Evaluating exercise as evidence-based practice for individuals with autism spectrum disorder

Abstract

Background: The purpose of this study was to conduct a systematic review of the literature to evaluate empirical support for the use of exercise as an evidence-based practice (EBP) for individuals with autism spectrum disorder (ASD), aged 1-21 years, using the Adapted Physical Activity Taxonomy (APAT) (1). Method: A systematic review of research, published within the past 10 years and accessible in SPORTDiscus, ProQuest Nursing, Science Direct, ERIC, Ovid MEDLINE, and PsychINFO databases, was conducted following seven inclusion criteria. An initial 169 articles were identified of which 23 articles were found that met the inclusion criteria including implementation of an exercise intervention for participants diagnosed with ASD and utilization of an experimental/quasi experimental, correlational, single-subject, or qualitative research design. These 23 articles were evaluated using the APAT to determine the quality of the research and the strength of the recommendation in establishing exercise as an EBP. Results: Of the 23 articles evaluated, 17 employed an experimental/quasi experimental design, 1 article employed a correlational design, and 5 articles employed a single-subject design. Only one article (2) was found to meet the minimum overall quality indicator of moderate (i.e., Level 2) when evaluated on the APAT. In total, 13 of the 23 articles (57%) had method sections evaluated as weak, and 17 of the 23 articles (74%) had results sections evaluated as weak. Conclusion: From the findings of this systematic review, and in accordance with the Every Student Succeeds Act of 2015 (3) definition of an EBP, it appears that exercise can be considered an EBP for school-aged children with ASD. However, this recommendation is based solely on moderate evidence from one well-designed and well-implemented experimental study; therefore, generalization is still pending further similar findings. Recommendations for future research are offered. Autism spectrum disorder (ASD) is defined by the American Psychiatric Association (APA) as a group of developmental disabilities causing significant delays in communication (e.g., limited expressive language) and social skills (e.g., difficulty with social reciprocity) and is associated with repetitive behavior (e.g., engages in hand-flapping) and stereotypical movements (e.g., body rocking) (4). Recent investigations of the motor and exercise patterns of individuals with ASD have also established motor development delays as an attribute of ASD (5-7). Individuals diagnosed with ASD will be categorized as one of three levels based on support needed: Level 1, requiring support; Level 2, requiring substantial support; and Level 3, requiring extreme support at all times (APA). These individual attributes and the levels of support needed by individuals with ASD may interfere with the development of age-appropriate motor skills and participation in exercise. The physical benefits of exercise reported for children with ASD include improvements in cardiorespiratory functioning (8-10), motor skill performance (11), and muscular strength (10, 12), as well as a reduction in body mass index (13). Along with physical benefits, behavioral and cognitive functioning improvements have been reported. Exercise, as an intervention, has also been shown to reduce maladaptive behaviors (14, 15) and stereotypic behaviors (16) as well as increase on-task behaviors (17) and academic responding (e.g., participating in instructional tasks, asking, and answering questions) (18). Exercise has also been shown to improve academic achievement (19) and social skills (20). However, the research studies cited above provide varying definitions of exercise, utilize different methods to determine levels of heart rate or energy expenditure, and examine differing health-related fitness components. These research studies also involve participants across a wide age range and participants who include, but may not be exclusive to, individuals with ASD. These factors contribute to the difficulties of establishing exercise as an evidence-based practice (EBP). Furthermore, to date, no systematic review has been completed that examines the quality of the research or the strength of the recommendation needed to establish exercise as an EBP.