Exercise and Cognition in Children With ASD
Condition: Cognitive Impairment; Child Autism
MeSH terms: Autistic Disorder
Study type: Interventional

Summary: 
      Physical exercise is widely reported to be beneficial to executive functions (EFs) in
      children with autism spectrum disorder (ASD). However, the impact of physical exercise on
      self-regulation (SR) in this population remains unknown. Moreover, very few studies have been
      done to examine the mechanism(s) that underlie the exercise-EF and exercise-SR relationships.
      The purposes of the present study were to test whether two types of physical exercise
      (cognitively engaging vs. non-cognitively engaging) benefited SR, and if the social,
      emotional and physical needs of an individual mediated the exercise-EF and exercise-SR
      relationships. Children diagnosed with ASD were randomly assigned into one of three groups:
      learning to ride a bicycle (n = 23), stationary cycling (n = 19) or an active control with
      walking (n = 22). Two EFs (flexibility and inhibition), SR and the mediating roles of
      perceived social support, enjoyment, stress, physical self-efficacy and perceived physical
      fitness were assessed.
    

Detailed description: 
      Given the well-evidenced cognitive benefits of physical exercise for executive functions
      (EFs) in children with typical development (TD), there is growing research interest in
      whether such benefits could also be translated to children with autism spectrum disorder
      (ASD). Previously, the investigators examined the effectiveness of a 12-week basketball
      training intervention on inhibition control and working memory in children with ASD. Results
      showed that the training improved inhibition control. More recently, Liang and colleagues
      (2022) conducted a meta-analysis of seven studies examining the effect of physical exercise
      interventions on EFs in children and adolescents with ASD. They concluded that chronic
      exercise interventions were beneficial to overall EFs in the population, particularly for
      cognitive flexibility and inhibitory control. While physical exercise appears to be
      beneficial in this population, the mechanism by which physical exercise potentially impacts
      EFs in children with ASD remains a question. It is important to understand the mechanism in
      order to design an effective physical exercise intervention to promote the development of EFs
      among children with ASD.

      Over the past few decades, most of the studies examining the exercise-cognition relation in
      the general population have viewed the mediating mechanism via a neurobiological framework,
      expressed most clearly by the neurotrophic hypothesis. The hypothesis states that physical
      activity increases metabolic demands and triggers a cascade of biochemical changes, such as
      enhancing cerebral blood blow and increasing the availability of brain-derived neurotrophic
      factor, which strengthens brain plasticity for higher-level cognitive activities such as
      those involved in executive functions. It is not until recently that scientists started
      questioning whether the exercise-cognition relation could also be mediated by a person's
      social, emotional, and physical needs. Diamond and Ling (2016) hypothesized that the most
      successful approaches for improving EFs would address social, emotional and physical needs,
      and that cognitively engaging physical activity (e.g., martial arts, dance) that enhances
      social interaction and joy would be more beneficial to EFs than less cognitively engaging
      physical activity. To the best of our knowledge, no previous studies have examined the
      possible mediating roles of social support, emotion and physical fitness in the exercise-EF
      relation.

      Also of interest is the impact of physical exercise on self-regulation. Self-regulation (SR)
      is a psychological construct that encompasses a range of functional behaviors, such as
      interacting with peers, remembering rules and regulations, controlling emotions and
      inhibiting inappropriate and aggressive actions. Given these behaviors call upon the
      higher-order cognitive processes associated with EFs (e.g., shifting attention, working
      memory, inhibition), and the fact that SR and EFs predict many of the same positive outcomes
      (e.g., physical health, mental health, academic achievement), SR has long been thought of as
      the behavioral manifestation of EFs. However, several recent studies provided compelling
      evidence that SR and EFs are distinguishable and should be treated independently. Confusion
      may arise when measuring one without the other. Therefore, it is important to investigate
      whether physical exercise could yield similar benefits in SR as those in EFs, particularly in
      children with ASD where SR difficulties are common.

      Therefore, the purposes of this study were to examine the exercise-SR relation, and to
      investigate the possible mediating roles of social and emotional experience and physical
      perception in the exercise-EF and exercise-SR relationships in children with ASD. In the
      present study, these needs were expressed by individuals' perceived social support,
      enjoyment, stress, physical self-efficacy and perceived physical fitness. Similar to our
      previous study, the investigators compared EFs among three groups: 1) learning to ride a
      bicycle, 2) stationary cycling and 3) active control (walking) before and immediately after
      the two-week intervention period. Following the suggestion by Diamond and Ling (2016), the
      active control group with walking (instead of a no-treatment control group) was used to
      control for potential Hawthorne effects. Walking was chosen because it was a low intensity
      physical activity that enabled us to assess the same potential mediators as those in the
      intervention groups. Unlike our previous study, only inhibition and flexibility were measured
      in this study because exercise interventions were shown effective to improve these two EFs in
      children with ASD, and to enhance the feasibility of the study (to avoid overburdening
      participants with the additional mediation assessments compared to our previous study). To
      examine the mediating effects, perceived social support, enjoyment, stress, physical
      self-efficacy, and perceived physical fitness were measured during the baseline period,
      mid-intervention and post-intervention.
    

Intervention name(s): Bicycle learning; Stationary cycling
Intervention type(s): Other; Other
Intervention description(s): The 10 intervention sessions were conducted in an identical format, comprising three activities: warm-up (10 min), bicycle learning (40 min), and cool-down (10 min). In the bicycle training activity, participants were asked to ride on a training bicycle with training wheels to gain better control of the bike in a gradual way. Participants then progressed from the training bicycle to a two-wheel bicycle. To keep participants on the learning curve, they were asked to ride through an obstacle course that was progressively more difficult to negotiate. The obstacles were designed by a focus group, which consisted of four physical education teachers from participating schools and one experienced cycling coach with more than five years of coaching experience.; The 10 intervention sessions were conducted in an identical format, comprising three activities: warm-up (10 min), stationary cycling (40 min), and cool-down (10 min). For stationary cycling activity, they were also asked every 10 mins during exercise to indicate their ratings of perceived exertion (target range: 3-5). Participants were positively reinforced verbally with compliments for their efforts in the training program and their daily improvements were visualized through graphs kept in the child's home.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: Cognitive function; Self-regulation; Executive Function; Physical exercise; Children; Autism