Nonlinear dose-response relationship between exercise intervention and executive function in children with autism spectrum disorder: A systematic review and multilevel meta-analysis.

This study aims to examine the effects of exercise interventions on executive function in children with ASD and to investigate the dose-response relationship between exercise dosage and intervention effects. We searched databases including PubMed, Web of Science, Embase, and the Cochrane Library to identify studies evaluating the effects of exercise interventions on executive function in children with ASD. Effect sizes were calculated using Hedges' g. Using the metafor package in R, we constructed a three-level random-effects model to account for inter-effect dependencies and conducted a multilevel meta-analysis. Furthermore, we employed a TPS model to assess the dose-response relationship between exercise interventions and executive function, and to identify the effects of potential moderating variables on executive function. This review included 21 studies from six countries, involving 742 participants aged 3-15 years. Three-level meta-analysis showed that exercise interventions significantly improved executive function in children with ASD (Hedges' g = 0.64, 95% CI [0.39, 0.88]), including inhibitory control (Hedges' g = 0.59, 95% CI [0.34, 0.84]), working memory (Hedges' g = 0.56, 95% CI [0.26, 0.87]), and cognitive flexibility (Hedges' g = 0.75, 95% CI [0.50, 1.00]). The TPS model suggested potential dose-response patterns, with the highest predicted effect near the upper boundary of the observed data. Age-moderated intervention effects. Given the low certainty of evidence, findings should be interpreted cautiously. Exercise interventions can significantly improve executive function in children with ASD, and there is a significant dose-response relationship between exercise and executive function.