“Our kids won’t want to do that; they don’t like to exercise.”
When I first proposed an exercise program for autistic children at the Institute for Autism Research at Canisius University, that was a response I often heard. The reasons why autistic individuals won’t exercise are as varied as the individuals themselves: uninterested, difficulty moving, picked last in gym class. Yet, none of the reasons seem impossible to overcome, and exercise can be a powerful therapy.
Estimates from 2020 indicate that 1 in 36 children in the United States have autism spectrum disorder (ASD). While each autistic individual is unique in terms of motor, cognitive and language ability, key characteristics of ASD include social impairments and restricted and repetitive interests and behaviors. We know these characteristics can continue into adulthood and have a negative impact on long-term outcomes. Ongoing impairments can lead to limited social skills and misreading social cues, primary factors for poor social and occupational well-being. Recent reviews have also found that autistic children are generally less physically active and have lower participation rates specifically in group sport/recreational activities compared to their peers.
Autistic children commonly exhibit multifaceted motor difficulties (e.g., fine and gross motor; postural stability; and motor coordination, control and learning). These challenges place them at a disadvantage when engaged in activities with peers and may be more pronounced for group activities. As such, motor challenges limit participation in group sport or exercise-based recreational activities. This reduces opportunities for autistic children to interact with peers and improve social and communication skills and may have additional negative impacts on other physical health outcomes.
Past studies have tested the effects of exercise-based activities on physical and behavioral outcomes and shown a variety of improved outcomes in problem behaviors, physical performance, social competence and motor and academic skills. Vigorous exercise, in particular, is associated with greater improvements. Most research to date has used individual exercise modalities (e.g., running around a track or treadmill, swimming) with limited information on group exercise-based programs. Of the work done evaluating group programs, results do demonstrate a small but significant effect for improvements in social function. There is much room for hope!
There are various practical suggestions to consider in developing exercise-based programs for autistic individuals. Exercise programs should be held in structured, consistent and supportive environments. A regular daily routine and order helps to provide consistency and improve compliance. Exercise professionals should also delineate specific expectations and goals during participation for autistic children, telling them exactly what they will be doing during each session and for each activity. Commonly identified coaching procedures that are useful include direct instruction (verbal and/or visual), modeling, hand-over-hand guidance, repeated practice, and frequent feedback and positive renforcement. Though verbal instruction is most useful for those with higher verbal abilities, including and simplifying visual instruction (e.g., slowing the speed of demonstrations) and providing visual cues may also help improve motor performance through imitation. Exercise programs for autistic children should also include specific procedures for teaching and promoting social skills within the exercise-based sessions.
At the Institute for Autism Research, we have found success using a group exercise-based social program for autistic children that specifically targets social outcomes, behavioral challenges associated with autism, and physical performance. Our program involves concurrent strength and aerobic training in a highly structured 60-minute session and includes variations in and combinations of cardiovascular, gymnastic, body weight and weightlifting movements. The program includes both cooperatively completed and individually completed skills and games to provide the children with natural opportunities to develop and practice social skills. Initial results show that the children and staff find the program enjoyable, with improved performance and socialization outcomes and also a decrease in ASD symptom severity among participants. This was all accomplished with no adverse events or injuries during participation.
Ultimately, exercise can and should be an enjoyable and regular part of an autistic individual’s routine. Research supports that regular participation in exercise can improve motor skills, behavior, social skills and physical performance in autistic individuals. If the exercise program, environment and professional are supportive, barriers to exercise can be removed for autistic individuals to allow for enjoyable exercise participation and support a long and healthy life.
Karl F. Kozlowski, PhD, is a professor and chair of the kinesiology department and a researcher at the Institute for Autism Research at Canisius University in Buffalo, New York. Dr. Kozlowski is actively involved in ACSM, as a member of the Exercise Science Education Special Interest Group and ACSM’s Mid-Atlantic Regional Chapter. Dr. Kozlowski is a published expert and presenter on the use of exercise as a therapeutic intervention for concussion and autism as well as the impact of autism on physical health through the lifespan.
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