Exercise as an Adjunctive Lifestyle Intervention for Psychiatric Comorbidities in Autism Spectrum Disorder.

Autism Spectrum Disorder (ASD) is frequently accompanied by psychiatric comorbidities, including anxiety, depression, attentional difficulties, irritability, and emotional dysregulation, which substantially impair functioning and quality of life beyond core neurodevelopmental features. Although pharmacologic and behavioral interventions remain central to management, their effectiveness may be limited by adverse effects, variable response, and accessibility barriers. This review examines structured physical exercise as an adjunctive lifestyle intervention for improving psychiatric comorbidities in individuals with ASD. A scoping review of peer-reviewed literature was conducted, examining exercise-based interventions in ASD, including aerobic, resistance, mind-body, and school- or community-based programs. Studies reporting psychiatric and behavioral comorbidities across pediatric and adult populations were included. Across studies, exercise participation was associated with reductions in anxiety and other internalizing symptoms, improvements in mood regulation, and enhancements in attention and executive functioning, with the most consistent effects observed in children and adolescents. Additional reported benefits included improved behavioral regulation, increased opportunities for social engagement, and gains in adaptive functioning. However, the evidence base is limited by small and heterogeneous samples, variability in intervention protocols, limited mechanistic investigation, and insufficient long-term follow-up. Current evidence supports structured exercise as a safe and accessible adjunctive intervention within multidisciplinary care models for ASD. Future research should prioritize standardized reporting, longitudinal and mechanistic designs, and individualized exercise approaches that account for sensory sensitivities, cognitive profiles, and functional capacity. Formal integration of structured exercise into clinical care pathways may enhance psychiatric outcomes and overall well-being in individuals with ASD.