Exercise Modalities for Improving Motor and Behavioural Outcomes in Autism Spectrum Disorder: A Comparative Narrative Review

Objective – to compare the effects of different exercise modalities on motor performance and behavioural outcomes in individuals with autism spectrum disorder (ASD) and to inform individualised exercise prescription. Materials and Methods. A narrative review was conducted following the Scale for the Assessment of Narrative Review Articles (SANRA). Electronic databases were searched for English-language studies published between 2008 and 2025. A total of 46 eligible sources, comprising primary empirical studies and secondary evidence including systematic reviews and meta-analyses, were identified and included in the review. The primary empirical evidence evaluated aerobic exercise, aquatic exercise, yoga, martial arts, resistance training, and exergaming in individuals with ASD. Results. The review included 46 eligible sources, including primary empirical studies, systematic reviews and meta-analyses, which provided context and interpretation of the findings. The length of the intervention typically was 6-24 weeks, and the number of exercise sessions was 2-5 per week. The exercise modalities most commonly studied were aerobic exercise, aquatic exercise, yoga, martial arts, exergaming, and resistance training. The evidence from the included studies was generally positive regarding the benefits of structured exercise for motor performance, physical fitness, executive functioning, behavioural regulation, and social participation, with included evidence varying in strength and consistency across the modalities and outcome domains. The scope of the benefits reported from aquatic exercise was wide, ranging from motor to behavioural, social and physical, but this may be due in part to variations in intervention characteristics and outcome selection. The main areas of development for yoga were self-regulation and sensory processing, and for martial arts, motor competence and social interaction. Evidence was favourable, and although fewer studies were available, the evidence for resistance training and exergaming was positive. Conclusions. Structured exercise is an effective complementary intervention for individuals with ASD, with different exercise modalities demonstrating distinct therapeutic strengths. Exercise prescription should therefore be individualised according to functional goals, clinical characteristics, and personal preferences. Future comparative trials using standardised outcome measures and longer follow-up periods are needed to strengthen the evidence base for precision exercise prescription.