Exercise is health-enhancing and life-extending, yet many of us feel it’s a chore. But, as Kelly McGonigal reveals, it doesn’t have to be. Movement can and should be a source of joy. Through her trademark blend of science and storytelling, McGonigal draws on insights from neuroscience, psychology, anthropology, and evolutionary biology, as well as memoirs, ethnographies, and philosophers. She shows how movement is intertwined with some of the most basic human joys, including self-expression, social connection, and mastery–and why it is a powerful antidote to the modern epidemics of depression, anxiety, and loneliness. McGonigal tells the stories of people who have found fulfillment and belonging through running, walking, dancing, swimming, weightlifting, and more, with examples that span the globe, from Tanzania, where one of the last hunter-gatherer tribes on the planet live, to a dance class at Juilliard for people with Parkinson’s disease, to the streets of London, where volunteers combine fitness and community service, to races in the remote wilderness, where athletes push the limits of what a human can endure. Along the way, McGonigal paints a portrait of human nature that highlights our capacity for hope, cooperation, and self-transcendence. The result is a revolutionary narrative that goes beyond familiar arguments in favor of exercise, to illustrate why movement is integral to both our happiness and our humanity. Readers will learn what they can do in their own lives and communities to harness the power of movement to create happiness, meaning, and connection.

McGonigal, K. (2019). The joy of movement: How exercise helps us find happiness, hope, connection, and courage. Penguin Random House. 

The purpose of this review was to systematically search and critically analyse the literature pertaining to behavioural outcomes of exercise interventions for individuals with autism spectrum disorder aged ⩽16 years. This systematic review employed a comprehensive peer-reviewed search strategy, two-stage screening process and rigorous critical appraisal, which resulted in the inclusion of 13 studies. Results demonstrated that exercise interventions consisting individually of jogging, horseback riding, martial arts, swimming or yoga/dance can result in improvements to numerous behavioural outcomes including stereotypic behaviours, social-emotional functioning, cognition and attention. Horseback riding and martial arts interventions may produce the greatest results with moderate to large effect sizes, respectively. Future research with well-controlled designs, standardized assessments, larger sample sizes and longitudinal follow-ups is necessary, in addition to a greater focus on early childhood (aged 0–5 years) and adolescence (aged 12–16 years), to better understand the extent of the behavioural benefits that exercise may provide these populations.

Bremer, E., Crozier, M., & Llyod, M. (2016). A systematic review of the behavioural outcomes following exercise interventions for children and youth with autism spectrum disorder. Autism 20(8), 899-915. 

Physical activity (PA) is linked to multiple positive health outcomes for young children, with potential benefits in other domains as well. Engaging in higher intensity PA may produce positive gains for children with autism spectrum disorders (ASD), especially in academic engagement and on-task behavior. However, there is limited research documenting current levels of PA in young children with ASD and effective strategies for early childhood educators to increase PA. The aim of this study is to address these gaps by examining the extent to which embedded antecedent exercise (AE) increases and sustains engagement for children with ASD in early childhood settings. Three kindergarten students with ASD participated in this study, using a single-case withdrawal design to investigate the relationship between intensity of PA and student engagement during two unique classroom activities. Overall, results showed an increase in student engagement across classroom activities after participating in embedded AE.

Harbin, S.G., Davis, C.A., Sandall, S. & Fettig, A. (2021). The Effects of physical activity on engagement in young children with autism spectrum disorder. Early Childhood Education Journal, 50, 1461-1473. 

Poor sleep quality and low behavioral functioning are commonly reported in children with autism spectrum disorder. This study examined the impact of exercise on sleep on melatonin level and behavioral functioning in the population. Children with autism spectrum disorder(n = 55; age = 10.97 ± 1.90) were randomly allocated to a morning jogging intervention group or a control group. Participants’ sleep was measured using actigraphy and sleep log assessments. Twenty-fourhour and first morning urinary 6-sulfatoxymelatonin were used to determine whether the exercise intervention could elicit changes in melatonin levels. Behavioral functioning of the participants was assessed by the repetitive subscale of the Gilliam Autism Rating Scale–3rd edition. All assessments were carried out in baseline, post-intervention, or regular treatment, and follow-up to elucidate the sustainability of the exercise effects. Positive changes were observed between baseline and post-intervention in actigraphy-assessed sleep efficiency and wake after sleep onset, as well as melatonin level and behavioral functioning within the intervention group (ps < 0.017). However, no significant changes were observed in all measurements between post-intervention and follow-up (ps > 0.05). The findings suggest that physical exercise is effective to improve sleep with an increase in melatonin level. It can also reduce repetitive behaviors in children with autism spectrum disorder.

Tse, A. C., Lee, P.H., Zhang, J., Chan, R. C., Ho, A. W., & Lai, E. WH. (2022). Effects of exercise on sleep, melatonin level, and behavioral functioning in children with autism. Autism, 26(7), 1712-1722. https://doi.org/10.1177/13623613211062952 

Purpose: Evidence revealed that physical activity has positive effects on quality of life and mental health. Nevertheless, this topic has received little attention among special groups such as autism. Thus, this study was designed to examine the associations between physical activity with health-related quality of life and wellbeing among children with autism. Method: 65 children with autism (aged 9 to 13 years old) from special school and 70 typically developing children from regular primary schools (aged 9 to 12 years old) participated in this study. Physical activity, health-related quality of life, and wellbeing were measured by using standard questionnaires. Pearson correlation, regression analysis, and independent t test were used for data analysis. Results: Both children with and without autism had low physical activity. Children without autism had significantly higher levels of physical activity, health-related quality of life, and wellbeing compared with children with autism. Physical activity was positively associated with health-related quality of life and wellbeing among both children with and without autism. Conclusion: These findings, together, indicate that physical activity is a critical concern for children with autism. Accordingly, it is necessary to adopt appropriate strategies to increase the level of physical activity among children with autism.

Sari, O., Banu, H., Yanci, A., Bişgin, H., & Öztürk, M. (2022). Associations between physical activity with health-related quality of life and wellbeing among children with and without autism. Pakistan Journal of Medical & Health Sciences, 16(03), 448-448. 

Numerous interventions have been identified as evidence-based practices for educating students with autism spectrum disorder (ASD). Physical activity (PA) has recently been recognized as an evidence-based practice to decrease maladaptive behaviors and increase desired behaviors. Exercise has been found to increase academic engagement in students with ASD; however, little research has been completed on the effectiveness of physical exercise as a school-based intervention. PA has also been found to be an effective intervention to increase executive functioning (EF) in students with attention deficit hyperactivity disorder. However, little research has been completed on the effects of PA on EF in students with ASD. A multiple-baseline design was used to examine the effects of PA on academic engaged time and EF. Three students participated in a jogging intervention, were observed in the classroom, and completed EF measures. Results suggested large effect sizes for academic engagement for all three students. Although no significant effects were found on EF, results indicated PA may be an effective and feasible intervention to support academic achievement for students with ASD in schools.

Nakutin, S. N., & Gutierrez, G. (2019). Effect of physical activity on academic engagement and executive functioning in children with ASD. School Psychology Review, 48(2), 177-184. DOI: 10.17105/SPR-2017-0124.V48-2 

Recommendations for improving sleep patterns in all children, including those with neurodevelopmental disorders, includes having a healthy level of physical exertion during the day, as this is known to help with sleep-onset and sleep efficiency in children (proportion of time in bed that is spent sleeping) [Dworak 2008]; the most common sleep-related difficulties encountered by the families in our cohort. A recent meta-analysis [Cerrillo-Urbina 2015] found that aerobic exercise had a moderate to large positive effect on several features of attention deficit hyperactivity disorder (ADHD), including hyperactivity, impulsivity, and executive functioning deficits, each of which is likely contributory to the night-time difficulties encountered in families of children with ADHD. This suggests aerobic exercise may provide an effective non-pharmacological intervention for managing such difficulties. A focus group held with 6 parents of children attending a Special Needs Primary School (Southwark) concluded that all parents of children in this group (all children having a severe level of intellectual disability, four with co-morbid autism spectrum disorder) found it difficult to access out-of-school physical activities for their child, either due to there being a lack of groups specifically for children with significant neurodevelopmental impairments, or finding it difficult to access mainstream activities such as parks and playgrounds due to unpredictability as to how their child may interact with other families or cope with the setting. Many local sports initiatives for children with disabilities adopt a lower age limit of 8–11 years, which excludes a large number of the children seen in our clinic (mostly early primary school age), and misses an earlier window of opportunity for helping improve sleep patterns before sleep difficulties become entrenched and more difficult to adjust. The present project is therefore constructed with the aim of addressing this shortfall in services that would act as an intervention to improve sleep patterns in children in this group, with the potential added benefit of improved wellbeing to both child and family.

Turbull, J., Hobson, S., Jensen, Y., & Haitham, N. (2018). Evaluation of the impact of an exercise-based intervention on sleep and wellbeing in children with neurodevelopmental disorders attending a community-based sleep clinic. Journal of Thoracic Disease, 10(1). doi: 10.21037/jtd.2018.s008  

The developmental wellbeing of students is strongly influenced by their response to their environments (Frankish et al. in Health impact assessment as a tool for population health promotion and public policy. University of British Columbia, Canada 1996). Creating learning spaces that promote participation, engagement and wellbeing are therefore important for all students. In the case of students on the spectrum, evidence suggests that students on the spectrum have sensitivities to environmental stimuli that may affect their attention and academic performance in the classroom (Ashburner et al. in J Occup Ther 62:564–573 2008). As a result, consideration of the design elements of learning environments is essential to not only promote effective teaching and learning but also support wellbeing for this specific group of students. This chapter will explore some of the key issues for students on the spectrum identified in the research. An extensive review of the literature is used to inform the creation and design of learning spaces to address these key issues with the aim of positively influencing their learning , participation and engagement in educational settings. The benefits for all children will also be highlighted.

Saggers, B., & Ashburner, J. (2019). Creating learning spaces that promote wellbeing, participation and engagement: Implications for students on the autism spectrum. In School Spaces for Student Wellbeing and Learning (pp. 139-156). Springer, Singapore. 

Sleep-related difficulties are common in children with neurodevelopmental disabilities. Poor sleep health is associated with detrimental impacts not only for the child/young person, but also their family members. Exercise is considered to be important for sleep health, improving duration and quality of sleep in adult studies, however there is limited literature on impact in children with neurodevelopmental disabilities, and barriers to participation exist for this group. We set out to test the feasibility and acceptability of an exercise-intervention for children with neurodevelopmental disorders and troublesome sleep, whilst also evaluating impact on child’s sleep and whole family wellbeing. Design: Feasibility study. Setting: Community-based Sleep Clinic for children with neurodevelopmental disorders. Patients: Total 15 children aged 5 years 0 months to 15 years 11 months. Intervention: A 10-week exercise intervention, providing one swimming session, and one dry-sports session (1.5 hours per session) per week (overall 20 x 1.5 hours). Main outcome measures: Mixed-methods design; primary outcomes of feasibility and acceptability measured by ability to run intervention, attrition rate, and semi-structured parent-completed questionnaire of acceptability, appropriateness, and free-text comments. Secondary outcomes of impact on sleep and wellbeing measured by pre-and post-intervention parent-reported diary of child’s sleep (14-nights) and semi-structured parent-reported Likert-scale questionnaire for impact on child’s sleep, wellbeing, mood and behaviour, and family wellbeing. Descriptive analyses applied to the generated data. Primary outcomes: Twelve of 15 recruited participants took part on a regular basis; attendance rate remained high throughout the 10 weeks at swimming sessions, but was lower at dry-sports sessions. Parent-reported Likert-scale measures found the intervention to be acceptable to families and appropriate to their child’s needs. All attending families were interested in future sessions if these were to be offered. Secondary outcomes: Average parent-reported sleep-onset latency, night-wakings, and estimated overall sleep duration of child improved over the course of the intervention. Families’ perceived impact on child and family wellbeing was overwhelmingly positive. Provision of a participation-focused exercise intervention for children with neurodevelopmental disorders in our area has been possible, and has been well-received by families. Families reported positive impacts on child’s sleep, wellbeing, and family wellbeing over the course of the intervention. Perceived barriers to completing the intervention included competing family priorities, family stressors, language barriers, and transport barriers. Overcoming such barriers to participation in physical activity for children with neurodevelopmental disorders continues to be important.

Turnbull, J. R., Vyas-Lee, J., & Hobson, S. (2021). A Participation-focused exercise intervention for children with neurodevelopmental disorders: Feasibility, acceptability, and impact on sleep and wellbeing. OBM Neurobiology, 5(2), 1-15. 

The purpose of the present study was to investigate the effects of long term Kata techniques training on social interaction of children with autism spectrum disorders (ASD). We assigned 30 school aged children with ASD to an exercise (n=15) or a no-exercise group (n=15). We required participants of the exercise group to exercise Kata techniques for 14 weeks, while participants of the control group received no exercise. We evaluated the social interaction of the participants at baseline, post-intervention (week 14), and at one month follow up. Results revealed that Kata techniques training significantly improved social dysfunction in the exercise group. Interestingly, at one month follow up improvement in social deficiency in the exercise group remained unchanged compared to post-intervention time. The social deficiency of participants of the control group was not changed across the experimental period. We concluded that teaching martial arts techniques to children with ASD leads to significant improvement in their social interaction.

Movahedi, A., Bahrami, F., Marandi, S. M., & Abedi, A. (2013). Improvement in social dysfunction of children with autism spectrum disorder following long term Kata techniques training. Research in Autism Spectrum Disorders, 7(9), 1054–1061. 

Background: Sustaining the wellbeing for children with an autism spectrum disorder (ASD) can be highly demanding. Dance Movement Psychotherapy (DMP), a form of psychotherapy with a non-verbal character, may present as a relevant intervention option for this group of children. Methods: A protocol-based group DMP intervention was developed and implemented in two special educational needs schools in the North West of England. We aimed to investigate the effects of DMP on children with ASD using the Social Communication Questionnaire (SCQ) and Strengths and Difficulties Questionnaire (SDQ). Twenty-six children aged between 8 and 13 years (mean age = 10.65 years) with ASD were randomly allocated to DMP and a control group with standard care, following a crossover research design. Results: Results showed no significant carryover or period effects for either the SCQ or SDQ (p > 0.05). A significant intervention effect was found only for SCQ (p = 0.005) but not for SDQ (p > 0.05). ANCOVAs were performed on the data before the crossover to test for differences in SCQ and SDQ scores between the DMP intervention and control groups while controlling for pre-intervention scores. Those in the DMP intervention group presented significantly lower SCQ scores following the intervention period than those in the control group (p = 0.001). No significant differences in post-intervention SDQ scores were found between DMP intervention and control groups (p = 0.2). However, minimal clinically important differences (MCID) were reached for both SCQ and SDQ measures before crossover for those in the DMP intervention group. Moreover, repeated measures ANOVAs performed on SCQ and SDQ measures following crossover were significant, with the change in both SCQ (p = 0.001) and SDQ (p = 0.009) pre-and post-intervention being significantly greater for those in the DMP intervention than the control group. Conclusion: The pilot DMP intervention has shown promising results on the social and emotional wellbeing of children with ASD irrespective of whether they preferred verbal or non-verbal mode of communication. Limitations and appropriateness of the research methods implemented in this study for their use in a large RCT are discussed in detail. Overall, our findings highlight the value of creative therapies for improving the lives of young vulnerable groups.

Aithal, S., Karkou, V., Makris, S., Karaminis, T., & Powell, J. (2021). A dance movement psychotherapy intervention for the wellbeing of children with autism spectrum disorders: A pilot intervention study. Frontiers in Psychology, 12. 

Yoga and mindfulness‐based programs are becoming increasingly popular as a supplemental intervention for children and adolescents with autism spectrum disorders (ASD). Increasing numbers of children, parents, and schools are participating in programs around the country with an enthusiasm that far exceeds the research support for their efficacy. Therapies that are safe but not effective may not cause immediate harm. Nevertheless, the misappropriation of limited time and financial resources may result in missed opportunities. The need for clearly defined, evidence‐based therapies for youth with ASD is essential. Method Electronic databases were searched for peer‐reviewed intervention research studies using the key words autistic or autism in combination with yoga, mindfulness, or meditation. Eight studies met inclusion criteria. Results The findings are described in this critical review of eight empirical research studies that implemented yoga and mindfulness‐based interventions for children with ASD. Although few studies reported improvements in core symptoms of ASD, preliminary findings suggest that yoga and mindfulness‐based interventions are feasible and may improve a variety of prosocial behaviors, including communication and imitative behaviors; increased tolerance of sitting and of adult proximity; self‐control; quality of life; and social responsiveness, social communication, social cognition, preoccupations, and social motivation. Reductions in aggressive behaviors, irritability, lethargy, social withdrawal, and noncompliance were also reported. Conclusions Based on the available literature, the empirical evidence to support the efficacy of yoga and mindfulness‐based interventions for children and adolescents with ASD is inconclusive. The current body of research has significant limitations, including small sample sizes, no fidelity measures, and no control groups. Each of the eight studies, however, reported some positive effects on social, emotional, or behavioral metrics. These early results are promising and sufficient to warrant support for further research.

Semple, R. J. (2019). Review: Yoga and mindfulness for youth with autism spectrum disorder: review of the current evidence. Child and Adolescent Mental Health, 24(1), 12–18.