Background: Children with autism spectrum disorder often exhibit difficulties in emotion regulation, elevated anxiety levels, and deficits in social functioning. This systematic review and meta-analysis aimed to critically evaluate the evidence on the effectiveness of exercise interventions in improving emotion regulation, reducing anxiety, and enhancing social skills among children with autism spectrum disorder.
Methods: This review followed the PRISMA 2020 guidelines. Four databases PubMed, Scopus, Web of Science, and Google Scholar were systematically searched for randomized controlled, quasi-experimental, and non-randomized studies published from January 2015 to February 2026. Eligible studies included children with a formal autism spectrum disorder diagnosis who participated in structured exercise programs targeting at least one of the three outcomes. Methodological quality was assessed using the McMaster and PEDro scales.
Findings: A total of 16 studies involving 569 children with ASD (mean age 8.05 years; 81% boys) were included. For social skills, meta-analysis of 13 studies showed a small, non-significant overall effect (SMD = 0.16, p = 0.62), with considerable heterogeneity (I² = 87%). Most individual studies (14 of 16) reported positive improvements in this domain. Regarding emotional regulation, a significant baseline deficit was identified in children with ASD compared to TD peers (pooled SMD = −0.64, p = 0.008). Following exercise interventions, enhancements in emotion regulation were reported in four studies. Only one study measured anxiety outcomes, precluding a pooled analysis; however, it found a reduction in anxiety symptoms post-intervention.
Conclusion: Collectively, the evidence indicates that structured exercise interventions may benefit children with ASD, though the strength and consistency of effects vary across outcomes. Meta-analysis showed a small, non-significant pooled effect on social skills, with high heterogeneity suggesting that intervention success may depend on program characteristics and measurement approaches.