Implementation,Reach,and Safety of Physical Activity Interventions for Autistic Adults: A Scoping Review

Abstract

Background: Despite the known benefits of physical activity—such as better sleep, increased social connection, and reduced psychological distress—autistic adults often do not meet recommended levels. As physical and psychological conditions often co-occur with autism, increasing physical activity represents a potential avenue for improved health and well-being outcomes. Physical activity research to date has primarily focused on autistic children and adolescents. The aim of this study was to understand the implementation, reach, and safety of physical activity programs for autistic adults.

Methods: We conducted a scoping review. Reported according to PRISMA-ScR guidelines, our review included studies implementing physical activity interventions in autistic people aged ≥18 years. We searched six databases to June 2024 with keywords, MeSH headings and derivatives relating to autism and physical activity. We extracted data using a standardized template, applying a descriptive analytical approach to map data to categories associated with the review’s aim.

Results: Nine studies involving 148 autistic adults (108 male; aged 19–34 years) met inclusion criteria. Physical activity interventions implemented included aerobic exercise, walking or jogging, strength training, motor skills training, soccer, and exer-gaming. Trained instructors, exercise or health professionals, students, coaches, teaching assistants, or residential staff supervised programs conducted in home, school, university, or community settings. Strategies used to support implementation were incorporating appropriate adaptations and scaffolding, using social support strategies and facilitating self-determination. Elements of reach were described variably among the included studies. Reasons for reduced reach and nonparticipation included lack of interest, scheduling, and medical and personal issues. Safety strategies included conducting pre-exercise medical screening and providing physical and psychological training for support people.

Conclusion: Safe implementation of physical activity among autistic adults is possible with support. However, there is a lack of research addressing physical activity among autistic women and those with complex needs.

Community Brief

Why is this an important issue?

Autistic adults have high rates of physical inactivity, and many do not meet physical activity guidelines promoted by the World Health Organization. The benefits of physical activity include improved sleep, increased social interactions, and reduced psychological distress. Participation in physical activity is important for autistic adults who have a propensity to sleep poorly, be socially isolated, and have a high likelihood of mental health issues.

What was the purpose of the review?

In this scoping review, we sought to identify and describe what is known about physical activity interventions for autistic adults and understand how the interventions worked in practice, who took part, and the safety of these interventions.

What did the authors do to review the literature?

Following published guidelines for conducting scoping reviews, we identified and screened peer-reviewed articles for studies that investigated a physical activity intervention involving autistic adults. We extracted information from each study to better understand how the intervention was carried out, who took part and the reasons for this, and the safety of the interventions, including any measures to ensure safe participation.

What studies did the authors find?

We identified nine studies describing physical activity interventions for autistic adults. Most participants were male, and all studies were done in high-income countries. The types of physical activity carried out were weight and aerobic training, walking and jogging programs, motor skill development, soccer, swimming and “exer-gaming” (i.e., active video games). These activities were completed either in small groups or one-to-one and were supervised by a trained person. Strategies to support participation included logistical support, orientation and specialist support, and motivation and peer support. Support strategies were used to adapt and give structure to the activity to meet the needs of individuals. Only one study gave reasons for people not taking part, which included a lack of interest, scheduling, and personal issues. Preexisting health conditions and complexity of needs excluded some autistic adults from taking part. Safety strategies included pre-exercise screening, having cardiopulmonary resuscitation-trained supervisors and physical and psychological training for support people. No studies reported adverse events because of participation in physical activity.

In summary, what did those studies show?

Having support in place, making adaptations, and having a structure that meets an individual’s needs and preferences may facilitate uptake of physical activity among autistic adults.

What are the remaining gaps in the literature?

Understanding the reasons for low or nonparticipation needs further exploration. There remains a need to better understand physical activity from the perspective of autistic women and among autistic individuals with complex needs and those living in low-income countries.

Based on this review, what do the authors recommend?

Understanding the needs of all autistic adults is important to facilitate their uptake and inclusion in a variety of physical activities regardless of the setting. Autistic individuals need to be included in the design of physical activity programs to ensure their needs and preferences are met. Further, there is a need for physical activity programs that can translate to low socioeconomic environments.