运动干预改善孤独症儿童青少年基本动作技能：31项RCT的元分析与元回归

摘要

目的：

本研究旨在系统评估运动干预对自闭症谱系障碍（ASD）儿童和青少年基本运动技能（FMS）的影响，并确定不同的FMS领域是否对运动剂量和干预特征表现出不同的反应。

方法：

对PubMed、Cochrane Library、Embase和Web of Science截至2026年7月的全面检索共纳入31项随机对照试验（RCT）。计算标准化均数差以评估运动干预对物体控制技能、位移技能和稳定性技能的影响。采用亚组分析和元回归分析考察干预特征和运动剂量的影响，同时通过敏感性分析和偏倚风险评估评价研究结果的稳健性。

结果：

运动干预显著改善了ASD儿童和青少年FMS的三个维度：物体控制技能（OCS）（Hedges' g = 1.13，95% CI：0.67至1.59）、位移技能（LMS）（Hedges' g = 1.19，95% CI：0.87至1.51）和稳定性技能（SS）（Hedges' g = 1.08，95% CI：0.68至1.49）。进一步分析揭示了各领域对运动剂量的特异性反应。较长的单次运动时间与OCS的更大改善相关，亚组分析和元回归均支持这一结果。对于LMS，亚组分析显示每周三次、干预持续≤10周时效果更佳，但元回归未证实这些发现。SS未发现显著的剂量相关关联。

结论：

运动干预可改善ASD儿童和青少年的OCS、LMS和SS。不同FMS领域可能对运动剂量表现出不同的反应，提示未来的运动方案可能需要考虑目标运动领域的特定特征。

系统综述注册：

https://www.crd.york.ac.uk/PROSPERO/view/CRD420251139963，注册号CRD420251139963。

1 引言

自闭症谱系障碍（ASD）是一种复杂的神经发育障碍，其核心特征包括社交沟通与互动困难，以及受限、重复的行为、兴趣或活动模式（）。近期流行病学证据显示，截至2022年，美国8岁儿童ASD患病率达到每1000人32.2例（约1/31），较往年显著上升。全球范围内也记录了类似的上升趋势（）。这为ASD儿童和青少年在教育、社会融合和日常生活方面带来了日益严峻的挑战。除核心症状外，ASD个体常伴有感觉加工问题、智力障碍和运动障碍等共病困难。这些额外挑战可能进一步扰乱发育轨迹并降低生活质量。

越来越多的证据表明，运动障碍是ASD儿童的显著特征（）。约五分之四的ASD儿童表现出发育迟缓或非典型运动模式（），其中基本运动技能（FMS）缺陷最为突出。

FMS 被广泛认为是儿童运动发育的基础，是习得复杂运动模式和维持终身身体活动的基础（）。它们通常被分为三个领域：位移技能（LMS）（如跑、跳）、物体控制技能（OCS）（如投掷、接球）和稳定性技能（SS）（如平衡、转身）。ASD 儿童在这些领域往往表现出缺陷，这可能与神经发育迟缓和大脑功能异常有关（，），且此类困难常延续至青春期（）。除限制运动能力外，这些损伤还限制了进行规律身体活动的机会，并增加社交退缩、久坐生活方式、肥胖和心理健康问题的易感性（），从而强化了运动缺陷、参与减少和健康风险升高的有害循环。

在用于改善 ASD 儿童和青少年运动能力的策略中，运动干预因其形式多样、易于实施且不良反应极少，日益被认为是一种有效方法。运动干预可能通过促进神经可塑性、增强功能性大脑连接和调节神经递质水平来改善运动技能（–）。马术运动、游泳和柔道等干预可以显著改善 ASD 儿童的运动协调、平衡和技能（–）。然而，一些研究未能观察到任何显著效果（），表明运动干预的效果存在差异，并可能与干预类型、持续时间、频率、强度和个体特征等因素密切相关。

近年来，系统综述和荟萃分析一致证实了运动干预对 ASD 儿童 FMS 的有益效果（–）。既往研究表明，运动干预可以改善多个 FMS 领域，包括 LMS、OCS 和 SS。此外，干预特征和运动剂量对运动结果的潜在影响日益受到关注。例如，Ji 等（）和 Ye 等（）探讨了运动方式、干预频率和持续时间对 FMS 改善的影响，而更近期的研究进一步应用亚组分析和元回归方法来识别潜在调节因素，包括剂量相关因素（–）。然而，尽管既往研究探讨了干预持续时间和频率等剂量相关因素，改善 FMS 的最佳运动剂量仍不确定。此外，不同 FMS 领域是否与运动剂量表现出不同的剂量–反应关系也仍不清楚。

为弥补既往综述的局限性，本项更新的meta分析考察了运动剂量在ASD儿童和青少年的不同FMS领域是否具有差异化效应。为提供更全面的证据基础，本研究纳入了新发表的研究，并分别在三个FMS领域——OCS、LMS和SS——评估运动干预的效果。基于这些领域特异性分析，亚组分析比较了不同干预特征和剂量类别的效果，而meta回归分析则进一步探讨了运动参数与FMS结局之间潜在的剂量–反应关系。通过整合这些发现，本研究阐明了领域特异性的剂量模式，并为ASD儿童和青少年的运动处方提供了更具针对性的证据。

2 方法

2.1 设计

本meta分析按照PRISMA指南（）和Cochrane干预系统评价手册（）进行。研究方案已在PROSPERO注册（CRD420251139963）。

2.2 检索策略

在PubMed、Cochrane Library、Embase和Web of Science中分两个阶段进行了系统检索。第一次检索覆盖数据库建库至2025年10月，第二次检索覆盖2025年10月至2026年7月。两个阶段使用相同的检索策略，仅在第二次检索中更新了检索时段。进行更新检索是为了确保纳入最新的合格研究，并全面覆盖现有证据。在PICOS框架下，将主题词与自由词相结合：（人群）AND（干预）AND（结局）AND（儿童/青少年过滤器）。还筛查了相关综述的参考文献列表和引文记录，以识别其他合格研究。完整的数据库检索策略见补充材料。

2.3 纳入标准

本研究纳入RCT。参与者为18岁以下、经临床确诊为ASD的儿童和青少年，不限性别或种族。干预组接受结构化体育活动方案，而对照组不接受干预、作为等待名单对照、接受常规照护或维持其日常活动。结局指标要求使用标准化、经过验证的运动技能评估工具，如TGMD-2、TGMD-3、BOT-2和MABC-2。研究需报告完整的干预前后数据，包括样本量、平均得分和标准差。

排除标准如下：非随机对照试验、动物研究、缺乏全文的会议摘要、重复发表、结局数据不完整或缺少关键结局指标的研究，以及无法获取全文的报告。

2.4 数据提取与质量评价

2.4.1 数据提取过程

两名评价者（LL 和 WY）独立筛选文献、提取相关数据，并依据预先设定的纳入标准对结果进行核对。任何分歧均通过讨论解决，必要时由第三名评价者参与裁定。提取的信息包括：（1）研究的一般特征，如标题、第一作者、发表年份和国家；（2）参与者的人口学特征和基线数据（如年龄、样本量）；（3）实验组和对照组的干预细节，包括干预类型、干预频率、干预持续时间、每次运动时长，以及结局指标和相应结果。

此外，基于既往研究（–）和纳入研究的干预描述，运动干预被分为五类。各类别的定义见表 1。

表 1

纳入 meta 分析的治疗节点的操作性定义。

2.4.2 质量评价

采用物理治疗证据数据库（PEDro）量表评估纳入 RCT 的方法学质量。该量表由 11 个条目组成，第一个条目（纳入标准）不计入总分。其余 10 个条目评估随机分配、分配隐藏、基线可比性、参与者盲法、治疗师盲法、评估者盲法、充分随访、意向性治疗分析、组间比较，以及点估计和变异度测量。每个条目评分为 1（满足）或 0（不满足），最高分为 10 分。得分 <4、4–5、6–8 和 9–10 分别被归类为差、一般、良好和优秀质量（）。两名评价者独立评估研究质量，分歧通过与第三名评价者讨论解决。

2.5 数据分析

由于各研究中运动技能评估工具存在差异，采用Hedges' g作为效应量指标。该指标能够比较运动干预对ASD儿童三个核心运动表现领域的效果：OCS、LMS和SS。计算了相应的95%置信区间（CIs），以评估合并估计值的精确性和统计学显著性。统计分析使用R软件的metafor包进行。为考虑参与者特征和干预方案差异可能导致的异质性，采用I²统计量对异质性进行量化。当I²超过50%时，表明研究间存在显著异质性，则采用随机效应模型。鉴于各评估工具对整体FMS的定义和测量方式不一致，未对整体FMS进行合并分析。取而代之的是，分别对OCS、LMS和SS进行了独立的meta分析。对于多臂试验，每个干预组分别与共享对照组进行比较。为避免重复计数，对照组样本量在各项干预比较之间平均分配。此外，为评估方法学质量较低的研究的影响，通过暂时排除PEDro评分为4–5分的研究进行了敏感性分析。随后使用相同的随机效应模型重新计算合并效应。

2.6 亚组分析

基于既往的元分析研究结果，我们进行了多维度的亚组分析，以系统考察干预特征和测量工具是否影响运动干预对ASD儿童FMS的效果。具体而言，分析聚焦于三个关键运动领域：OCS、LMS和SS。干预特征从多个维度进行探讨。首先，根据每个干预项目的主要成分和特征，将干预类型分为多成分身体活动（MPA）、基本运动技能训练（FMST）、水中运动（AE）、身心运动（MBE）和体感游戏。其次，根据既往元分析的分类和纳入研究的频率分布，按每周训练次数将干预频率分为每周1–2次、每周3次和每周4–5次（，）。第三，参照既往元分析和纳入研究的分布，将每次运动时长分为< 60分钟和≥ 60分钟，以考察其对干预效果的潜在影响（，）。第四，基于既往元分析的分类和纳入研究的分布，将干预持续时间分为≤ 10周和> 10周，以评估项目时长是否影响干预效果（）。第五，根据既往研究采用的年龄分类和纳入研究中参与者的年龄分布，将参与者年龄分为3–7岁和7–12岁（）。最后，基于测量工具进行亚组分析，以评估潜在的测量相关异质性，纳入的评估工具包括粗大运动发展测试（TGMD）、Bruininks–Oseretsky运动能力测试（BOT）、儿童运动评估成套测验（MABC-2）、单腿站立测试（OLS）、Berg平衡量表（BBS）和压力中心（COP）测量。

2.7 发表偏倚分析

为评估发表偏倚风险，本研究首先使用R绘制漏斗图进行初步评估。当漏斗图呈现明显不对称时，采用Egger回归偏倚检验定量评估小样本效应和潜在发表偏倚。随后，为探究偏倚对总体效应量估计的具体影响，应用剪补法。该方法用于估计潜在缺失研究的数量并获得偏倚校正后的合并效应估计值。

3 结果

3.1 文献检索与筛选流程

图1展示了文献检索和研究筛选的详细流程。第一次检索从Web of Science（n = 643）、PubMed（n = 182）、Embase（n = 407）、Cochrane Library（n = 125）和其他来源（n = 3）中识别出1,360条记录。去除486条重复记录后，基于标题和摘要筛选了874条记录，排除了815条。在评估合格性的59篇报告中，34篇因非RCT设计（n = 16）、数据不完整（n = 9）或全文不可获取（n = 9）而被排除。最终，第一次检索纳入了25项研究。第二次检索于2025年10月至2026年7月进行，从Web of Science（n = 97）、PubMed（n = 34）、Embase（n = 50）和Cochrane Library（n = 43）中额外识别出224条记录。去除84条重复记录后，筛选了140条记录，基于标题和摘要排除了117条。在评估合格性的23篇全文文章中，17篇因结局不符合条件（n = 5）、非随机设计（n = 6）、数据不完整（n = 2）、年龄范围不符合条件（n = 1）或对照组不合适（n = 3）而被排除。更新检索额外纳入了6项研究。合并两次检索后，最终定量合成共纳入31项随机对照试验（图1）。

图1

3.2 纳入研究的特征

本meta分析纳入了在亚洲、欧洲、北美、非洲和澳大利亚开展的31项研究（，–65）。共纳入880名ASD儿童和青少年。参与者主要为年龄约4.3–12.8岁的儿童。干预措施包括FMST、MPA、MBE、AE、体感游戏和其他结构化体育活动方案。干预方案差异较大，频率为每周1至5次，干预持续时间为2至18周，单次时间为30至80分钟。详细研究特征见表2。

表2

纳入研究的特征。

TGMD-2，粗大运动发展测试——第二版；TGMD-3，粗大运动发展测试——第三版；BOT-2，Bruininks-Oseretsky 运动能力测试——第二版；BOTMP，Bruininks-Oseretsky 运动能力测试；MABC-2，儿童运动评估成套测验——第二版；PDMS-2，学龄前儿童运动发育量表——第二版；SPARK，SPARK 运动训练方案；ICPL，I Can have Physical Literacy；TAT，水中技术活动方案；GAT，游戏式水中活动方案；MIP，运动干预方案；BCTP，球类组合训练方案；FMST，基本运动技能训练

3.3 质量评估

纳入荟萃分析的 31 篇文章使用 PEDro 量表进行评估，得分范围为 4 至 8 分，大多数研究得分为 6 分，表明总体方法学质量为中等至良好。七项试验被评为中等质量（得分 4–5），而 24 项试验被归类为良好质量（得分 6–8）（见 表 3）。

表 3

采用 PEDro 量表评估纳入 RCT 的方法学质量。

所有研究均采用随机分配，并显示组间基线具有可比性。此外，所有试验均报告了主要结局的组间比较，以及相应的点估计值和变异性指标，支持所报告结果的可靠性。然而，仅七项研究报告了分配隐藏，且没有任何试验实施受试者或治疗师盲法。八项研究报告了评估者盲法，提示存在选择偏倚和检测偏倚的潜在风险。大多数研究充分处理了脱落率（28/31），并采用了意向性治疗分析（23/31）。

3.4 Meta 分析结果

3.4.1 运动干预对 OCS 的影响

OCS 的 Meta 分析纳入 20 项研究，贡献 23 个效应量估计值，涉及实验组和对照组共 604 名参与者。异质性分析（图 2）显示研究间存在显著异质性（τ² = 0.95，I² = 83.23%，Q(22) = 90.91，p <.001），因此需要使用随机效应模型进行合并（图 2）。结果表明，运动干预显著改善了 ASD 儿童和青少年的 OCS（Hedges’ g = 1.13，95% CI：0.67–1.59，p <.001），差异具有统计学意义。值得注意的是，一些研究（例如 ， ）显示出相对较大的效应量，这可能影响了合并估计值。

图 2

3.4.2 运动干预对 LMS 的影响

LMS 的 Meta 分析纳入 16 项研究，贡献 18 个效应量估计值，涉及实验组和对照组共 470 名参与者。异质性分析（图 3）显示研究间存在显著异质性（τ² = 0.23，I² = 54.33%，Q(17) = 37.10，p = .003），因此采用随机效应模型（图 3）。结果表明，运动干预显著改善了 ASD 儿童和青少年的 LMS（Hedges’ g = 1.19，95% CI：0.87–1.51，p <.001），差异具有统计学意义。值得注意的是，一些研究（例如 ，60）显示出相对较大的效应量，这可能导致了所观察到的异质性。

图 3

3.4.3 运动干预对SS的影响

SS的meta分析纳入了20项研究，贡献了23个效应量估计值，涉及实验组和对照组共522名参与者。异质性分析（图4）显示研究间存在显著异质性（τ² = 0.71，I² = 76.05%，Q(22) = 83.93，p <.001），支持使用随机效应模型（图4）。合并结果显示，运动干预显著改善了ASD儿童和青少年的SS（Hedges' g = 1.08，95% CI：0.68–1.49，p <.001）。值得注意的是，Sarabzadeh等（）Aly等（56）和Liu等（58）显示出相对较大的效应量，这可能导致了所观察到的异质性。

图4

3.5 亚组分析

3.5.1 OCS亚组分析

亚组分析表明，运动干预在不同干预参数和测量方法下均倾向于改善OCS（图5），尽管并非所有亚组均观察到显著效应。进一步的调节变量分析显示，仅运动单次时长显著调节了组间差异，提示单次时长可能与OCS改善幅度的变化有关。

图5

干预频率不是OCS的显著调节变量（QM(2) = 2.06，p = .357）。每周1–2次（Hedges' g = 1.15，95% CI：0.51–1.78）和每周3次（Hedges' g = 1.47，95% CI：0.64–2.31）观察到显著效应，而每周4–5次未达到统计学显著性（Hedges' g = 0.41，95% CI：-0.79–1.60）。

干预周期未显著调节对OCS的效应（QM(1) = 1.68，p = .195）。≤ 10周（Hedges' g = 1.50，95% CI：0.78–2.22）和 > 10周（Hedges' g = 0.87，95% CI：0.25–1.49）的干预方案均显示出OCS的显著改善。

运动单次时长是OCS唯一的显著调节变量（QM(1) = 5.88，p = .015）。单次时长 ≥ 60 min显示出显著效应（Hedges' g = 1.54，95% CI：0.99–2.09），而单次时长 < 60 min未达到统计学显著性（Hedges' g = 0.53，95% CI：-0.09–1.14，p = .093）。

干预类型未显著解释OCS的亚组间差异（QM(4) = 6.91，p = .141）。FMST（Hedges' g = 1.37，95% CI：0.60–2.14）和MBE（Hedges' g = 1.77，95% CI：0.81–2.72）发现显著的组内效应。相比之下，MPA（Hedges' g = 0.74，95% CI：-0.13–1.60）、AE（Hedges' g = 1.69，95% CI：-0.02–3.39）和体感游戏（Hedges' g = 0.03，95% CI：-1.11–1.16）未显示出统计学显著效应。

测量工具不是OCS的显著调节因素（QM(3) = 1.79，p = .617）。在TGMD（Hedges' g = 1.19，95% CI：0.43–1.95）和BOT（Hedges' g = 1.91，95% CI：0.58–3.25）中观察到显著效应，而PDMS-2（Hedges' g = 1.00，95% CI：-0.75–2.75）和MABC-2（Hedges' g = 0.82，95% CI：-0.10–1.74）未达到统计学显著性。

年龄不是OCS的显著调节因素（QM(1) = 0.38，p = .535）。在3–7岁（Hedges' g = 0.94，95% CI：0.14–1.74）和7–12岁（Hedges' g = 1.25，95% CI：0.66–1.85）中观察到显著效应。

3.5.2 LMS亚组分析

亚组分析提示，运动干预在大多数干预条件下对LMS产生了显著改善（图 6）。干预时长和干预频率均显著调节了效应，表明这些剂量相关因素可能影响移动能力结局。

图 6

干预频率是LMS的显著调节因素（QM(2) = 8.06，p = .018）。在每周1–2次（Hedges' g = 0.98，95% CI：0.59–1.37）和每周3次（Hedges' g = 1.72，95% CI：1.23–2.21）中观察到显著效应，其中后者效应最大。相比之下，每周4–5次亚组未达到统计学显著性（Hedges' g = 0.58，95% CI：-0.16–1.32）。

干预时长显著调节了干预对LMS的效应（QM(1) = 5.84，p = .016）。≤ 10周（Hedges' g = 1.72，95% CI：1.19–2.25）和 > 10周（Hedges' g = 0.96，95% CI：0.65–1.27）的方案均显示出显著改善，其中持续时间≤ 10周的干预观察到更大的效应。

单次运动时长未显著调节移动能力结局（QM(1) = 0.64，p = .424）。在 < 60 min（Hedges' g = 1.01，95% CI：0.45–1.57）和 ≥ 60 min（Hedges' g = 1.29，95% CI：0.89–1.69）的场次中均观察到显著效应。

干预类型未显著解释LMS的亚组间变异（QM(4) = 0.90，p = .925）。在MPA（Hedges' g = 1.24，95% CI：0.55–1.92）、FMST（Hedges' g = 1.08，95% CI：0.53–1.64）、AE（Hedges' g = 1.69，95% CI：0.26–3.11）和MBE（Hedges' g = 1.49，95% CI：0.40–2.57）中观察到显著的亚组内效应。体感游戏显示出正向效应，但未达到统计学显著性（Hedges' g = 1.16，95% CI：-0.26–2.57）。

测量工具不是LMS的显著调节因素（QM(3) = 0.59，p = .744）。在TGMD（Hedges' g = 1.23，95% CI：0.81–1.65）、BOT（Hedges' g = 1.06，95% CI：0.45–1.68）和Agility T-test（Hedges' g = 2.71，95% CI：0.96–4.46）中观察到显著效应，而PDMS-2未达到统计学显著性（Hedges' g = 0.84，95% CI：-0.16–1.84）。

年龄不是 LMS 的显著调节因素（QM(1) = 0.96，p = .328）。在 3–7 岁（Hedges’ g = 0.99，95% CI：0.47–1.51）和 7–12 岁（Hedges’ g = 1.32，95% CI：0.91–1.73）观察到显著效应。

3.5.3 SS 亚组分析

亚组分析显示，运动干预在不同干预参数下均显著改善了 SS（图 7）。然而，所考察的调节因素，包括干预频率、干预时长、运动课时长、干预类型和测量工具，均未能显著解释组间差异。

图 7

干预频率不是 SS 的显著调节因素（QM(2) = 0.19，p = .906）。在每周 1–2 次（Hedges’ g = 1.04，95% CI：0.25–1.84）和每周 3 次（Hedges’ g = 1.08，95% CI：0.53–1.64）观察到显著效应，而每周 4–5 次亚组未达到统计学显著性（Hedges’ g = 1.42，95% CI：-0.08–2.91）。

干预时长未显著调节稳定性结局（QM(1) = 1.44，p = .231）。然而，在 ≤ 10 周（Hedges’ g = 0.94，95% CI：0.46–1.41）和 > 10 周（Hedges’ g = 1.50，95% CI：0.70–2.30）的干预方案中均观察到显著改善。

运动课时长不是 SS 的显著调节因素（QM(1) = 1.32，p = .251）。在 < 60 min（Hedges’ g = 0.87，95% CI：0.33–1.42）和 ≥ 60 min（Hedges’ g = 1.35，95% CI：0.74–1.96）的课时中均观察到显著效应。

干预类型未能显著解释 SS 的亚组间变异（QM(4) = 4.58，p = .334）。在 MPA（Hedges’ g = 0.77，95% CI：0.09–1.44）、FMST（Hedges’ g = 1.19，95% CI：0.33–2.04）、AE（Hedges’ g = 1.74，95% CI：0.58–2.90）和 MBE（Hedges’ g = 1.53，95% CI：0.62–2.44）中观察到显著的亚组内效应。相比之下，体感游戏未达到统计学显著性（Hedges’ g = 0.27，95% CI：-1.02–1.56）。

测量工具不是 SS 的显著调节因素（QM(5) = 4.67，p = .097）。在 BOT（Hedges’ g = 1.74，95% CI：0.97–2.52）、MABC-2（Hedges’ g = 0.68，95% CI：0.05–1.31）、OLS（Hedges’ g = 0.88，95% CI：0.27–1.49）和 BBS（Hedges’ g = 3.29，95% CI：1.17–5.42）中观察到显著效应。然而，PDMS-2（Hedges’ g = 1.04，95% CI：-0.50–2.58）和 COP（Hedges’ g = 0.26，95% CI：-1.39–1.91）未达到统计学显著性。

年龄不是 SS 的显著调节因素（QM(1) = 0.47，p = .493）。在 7–12 岁观察到显著效应（Hedges’ g = 1.16，95% CI：0.69–1.63），而 3–7 岁（Hedges’ g = 0.79，95% CI：-0.15–1.74）未达到统计学显著性。

在亚组分析中，若干亚组估计值未达到统计学显著性，其95% CI跨越零。如图5、6、7所示，其中一些亚组纳入的研究和参与者相对较少，所得估计值伴随相对较宽的置信区间。因此，这些估计值周围的不确定性可能部分与这些亚组中可用的研究和参与者数量有限有关。相应地，这些发现应谨慎解读，不应被视为干预效果不存在的确凿证据。

3.6 Meta回归分析

为进一步探索研究间异质性的潜在来源，进行了Meta回归分析，以检验运动剂量变量（包括单次运动时长、干预时长、总干预剂量和干预频率）是否与FMS改善相关。总干预剂量按干预时长 × 干预频率 × 单次运动时长计算，并在Meta回归分析中以100 min为单位进行缩放。

对于OCS，单次运动时长是效应量的显著正向预测因子（β = 0.05，95% CI：0.02–0.08，z = 3.56，p <.001；R² = 59.64%），表明单次运动时长越长，OCS改善越大。相比之下，干预时长、总干预剂量和干预频率不是显著预测因子（分别为p = .293、p = .979和p = .506；图8）。

图8

对于LMS，所检验的运动剂量变量均未显著预测效应量。干预时长显示出接近统计学显著性的负相关（β = -0.11，95% CI：-0.22–0.00，z = -1.95，p = .051；R² = 24.42%），而单次运动时长、总干预剂量和干预频率不是显著预测因子（分别为p = .126、p = .925和p = .955；图9）。

图9

对于SS，所检验的运动剂量变量均未显著预测效应量。单次运动时长与稳定性结局呈正向但非显著相关（p = .116），而干预时长、总干预剂量和干预频率也不是显著预测因子（分别为p = .189、p = .174和p = .752；图10）。

图10

3.7 敏感性分析

留一法敏感性分析（Supplementary Figure 1-S3）证实了meta分析结果的稳健性。对于OCS，依次剔除单个研究后，合并效应估计值范围为Hedges' g = 0.99至1.19，所有95%置信区间均保持在零效应线以上。异质性仍然很大，I²值范围为77.84%至84.74%。对于LMS，合并估计值范围为Hedges' g = 1.08至1.26，具有中等异质性（I² = 39.22%–57.69%），总体效应的方向和显著性保持不变。对于SS，合并效应范围为Hedges' g = 0.97至1.15，I²值范围为69.90%至77.64%。为进一步评估结果的稳定性，排除了PEDro评分为4–5分的研究。对于OCS，合并效应从Hedges' g = 1.13（95% CI：0.67–1.59）变为1.35（95% CI：0.64–2.06）。对于LMS，合并效应从Hedges' g = 1.19（95% CI：0.87–1.51）变为1.31（95% CI：0.93–1.69）。对于SS，合并效应从Hedges' g = 1.08（95% CI：0.68–1.49）变为1.05（95% CI：0.64–1.45）（Supplementary Figure 4-S6）。排除后所有合并效应仍具有统计学显著性。总体而言，两项敏感性分析中合并效应的方向和显著性均保持不变，支持结果的稳定性。

3.8 发表偏倚分析

为评估潜在的发表偏倚，我们为OCS、LMS和SS组构建了漏斗图（Supplementary Figures 7-S12）。目视检查显示三个结局均存在一定的不对称性。Egger检验对OCS（z = 5.35，p <.001）、LMS（z = 2.61，p = .009）和SS（z = 5.29，p <.001）均显著，提示可能存在小样本研究效应。一些精确度较低的研究也显示出相对较大的阳性效应量，提示较小的研究可能报告了较大的干预效应。然而，剪补法分析未发现OCS、LMS或SS存在缺失研究（k = 0），合并估计值保持不变。这些发现提示可能存在小样本研究效应，但并未对合并估计值产生实质性影响。鉴于漏斗图的不对称性和显著的异质性，结果仍应谨慎解读。

4 讨论

这项更新的meta分析综合了31项随机对照试验的证据，提供了64个领域特异性效应量估计，并证明运动干预有效改善了ASD儿童和青少年的FMS，包括OCS、LMS和SS。这些发现与既往系统综述和meta分析报道的运动干预对ASD儿童运动技能发展有益效果一致（,,,）。此外，还进行了调节效应分析，以探讨不同FMS领域是否对干预特征表现出不同反应。研究结果提示，运动剂量反应存在领域特异性模式。OCS的改善与运动单次时长相关，较长的单次时长（≥ 60 min）显示出更大的效应。LMS的改善与干预时长和频率相关，较短的干预周期（≤ 10周）和每周三次显示出相对较大的效应。相比之下，尽管运动干预后SS显著改善，但所考察的干预特征均未显示出显著的调节效应。

4.1 运动干预对OCS的影响

4.1.1 潜在机制

meta分析结果表明，运动干预可显著改善ASD儿童和青少年的OCS（Hedges’ g = 1.13，95% CI：0.67–1.59），与早期证据一致（, 66）。观察到的OCS改善可能与神经认知和运动学习过程有关。一方面，运动干预可能促进神经可塑性和多感官整合（67），从而可能提高包括视觉、前庭和本体感觉系统在内的感觉通路的信息处理效率。另一方面，运动干预还可能增强手眼协调和执行功能（68, 69），从而可能有助于改善运动调节和控制。

4.1.2 干预特征的调节效应

关于运动时长，本研究发现它可能是影响OCS改善的重要剂量因素。亚组分析显示，运动时长≥60分钟的干预比时长<60分钟的干预产生更大的效果。此外，元回归分析显示，运动时长与OCS效应量之间存在显著正相关（p <.001）。根据运动学习理论，充足练习机会、重复任务参与和基于反馈的调整有助于运动技能的习得（70）。对于ASD儿童和青少年，可能存在运动协调、运动计划和运动控制相关处理方面的困难（），这可能增加对重复练习机会的需求，以促进稳定运动模式的形成。因此，更长的运动时长可能提供更多动作尝试和重复练习的机会，从而促进OCS的发展。此外，从神经可塑性角度看，重复运动训练可能通过持续的感觉运动刺激诱导经验依赖的神经可塑性变化，并支持训练相关运动表征的形成与强化（71，72）。

然而，更长的运动时间并不一定带来更大益处。过度延长的时间可能增加疲劳水平，降低持续注意力、参与度和动作执行质量，尤其是在ASD儿童和青少年中。因此，未来研究应考虑多种因素，包括运动强度、任务复杂性、训练内容变化和个体特征，以进一步确定改善OCS的最佳剂量组合。

关于干预类型，既往元分析提示AE可能对改善ASD儿童OCS具有显著益处（）。然而，本元分析并未证实这一优势。尽管AE显示出相对较大的效应量（Hedges’ g = 1.69），但置信区间跨越零（95% CI：-.02–3.39），表明该效应未达到统计学显著性。此外，干预类型未能显著解释OCS改善的亚组间差异（QM(4) = 6.91，p = .141），提示在本分析中，没有特定运动方式被证实对改善OCS具有优势。

相比之下，FMST（Hedges' g = 1.37，95% CI：.60–2.14）和 MBE（Hedges' g = 1.77，95% CI：.81–2.72）观察到了显著的组内效应。FMST 的有益效果可能归因于其任务特异性特征，因为这些干预直接针对物体操作技能，包括投掷、接球和踢球，提供反复的机会来发展手眼协调、动作计划和运动控制。MBE 在本分析中显示出最大的效应量，这可能与其强调姿势控制、身体意识和注意力调节有关。通过姿势训练、呼吸控制和集中注意力，MBE 可能增强动作协调和身体意识，从而促进运动控制和动作执行（51）。此外，MBE 可能通过增强感觉处理能力来提高对外部刺激的反应性（）。持续的身心练习也被认为可以促进功能连接和神经可塑性适应，可能增强参与运动时序控制和反应调节的神经传递效率（73）。然而，这些发现应谨慎解读，因为运动类型并未显著调节 OCS 改善，且 MBE 观察到的相对较大效应并不表明其优于其他运动方式。

4.2 运动干预对 LMS 的影响

4.2.1 潜在机制

该荟萃分析显示，运动干预显著改善了 ASD 儿童和青少年的 LMS（Hedges' g = 1.19，95% CI：0.87–1.51），这与既往研究结果一致（74）。LMS 指执行全身动作的能力，如跑步、跳跃和攀爬，这些动作需要整合下肢力量、协调性和心肺能力。观察到的 LMS 改善可能与神经生物学适应、体能增强和动作协调发展的综合效应有关。在神经层面，运动可能促进神经可塑性适应和改善功能连接，这可能支持运动技能的习得和保持（75，76）。在生理层面，运动训练可能改善 ASD 儿童的肌肉力量和耐力（77），为执行和维持移动动作提供必要的身体支持。此外，运动可能增强动作协调和运动控制，这对 ASD 儿童移动能力的发展很重要（78）。

4.2.2 干预特征的调节效应

关于干预时长，本研究发现，与较长干预周期（> 10周）相比，较短干预周期（≤ 10周）对ASD儿童和青少年LMS的改善效果更大。然而，元回归分析并未发现干预时长与LMS效应量之间存在显著关联，提示干预时长对LMS改善的影响仍需进一步研究。与我们的发现一致，Li et al.（79）报告称，持续≤ 10周的干预对LMS的改善效果大于持续时间更长的干预，提示延长干预时长并不一定会带来额外的运动技能获益。这一发现可能与长时间干预期间维持儿童参与度和训练依从性所面临的挑战有关。既往研究表明，反复接触相同训练内容可能会降低儿童的兴趣和依从性，从而削弱干预效果（80）。对于可能存在注意调节和任务转换困难的ASD儿童和青少年（81、82），较长的干预周期可能进一步增加维持积极参与和持续注意的挑战，进而可能影响训练质量和运动技能习得。因此，对于ASD儿童和青少年的LMS训练，适当控制干预时长，并纳入任务变化和有趣活动以维持参与度，可能比单纯延长干预周期更有益。

本研究发现，干预频率显著调节了LMS的改善，与每周1–2次和4–5次相比，每周3次的效应量最大。然而，元回归分析并未揭示干预频率与LMS效应量之间存在显著的线性关联，提示干预频率类别之间的差异可能受到样本特征、干预内容及其他剂量相关因素的影响。较低的干预频率可能无法提供足够一致的运动刺激，限制了运动经验的积累和已学技能的巩固，从而降低LMS的改善。相反，尽管较高的干预频率增加了运动暴露机会，但过于频繁的训练可能增加ASD儿童和青少年的身体和心理需求（83），可能降低训练期间的参与度和动作质量。

4.3 运动干预对SS的影响

4.3.1 潜在机制

The meta-analysis findings of this study indicate that exercise interventions significantly improve SS in children with ASD (Hedges’ g = 1.08, 95% CI: 0.68–1.49), which is consistent with previous research findings (84). The observed improvements in SS may be related to adaptive changes in sensory integration processes. Children with ASD often exhibit difficulties in processing and integrating visual, vestibular, and proprioceptive information (85). Regular exercise training may contribute to improved sensory processing through repeated sensorimotor experiences, enhanced proprioceptive input, and more efficient integration across multisensory pathways (86, 87). These neuroadaptive changes may support better coordination between sensory systems and provide a potential foundation for improved motor control and postural stability.

4.3.2 Moderating effects of intervention characteristics

None of the examined factors—including intervention duration, intervention frequency, exercise session duration, intervention type, and measurement instrument—significantly moderated improvements in SS, suggesting that improvements in SS may not depend on a single intervention characteristic but may result from the combined effects of multiple training components. SS involve complex processes, including postural control, sensory integration, and neuromuscular coordination, which may be influenced by various factors during exercise training. In addition, variations in intervention protocols and the limited number of available studies may have reduced the ability to detect potential moderating effects. Future studies with larger samples and standardized intervention designs are needed to further clarify the factors influencing improvements in SS.

4.4 Clinical implications

The findings of this study may provide several implications for clinical and educational practice. Exercise interventions should be designed according to specific motor domains rather than applying a uniform approach for all FMS outcomes. Based on the subgroup findings, these domain specific dosage patterns may provide practical guidance for clinical and educational practice. For OCS, exercise programs combining an intervention duration of ≤10 weeks, a single-session duration of ≥60 minutes, three sessions per week, and MBE or FMST may be considered as potential strategies, with training emphasizing object-control activities such as throwing, catching, kicking, and other tasks requiring coordinated interaction with objects. For LMS, programs incorporating an intervention duration of ≤10 weeks, a single-session duration of ≥60 minutes, three sessions per week, and AE may be considered, with a focus on improving lower-limb strength, coordination, and endurance. For SS, interventions involving an intervention duration of >10 weeks, a single-session duration of ≥60 minutes, 1–2 sessions per week, and AE or MBE may represent potential approaches, with training focusing on balance, postural control, and body stability.

However, these recommendations should be interpreted with caution because they are based on subgroup analyses and do not represent optimal exercise prescriptions. Clinicians and special education practitioners should further adapt these parameters according to individual characteristics, such as age, baseline motor abilities, ASD severity, motivation, exercise tolerance, and available resources.

4.5 Limitations and future directions

Several limitations should be considered. First, although this study included 31 randomized controlled trials contributing 64 domain-specific effect-size estimates, the number of available studies was limited, and some subgroup analyses were based on a small number of studies, which may have affected the stability of moderator analyses. Second, heterogeneity existed across studies in participant characteristics, intervention protocols, and outcome measures. Important ASD-related characteristics, including ASD subtypes, ASD severity stratification, basic motor ability levels, intellectual ability, and comorbid conditions, were not consistently reported, limiting the interpretation of individual differences in response to exercise interventions. Third, methodological limitations should be noted. Due to the nature of exercise interventions, blinding of participants and therapists is difficult to implement. In addition, incomplete reporting of allocation concealment and assessor blinding in some studies may have increased the risk of bias. Fourth, potential small-study effects should be considered. The observed asymmetry may partly be related to the small sample sizes of some included studies. Effect estimates from small samples are often less stable and more easily influenced by extreme values. Finally, most studies did not include long-term follow-up assessments, limiting the evaluation of whether improvements in FMS were maintained over time. Future studies should include larger samples, provide more detailed participant information, adopt standardized intervention protocols, and include longer follow-up periods to further strengthen the evidence regarding exercise interventions for children and adolescents with ASD.

5 Conclusions

This meta-analysis included 31 randomized controlled trials and demonstrated that exercise interventions significantly improved FMS, including OCS, LMS, and SS, in children and adolescents with ASD. Further analyses indicated that different motor domains may exhibit distinct responses to intervention characteristics. Specifically, longer exercise session durations were associated with greater improvements in OCS, and meta-regression analyses further identified a significant positive association between session duration and OCS effects, indicating a potential dose–response relationship. In contrast, LMS showed greater effects with shorter intervention durations and an intervention frequency of three sessions per week, although these subgroup findings were not confirmed by significant dose–response associations. No significant moderating effects of intervention characteristics were identified for SS, suggesting that exercise interventions should be tailored to specific motor domains rather than applying a uniform approach across all FMS outcomes. Future research should further investigate individualized exercise strategies through well-designed trials with standardized intervention protocols.

Statements

Data availability statement

The original contributions presented in the study are included in the article/Supplementary Material. Further inquiries can be directed to the corresponding author/s.

Author contributions

JS: Conceptualization, Data curation, Methodology, Software, Validation, Visualization, Writing – original draft, Writing – review & editing. LL: Conceptualization, Data curation, Methodology, Writing – review & editing. YW: Data curation, Methodology, Visualization, Writing – original draft. TF: Funding acquisition, Methodology, Supervision, Validation, Writing – review & editing.

Funding

The author(s) declared that financial support was received for this work and/or its publication. The authors gratefully acknowledge project approval and financial support from the Zhejiang Provincial School Sports Association (Grant No. ZGTX202508).

Acknowledgments

The authors would like to express their gratitude to the Shanghai University of Sport for its support of this study.

Conflict of interest

The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Generative AI statement

The author(s) declared that generative AI was not used in the creation of this manuscript.

Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1954728/full#supplementary-material

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Keywords

autism spectrum disorder, exercise intervention, locomotor skills, object control skills, stability skills

Citation

Su J, Li L, Wang Y and Fan T (2026) Effects of exercise interventions on fundamental motor skills in children and adolescents with autism spectrum disorder: a meta-analysis with meta-regression analyses of randomized controlled trials. Front. Psychiatry 17:1954728. doi: 10.3389/fpsyt.2026.1954728

Received

31 July 2026

Revised

22 August 2026

Accepted

25 August 2026

Published

30 September 2026

Volume

17 - 2026

Updates

Copyright

© 2026 Su, Li, Wang and Fan.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Tonggang Fan, tonggangfan@126.com

Disclaimer

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