# Exercise as it relates to Disease/Effects of Physical Activity on Children with Autism Spectrum Disorder

This is a critic of the meta analysis “Effects of physical exercise on Autism Spectrum Disorders” by Sowa & Meulenbroek (2012).

## The background to this research

Autism spectrum disorder is a neuropsychological condition. The rate of diagnosis of autism spectrum disorder has been on the rise and in 2012 it was reported that 115,400 Australians were currently diagnosed with autism spectrum disorder. Children with autism experience challenges in interactions and social communication and often exhibit a restricted pattern of interests and behaviour that affect their social functioning.
Children with autism also typically have challenges with:
* Fine and gross motor skills
* Sensory integration
* Poor attention span
* Poor coordination
* Visual tracking of moving objects
* Slow reaction times.
Physical activity provides benefits for all children but it has the potential to have particular benefits for children on the autism spectrum who may experience problems with communication abilities, social skills, gross motor skills and behaviour. Physical activity has been show not only improve physical conditioning but also to reduce the incidence and frequency of negative, self-stimulating behaviours like body rocking, repetitive tapping or motions like hand flapping that are common behaviours among individuals with autism.

## Where is the research from

It was conducted by Michelle Sowa and Ruud Meulenbroek at the Donders Institute for Brain, Cognition and Behaviour at the Radboud University Nijmegen in the Netherlands. The Donders Institute is a world class research centre that has more than 600 researchers from 35 countries who work towards the advancement of brain, cognitive and behavioural sciences. The review was published in Research in Autism Spectrum Disorders which publishes high quality empirical articles that contribute to a better understanding of autism spectrum disorders. All published articles are reviewed by a minimum of three knowledgeable reviewers. The authors listed no conflicts of interest. This means that the analysis comes from a leading research institute and is published in a reputable journal, it is expected to be of high quality. The studies included in the analysis come from various western countries and the findings are expected to be applicable to children in Australia.

## Research type

This was a meta analysis. Meta analyses involve combining the results from all the included studies and completing a statistical analysis on the combined results. Meta analysis are considered to be the highest level of evidence available.

## What the research involved

This meta-analysis evaluates 16 behavioural studies reporting on a total of 133 children and adults with multiple variants of autism spectrum disorder who were offered structured physical activities either in an individual or a group setting. It was conducted in accordance with the Bambra (2011) guidelines for a systematic literature review.
To be included in this meta-analysis, the following criteria was used:
* Studies were published between 1991 and 2011.
* Studies included children or adults with an autism spectrum diagnosis.
* The interventions described involved some kind of physical exercise.
* The behavioural effects attributed to the interventions were quantitative so that they could be reflected as a percent in relation to behavioural change.
For analysis the studies were divided into either ‘individual’’ or ‘‘group’’ physical activity. Of the 16 studies included half were individual and the other half group-based exercise interventions.
Table 1
Types of physical activity reported in studies.
* Physical Activity reported
* Swimming (n=6)
* Jogging (n=5)
* Horseback riding (n=2)
* Cycling and weight training (n=1)
* Walking (n=1)
* Other (n=1)
Limitations of this analysis include that the sample sizes of the studies included were considered to be small. This limits the generalizability of the results of this analysis. In many studies the subjects continued with alternate therapies (physiotherapy, occupational therapy, speech therapy & pharmaceuticals). The effects of these additional therapies on the study results are not know. The authors could only find studies that demonstrated significant positive results. This may be the result of exercise always having a significant effect on people with autism spectrum disorder or it could be due to a publication bias where non-significant effects were not published .

## Basic results

The meta-analysis revealed an overall improvement in social skills, gross motor skills and other skills measured by 37.5%. This shows that physical exercise provides positive behavioural changes in children with autism spectrum disorder.
Table 2
Improvement rate (%) seen per type of Intervention on autism spectrum disorder problem areas.
| | Motor Skills | Social Skills | Other | Overall Improvement Average |
| Individual Activity | 48.35 % | 71.43 % | 12.26 % | 48.57 % |
| Group Activity | 35.98 % | 26.37 % | 24.74 % | 31.54 % |
| Individual & Group Average | 40.30 % | 39.51 % | 21.62 % | ---- |
Overall, the participants with autism spectrum disorder benefited more from the individual interventions (M = 48.57%) than from the group interventions (M = 31.54%) In both the motor and social skill domains, the individual activities provided a statistically significant positive difference to the group activities. The effect size was moderate for both the these differences.

## Conclusions from this research

This meta-analysis provides insight into the impact of physical activity on people with autism spectrum disorder. It shows that physical activity provides positive effects on both motor and social functioning in children with autism spectrum disorder. It also highlights the need for further experimental research to determine what extent the severity of autism has on the benefits received. There is also a need for more longitudinal studies assessing the effects of physical activity over time.

## Practical advice

* All forms of physical activity are beneficial for children with autism spectrum disorder.
* Individual activities like swimming, jogging, cycling and horseback riding provided the greatest overall motor and social benefits for children.
* The benefit of individual activities is that the programs can be tailored to the specific needs of the individual.

## Further information/resources

* Autism Awareness Australia : http://www.autismawareness.com.au
* Autism After Hours Actives : http://www.aaha.com.au
* Autism Speaks: https://www.autismspeaks.org/science/science-news/sports-exercise-and-benefits-physical-activity-individuals-autism
* National Centre on Health, Physical Activity and Disability - Improving the Lives of Individuals with Autism through Exercise: https://www.youtube.com/playlist?list=PLwMObYmlSHaOeFCW8iO6BUNHosVIAHk-L
* Social Stories for Students with Autism in Physical Education : http://dx.doi.org/10.1080/07303084.2008.10598198

## References

* 1 2 3 4 5 6 7 8 9 10 11 12 Sowa, M., & Meulenbroek, R. G. J. (2012). Effects of physical exercise on autism spectrum disorders: A meta-analysis. Research in Autism Spectrum Disorders, 6, 48-57.
* 1 2 3 4 Awamleh, A. A., & Woll, A. (2014). The influence of physical exercise on individuals with autism: Is physical exercise able to help autistic? Journal of Social Sciences, 10(2), 46-50.
* ↑ Australian Bureau of Statistics. (2012). Autism in Australia. (Cat.no.4428.0) Retrieved from http://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/4428.0Main%20Features32012
* 1 2 Pan, C.Y., Chu, C.H., Tsai, C.L., Sung, M.C., Huang, C.Y., & Ma, W.Y. (2016). The impacts of physical activity intervention on physical and cognitive outcomes in children with autism spectrum disorder. Autism, 1–13. DOI: 10.1177/1362361316633562
* 1 2 3 Dawson, G., & Rosanoff, M., (2009). Sports, Exercise, and the Benefits of Physical Activity for Individuals with Autism. Retrieved from Autism Speaks website:https://www.autismspeaks.org/science/science-news/sports-exercise-and-benefits-physical-activity-individuals-autism
* 1 2 Nahmias, A. S., Kase, C., & Mandell, D. S. (2014). Comparing cognitive outcomes among children with autism spectrum disorders receiving community-based early intervention in one of three placements. Autism, 18(3), 311-320. doi:10.1177/1362361312467865
* 1 2 Geslak, D. S. (2016). Exercise, autism, and new possibilities. Urbana: Sagamore Publishing LLC.
* ↑ Donders Institute. (n.d.). What is the Donders Institute. Retrieved from Donders Institute website: http://www.ru.nl/donders/
* ↑ Elsevier. (n.d.). Research in Autism Spectrum Disorders. Retrieved from Elsevier website: http://www.journals.elsevier.com/research-in-autism-spectrum-disorders
* ↑ National Health and Medical Research Council. (2009). NHMRC Levels of Evidence and Grades for Recommendations for Developers of Clinical Practice Guidelines. Retrieved from:https://www.nhmrc.gov.au/_files_nhmrc/file/guidelines/developers/nhmrc_levels_grades_evidence_120423.pdf
* ↑ Bambra, C. (2011). Real world reviews: A beginner’s guide to undertaking systematic reviews of public health policy interventions. Journal of Epidemiological Community Health, 65, 14–19.
* ↑ Sandt, D. (2008). Social stories for students with autism in physical education. Journal of Physical Education, Recreation & Dance, 79(6), 42-45. doi:10.1080/07303084.2008.10598198