Effects of Physical Exercise Interventions on Social Skills in Children With Autism Spectrum Disorder: A Systematic Review and Meta-Analysis.

PURPOSE: Children with autism spectrum disorder (ASD) often have social skill deficits. This systematic review and meta-analysis examined the effects of physical exercise interventions on social skills in children with ASD. METHODS: PubMed, Web of Science, Embase, and Scopus were searched from inception to January 10, 2025, for randomized controlled trials (RCTs). Studies were screened using predefined eligibility criteria. Methodological quality was assessed with the Cochrane Risk of Bias Tool. RevMan 5.3.5 and Stata 16.0 were used for subgroup, sensitivity, and publication-bias analyses. RESULTS: Eleven RCTs involving 349 participants were included. The primary random-effects meta-analysis suggested a small significant pooled effect on social skills (SMD = 0.34, 95% CI 0.03-0.65, P = 0.03; I² = 49%). However, after excluding one influential study in a post-hoc sensitivity analysis, the effect was attenuated and no longer significant (10 RCTs; SMD = 0.19, 95% CI - 0.03-0.41, P = 0.09; I² = 0%). Differences among intervention-duration subgroups were not significant (P = 0.61). Egger's tests detected no significant small-study effects in the primary (P = 0.432) or sensitivity analysis (P = 0.263), although publication bias could not be excluded. CONCLUSION: Physical exercise may have a small beneficial effect on social skills in children with ASD, but the estimate was sensitive to one influential study, and longer interventions were not clearly superior. Given the limited evidence base and variability in protocols and outcomes, findings should be interpreted cautiously. Larger, rigorous RCTs are needed to clarify effects and potential moderators.