The Effect of Aerobic Exercises on Balance, Aerobic Capacity, and Cognitive Functions in Children With Autism Spectrum Disorder

Authors

  • Simona Petrylienė Department of Health Promotion and Rehabilitation, Lithuanian Sports University, Kaunas
    Lithuania
  • Rima Solianik Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas
    Lithuania

Abstract

Background: The increasing prevalence of autism spectrum disorder (ASD) worldwide highlights the importance of rehabilitation services, as ASD is often associated with gross motor and cognitive impairments. However, it has not yet been investigated whether aerobic exercise can enhance the effects of conventional physiotherapy on balance, aerobic capacity, and cognitive functions.

Methods: This study included 30 children aged 8–11 years with diagnosed ASD. Fifteen children were assigned to control group who performed conventional physiotherapy, while the other 15 of the experimental group had combined conventional physiotherapy with an additional aerobic exercise. Balance was assessed using the modified Berg Balance Scale, aerobic capacity with the 6-minute run test (modified Cooper test), and cognitive functions were assessed using RehaCom computer system tasks evaluating topological memory and logical reasoning.

Results: The results showed that balance scores and aerobic capacity increased significantly (p < 0.05), while no significant changes were observed in the control group. Regarding cognitive functions, the experimental group showed significantly reduced task solving time and memory acquisition time, as well as a shorter reaction time median (p < 0.05). No significant changes were found in the control group.

Conclusions: The integration of aerobic exercise into conventional physiotherapy significantly improves balance, aerobic capacity, and cognition in children with autism spectrum disorder, highlighting the efficacy of a combined therapeutic approach

Keywords: Cognition, aerobic endurance, autism spectrum disorder, postural control

References

Avgerinos, K. I., Liu, J., & Dalamaga, M. (2023). Could exercise hormone irisin be a therapeutic agent against Parkinson’s and other neurodegenerative diseases? Metabolism Open, 17, 100233. https://doi.org/10.1016/j.metop.2023.100233

Bataweel, E. A., & Ibrahim, A. I. (2020). Balance and musculoskeletal flexibility in children with obesity: A cross-sectional study. Annals of Saudi Medicine, 40(2), 120–125. https://doi.org/10.5144/0256-4947.2020.120

Cai, K., Yu, Q., Herold, F., Liu, Z., Wang, J., Zhu, L., Xiong, X., Chen, A., Müller, P., Kramer, A. F., Müller, N. G., & Zou, L. (2020). Mini-basketball training program improves social communication and white matter integrity in children with autism. Brain Sciences, 10(11), 803. https://doi.org/10.3390/brainsci10110803

Choi, J.-W., & Balakrishnan, R. (2026). Aerobic exercise-induced myokine irisin release: A novel strategy to promote neuroprotection and improve cognitive function. Neural Regeneration Research, 21(1), 306–307. https://doi.org/10.4103/NRR.NRR-D-24-01034

Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed., reprint). Psychology Press.

Cui, J., Zou, L., Herold, F., Yu, Q., Jiao, C., Zhang, Y., Chi, X., Müller, N. G., Perrey, S., Li, L., & Wang, C. (2020). Does cardiorespiratory fitness influence the effect of acute aerobic exercise on executive function? Frontiers in Human Neuroscience, 14, 569010. https://doi.org/10.3389/fnhum.2020.569010

Date, S., Munn, E., & Frey, G. C. (2024). Postural balance control interventions in autism spectrum disorder (ASD): A systematic review. Gait & Posture, 109, 170–182. https://doi.org/10.1016/j.gaitpost.2024.01.034

Demetriou, E. A., DeMayo, M. M., & Guastella, A. J. (2019). Executive function in autism spectrum disorder: History, theoretical models, empirical findings, and potential as an endophenotype. Frontiers in Psychiatry, 10. https://doi.org/10.3389/fpsyt.2019.00753

Ding, L., Luo, J., Smith, D. M., Mackey, M., Fu, H., Davis, M., & Hu, Y. (2022). Effectiveness of warm-up intervention programs to prevent sports injuries among children and adolescents: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 19(10), 6336. https://doi.org/10.3390/ijerph19106336

Elwadhi, A., Panda, P. K., Tyagi, A. K., Neyaz, O., Kaur, A., Tiwari, L. K., & Sharawat, I. K. (2025). Early protocolized rehabilitation versus usual care in improving functional outcomes in pediatric neurocritical patients: A randomized controlled trial. Neurocritical Care, 43(3), 783–798. https://doi.org/10.1007/s12028-025-02357-3

Franjoine, M. R., Gunther, J. S., & Taylor, M. J. (2003). Pediatric balance scale: A modified version of the berg balance scale for the school-age child with mild to moderate motor impairment. Pediatric Physical Therapy, 15(2), 114. https://doi.org/10.1097/01.PEP.0000068117.48023.18

Hirota, T., & King, B. H. (2023). Autism spectrum disorder: A review. JAMA, 329(2), 157–168. https://doi.org/10.1001/jama.2022.23661

Hou, K. (2020). Relationship between neurotransmitter changes and physical exercise of college students. Revista Argentina de Clínica Psicológica, 29(2), 428. https://doi.org/10.24205/03276716.2020.259

Hou, Y., Wang, Y., Deng, J., & Song, X. (2024). Effects of different exercise interventions on executive function in children with autism spectrum disorder: A network meta-analysis. Frontiers in Psychiatry, 15. https://doi.org/10.3389/fpsyt.2024.1440123

Jabouille, F., Billot, M., Hermand, E., Lemonnier, E., & Perrochon, A. (2021). Balance rehabilitation for postural control in children with Autism Spectrum Disorder: A two-case report study. Physiotherapy Theory and Practice, 39(3), 658–666. https://doi.org/10.1080/09593985.2021.2017090

Jouira, G., Alexe, C. I., Zinelabidine, K., Rebai, H., Mocanu, G. D., Cojocaru, A. M., Dragomir, L., Čaušević, D., & Sahli, S. (2024). The impact of aerobic dance intervention on postural balance in children: A randomized controlled trial. Children, 11(5), Article 5. https://doi.org/10.3390/children11050573

Kotegawa, K., Megumi, A., Matsumoto, K., Morozumi, A., Sakamoto, K., & Yasumura, A. (2025). Effect of computerized training in logical thinking on autistic children: A pilot study. Asian Journal of Occupational Therapy, 21(1), 64–71. https://doi.org/10.11596/asiajot.21.64

Kubica, J., Szymura, J., Domagalik, A., Golda, S., Wiecek, M., Fafrowicz, M., Marek, T., & Pera, J. (2019). Systematic balance exercises influence cortical activation and serum BDNF levels in older adults. Journal of Clinical Medicine, 8(11), 1910. https://doi.org/10.3390/jcm8111910

Laurens, C., Bergouignan, A., & Moro, C. (2020). Exercise-released myokines in the control of energy metabolism. Frontiers in Physiology, 11, 91. https://doi.org/10.3389/fphys.2020.00091

Lietuvos Respublikos sveikatos apsaugos ministerija. Lietuvos Respublikos sveikatos apsaugos ministro įsakymas dėl mokinių, besimokančių pagal pradinio, pagrindinio ir vidurinio programas, fizinio pajėgumo nustatymo tvarkos aprašo patvirtinimo (2019-10-08, Nr. V-V-1153). https://sam.lrv.lt/uploads/sam/documents/files/Įsakymas.pdf

Lippi, G., Mattiuzzi, C., & Sanchis-Gomar, F. (2020). Updated overview on interplay between physical exercise, neurotrophins, and cognitive function in humans. Journal of Sport and Health Science, 9(1), 74–81. https://doi.org/10.1016/j.jshs.2019.07.012

Mangiafico, S. S. (2016). Summary and analysis of extension program evaluation in R. Rutgers Cooperative Extension. https://rcompanion.org/handbook/

Mao, D., He, Z., Xuan, W., Deng, J., Li, W., Fang, X., Li, L., & Zhang, F. (2021). Effect and mechanism of BDNF/TrkB signaling on vestibular compensation. Bioengineered, 12(2), 11823–11836. https://doi.org/10.1080/21655979.2021.1997565

Richer, N., & Lajoie, Y. (2020). Automaticity of postural control while dual-tasking revealed in young and older adults. Experimental Aging Research, 46(1), 1–21. https://doi.org/10.1080/0361073X.2019.1693044

Saraiva, M., Vilas-Boas, J. P., Marouvo, J., & Castro, M. A. (2022). The effect of the motor dual-task on static and dynamic postural control and classification of the motor task difficulty—Systematic review. Retos, 46, 264–274. https://doi.org/10.47197/retos.v46.93387

Seidler, K., & Barrow, M. (2022). Intermittent fasting and cognitive performance—Targeting BDNF as potential strategy to optimise brain health. Frontiers in Neuroendocrinology, 65, 100971. https://doi.org/10.1016/j.yfrne.2021.100971

Shao, X., He, L., & Liu, Y. (2025). The effects of exercise interventions on brain-derived neurotrophic factor levels in children and adolescents: A meta-analysis. Neural Regeneration Research, 20(5), 1513–1520. https://doi.org/10.4103/NRR.NRR-D-23-01296

Shapiro, S. S., & Wilk, M. B. (1965). An Analysis of Variance Test for normality (complete samples). Biometrika, 52(3/4), 591–611. https://doi.org/10.2307/2333709

Solianik, R., Brazaitis, M., & Čekanauskaitė-Krušnauskienė, A. (2021). Tai chi effects on balance in older adults: The role of sustained attention and myokines. The Journal of Sports Medicine and Physical Fitness, 62(11), 1512–1518. https://doi.org/10.23736/S0022-4707.21.12990-1

Stössel, S., Neu, M. A., Wingerter, A., Bloch, W., Zimmer, P., Paret, C., Malki, K. E., Baumann, F. T., Russo, A., Henninger, N., Lehmann, N., Otto, H., & Faber, J. (2020). Benefits of exercise training for children and adolescents undergoing cancer treatment: Results from the randomized controlled MUCKI trial. Frontiers in Pediatrics, 8. https://doi.org/10.3389/fped.2020.00243

Van Waelvelde, H., Vanden Wyngaert, K., Mariën, T., Baeyens, D., & Calders, P. (2020). The relation between children’s aerobic fitness and executive functions: A systematic review. Infant and Child Development, 29(3), e2163. https://doi.org/10.1002/icd.2163

Yang, S., Ye, H., Huang, J., Tao, J., Jiang, C., Lin, Z., Zheng, G., & Chen, L. (2014). The synergistic effect of acupuncture and computer-based cognitive training on post-stroke cognitive dysfunction: A study protocol for a randomized controlled trial of 2 × 2 factorial design. BMC Complementary and Alternative Medicine, 14(1), 290. https://doi.org/10.1186/1472-6882-14-290

Zeidan, J., Fombonne, E., Scorah, J., Ibrahim, A., Durkin, M. S., Saxena, S., Yusuf, A., Shih, A., & Elsabbagh, M. (2022). Global prevalence of autism: A systematic review update. Autism Research: Official Journal of the International Society for Autism Research, 15(5), 778–790. https://doi.org/10.1002/aur.2696

Zong, W., Lu, X., Dong, G., Zhang, L., & Li, K. (2023). Molecular mechanisms of exercise intervention in alleviating the symptoms of autism spectrum disorder: Targeting the structural alterations of synapse. Frontiers in Psychiatry, 14. https://doi.org/10.3389/fpsyt.2023.1096503

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Published

2026-04-02

Issue

Section

Health, Rehabilitation and Adapted Physical Activity

How to Cite

The Effect of Aerobic Exercises on Balance, Aerobic Capacity, and Cognitive Functions in Children With Autism Spectrum Disorder. (2026). Baltic Journal of Sport and Health Sciences. https://doi.org/10.33607/bjshs.v3i140.2142