diagnosed disorders. The effectiveness of the therapy will 
be evaluated through an environmental adaptation test (assessing comfort in contact and 
cooperation with others during training) and an analysis of physical fitness changes using the 
EUROFIT Test and stabilometric platform.  
To expand the assessment of changes in participants' physical fitness levels, an analysis of 
postural stability under static conditions will be conducted. Measurements will be performed 
using the CQStab2P dual-plate stabilometric platform. The assessment will evaluate the ability 
to maintain balance in a standing position during two trials: with eyes open and with eyes closed 
(Romberg test). This analysis will serve as a key element in verifying the impact of the 
intervention (judo training and nutritional counseling) on the participants' neuromuscular 
control. The primary objective of the analysis will be to determine whether systematic judo 
training leads to improved postural stability, as evidenced by a reduction in center of pressure 
(COP) sway parameters, such as the sway area and the total staturogram path length. 
While research indicates that coaches can influence the healthy eating habits of their athletes 
(Desbrow, 2021), such data is lacking regarding youth with ASD. A common problem among 
individuals with ASD is food selectivity (picky eating), involving the consumption of a very 
limited group of accepted food products. This can lead to vitamin or micronutrient deficiencies, 
as well as growth and body mass disorders. Therefore, this study proposes an innovative 
scientific approach consisting of nutritional counseling conducted in cooperation with legal 
guardians, involving the collection of dietary habit data and subsequent nutritional guidance. 
To assess micronutrient levels, blood morphology will be performed to analyze iron, vitamin 
B12, total protein, magnesium, and folic acid content. These results, combined with body 
composition analysis using bioelectrical impedance (BIA), will help design properly balanced 
diets for individual participants. 
Limited genetic research on individuals with ASD has shown that identifying targeted, highly 
effective therapeutic and preventive actions is crucial for optimizing their functioning. Studies 
(Wilczyński et al., 2023) suggest a link between polymorphisms in genes encoding oxytocin 
receptors or those responsible for its secretion (e.g., the CD38 gene) and the functioning of 
individuals with ASD. Based on these observations, the CD38 gene polymorphism will be 
examined in participants using Real-Time PCR genetic analysis. 
Assessments of physical fitness, dietary habits, blood morphology, and body composition will 
be conducted three times: before, at the midpoint, and after the completion of the training 
process. The genetic polymorphism analysis will be performed once, toward the end of the 
process. This scientific endeavor will enable the analysis of the therapeutic effectiveness 
achieved through a tailored judo training program and nutritional counseling for individuals 
with Autism Spectrum Disorder. To date, no study has combined a long-term (10-month) 
tailored close-contact sports program in integrated groups with nutritional counseling. 
 

Study goals and objectives 
The objective of this research project is to evaluate the feasibility of utilizing a tailored judo 
training program as a supportive therapy, alongside nutritional counseling, to influence physical 
fitness levels, dietary habits, body composition, and blood morphology. The study will account 
for genetic polymorphisms in children and adolescents with Autism Spectrum Disorder (ASD) 
who demonstrate functional communication skills and no diagnosed aphasia. 
Study design 
This is an interventions study. Current research demonstrates that judo training, despite being 
a contact sport, reduces the severity of symptoms in individuals with autism spectrum disorder 
(ASD) (Morales et al., 2022). This suggests that, due to its specific format, judo may serve as 
a valuable therapeutic intervention for children and adolescents with ASD. Consequently, this 
study plans to implement adapted judo training as a form of therapy for participants aged 7 to 
14. The sessions will be conducted over a 10-month period in integrated training groups, 
comprising both individuals with ASD and neurotypical peers. The objective of this training 
program is to analyze the effectiveness of environmental adaptation, the overcoming of 
resistance to interpersonal contact through contact sports, and to perform a comparative analysis 
of changes in examined variables between the ASD and non-ASD groups. 
The training program will be based on movement-based games and activities designed to 
influence psychosocial behavior, peer interaction, and the acquisition of new motor skills to 
enhance functional abilities. Furthermore, it will include components of general physical 
literacy and judo-specific techniques (e.g., safe falling, displacement, applying and escaping 
holds, body rotations, and off-balancing/kuzushi). Sessions will be held twice weekly for 60 
minutes. The study will enroll 50 participants aged 7–14 with a confirmed ASD diagnosis, 
possessing at least a "fair" level of communication skills and no diagnosed aphasia, alongside 
a control group of 50 neurotypical individuals. Therapeutic efficacy regarding physical fitness 
will be assessed through environmental adaptation tests (evaluating social comfort and 
cooperation), the EUROFIT Test battery, and stabilometric platform measurements. 
It has been shown that coaches can influence the conscious healthy eating habits of their trainees 
(Desbrow, 2021); however, there is a lack of such data regarding children and adolescents with 
ASD. A frequent issue in the ASD population is food selectivity, characterized by the 
consumption of a highly restricted range of accepted food products. This may lead to 
micronutrient deficiencies as well as weight and growth disturbances. Therefore, this study 
proposes an innovative scientific intervention involving nutritional counseling conducted in 
cooperation with legal guardians, based on the collection of dietary habit data. To evaluate 
micronutrient status, blood morphology will be performed to analyze levels of iron, vitamin 
B12, protein, magnesium, and folic acid. These results, combined with body composition 
analysis via bioelectrical impedance (BIA), will facilitate the design of appropriately balanced 
diets for individual participants. 
Existing, though limited, genetic studies in individuals with ASD highlight the importance of 
identifying targeted, highly effective therapeutic and preventive measures to optimize 
functional outcomes. Research (Wilczyński et al., 2023) suggests a correlation between 
polymorphisms in genes encoding oxytocin receptors or those responsible for its secretion (e.g., 
the CD38 gene) and the functioning of individuals with ASD. Based on these observations, 
CD38 gene polymorphisms will be examined in the study participants using real-time PCR 

genetic analysis. Assessments of physical fitness, body stability, blood morphology,  body 
composition will be conducted at three intervals: baseline (pre-intervention), mid-point, and 
post-intervention. Genetic polymorphism analysis assessments will be performed once, towards 
the conclusion of the training process. 
Methodology  
Physical fitness level 
Changes in physical fitness levels will be assessed using the European Physical Fitness Test 
(EUROFIT), comprising eight test items (Council of Europe, 1983). The 20-m multistage 
shuttle run test was excluded from the assessment due to the auditory signals required during 
its execution and the unpredictable behaviors of the study participants. In order to standardize 
the results obtained in the individual test items, participants’ raw scores will be converted into 
age-adjusted point scores, with age calculated to the nearest three months. The normative values 
used to convert raw scores into points are based on reference standards for children and 
adolescents from the Polish population (Dobosz, 2012; Dobosz, 2012). 
Measurements were performed at three time points: before the commencement of the training 
process, after five months, and upon completion of the training program 
The European Physical Fitness Test - EUROFIT 
The European Physical Fitness Test (EUROFIT) was employed to determine the level of 
physical fitness. The EUROFIT test was used to measure the level of balance (Flamingo 
Balance Test), hand movement speed (Plate Tapping Test), explosive power (Standing Broad 
Jump), flexibility (Sit and Reach Test), static strength (Hand Grip Test), trunk strength (Sit-Ups 
Test), functional strength (Bent Arm Hang) and agility (10 x 5 m Shuttle Run). 
 
Flamingo Balance Test 
The balance test was performed using a wooden beam measuring 50 × 4 × 3 cm, equipped with 
two supports (15 × 2 cm each) and end stops to provide stability. Participants were instructed 
to maintain balance while standing on the beam on one self-selected leg, aligned with the 
longitudinal axis of the beam. The free leg was flexed at the knee, and the participant had to 
grasp the foot of the free leg with the hand on the same side, maintaining an upright posture. 
Before the main trial, participants were allowed to use the shoulder of an assistant to achieve 
the correct starting position. The trial commenced at the moment the participant released the 
assistant’s shoulder. The task was to maintain the prescribed position for 60 seconds. The trial 
was terminated whenever balance was lost, after which the participant repeated the attempt. 
The test was evaluated based on the number of attempts required to maintain balance for the 
full 60-second duration.  
 
Hand Movement Speed Test (Plate Tapping Test) 
The hand movement speed test was conducted using a height-adjustable table (or a gymnastic 
box of equivalent height). Two rubber discs (20 cm in diameter) were horizontally affixed to 
the table surface, with the centers of the discs positioned 80 cm apart. A rectangular plate (10 
× 20 cm) was placed midway between the discs to serve as the central reference area. A digital 
stopwatch was used for timing. Participants stood in a small straddle stance in front of the table. 
The non-dominant hand was placed flat on the central rectangular plate, while the dominant 
hand was positioned on one of the outer discs. Upon the command “ready—start,” participants 
were instructed to move the dominant hand alternately between the two discs, passing it over 
the stationary non-dominant hand as quickly as possible. Each disc had to be touched on every 
movement. One trial consisted of 25 complete cycles (50 total touches). Participants stopped 

the movement on the command “stop.” To maintain consistency, participants were instructed 
to count each completed cycle aloud. Each participant performed two trials, with a brief rest 
interval between them. The best (shortest) time obtained across the two attempts was recorded 
as the final score. 
 
Explosive Power Test (Standing Long Jump) 
The assessment of lower-limb explosive power was performed using two connected gymnastic 
mats (or an exercise mat), chalk, and a measuring tape. Participants stood in a parallel stance 
with feet shoulder-width apart, positioned just behind a designated starting line. From this 
position, they executed a preparatory movement involving a slight forward lean of the trunk, 
knee flexion, and a backward arm swing. This was immediately followed by a vigorous forward 
arm swing and a simultaneous two-foot take-off, jumping forward as far as possible. The 
landing distance was measured from the starting line to the nearest heel mark left on the mat. 
Each participant performed three jumps, and the longest distance (in centimeters) was recorded 
as the final result.  
 
Flexibility Test (Sit and Reach Test) 
The flexibility test was carried out using a custom-built measuring table (length: 35 cm; height: 
32 cm; width: 45 cm) with an extended top surface measuring 55 cm in length. The tabletop 
extended 15 cm beyond the front vertical board, which served as a foot support. A measurement 
scale (0–50 cm) was marked along the longitudinal axis of the tabletop. A movable measuring 
ruler, approximately 30 cm in length, was placed perpendicularly across the table surface, 
allowing participants to slide it forward with their hands during trunk flexion. Participants were 
seated on the floor in an upright position with their legs extended and the soles of the feet placed 
flat against the front wall of the table (or box). Keeping the knees fully extended, they slowly 
leaned forward, reaching as far as possible with both hands, and moved the ruler forward along 
the tabletop in a smooth, continuous motion. Each participant performed two trials. The greater 
of the two reach distances (measured in centimeters) was recorded as the final result. 
 
Static Strength (Hand Grip Test) 
Static muscular strength was assessed using a calibrated hand dynamometer. Participants stood 
in a small straddle stance with the testing arm extended naturally along the side of the body, 
ensuring that the hand did not touch the torso during measurement. The dynamometer handle 
was held firmly in the fingers, adjusted to fit the participant’s hand size. Upon the examiner’s 
signal, participants performed a brief maximal contraction by squeezing the dynamometer with 
maximal effort for approximately 2–3 seconds. The non-testing arm remained relaxed alongside 
the body. Each participant completed two trials with the dominant hand. The higher of the two 
readings was recorded as the final score, expressed in kilograms (kg) with an accuracy of 1 kg. 
Due to the specific nature of the study group, measurements were taken on both hands, and the 
hand that achieved the better result was selected for analysis. 
 
Trunk Strength Test (Sit-Ups Test) 
Trunk muscle strength was evaluated using the 30-second sit-ups test. Participants lay in a 
supine position on a gymnastics mat with the knees flexed at a 90° angle and the feet positioned 
approximately 30 cm apart. The fingers were interlaced and placed behind the head. An 
assistant kneeling between the participant’s feet stabilized them by pressing gently against the 
mat. At the examiner’s signal, participants performed repeated sit-ups by lifting the upper body 
until both elbows touched the knees, then returning immediately to the supine position so that 
the interlaced fingers briefly contacted the mat. During the movement, participants were 
instructed not to use their elbows or arms to push off the mat. 

Performance was evaluated as the total number of correctly executed sit-ups completed within 
30 seconds. 
 
Functional Strength Test (Bent Arm Hang) 
Functional upper-body strength was assessed using the bent arm hang test. Participants stood 
on a raised platform and grasped a horizontal bar with a pronated (overhand) grip, ensuring that 
the elbows were bent and the chin positioned above the bar without making contact. Upon 
removal of the support from under the feet, the participant maintained the initial position for as 
long as possible without any part of the body touching the bar or swinging excessively. 
Performance was recorded as the total duration of the hang, measured in seconds, from the 
moment the support was removed until the chin dropped below the level of the bar. 
 
Agility Test (10 x 5 m Shuttle Run) 
Running - Agility were assessed using a 10 x 5 m shuttle run test. Two parallel lines were 
marked 5 m apart on a flat, non-slip surface. Participants began from a standing 
 split stance position behind the starting line. Upon the command “start,” they sprinted to the 
opposite line, crossed it completely with both feet, and immediately returned to the starting line. 
This sequence was repeated until completing a total of ten 5 m segments (five full cycles). Each 
participant performed the test once. The total time required to complete the 50 m distance (five 
cycles) was recorded to the nearest 0.1 second using a stopwatch (Council of Europe, 1983; 
Cvejic et al., 2013). 
 
The Maximal Multistage 20-m Shuttle Run Test was not used in this study. This test is a part 
of the EUROFIT test but was excluded due to the presence of audible signals during the test, 
signaling the start of the next stage of the run. This raised concerns among the research team 
about potential reactions in individuals with autism spectrum disorder, which could affect the 
proper conduct of the test, and the failure to provide a true measurement of aerobic endurance. 
 
The results obtained by the subjects in each term were converted into points adjusted to the age 
and gender of the subjects, in accordance with the scoring tables developed for Polish children 
and adolescents (Dobosz, 2012; Dobosz, 2012). 
 
Body composition  
Body composition will be evaluated using the bioelectrical impedance analysis (BIA) method. 
The measurements will be performed with a professional multi-frequency analyzer - Tanita. 
The following parameters will be recorded for each participant: Fat Mass (FM), Fat-Free Mass 
(FFM), Total Body Water (TBW), and Skeletal Muscle Mass (SMM). The measurements will 
be taken in the morning, in a fasting state. Participants will stand barefoot on the analyzer 
electrodes according to the standardized measurement protocol. Body composition changes will 
be analyzed with adjustments for age and baseline measurements. 
 
Postural stability 
Postural stability will be assessed using the CQStab2P stabilometric platform. The device will 
record the Center of Pressure (COP) position using six sensors. The measurement will last 30 
seconds in a free-standing position (arbitrary, non-forced foot placement) with eyes open, and 
30 seconds in a free-standing position with eyes closed. The platform will be placed 10 cm from 
the wall, and subjects will focus their gaze on a point in front of them. Prior to the measurement, 
subjects will be rested and will not have performed a warm-up. The analysis of changes in 
postural stability will be one of the elements evaluating the impact of the intervention on the 

participants' fitness levels. It will be analyzed whether judo training leads to a reduction in body 
sway in a standing position, both with eyes open and eyes closed. 
 
Blood morphology  
The subject will be seated in a comfortable, relaxed position on a prepared chair. The nurse will 
position the arm downward and proceed with the blood collection procedure. The vein will be 
punctured, and once blood appears in the test tube, the previously applied tourniquet will be 
released. Immediately after the procedure, a dry sterile swab will be pressed onto the puncture 
site until bleeding stops. Following the collection, blood samples will be analyzed for iron, 
vitamin B12, total protein, magnesium, and folic acid content. These analyses will be conducted 
by qualified specialists in a professional laboratory. Blood morphology results will be analyzed 
in relation to the duration of the training process, changes in physical fitness levels, and body 
composition parameters. 
 
Genetic Polymorphism Analysis 
Buccal swabs will be collected for genetic polymorphism analysis. The subject will be seated 
in a comfortable position, and the sample will be obtained by rubbing a sterile swab against the 
oral mucosa. Immediately following collection, the swabs will be placed in sterile tubes and 
stored in a portable cooler to maintain the required temperature during transport to the 
laboratory. The CD38 gene polymorphism will be examined to investigate its potential 
association with changes in physical fitness, body composition and morphology during adapted 
judo training. Genetic analyses will be conducted using the Real-Time Polymerase Chain 
Reaction (Real-Time PCR) method. 
 
Safety considerations  
During the training sessions, two coaches will always be present. For assessments of physical 
fitness, body posture, body composition, blood morphology, and genetic polymorphism, only 
verified and certified measurement equipment will be used. The testing area will be prepared 
prior to the commencement of each measurement. Participants will be divided into groups to 
ensure that an excessive number of individuals are not present at the testing site simultaneously. 
Only the participants being assessed (and their legal guardians) will be informed of their results, 
and this information will be provided individually. 
Follow-up  
Long-term participation in the integrated judo training program is expected to yield significant 
psychosocial benefits for children with ASD. Beyond physical improvements, the continuation 
of the training process fosters social integration, reduces performance-related anxiety, and 
enhances self-esteem. Through structured interactions in mixed groups (neurodivergent and 
neurotypical peers), participants develop better communication skills and emotional regulation, 
which are crucial for their daily functioning in society. For interested participants, groups will 
be established to continue the judo training process. This will allow for the monitoring of their 
progress, skill acquisition, and overall development (e.g., physical fitness, postural stability, 
and social communication. 
 
 

Data management and statistical analysis  
Each participant was assigned an individual identification number, on the basis of which the 
results obtained in the respective tests were recorded. This procedure ensured the protection of 
personal data by preventing their association with the research results. 
In accordance with Article 13 of Regulation (EU) 2016/679 of the European Parliament and of 
the Council of 27 April 2016 on the protection of natural persons with regard to the processing 
of personal data and on the free movement of such data (Official Journal of the European Union 
L 2016, No. 119), it is hereby stated that the controller of personal data is the University of 
Physical Education, located at ul. Królowej Jadwigi 27/39, 61-871 Poznań. Personal data shall 
be processed by the data controller exclusively for the period necessary to fulfil the purposes 
for which they were collected. The legal basis for the processing of personal data is the freely 
given consent of the data subject. The provision of personal data is voluntary; however, it is 
indispensable for the attainment of the purpose for which the data were collected, namely the 
implementation of the research project. Personal data may be transferred by the controller to 
entities processing data on the basis of data processing agreements, as well as to other entities 
authorized under separate legal provisions. The data subject has the right of access to personal 
data, the right to rectification, erasure, restriction of processing, the right to data portability, the 
right to object, and the right to withdraw consent at any time. Withdrawal of consent shall not 
affect the lawfulness of processing carried out on the basis of consent prior to its withdrawal. 
The data subject also has the right to lodge a complaint with the President of the Personal Data 
Protection Office, located at ul. Stawki 2, 00-193 Warsaw. Personal data shall not be processed 
by automated means and shall not be subject to profiling. 
Quality assurance 
Only certified devices were used for the measurements. Data management was conducted in 
accordance with Article 13 of Regulation (EU) 2016/679 of 27 April 2016 on the protection of 
personal data (Official Journal of the European Union L 2016, No. 119). 
Expected outcomes of the study  
The methodology of the classes is innovative and has not been previously investigated. 
Analyzing changes in physical fitness levels, postural stability, body composition, and blood 
morphology, while accounting for nutritional habits and genetic polymorphisms, will allow for 
an assessment of whether adapted judo training in integrated groups constitutes a justified 
educational intervention for both individuals with ASD and neurotypical participants. 
Furthermore, it will enable the identification of functional changes and promote an increase in 
environmental tolerance and social acceptance among children and adolescents through 
physical activity. 
Duration of the project  
04.2024 – 06.2024 – Obtaining approval from the Bioethics Committee 
06.2024 – 09.2025 – Recruitment of study participants, 
09.2024 – 06.2025 – Implementation of the training protocol and data collection 
07.2025 – 03.2026 – Data analysis 
03.2026 – 12.2026 - Manuscripts preparation 

Problems anticipated  
Failure to recruit an adequate sample size.  
High attrition rate within a specific study group (ASD/neurotypical). 
Participant non-compliance or reluctance to perform physical fitness tests 
Social interaction difficulties within the training groups 
Disruption or loss of funding, precluding the completion of the project. 
Reluctance to undergo blood morphology examinations (needle phobia and anxiety related to 
venipuncture) 
 
Ethics  
The study received approval from the Bioethics Committee at the Poznan University of Medical 
Sciences (Decision No. 416/24, issued on June 27, 2024). The research team obtained informed 
consent based on documentation completed by both the participants and their legal guardians. 
The informed consent forms used in this study were reviewed and approved by the Bioethics 
Committee. 
 
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