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Neuropediatrics 2025; 56(05): 302-309
DOI: 10.1055/a-2561-8487
Review Article

Exercise Intervention Influences on Sleep and Anxiety in Children with Autism Spectrum Disorder: A Meta-Analyses of Randomized Controlled Trials

Jiaju Wang
1   School of Physical Education, Changchun Normal University, Erdao District, Jilin Province, China
,
Jiangyan Li
1   School of Physical Education, Changchun Normal University, Erdao District, Jilin Province, China
,
Feifei Wang
1   School of Physical Education, Changchun Normal University, Erdao District, Jilin Province, China
,
Yang You
2   Department of Physical Education, China University of Petroleum (East China), Huang Dao District, Qingdao City, China
› Author Affiliations
Funding This work was supported by the 2023 Jilin Provincial Department of Education Scientific Research Program under the grant (no. JJKH20230887SK) and the National Social Science Fund of China (no. BLA220239).
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Abstract

Related issues, such as sleep disturbance, are also frequently reported by children with autism spectrum disorder (ASD). This study systematically reviewed the influences of exercise on sleep and anxiety in children with ASD. Search for eligible studies through four databases, and then proceed with screening. The inclusion criteria are as follows: 1) children with ASD; 2) age 3 to 14 years; 3) randomized controlled trial (RCT); 4) the intervention group received exercise training; 5) conducted pre-and posttest, which includes sleep and anxiety. Use the Cochrane bias risk assessment tool to evaluate the quality of the selected study. Select standardized mean difference (SMD) as the appropriate effect scale index, and use Revman 5.4 software to analyze the mean difference of the selected article data. A total of seven studies fulfilled the inclusion criteria and were selected for the meta-analysis. The included studies involved 387 males and 79 females. The results demonstrated that the EXP group benefited from improved sleep (SMD, −1.05 [−1.25, −0.85], p < 0.05, I2 = 27%, p for heterogeneity = 0.22) and anxiety (SMD, −1.14 [−1.56, −0.72], p < 0.05, I2 = 95%, p for heterogeneity < 0.01) than the CON group. According to the findings, physical activities could offer nonpharmacological interventions for improving sleep and anxiety in children diagnosed with ASD. Sports training could also be considered to promote the rehabilitation of children patients with ASD, which might provide valuable insights.

Keywords

randomized controlled trial - autism spectrum disorder - children with ASD

Authors' Contributions

J.W. wrote the main manuscript text. J.L. and F.W. prepared [Figs. 1] [2] [3] to [4] and [Table 1]. Y.Y. drafted and reviewed the manuscript.




Publication History

Received: 24 December 2024

Accepted: 04 March 2025

Accepted Manuscript online:
19 March 2025

Article published online:
31 March 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • References

  • 1 Johnson KP, Zarrinnegar P. Autism spectrum disorder and sleep. Psychiatr Clin North Am 2024; 47 (01) 199-212
    Search in Google Scholar
  • 2 Durán-Pacheco G, Silkey M, Johnson M. et al. Effect of children's autism spectrum disorder severity on family strain and sleep quality: a cross-sectional online survey in the U.S. J Autism Dev Disord 2023; 53 (05) 1795-1808
    Search in Google Scholar
  • 3 Abel E, Kim SY, Kellerman AM, Brodhead MT. Recommendations for identifying sleep problems and treatment resources for children with autism spectrum disorder. Behav Anal Pract 2016; 10 (03) 261-269
    Search in Google Scholar
  • 4 Kang J, Park M, Oh CM, Kim T. High-fat diet-induced dopaminergic dysregulation induces REM sleep fragmentation and ADHD-like behaviors. Psychiatry Res 2023; 327: 115412
    Search in Google Scholar
  • 5 Sahu M, Tripathi R, Jha NK, Jha SK, Ambasta RK, Kumar P. Cross talk mechanism of disturbed sleep patterns in neurological and psychological disorders. Neurosci Biobehav Rev 2022; 140: 104767
    Search in Google Scholar
  • 6 Fadini CC, Lamônica DA, Fett-Conte AC. et al. Influence of sleep disorders on the behavior of individuals with autism spectrum disorder. Front Hum Neurosci 2015; 9: 347
    Search in Google Scholar
  • 7 Ansari S, AdibSaber F, Elmieh A, Gholamrezaei S. The effect of water-based intervention on sleep habits and two sleep-related cytokines in children with autism. Sleep Med 2021; 82: 78-83
    Search in Google Scholar
  • 8 Oriel KN, Kanupka JW, DeLong KS, Noel K. The impact of aquatic exercise on sleep behaviors in children with autism spectrum disorder. Focus Autism Other Dev Disabl 2016; 31 (04) 254-261
    Search in Google Scholar
  • 9 Malow B, Adkins KW, McGrew SG. et al. Melatonin for sleep in children with autism: a controlled trial examining dose, tolerability, and outcomes. J Autism Dev Disord 2012; 42 (08) 1729-1737 , author reply 1738
    Search in Google Scholar
  • 10 Vriend JL, Corkum PV, Moon EC, Smith IM. Behavioral interventions for sleep problems in children with autism spectrum disorders: current findings and future directions. J Pediatr Psychol 2011; 36 (09) 1017-1029
    Search in Google Scholar
  • 11 Wachob D, Lorenzi DG. Brief report: influence of physical activity on sleep quality in children with autism. J Autism Dev Disord 2015; 45 (08) 2641-2646
    Search in Google Scholar
  • 12 Brand S, Jossen S, Holsboer-Trachsler E, Pühse U, Gerber M. Impact of aerobic exercise on sleep and motor skills in children with autism spectrum disorders - a pilot study. Neuropsychiatr Dis Treat 2015; 11: 1911-1920
    Search in Google Scholar
  • 13 Tanksale R, Sofronoff K, Sheffield J, Gilmour J. Evaluating the effects of a yoga-based program integrated with third-wave cognitive behavioral therapy components on self-regulation in children on the autism spectrum: a pilot randomized controlled trial. Autism 2021; 25 (04) 995-1008
    Search in Google Scholar
  • 14 Higgins JPT, Thomas J, Chandler J. et al. Cochrane Handbook for Systematic Reviews of Interventions. In: Higgins JPT, Thomas J, Chandler J. et al., eds. Hoboken, NJ: Wiley; 2019.
    Search in Google Scholar
  • 15 Li S, Shaharudin S, Cirer-Sastre R, Li F, Abdul Manaf F, Mohd Shukri MF. Effects of high-intensity interval exercise on cardiac troponin elevation when comparing with moderate-intensity continuous exercise: a systematic review and meta-analysis. PeerJ 2023; 11: e14508
    Search in Google Scholar
  • 16 Tse AC, Lee PH, Zhang J, Chan RC, Ho AW, Lai EW. Effects of exercise on sleep, melatonin level, and behavioral functioning in children with autism. Autism 2022; 26 (07) 1712-1722
    Search in Google Scholar
  • 17 Tse ACY, Lee PH, Sit CHP. et al. Comparing the effectiveness of physical exercise intervention and melatonin supplement in improving sleep quality in children with ASD. J Autism Dev Disord 2024; 54 (12) 4456-4464
    Search in Google Scholar
  • 18 Tse CYA, Lee HP, Chan KSK, Edgar VB, Wilkinson-Smith A, Lai WHE. Examining the impact of physical activity on sleep quality and executive functions in children with autism spectrum disorder: a randomized controlled trial. Autism 2019; 23 (07) 1699-1710
    Search in Google Scholar
  • 19 Toscano CVA, Ferreira JP, Quinaud RT, Silva KMN, Carvalho HM, Gaspar JM. Exercise improves the social and behavioral skills of children and adolescent with autism spectrum disorders. Front Psychiatry 2022; 13: 1027799
    Search in Google Scholar
  • 20 Gehricke JG, Lowery LA, Alejo SD. et al. The effects of a physical exercise program, LEGOR and Minecraft activities on anxiety in underserved children with autism spectrum disorder. Res Autism Spectr Disord 2022; 97: 102005
    Search in Google Scholar
  • 21 Lu Y, Wang W, Ding X, Shi X. Association between the promoter region of serotonin transporter polymorphisms and recurrent aphthous stomatitis: a meta-analysis. Arch Oral Biol 2020; 109: 104555
    Search in Google Scholar
  • 22 Hayashi M, Mishima K, Fukumizu M. et al. Melatonin treatment and adequate sleep hygiene interventions in children with autism spectrum disorder: a randomized controlled trial. J Autism Dev Disord 2022; 52 (06) 2784-2793
    Search in Google Scholar
  • 23 Yano N, Hosokawa K. The importance of comprehensive support based on the three pillars of exercise, nutrition, and sleep for improving core symptoms of autism spectrum disorders. Front Psychiatry 2023; 14: 1119142
    Search in Google Scholar
  • 24 Hirota T, King BH. Autism spectrum disorder: a review. JAMA 2023; 329 (02) 157-168
    Search in Google Scholar
  • 25 Vonder Hulls DS, Walker LK, Powell JM. Clinicians' perceptions of the benefits of aquatic therapy for young children with autism: a preliminary study. Phys Occup Ther Pediatr 2006; 26 (1-2): 13-22
    Search in Google Scholar
  • 26 Oblak A, Gibbs TT, Blatt GJ. Reduced serotonin receptor subtypes in a limbic and a neocortical region in autism. Autism Res 2013; 6 (06) 571-583
    Search in Google Scholar
  • 27 Sejbuk M, Mirończuk-Chodakowska I, Witkowska AM. Sleep quality: a narrative review on nutrition, stimulants, and physical activity as important factors. Nutrients 2022; 14 (09) 1912
    Search in Google Scholar
  • 28 Chellappa SL, Aeschbach D. Sleep and anxiety: from mechanisms to interventions. Sleep Med Rev 2022; 61: 101583
    Search in Google Scholar
  • 29 Cortesi F, Giannotti F, Ivanenko A, Johnson K. Sleep in children with autistic spectrum disorder. Sleep Med 2010; 11 (07) 659-664
    Search in Google Scholar
  • 30 Hurtado-Alvarado G, Pavón L, Castillo-García SA. et al. Sleep loss as a factor to induce cellular and molecular inflammatory variations. Clin Dev Immunol 2013; 2013: 801341
    Search in Google Scholar
  • 31 Alzghoul L, Abdelhamid SS, Yanis AH, Qwaider YZ, Aldahabi M, Albdour SA. The association between levels of inflammatory markers in autistic children compared to their unaffected siblings and unrelated healthy controls. Turk J Med Sci 2019; 49 (04) 1047-1053
    Search in Google Scholar
  • 32 Veler H. Sleep and inflammation: bidirectional relationship. Sleep Med Clin 2023; 18 (02) 213-218
    Search in Google Scholar
  • 33 Forti LN, Van Roie E, Njemini R. et al. Effects of resistance training at different loads on inflammatory markers in young adults. Eur J Appl Physiol 2017; 117 (03) 511-519
    Search in Google Scholar
  • 34 Gleeson M, Bishop NC, Stensel DJ, Lindley MR, Mastana SS, Nimmo MA. The anti-inflammatory effects of exercise: mechanisms and implications for the prevention and treatment of disease. Nat Rev Immunol 2011; 11 (09) 607-615
    Search in Google Scholar
  • 35 Scheffer DDL, Latini A. Exercise-induced immune system response: anti-inflammatory status on peripheral and central organs. Biochim Biophys Acta Mol Basis Dis 2020; 1866 (10) 165823
    Search in Google Scholar
  • 36 Pedersen BK. The anti-inflammatory effect of exercise: its role in diabetes and cardiovascular disease control. Essays Biochem 2006; 42: 105-117
    Search in Google Scholar