Physical Activity for Autistic Adults: Recommendations for a Shift in Approach

Abstract

Abstract

Physical activity is beneficial for physical and mental health in the general population. Among autistic people, a range of physical and mental health conditions, particularly depression and anxiety, occur more frequently than in the general population. Physical activity interventions could help improve physical and mental health in autistic adults, but there is a lack of research in the area. The aim of this perspective article is to explore research into physical activity interventions for autistic adults, and identify gaps particularly in need of addressing. This perspective article considers six intervention studies carried out with adults, a pilot study, and seven review studies of adult and child interventions. Studies found significant increases in amount of physical activity undertaken, well-being, interaction, emotion, and regulation. There were decreases in imitative and distress behaviors. However, there were few studies, samples were small, participants all had co-occurring intellectual disability (ID), and measures were heterogeneous with lack of assessment of changes in physical fitness levels. Qualitative exploration was extremely limited. Recommendations are that there should be increased focus on research into physical activity for autistic adults, with input from autistic people to identify enjoyable, accessible activities. There should be particular consideration of longer term, sustainable activities for autistic people both with and without ID. Finally, but of major importance, there should be an increased focus on addressing mental health and anxiety through physical activity.

Lay summary

Why is this topic important?

Physical activity is effective at reducing the risk of and managing long-term physical and mental health conditions in the general population. Autistic people's health is poorer on average than the general population, so exercise might be particularly helpful for them, but little is known in this area.

What is the purpose of this article?

The article looks at the existing research on physical activity for autistic people and identifies where research is needed to understand better how physical activity could benefit autistic people's health and well-being.

What is the perspective of the author?

The author is a late-diagnosed autistic woman who worked as a fitness instructor before she completed her studies in psychology. She was awarded a PhD in psychology in 2015, looking at music in exercise, and works as a university researcher and tutor.

What does existing research show?

Research so far has consisted of small studies, and the designs have often been poor. There is a tendency to overlook the well-being of autistic people and to focus on stopping certain behaviors without recognizing why they are happening, or that they may be helpful for autistic people. Studies found that physical activity has many benefits for autistic people, such as increasing well-being, helping with emotional regulation, improving walking gait and balance, and raising activity levels. However, most studies did not look at health and fitness outcomes and were more focused on outcomes that have not been identified as important to autistic people.

What is recommended for future research?

Research needs to focus much more on autistic adults, across a wide age range, as needs and physical characteristics change across the life span. Autistic people need to be involved with the design of the programs that the research is testing, to make sure they are acceptable and appropriate for their needs. At the moment, research has looked at mainly short programs and researchers have not measured fitness. Unless fitness is measured at the outset and end of physical activity programs, we will not know if they are effective at improving fitness. Fitness improvements are lost if physical activity is not continued, so programs need to be continued after the end of a research study if they are effective.

Research on physical activity for autistic adults has only looked at adults who also have intellectual disabilities. Research needs to consider adults without intellectual disabilities, and also consider adults who have other common conditions that are often found alongside autism, for example, epilepsy, and Ehlers–Danlos syndrome. Perhaps most importantly, researchers need to recognize neurodiversity and understand it better, so that they can avoid trying to suppress activities such as stimming, which many autistic people find helpful in managing everyday stresses. Instead, researchers need to avoid treating autism as a disorder that needs to be fixed and focus on the needs and wishes of autistic people.

How will these findings help autistic adults now or in the future?

This article gives clear guidance on a way forward for research. The author hopes that this will lead to good-quality studies focusing on autistic people's priorities, and that the evidence these studies generate will lead to better provision of physical activity facilities and opportunities for autistic people, improving their health and well-being.