Comparison of physical activity between children with Autism Spectrum Disorder and their typically developing peers: A systematic review and meta-analysis

Background: Autism spectrum disorder (ASD) is a highly prevalent condition affecting millions of children worldwide. Due to diagnosis-related deficits, children with ASD may be achieving lower amounts of physical activity (PA) compared to children who are typically developing (TD). However, current literature lacks consensus on PA among children with ASD. Purpose: The purpose of this systematic review and meta-analysis was to compare the differences in PA levels between children (2-18 years) with ASD and their TD peers. Methods: Five online databases (PubMed, Web of Science, PsycINFO, Academic Search Complete, and Sports Medicine & Education Index) were searched using keywords, “physical activity” and “autism”. Studies were screened according to predetermined criteria. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was used to assess risk of bias and quality of included studies. Descriptive details extracted included study characteristics (i.e., authors, dates, study design, recruitment strategies, and country of origin), population characteristics (i.e., sample size, age range, and sex), PA outcome measures, and assessment methodology. Quantitative data for total time spent in PA was extracted from the included studies. A pooled hedge’s g random effects model (pQ and I2 statistics, while publication bias was evaluated with the Failsafe N value. Results: The search returned a total of 769 results. Twenty-nine studies (STROBE=18.07+/-1.73) were included in the systematic review and 15 studies were included in the meta-analysis providing a total of 18 effect sizes. There was a large, significant effect (g=-0.64; pQ=49.2; I2=65.5), but this effect was very stable (Failsafe N=651). Further, sub-analyses on intensity levels, ages, settings, and measurement types revealed significant associations remained, except for light (g=-0.43; p=0.12) and vigorous (g=-0.21; p=.24) intensity PA. Conclusion: This study revealed important disparities in PA among children with and without ASD. Specifically, children with ASD were significantly less physically active compared with TD peers. These differences in PA were noted across intensity levels, ages, settings, and measurement approaches. The findings of this study support the need for clinicians, educators, and caregivers to pursue PA options for children with ASD more often. Future studies are needed to further understand the PA behaviors of children with ASD and to examine differences associated with level of severity or disorder profiles of ASD and other confounding variables such as age and gender