How physical intervention program influence physical and mental rehabilitation of children with autism spectrum disorder: A case report

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Therefore, this study aims to explore the effects of exercise intervention on the physical and mental rehabilitation of children with ASD, and provide a reference for expanding behavioral intervention methods for autism. Design : According to the physical and mental characteristics of children with ASD, a 16-week, three-stage rehabilitation program was designed and implemented. During the training period, measurement methods such as ActiGraph GT3X+, Health Related Physical Fitness (HRPF), Test of Gross Motor Development 3 (TGMD-3), and ABC Behavior Observation Scale were used to evaluate the effects of rehabilitation training at each stage. Results : After completing the targeted intervention, the physical acvtivity of the two children was significantly promoted at a healthy physical fitness level, including the decreased sedentary behavior ( M change =290.07 d/min, 218.16 d/min), the increased low-intensity physical activity ( M change =367.39 d/min, 158.19 d/min), the increased moderate/high-intensity physical activity ( M change =135.05 d/min, 36.45 d/min), and the increased total physical activity ( M change =502.44 d/min, 194.64 d/min). In terms of healthy physical fitness level, the body mass index (BMI) of the the children with ASD was decreased ( M change =0.7, 4.92), together with the increased grip strength ( M change =1.8, 4.2) and forward bending in the new sitting position ( M change =4.3, 5.6). In terms of basic motor skills, the total score of the children with ASD was increased ( M change =4, 10), especially the object control skill score ( M change =4, 7). In terms of the physical behavior, the frequency and duration of stereotyped behaviors of the two children were decreased. In addition, the positive communication times of the two children were also increased ( M change =14, 12). Conclusion : After the 16-week exercise intervention, the physical activity and healthy fitness levels of autistic children were significantly improved, especially in terms of sedentary behavior, low-intensity physical activity, body composition, muscle strength and flexibility, movement development level and object control skills. Furthermore, the behavior was improved to some extent, while the communication ability was also effectively promoted. In the following stage, it is suggested to further optimize the personalized exercise intervention program that adapts to the physical and mental characteristics of autistic children, and strengthen the organic interaction between schools and families, so as to ultimately improve the overall health of children. Autism spectrum disorder Children Physical activity Movement development Health-related fitness Figures Figure 1 Figure 2 Figure 3 Figure 4 1. Introduction Autism is a pervasive neurodevelopmental disorder with complex etiology, which often develops in early childhood and is characterized by two core symptoms: repetitive and stereotyped behavior patterns and social communication/interaction disorders [ 1 ] . According to statistics from the Centers for Disease Control and Prevention of the United States, the prevalence of autism in children has increased from 1:54 in 2020 to 1:36 in 2023 [ 2 ] . In 2022, the Autism Screening and Intervention Service Specifications for Children Aged 0–6 issued by the National Health Commission showed that the prevalence of autism in children in China is about 7% [ 3 ] . Consequently, the continued increase in the incidence of autism worldwide has posed a severe challenge to the country and society, which has become a major public health issue that urgently requires global attention and response. In recent years, with the advancement of medical technology and the improvement of public awareness of the ASD which China has paid more and more attention to, the national policies and social resources have gradually tilted towards children with ASD. After the 20th National Congress of the Communist Party of China, the main goals and tasks have gradually been implemented from “representing the interests of the broad masses of the people” to the indicator of “no one can be left behind”. As a special group in public health emergencies, how to improve the physical and mental health of children with ASD is not only an important factor in building a healthy China and a strong sports country, but also a key link in achieving the goal of universal health coverage. In order to improve the physical and mental health of autistic patients, especially children, currently used intervention methods include behavioral therapy, drug therapy, speech therapy, sensory integration training, exercise intervention and other means. Among them, behavioral therapy (such as applied behavior analysis, ABA) has a significant effect on improving the behavioral and social skills of autistic children. However, ABA therapy requires the guidance of professionally trained behavior analysts and requires long-term, high-intensity training, which places a large time and financial burden on families. Although drug treatment is quick-acting and can relieve symptoms in a short period of time, it can have side effects (such as drowsiness, weight gain, gastrointestinal discomfort, etc.) and cannot fundamentally solve the core symptoms of autism. The intervention effects of speech therapy and sensory integration therapy vary significantly among individuals. Exercise intervention is receiving increasing attention because it is consistent with the physiological and psychological characteristics of autistic children. To further improve the physical and mental health of autistic children from the perspective of physical education, such as improving basic motor abilities, improving physical activities and physical functions, and improving the interaction between individuals and the environment [ 4 , 5 ] , empirical domestic and foreign research on the physical and mental health of children with ASD as well as its health intervention has been carried out in an orderly manner. Although preliminary results have been achieved, the results are uneven, the scope of application is narrow and the promotion is poor [ 6 , 7 , 8 ] . With the promulgation of national and social policies and regulations for special children and the increase in funding investment, physical intervention methods are also constantly developing. For example, a personalized teaching model based on physical activities (a teaching model that considers children’s basic abilities, personality traits, interests and hobbies [ 9 ] ) has been launched in Peizhi schools in first-tier cities, such as Beijing and Shanghai. Even if this model adopts class teaching and one-to-one rehabilitation courses, how to accurately grasp the exercise needs of different types of children and how to build an efficient, fair and equal participation program still needs further exploration. To this end, this study developed a personalized exercise intervention plan for 2 autistic children with intellectual disability and prominent symptoms, and explored the effect of exercise intervention, with a view to enriching case studies on children with ASD and providing a basis for formulating personalized and rational plans. It is hoped that this study can provide a reference for exercise intervention programs for children with ASD. 2. Materials and Methods 2.1. Participants The experimental subjects were two children with ASD, who were selected from a special education school in Shanghai. The two children behaved indifferently during class, often together with screaming, clapping, slapping their heads, and spitting everywhere, which affected the normal teaching order. After consultation between the school and parents and after the parents filled out the informed consent form, they were selected as candidates to participate in this experimental activity. Afterwards, the Jingwei Center diagnosed that the two candidates met the diagnostic criteria for autism in the Diagnostic and Statistical Manual of Mental Disorders (5th edition) [ 10 ] , and neither of them had taken medication in the past 3 months. The cases were tested using the Wechsler Intelligence Scale for Children (2-in-1) and the Childhood Autism Rating Scales (CARS). The results were as follows: Case B had an intelligence score of less than 45 and a CARS score of 40; Case D had an intelligence score of less than 45 and a CARS score of 38. It can be seen that both children have intellectual disabilities. The background information of the two children was obtained through interviews and observations as follows. 1.1.1. Interview of Guardians Case B (pseudonym, male, 8.17 years old, delivered by caesarean section) was found by parents that the child was behind in language and social interaction at around 4 years old, and was diagnosed with ASD at 5 years old. No obvious abnormalities were found in his brain MRI scan, and the electroencephalogram (EEG) test showed that the indicators were within the normal range. As for the main manifestations, he unconsciously pronounced “Baba, mama” before 1 year old, and afterwards, his progress was slow, with occasional spontaneous speech or talking to himself. Although he could point to objects and selectively listen to instructions, he could not concentrate for a long time, sit still or stand still. He also knows simple numbers from 1 to 10, and has a good memory, and likes to flap hands and spit ptysis. Case D (pseudonym, female, 9.42 years old, born naturally) was diagnosed at 6 years old, and her genetic diagnosis of fragile X chromosome syndrome was normal. As for the main manifestations, most of her language skills are imitation, and occasionally she can write imaginative sentences. Moreover, she likes to flap head, shake hands and spit ptysis, but does not like to interact with his peers, nor share/show off. 1.1.2. Observation of Researchers Case B can simply flip through books, but does not know why he flips through them, and also can fold simple triangles and paper airplanes. He gets nervous around strangers or crowded places, and avoids eye contact, while sometimes he walks around aimlessly. He has a good sense of music and can play the piano. Case D is used to sitting alone or going to the toilet frequently, for example, she goes to the toilet after every class, and if does not go, she will keep shouting or talking to herself. Occasionally, she can accept being forced not to go to the toilet. After going to the toilet, she likes to pull up his pants outside the toilet, and if any step is missing, she will go to the toilet again and repeat all the steps. She likes to pass and dribble the ball, but cannot dribble the ball at a fixed position, and the dribble height is low. Additionally, when participating in a favorite project, she would like actively to participate, but when encountering a more difficult project or there are many companions, she tends to escape and retreat. Being praised by familiar teachers is also one of her hobbies. 1.2. Methodology 1.2.1. Physical Intervention This study adopted a cross-subject multiple baseline design. Referring to the German medical training therapy (MTT) training model, the standard of 2016 China Special Needs School “Sports and Health Rehabilitation Course”, and the research plan of Bo and Dong, a 16-week and 3-stage personalized exercise training program was developed. The first stage is the basic training stage (weeks 1–5). After communication with parents, basic information of the children was collected and sorted out. At the same time, professionals evaluated the children’s physical activity, physical fitness level, motor development and core symptoms through their behavioral performance. Based on this, the intervention goals of Case B and Case D were preliminarily determined. The overall goal of the intervention was to promote the sports participation of the children and improve their health level. The sub-goals of the intervention were to help Case B improve his attention during the intervention process, promote better emotional communication between teachers and students, strengthen interaction, improve the case’s sense of self-efficacy, enable him to actively express himself, actively participate and feedback his personal feelings. As for Case D, it aimed to reduce the behaviors of slapping his head, shaking his head and spitting, and establish a sense of familiarity and trust with other children by increasing the case’s interest, timely feedback on his meaningful behavior, and positive evaluation of his performance, and promote his level of sports participation. The second stage is the consolidation training stage (weeks 6–10), in which children were intervened in the sports rehabilitation room according to the preset plan. The intervention content was adjusted temporarily according to the children’s feedback from participation, and meanwhile the coach took the initiative to initiate tasks and further guide children to participate. The third stage is the strengthening training stage (weeks 11–16), in which the coach mainly arranged tasks to promote children’s active completion and to make them experience a sense of success. In this process, by recording the activities of children with teachers and peers in natural teaching situations, observing and analyzing the laws of children’s physical and mental development, the foundation was laid for children to actively integrate into society. Videos were recorded at each intervention stage to record the activities of children so that further observations could be made after class, and the performance of children could be analyzed comprehensively, in-depth and meticulously. Based on the observation records and communication with parents, the intervention plan was continuously optimized to ensure the operability and effectiveness of online intervention. According to the physical and mental characteristics of children with ASD in special schools, training goals for different stages were designed, and corresponding strategies and training plans were provided at the same time to ensure the smooth completion of the preset intervention activities and intervention effects at each stage. The first stage: Basic training stage Training objectives: Through participatory observation and video analysis of the characteristics of individual children, observe and record physical activities, health and fitness, motor development level, and symptom characteristics, gradually establisha sense of familiarity and trust with children, and provide support for the implementation of intervention and guarantee of results. In combination with the physical and mental characteristics of children, personalized rehabilitation plans should be design to guide children to participate, reduce sedentary behavior, and guide children to show behaviors consistent with the created situation when participating sports. Training strategy: During the intervention process, attention should be paid to the use of reinforcers and the selection of materials, and the difficulty of tasks is reduced through decomposition exercises. Training plan: The core of segmental rehabilitation training is to promote children’s sports participation and behavioral performance through physical movement skills. The preparation part includes teachers and students greeting (roll call answering), standing or sitting at a fixed point, and warming up with animal imitation exercises related to skills. Teachers and students must greet each other in every class, emphasizing “answering”, and the form could be diversified, such as language, body or eye contact. In the basic part, the learning of each skill requires decomposition exercises, and the difficulty and progress of teaching can be flexibly adjusted according to the physical and mental characteristics and actual conditions of the children. Through games, skills are consolidated or different limb functions are practiced, and attention should be paid to children’s awareness of waiting, cooperation and competition. In the end, the focus is on stretching the muscles used in the training process, reviewing the content learned, paying attention to the participation of children, and providing timely feedback on children’s performance, with encouragement as the main focus. At the same time, children’s classroom performance is recorded, and summaries and adjustments are made after class. Notably, the training duration is 5 weeks, 3 times/week, 60 minutes/time, and the specific training content is shown in Table S1 . The second stage: Consolidation training stage Training objectives: The consolidation training stage aims to enhance the awareness of participation in learning tasks of individual children, and further, to promote their physical flexibility and coordination. Under the guidance of teachers, individual children can abide by the rules of activities, reduce waiting and watching time, and increase imitation time. Training strategy: Visual prompt strategies, as shown in Fig. 1 , are used to attract children’s intentional attention, and meanwhile, the frequency of reinforcers used should be reduced. According to the actual performance of children, gradual transition from freehand activities to object manipulation exercises, as well as repetition and decomposition exercises are used to promote the motor skills acquisition and appropriate behavior performance of children. Training plan: The consolidation training is mainly used to promote children’s sports participation and behavior performance with object control skills. In the preparation part, under the guidance of teachers, children and teachers complete the placement of equipment together, and teachers can respond consciously during the roll call. In the basic part, children actively participate in object control skills exercises and experience a sense of success through interaction with teachers. In the end, children assist teachers in completing the task of returning equipment. Notably, the training duration is 5 weeks, 3 times/week, 60 minutes/time, and the specific training content is shown in Table S2. The third stage: Strengthening training stage Training goals: Strengthening training aims to significantly reduce children’s sitting behavior, increase their enthusiasm for sports participation, improve their completion and effectiveness of learning tasks, and at the same time, enable children to actively demonstrate appropriate behaviors in the created environment. Training strategy: This stage mainly focus on verbal prompts, and repeated exercises are applied to consolidate children’s behavioral performance. In the process of children’s participation, children’s ability to complete learning tasks independently is strengthened through the gradual withdrawal of assistance. Training plan: The core task of the consolidation training period is to create a positive environment and increase children’s sports participation time. In the preparation part, children can consciously practice following the warm-up music, understand the teaching content according to the teacher’s verbal prompts, and actively participate in the placement of equipment. In the basic part, children complete learning tasks step by step and improve their self-efficacy. At the end of the session, the children take the initiative to relax along with the music, and with the teacher’s gradual withdrawal strategy, they stretch and recover the equipment independently. Among them, the training duration is 6 weeks, and it is carried out 3 times/week, 60min/time. The specific arrangement is shown in Table S3. 1.2.2 Testing (1) Physical activity. The ActiGraph GT3X + accelerometer was used to assess the daily sedentary, low-intensity, moderate-intensity, and high-intensity physical activity time of children. Before the test, the researchers initialized the accelerometer and set the test time. Then, they distributed the accelerometer to the children, demonstrated how to wear it, and explained the relevant precautions. The children were required to wear the accelerometer on their right hip for one week, during which their guardians were informed in the consent form that the children had to wear it from waking up in the morning to going to bed at night, except the bathing or swimming time. Afterwards, the researchers used ActiLife (Version 5.5.5) to export the raw data and screened the data based on the criteria that each data item included at least 5 school days and 2 weekend wearing days, and the wearing time was not less than 8 hours per day. Finally, Kinesoft software was used to extract, process, and analyze the physical activity data. (2) Health and physical fitness. By reviewing relevant research on autistic children and combining it with the actual situation of the children, four test indicators for healthy physical fitness were determined as follows, including the body composition (BMI, waist-to-hip ratio), cardiopulmonary function (Pacer 20m), muscle strength and endurance (vertical jump, grip strength and 1-minute sit-ups), and flexibility (new sit-up). (3) Basic motor skills. Regarding the assessment of basic motor skills, Chinese scholars, such as Ning Ke [ 11 ] , Diao Yucui [ 12 ] , employed the third version of the Test of Gross Motor Development 3 (TGMD-3) to test normal children of different age groups, and they found that the scale had good reliability and validity. Given that the TGMD-3 is applicable to children aged 3–10 years and its main test content includes displacement skills and object control skills [8] , the TGMD-3 was used to assess the basic motor abilities of the children. Physical activity, health and physical fitness were tested four times, including the 1st, 6th, 11th, and 16th week. 1.2.3. Observation (1) Junfeng Xiao [ 13 ] , Xiaodong Tian [ 14 ] , Fei Zan [ 15 ] , Biyu Cui [ 16 ] and other scholars have used the “ABC Behavior Observation Record Form” in their research on repetitive stereotyped behaviors in autism, and the results show that its reliability and validity were good. Therefore, this study used the ABC Behavior Observation Scale as a tool to record the frequency and duration of repetitive stereotypes in individual children and evaluate their repetitive stereotyped behaviors. The behavioral observation was conducted 3 times/week, and the average value was used as the reported result. (2) A self-compiled “Active Communication Behavior Observation Record Form” was used to record the method, frequency, content and behavioral function of the individual's active communication behavior during the baseline and intervention periods, respectively. 1.2.4. Interview During the baseline period, teachers and guardians were interviewed to understand the basic situation, physical activities, health and fitness, motor development, preferences and interests of the children. During the intervention period, teachers were interviewed weekly to understand the classroom performance and teaching implementation of the children. After the intervention, a self-made semi-structured interview outline of “Social Perspective Interview” was used to investigate the satisfaction and acceptability of the intervention among teachers, teaching managers and parents. 1.2.5 Condition control The implementation of the program maintained consistent lighting and temperature, and a double-blind experimental design was used to eliminate interference factors of the children and teachers. In order to improve the compliance of the children with physical activities, this study adopted appropriate teaching methods and strategies, and used piano, music and food as rewards to fully mobilize the children’s enthusiasm for participation and ensure the smooth implementation of the physical intervention program. At the same time, the researchers integrated into the living environment of the children and conducted covert observations of the children’s daily social life, mainly including consistency tests in scoring (maintaining the reliability of the evaluation between the scorers at 86%) and recording the participation of the children in the activities. In addition, the researchers communicated with relevant personnel in the form of semi-structured interviews to explore the effect of the implementation of the program, and the interview content was recorded to maximize and effectively record the changes of teachers and children during the intervention process. 2. Results and Analyzation 2.1 Analysis of test results on physical activity, health fitness and basic motor skills During the basic training, intensive training and consolidation training stages, the physical activity (PA) of Case B and D significantly decreased their sitting time as the intervention time prolonged, and their low-intensity physical activity (LPA), medium-high intensity (MVPA) and total physical activity (TPA) all increased significantly as shown in Table 1 . Therefore, it can be judged that the physical activity level of Case B and D has been improved after the exercise intervention. Table 1 Changes in physical activity at different stages Physical activity Week 1 Week 6 Week 11 Week 16 Case B SB LPA MVPA TPA 533.27 77.53 27.26 104.79 443.62 216.49 87.7 304.19 398.36 378.74 119.11 497.85 243.2 444.92 162.31 607.23 Case D SB LPA MVPA TPA 432.74 43.25 12.53 55.78 421.87 173.98 24.31 98.29 394.25 192.77 43.46 236.23 214.58 201.44 48.98 250.42 In terms of Health-related Physical Fitness (HRPF), Case B and D showed significant improvement after exercise intervention. This is specifically reflected in the significant improvement in body composition (BMI), muscle strength and endurance (grip strength), and flexibility (forward bending in the new sitting position) as shown in Table S4. This result shows that the health fitness levels of Case B and D have improved to varying degrees after physical intervention. In terms of fundamental movement skills (FMS), Case B and D showed significant improvement after sports intervention, which was specifically reflected in the significant improvement in the total score and the sub-dimensions of object control skills, and there were also significant changes in displacement skills, as shown in Table S5. This result shows that exercise intervention can effectively improve the basic motor skills of Case B and D, especially the object control skills. 2.2 Analysis of the symptom observation form The observation method was used to analyze the changes in the frequency and duration of children’s behaviors at different stages. In terms of the repetitive stereotyped behaviors as shown in Fig. 2 , the frequencies of flapping hands and spitting ptysis for Case B were decreased by 18% and 17.7%, respectively, while the frequencies of flapping and shaking head for Case D were decreased by 25% and 17.7%, respectively. In terms of duration as shown in Fig. 3 , the durations of flapping hands and spitting ptysis for Case B were decreased by 24.7 s and 66.7 s, respectively, and the duration of flapping and shaking head for Case D were decreased by 32.3 s and 145.9 s, respectively. Overall, the frequency and duration of stereotyped behaviors of both Child B and Child D were decreased at different intervention stages, indicating that exercise intervention has a positive effect on children’s stereotyped behaviors. Figure 4 shows the changes in the communication behaviors of Case B and D at different stages. It can be found that the average communication number of Case B is 9.81 times, and the number of positive communications increased from 3 times to 18 times, while the average communication number of Case D is 8.38 times, and the number of positive communications increased from 2 times to 14 times. It is obvious that compared with those of children before the intervention, both the number of positive communication times of the children in one week and the average number of active communication times during the entire intervention period increased significantly after the intervention. This result indicates that physical intervention can effectively improve the communication ability of children with ASD. 3. Discussion This study explored the effects of exercise intervention on the physical and mental health of children with ASD, and the main findings are as follows. After the intervention, the physical activity level of both the two children was increased, especially in terms of reducing sedentary behavior and increasing low-intensity physical activity, which should be related to the design of the intervention program. During the intervention, children were encouraged to increase their physical activity level through intervention time based on the characteristics of children’s motor development. This result is ascribed to the duration and frequency of the intervention, which is similar to that of Jozkowski’s study [ 17 ] . Furthermore, the health and physical fitness level of the children improved after the physical intervention, which was more prominent in body composition, muscle strength and flexibility. The possible reasons are that, on the one hand, the learning of motor skills can directly promote the improvement of children’s neuromuscular coordination and recruitment ability, improve the coordination and integration ability of the brain’s nervous system pathways, and thus promote the development of muscle fitness. In addition, the intervention content design of this study requires children to practice and repeat many times. The improvement of motor skills can often make children more involved in repeated practice activities, so that the body gradually develops good adaptability to exercise load [ 18 ] . On the other hand, with the improvement of the basic motor skills the physical activity participation level of the children has increased, which is conducive to the development of their healthy physical fitness. Therefore, the intervention effect of the intervention program on muscle fitness is also achieved through the indirect way of promoting physical activity. In terms of the level of movement development, the movement level of the children was improved after the intervention, especially the object control skill level which was improved significantly. After Debolt conducted regular exercise intervention on three cases, the children’s basic motor skills have been improved [ 19 ] . After Colombo conducted standing jump and two-handed hitting exercises on two cases, the children’s standing jump and two-handed hitting abilities also have significantly improved [ 20 ] . In this study, the improvement in the children’s motor development review may be related to targeted practice, which provides more opportunities for learning and practice. At the same time, the development of basic motor skills in childhood was the cornerstone for participating in various leisure activities and acquiring advanced motor skills, and the proficiency of motor skills was positively correlated with the level of physical activity and health in adolescence and adulthood [ 21 ] . According to dynamic system theory, children’s development patterns and trajectories changed over time as a result of the interaction of different factors [ 22 ] . For autistic individuals, their development process was complex, and the interaction between the environment and the organism played an important role [ 23 , 24 ] . In addition, the children also showed some improvement in core symptoms after the intervention, which may be related to the influence of family and school. Family and school are the main places for autistic children to engage in activities [ 25 ] . Due to the defects in core symptoms, children with ASD face major challenges in integrating into daily life [ 26 , 27 ] . In terms of family environment, the consistency of parents or guardians with school goals and the way of implementation will affect the development of autistic children. In schools, targeted basic motor skills programs suitable for children with ASD are carried out to meet their personalized development needs. During the intervention process, attention is paid to children’s sports participation, which can gradually guide them to acquire specific sports skills [ 28 , 29 ] . As the practice deepens, children gradually transition from the initial autism and bystander state to parallel, parallel perception and meaningful participation, and can discuss activities related to basic motor skills in daily life. For example, when a child passes by the playground, the children can take the initiative to say the introduction of the social situation in the running teaching process, such as “Teacher, I can run here.” When children with ASD strengthen the skills which they have learned, they will establish a connection between their daily life and the intervention content. Moreover, Family and school are considered as the main learning places for children with ASD, and thus, parents, guardians and teachers need to give children with ASD appropriate guidance. In the intervention stage, teachers can use key response teaching methods and prompting strategies based on the actual performance of children to further create situations and encourage children to participate in teaching more attentively and patiently. Zhang Wenjing [ 30 ] , Liu Jianan [ 31 ] , and others believe that in individualized education and teaching, teachers should focus on the interests and actual conditions of autistic children, and the design of teaching should consider the two questions of “why” and “how to do it”, and use a variety of interactive strategies to pay attention to the attention and motor interests of autistic children. For example, Case B had a strong sense of music. After two weeks of intervention, Case B could walk to the teacher before each class, imitate the warm-up activities accompanied by music at the beginning, and further take the initiative to express his willingness to help the teacher turn on the speakers. After the teacher gave positive feedback, Case B would focus more on the warm-up activities. For example, if the speaker was turned on at an inappropriate time, the teacher would remind Case B to establish a sense of rules. Before the intervention, Case D could not understand the verbal instructions to turn on the speakers before class and during the stretching and relaxation session. After structured teaching, Case D could understand what should be done in a certain time period and position until he established the correct awareness. In summary of the whole process, the teacher gave positive feedback and support based on Case D’s performance. After Case D received full attention in the one-on-one session, she would become more confident in interacting with the teacher and gradually increased the time which she participated in interactive activities with the teacher. From the measurement results, the physical and mental health of children with ASD improved after the intervention, which indirectly reflects that they participate in sports. By participating in sports, they could recognize, learn and consolidate skills, which has a positive impact on the physical and mental health of children with ASD to a certain extent. The targeted design of exercise programs for children with ASD and the development of their perceptual abilities after intervention increased their motivation and interest in exercise [ 32 , 33 ] . For example, it is directly reported by the parents and teachers of Case B that the children with ASD after 4 weeks of intervention would like to participate in the intervention on their own initiative, and could also say to teachers and parents, “I like sports” and “Let’s go to the sports room.” This phenomenon was also reflected in the fact that after the intervention, when Case B was able to see the teacher, he held the teacher’s hand and went to the gym. During the test, the attention of the children with ASD was more focused, waiting for the research team to demonstrate and then repeat the same action, which was in sharp contrast to the indifference in the pre-test. Additionally, this study also found that during the intervention process, the attention of parents and teachers can also increase the organic connection between home and school. Children’s participation in activities depends on their acceptance and trust in the activities, which to a certain extent also establishes the connection from home to school in the daily life of autistic children. It can be seen that by creating specific situations, the core symptoms of children with ASD can be improved, thereby promting their all-round development. 4. Conclusions and Limitations After the 16-week exercise intervention program, the physical activity and health fitness levels of the two children were significantly improved, including sedentary behavior, low-intensity physical activity, body composition, muscle strength and flexibility. Furthermore, their motor development level and object control skills were significantly improved, and there was also a certain improvement of the stereotyped and communication behavior. At the same time, The results also show that the exercise intervention program developed for individual cases is a new method that can effectively help autistic children recover physically and mentally. This study aims to enrich the relevant research on individual autistic children and provide a reasonable reference for the development of personalized and rational exercise intervention for children with ASD. However, the following issues are still need to be paid attention to in the following studies. First, it needs to be paid attention to the impact of the establishment of self-awareness on the enthusiasm of children with ASD in sports participation. In view of the individual problems of children ASD, personalized education is adopted to provide them with different situations. Interactions in different situations require children to establish a correct self-concept. Facing the challenges of conflicts between rules and individual spontaneous behaviors that children encounter in different situations, the establishment of self-awareness helps them overcome their initial fear and avoidance of things. Therefore, in the intervention process and personalized education, it is important to study the impact of self-awareness on basic motor skills, behavioral control, and social interaction. for children with ASD. Second, social interaction skills and their changes during the interaction process also have a great impact on the physical and mental recovery of children with ASD. The creation of a family atmosphere and the guidance and support of parents and teachers are very important for children to fully engage in sports, and furthere, can consolidate the skills they have learned in the process. It can be seen that studying the interaction among children with ASD, teachers, parents, and peers is also an important factor in deepening autistic children's understanding skills, and further achieving internalization. Declarations Ethics and dissemination The study was conducted according to the guidelines of the Declaration of Helsinki and was approved by the Ethics Committee of Shanghai University of Sport (protocol code 102772020RT054 on May 9, 2020), the trial registration of which was included the report of a trial registration number (ChiCTR2200056090). Informed Consent Statement Informed consent was obtained from all parents or guardian of the participants involved in the study. Conflicts of Interest The authors declare no conflict of interest. Funding This work was supported by the Hainan Higher Education Educational Reform Research Project (Grant Nos. Hnjg2024-30), Hainan University Innovation and Entrepreneurship Education Project (Grant No. hdcxcy2023-3), Open Project of Hainan Provincial Key Laboratory of Sports and Health Promotion (Grant No. HNYJZ2023004), 2024 Youth Scholar Support Fund Program of Hainan University, and Annual Planning Project of Philosophy and Social Sciences in Hainan Province, HNSK(YB)25–52. Author Contribution Yu Xing: Conceptualization, Methodology, Software, Formal Analysis, Data Curation, Writing – Original Draft, Project Administration, Funding Acquisition.; Haoyan Liu: Validation, Resources, Supervision; Liang Li,Yongming He: Investigation, Project Administration, Funding Acquisition; Xueping Wu: Conceptualization, Validation, Writing – Review & Editing, Visualization, Project Administration. Acknowledgments We would like to thank the teachers of Shanghai and Wuhu School for their support and also thank the children who contributed to this study. Data Availability The date presented in this study are available on request the corresponding author. References Xing Y. Effects of gross motor skill learning on fundamental motor skill level of children with autism spectrum disorder. Journal of Capital Institute of Physical Education, 2020, 32(01):13–17. Dong L, Bo J, Shen B, Pang Y, Song Y. The effect of ten-week exercise intervention on fundamental motor skills and social ability of children with autism spectrum disorders. Chinese Journal of Sports Medicine, 2021, 40(03): 171–180. Zhang Y, Yang R. Prevalence of autism in children in China was about 7%. National Health Commission, 2022, (A04): 9–29. Ketcheson L, Staples K, Pitchford EA, et al. Promoting Positive health outcomes in an urban community-based physical activity intervention for preschool aged children on the autism spectrum. Journal of Autism and Developmental Disorders, 2021, 1–15. Hill AP, Zuckerman K E, Fombonne E. Obesity and autism. 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A case study on the effects of aerobics for problem behavior of child with autism. Beijing University of Sports, 2019. Jozkowski AC, Lichtenwalner MA, Cermak SA. Case studies on the feasibility of exergaming to enhance physical activity in youths on the autism spectrum. Good Autism Practice (GAP), 2016, 17(2): 24–36. Wang X, Yang J. Structured physical activity programs for children with autism spectrum disorders and their health benefits: a systematic review. Chinese Journal of Rehabilitation Theory and Practice, 2023, 29(10): 1117–1124. DeBolt L S, Clinton E A, Ball A. The effects of an adapted physical education program on children with autism: A case study. Kentucky Newsletter for Health, Physical Education, Recreation & Dance, 2010, 47(1): 24–27. Colombo-Dougovito AM, Block ME. Fundamental motor skill interventions for children and adolescents on the autism spectrum: a literature review. Review Journal of Autism & Developmental Disorders, 2019, 27–31. Stodden D, Goodway JD, Langendorfer SJ, Roberton MA, Rudisill ME, Garcia C, Garcia LE. A developmental perspective on the role of motor skill competence in physical activity: An emergent relationship. Quest, 2008༌60(2), 290–306. Thelen E. Motor development: A new synthesis. American psychologist, 1995, 50(2): 79. Payne VG, Isaacs LD. Human Motor Development: A Lifespan Approach[M]. 2020. Yu S. The individualized educationprogram (IEP): a dilemma and the development trend. Chinese Journal of Special Education 2015, (3): 3–8 + 27. Sigman M, Ruskin E, Arbelle S, et al. Continuity and change in the social competence of children with autism, Down syndrome, and developmental delays. Monographs of the society for research in child development, 1999: i-139. Battaglia G, Agrò G, Cataldo P, et al. Influence of a specific aquatic program on social and gross motor skills in adolescents with autism spectrum disorders: Three case reports. Journal of functional Morphology and Kinesiology, 2019, 4(2): 27. Lin C. Developmental psychology. ZheJiang Education Publishing House༌2004.47. Battaglia G, Agrò G, Cataldo P, et al. Influence of a specific aquatic program on social and gross motor skills in adolescents with autism spectrum disorders: Three case reports. Journal of functional Morphology and Kinesiology, 2019, 4(2): 27. Sigmund F. Developmental psychology. Wadsworth Publishing House, 2009. Zhang W. Individualized education and teaching for intellectually disabled children. Chongqing Publishing House, 2005. Liu J, Yu S. The problems about individualized educational program of children with autism. Journal of Suihua University, 2017, (1): 70–73. Barnett LM, Van Beurden E, Morgan PJ, et al. Childhood motor skill proficiency as a predictor of adolescent physical activity. Journal of adolescent health, 2009, 44(3): 252–259. Battaglia G, Agrò G, Cataldo P, et al. Influence of a specific aquatic program on social and gross motor skills in adolescents with autism spectrum disorders: Three case reports. Journal of functional Morphology and Kinesiology, 2019, 4(2): 27. Additional Declarations No competing interests reported. Supplementary Files SupplementaryMaterial.doc Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 12 Oct, 2025 Reviewers agreed at journal 07 Oct, 2025 Reviewers invited by journal 06 Oct, 2025 Editor invited by journal 03 Sep, 2025 Editor assigned by journal 03 Sep, 2025 Submission checks completed at journal 03 Sep, 2025 First submitted to journal 17 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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2","display":"","copyAsset":false,"role":"figure","size":106223,"visible":true,"origin":"","legend":"\u003cp\u003eFrequency of repetitive stereotyped behaviors for (a) Case B and (b) Case D during the intervention process.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7390564/v1/54665e4d2bed3236562b8a09.png"},{"id":93776403,"identity":"8c90465a-410d-4195-a279-b4ef14f27b54","added_by":"auto","created_at":"2025-10-17 12:37:31","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":90286,"visible":true,"origin":"","legend":"\u003cp\u003eDuration of repetitive stereotyped behaviors for (a) Case B and (b) Case D during the intervention process.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7390564/v1/7e00b78b11216ef1b6fc11af.png"},{"id":93776412,"identity":"06c43671-6a33-4812-a4fa-0f952322257c","added_by":"auto","created_at":"2025-10-17 12:37:31","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":180867,"visible":true,"origin":"","legend":"\u003cp\u003ePositive communication times for (a) Case B and (b) Case D during the intervention process.\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7390564/v1/99eac260a1b986cc4505cea7.png"},{"id":93780931,"identity":"da40bd1a-27cd-4f3a-8ec0-52f33ebd7e3f","added_by":"auto","created_at":"2025-10-17 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Introduction","content":"\u003cp\u003eAutism is a pervasive neurodevelopmental disorder with complex etiology, which often develops in early childhood and is characterized by two core symptoms: repetitive and stereotyped behavior patterns and social communication/interaction disorders\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e1\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. According to statistics from the Centers for Disease Control and Prevention of the United States, the prevalence of autism in children has increased from 1:54 in 2020 to 1:36 in 2023\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e2\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. In 2022, the Autism Screening and Intervention Service Specifications for Children Aged 0\u0026ndash;6 issued by the National Health Commission showed that the prevalence of autism in children in China is about 7%\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e3\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. Consequently, the continued increase in the incidence of autism worldwide has posed a severe challenge to the country and society, which has become a major public health issue that urgently requires global attention and response.\u003c/p\u003e\u003cp\u003eIn recent years, with the advancement of medical technology and the improvement of public awareness of the ASD which China has paid more and more attention to, the national policies and social resources have gradually tilted towards children with ASD. After the 20th National Congress of the Communist Party of China, the main goals and tasks have gradually been implemented from \u0026ldquo;representing the interests of the broad masses of the people\u0026rdquo; to the indicator of \u0026ldquo;no one can be left behind\u0026rdquo;. As a special group in public health emergencies, how to improve the physical and mental health of children with ASD is not only an important factor in building a healthy China and a strong sports country, but also a key link in achieving the goal of universal health coverage.\u003c/p\u003e\u003cp\u003eIn order to improve the physical and mental health of autistic patients, especially children, currently used intervention methods include behavioral therapy, drug therapy, speech therapy, sensory integration training, exercise intervention and other means. Among them, behavioral therapy (such as applied behavior analysis, ABA) has a significant effect on improving the behavioral and social skills of autistic children. However, ABA therapy requires the guidance of professionally trained behavior analysts and requires long-term, high-intensity training, which places a large time and financial burden on families. Although drug treatment is quick-acting and can relieve symptoms in a short period of time, it can have side effects (such as drowsiness, weight gain, gastrointestinal discomfort, etc.) and cannot fundamentally solve the core symptoms of autism. The intervention effects of speech therapy and sensory integration therapy vary significantly among individuals. Exercise intervention is receiving increasing attention because it is consistent with the physiological and psychological characteristics of autistic children.\u003c/p\u003e\u003cp\u003eTo further improve the physical and mental health of autistic children from the perspective of physical education, such as improving basic motor abilities, improving physical activities and physical functions, and improving the interaction between individuals and the environment\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e4\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e5\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, empirical domestic and foreign research on the physical and mental health of children with ASD as well as its health intervention has been carried out in an orderly manner. Although preliminary results have been achieved, the results are uneven, the scope of application is narrow and the promotion is poor\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e6\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e7\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e8\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. With the promulgation of national and social policies and regulations for special children and the increase in funding investment, physical intervention methods are also constantly developing. For example, a personalized teaching model based on physical activities (a teaching model that considers children\u0026rsquo;s basic abilities, personality traits, interests and hobbies\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e9\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e) has been launched in Peizhi schools in first-tier cities, such as Beijing and Shanghai. Even if this model adopts class teaching and one-to-one rehabilitation courses, how to accurately grasp the exercise needs of different types of children and how to build an efficient, fair and equal participation program still needs further exploration.\u003c/p\u003e\u003cp\u003eTo this end, this study developed a personalized exercise intervention plan for 2 autistic children with intellectual disability and prominent symptoms, and explored the effect of exercise intervention, with a view to enriching case studies on children with ASD and providing a basis for formulating personalized and rational plans. It is hoped that this study can provide a reference for exercise intervention programs for children with ASD.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1. Participants\u003c/h2\u003e\u003cp\u003eThe experimental subjects were two children with ASD, who were selected from a special education school in Shanghai. The two children behaved indifferently during class, often together with screaming, clapping, slapping their heads, and spitting everywhere, which affected the normal teaching order. After consultation between the school and parents and after the parents filled out the informed consent form, they were selected as candidates to participate in this experimental activity. Afterwards, the Jingwei Center diagnosed that the two candidates met the diagnostic criteria for autism in the Diagnostic and Statistical Manual of Mental Disorders (5th edition)\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e10\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, and neither of them had taken medication in the past 3 months. The cases were tested using the Wechsler Intelligence Scale for Children (2-in-1) and the Childhood Autism Rating Scales (CARS). The results were as follows: Case B had an intelligence score of less than 45 and a CARS score of 40; Case D had an intelligence score of less than 45 and a CARS score of 38. It can be seen that both children have intellectual disabilities. The background information of the two children was obtained through interviews and observations as follows.\u003c/p\u003e\u003cdiv id=\"Sec4\" class=\"Section3\"\u003e\u003ch2\u003e1.1.1. Interview of Guardians\u003c/h2\u003e\u003cp\u003eCase B (pseudonym, male, 8.17 years old, delivered by caesarean section) was found by parents that the child was behind in language and social interaction at around 4 years old, and was diagnosed with ASD at 5 years old. No obvious abnormalities were found in his brain MRI scan, and the electroencephalogram (EEG) test showed that the indicators were within the normal range. As for the main manifestations, he unconsciously pronounced \u0026ldquo;Baba, mama\u0026rdquo; before 1 year old, and afterwards, his progress was slow, with occasional spontaneous speech or talking to himself. Although he could point to objects and selectively listen to instructions, he could not concentrate for a long time, sit still or stand still. He also knows simple numbers from 1 to 10, and has a good memory, and likes to flap hands and spit ptysis.\u003c/p\u003e\u003cp\u003eCase D (pseudonym, female, 9.42 years old, born naturally) was diagnosed at 6 years old, and her genetic diagnosis of fragile X chromosome syndrome was normal. As for the main manifestations, most of her language skills are imitation, and occasionally she can write imaginative sentences. Moreover, she likes to flap head, shake hands and spit ptysis, but does not like to interact with his peers, nor share/show off.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section3\"\u003e\u003ch2\u003e1.1.2. Observation of Researchers\u003c/h2\u003e\u003cp\u003eCase B can simply flip through books, but does not know why he flips through them, and also can fold simple triangles and paper airplanes. He gets nervous around strangers or crowded places, and avoids eye contact, while sometimes he walks around aimlessly. He has a good sense of music and can play the piano.\u003c/p\u003e\u003cp\u003eCase D is used to sitting alone or going to the toilet frequently, for example, she goes to the toilet after every class, and if does not go, she will keep shouting or talking to herself. Occasionally, she can accept being forced not to go to the toilet. After going to the toilet, she likes to pull up his pants outside the toilet, and if any step is missing, she will go to the toilet again and repeat all the steps. She likes to pass and dribble the ball, but cannot dribble the ball at a fixed position, and the dribble height is low. Additionally, when participating in a favorite project, she would like actively to participate, but when encountering a more difficult project or there are many companions, she tends to escape and retreat. Being praised by familiar teachers is also one of her hobbies.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e1.2. Methodology\u003c/h2\u003e\u003cdiv id=\"Sec7\" class=\"Section3\"\u003e\u003ch2\u003e1.2.1. Physical Intervention\u003c/h2\u003e\u003cp\u003eThis study adopted a cross-subject multiple baseline design. Referring to the German medical training therapy (MTT) training model, the standard of 2016 China Special Needs School \u0026ldquo;Sports and Health Rehabilitation Course\u0026rdquo;, and the research plan of Bo and Dong, a 16-week and 3-stage personalized exercise training program was developed. The first stage is the basic training stage (weeks 1\u0026ndash;5). After communication with parents, basic information of the children was collected and sorted out. At the same time, professionals evaluated the children\u0026rsquo;s physical activity, physical fitness level, motor development and core symptoms through their behavioral performance. Based on this, the intervention goals of Case B and Case D were preliminarily determined. The overall goal of the intervention was to promote the sports participation of the children and improve their health level. The sub-goals of the intervention were to help Case B improve his attention during the intervention process, promote better emotional communication between teachers and students, strengthen interaction, improve the case\u0026rsquo;s sense of self-efficacy, enable him to actively express himself, actively participate and feedback his personal feelings. As for Case D, it aimed to reduce the behaviors of slapping his head, shaking his head and spitting, and establish a sense of familiarity and trust with other children by increasing the case\u0026rsquo;s interest, timely feedback on his meaningful behavior, and positive evaluation of his performance, and promote his level of sports participation. The second stage is the consolidation training stage (weeks 6\u0026ndash;10), in which children were intervened in the sports rehabilitation room according to the preset plan. The intervention content was adjusted temporarily according to the children\u0026rsquo;s feedback from participation, and meanwhile the coach took the initiative to initiate tasks and further guide children to participate. The third stage is the strengthening training stage (weeks 11\u0026ndash;16), in which the coach mainly arranged tasks to promote children\u0026rsquo;s active completion and to make them experience a sense of success. In this process, by recording the activities of children with teachers and peers in natural teaching situations, observing and analyzing the laws of children\u0026rsquo;s physical and mental development, the foundation was laid for children to actively integrate into society. Videos were recorded at each intervention stage to record the activities of children so that further observations could be made after class, and the performance of children could be analyzed comprehensively, in-depth and meticulously. Based on the observation records and communication with parents, the intervention plan was continuously optimized to ensure the operability and effectiveness of online intervention. According to the physical and mental characteristics of children with ASD in special schools, training goals for different stages were designed, and corresponding strategies and training plans were provided at the same time to ensure the smooth completion of the preset intervention activities and intervention effects at each stage.\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eThe first stage: Basic training stage\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eTraining objectives: Through participatory observation and video analysis of the characteristics of individual children, observe and record physical activities, health and fitness, motor development level, and symptom characteristics, gradually establisha sense of familiarity and trust with children, and provide support for the implementation of intervention and guarantee of results. In combination with the physical and mental characteristics of children, personalized rehabilitation plans should be design to guide children to participate, reduce sedentary behavior, and guide children to show behaviors consistent with the created situation when participating sports.\u003c/p\u003e\u003cp\u003eTraining strategy: During the intervention process, attention should be paid to the use of reinforcers and the selection of materials, and the difficulty of tasks is reduced through decomposition exercises.\u003c/p\u003e\u003cp\u003eTraining plan: The core of segmental rehabilitation training is to promote children\u0026rsquo;s sports participation and behavioral performance through physical movement skills. The preparation part includes teachers and students greeting (roll call answering), standing or sitting at a fixed point, and warming up with animal imitation exercises related to skills. Teachers and students must greet each other in every class, emphasizing \u0026ldquo;answering\u0026rdquo;, and the form could be diversified, such as language, body or eye contact. In the basic part, the learning of each skill requires decomposition exercises, and the difficulty and progress of teaching can be flexibly adjusted according to the physical and mental characteristics and actual conditions of the children. Through games, skills are consolidated or different limb functions are practiced, and attention should be paid to children\u0026rsquo;s awareness of waiting, cooperation and competition. In the end, the focus is on stretching the muscles used in the training process, reviewing the content learned, paying attention to the participation of children, and providing timely feedback on children\u0026rsquo;s performance, with encouragement as the main focus. At the same time, children\u0026rsquo;s classroom performance is recorded, and summaries and adjustments are made after class. Notably, the training duration is 5 weeks, 3 times/week, 60 minutes/time, and the specific training content is shown in Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003col start=2\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eThe second stage: Consolidation training stage\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eTraining objectives: The consolidation training stage aims to enhance the awareness of participation in learning tasks of individual children, and further, to promote their physical flexibility and coordination. Under the guidance of teachers, individual children can abide by the rules of activities, reduce waiting and watching time, and increase imitation time.\u003c/p\u003e\u003cp\u003eTraining strategy: Visual prompt strategies, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, are used to attract children\u0026rsquo;s intentional attention, and meanwhile, the frequency of reinforcers used should be reduced. According to the actual performance of children, gradual transition from freehand activities to object manipulation exercises, as well as repetition and decomposition exercises are used to promote the motor skills acquisition and appropriate behavior performance of children.\u003c/p\u003e\u003cp\u003eTraining plan: The consolidation training is mainly used to promote children\u0026rsquo;s sports participation and behavior performance with object control skills. In the preparation part, under the guidance of teachers, children and teachers complete the placement of equipment together, and teachers can respond consciously during the roll call. In the basic part, children actively participate in object control skills exercises and experience a sense of success through interaction with teachers. In the end, children assist teachers in completing the task of returning equipment. Notably, the training duration is 5 weeks, 3 times/week, 60 minutes/time, and the specific training content is shown in Table S2.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003col start=3\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eThe third stage: Strengthening training stage\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eTraining goals: Strengthening training aims to significantly reduce children\u0026rsquo;s sitting behavior, increase their enthusiasm for sports participation, improve their completion and effectiveness of learning tasks, and at the same time, enable children to actively demonstrate appropriate behaviors in the created environment.\u003c/p\u003e\u003cp\u003eTraining strategy: This stage mainly focus on verbal prompts, and repeated exercises are applied to consolidate children\u0026rsquo;s behavioral performance. In the process of children\u0026rsquo;s participation, children\u0026rsquo;s ability to complete learning tasks independently is strengthened through the gradual withdrawal of assistance.\u003c/p\u003e\u003cp\u003eTraining plan: The core task of the consolidation training period is to create a positive environment and increase children\u0026rsquo;s sports participation time. In the preparation part, children can consciously practice following the warm-up music, understand the teaching content according to the teacher\u0026rsquo;s verbal prompts, and actively participate in the placement of equipment. In the basic part, children complete learning tasks step by step and improve their self-efficacy. At the end of the session, the children take the initiative to relax along with the music, and with the teacher\u0026rsquo;s gradual withdrawal strategy, they stretch and recover the equipment independently. Among them, the training duration is 6 weeks, and it is carried out 3 times/week, 60min/time. The specific arrangement is shown in Table S3.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section3\"\u003e\u003ch2\u003e1.2.2 Testing\u003c/h2\u003e\u003cp\u003e(1) Physical activity. The ActiGraph GT3X\u0026thinsp;+\u0026thinsp;accelerometer was used to assess the daily sedentary, low-intensity, moderate-intensity, and high-intensity physical activity time of children. Before the test, the researchers initialized the accelerometer and set the test time. Then, they distributed the accelerometer to the children, demonstrated how to wear it, and explained the relevant precautions. The children were required to wear the accelerometer on their right hip for one week, during which their guardians were informed in the consent form that the children had to wear it from waking up in the morning to going to bed at night, except the bathing or swimming time. Afterwards, the researchers used ActiLife (Version 5.5.5) to export the raw data and screened the data based on the criteria that each data item included at least 5 school days and 2 weekend wearing days, and the wearing time was not less than 8 hours per day. Finally, Kinesoft software was used to extract, process, and analyze the physical activity data.\u003c/p\u003e\u003cp\u003e(2) Health and physical fitness. By reviewing relevant research on autistic children and combining it with the actual situation of the children, four test indicators for healthy physical fitness were determined as follows, including the body composition (BMI, waist-to-hip ratio), cardiopulmonary function (Pacer 20m), muscle strength and endurance (vertical jump, grip strength and 1-minute sit-ups), and flexibility (new sit-up).\u003c/p\u003e\u003cp\u003e(3) Basic motor skills. Regarding the assessment of basic motor skills, Chinese scholars, such as Ning Ke\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e11\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, Diao Yucui\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e12\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, employed the third version of the Test of Gross Motor Development 3 (TGMD-3) to test normal children of different age groups, and they found that the scale had good reliability and validity. Given that the TGMD-3 is applicable to children aged 3\u0026ndash;10 years and its main test content includes displacement skills and object control skills\u003csup\u003e[8]\u003c/sup\u003e, the TGMD-3 was used to assess the basic motor abilities of the children. Physical activity, health and physical fitness were tested four times, including the 1st, 6th, 11th, and 16th week.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\u003ch2\u003e1.2.3. Observation\u003c/h2\u003e\u003cp\u003e(1) Junfeng Xiao\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e13\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, Xiaodong Tian\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e14\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, Fei Zan\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e15\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, Biyu Cui\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e16\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e and other scholars have used the \u0026ldquo;ABC Behavior Observation Record Form\u0026rdquo; in their research on repetitive stereotyped behaviors in autism, and the results show that its reliability and validity were good. Therefore, this study used the ABC Behavior Observation Scale as a tool to record the frequency and duration of repetitive stereotypes in individual children and evaluate their repetitive stereotyped behaviors. The behavioral observation was conducted 3 times/week, and the average value was used as the reported result.\u003c/p\u003e\u003cp\u003e(2) A self-compiled \u0026ldquo;Active Communication Behavior Observation Record Form\u0026rdquo; was used to record the method, frequency, content and behavioral function of the individual's active communication behavior during the baseline and intervention periods, respectively.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section3\"\u003e\u003ch2\u003e1.2.4. Interview\u003c/h2\u003e\u003cp\u003eDuring the baseline period, teachers and guardians were interviewed to understand the basic situation, physical activities, health and fitness, motor development, preferences and interests of the children. During the intervention period, teachers were interviewed weekly to understand the classroom performance and teaching implementation of the children. After the intervention, a self-made semi-structured interview outline of \u0026ldquo;Social Perspective Interview\u0026rdquo; was used to investigate the satisfaction and acceptability of the intervention among teachers, teaching managers and parents.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section3\"\u003e\u003ch2\u003e1.2.5 Condition control\u003c/h2\u003e\u003cp\u003eThe implementation of the program maintained consistent lighting and temperature, and a double-blind experimental design was used to eliminate interference factors of the children and teachers. In order to improve the compliance of the children with physical activities, this study adopted appropriate teaching methods and strategies, and used piano, music and food as rewards to fully mobilize the children\u0026rsquo;s enthusiasm for participation and ensure the smooth implementation of the physical intervention program. At the same time, the researchers integrated into the living environment of the children and conducted covert observations of the children\u0026rsquo;s daily social life, mainly including consistency tests in scoring (maintaining the reliability of the evaluation between the scorers at 86%) and recording the participation of the children in the activities. In addition, the researchers communicated with relevant personnel in the form of semi-structured interviews to explore the effect of the implementation of the program, and the interview content was recorded to maximize and effectively record the changes of teachers and children during the intervention process.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"2. Results and Analyzation","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Analysis of test results on physical activity, health fitness and basic motor skills\u003c/h2\u003e\u003cp\u003eDuring the basic training, intensive training and consolidation training stages, the physical activity (PA) of Case B and D significantly decreased their sitting time as the intervention time prolonged, and their low-intensity physical activity (LPA), medium-high intensity (MVPA) and total physical activity (TPA) all increased significantly as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Therefore, it can be judged that the physical activity level of Case B and D has been improved after the exercise intervention.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eChanges in physical activity at different stages\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePhysical activity\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWeek 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eWeek 6\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eWeek 11\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eWeek 16\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCase B\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSB\u003c/p\u003e\u003cp\u003eLPA\u003c/p\u003e\u003cp\u003eMVPA\u003c/p\u003e\u003cp\u003eTPA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e533.27\u003c/p\u003e\u003cp\u003e77.53\u003c/p\u003e\u003cp\u003e27.26\u003c/p\u003e\u003cp\u003e104.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e443.62\u003c/p\u003e\u003cp\u003e216.49\u003c/p\u003e\u003cp\u003e87.7\u003c/p\u003e\u003cp\u003e304.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e398.36 378.74\u003c/p\u003e\u003cp\u003e119.11 497.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e243.2\u003c/p\u003e\u003cp\u003e444.92\u003c/p\u003e\u003cp\u003e162.31\u003c/p\u003e\u003cp\u003e607.23\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCase D\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSB\u003c/p\u003e\u003cp\u003eLPA\u003c/p\u003e\u003cp\u003eMVPA\u003c/p\u003e\u003cp\u003eTPA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e432.74\u003c/p\u003e\u003cp\u003e43.25\u003c/p\u003e\u003cp\u003e12.53\u003c/p\u003e\u003cp\u003e55.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e421.87\u003c/p\u003e\u003cp\u003e173.98\u003c/p\u003e\u003cp\u003e24.31\u003c/p\u003e\u003cp\u003e98.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e394.25\u003c/p\u003e\u003cp\u003e192.77\u003c/p\u003e\u003cp\u003e43.46\u003c/p\u003e\u003cp\u003e236.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e214.58\u003c/p\u003e\u003cp\u003e201.44\u003c/p\u003e\u003cp\u003e48.98\u003c/p\u003e\u003cp\u003e250.42\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn terms of Health-related Physical Fitness (HRPF), Case B and D showed significant improvement after exercise intervention. This is specifically reflected in the significant improvement in body composition (BMI), muscle strength and endurance (grip strength), and flexibility (forward bending in the new sitting position) as shown in Table S4. This result shows that the health fitness levels of Case B and D have improved to varying degrees after physical intervention.\u003c/p\u003e\u003cp\u003eIn terms of fundamental movement skills (FMS), Case B and D showed significant improvement after sports intervention, which was specifically reflected in the significant improvement in the total score and the sub-dimensions of object control skills, and there were also significant changes in displacement skills, as shown in Table S5. This result shows that exercise intervention can effectively improve the basic motor skills of Case B and D, especially the object control skills.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Analysis of the symptom observation form\u003c/h2\u003e\u003cp\u003eThe observation method was used to analyze the changes in the frequency and duration of children\u0026rsquo;s behaviors at different stages. In terms of the repetitive stereotyped behaviors as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, the frequencies of flapping hands and spitting ptysis for Case B were decreased by 18% and 17.7%, respectively, while the frequencies of flapping and shaking head for Case D were decreased by 25% and 17.7%, respectively. In terms of duration as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, the durations of flapping hands and spitting ptysis for Case B were decreased by 24.7 s and 66.7 s, respectively, and the duration of flapping and shaking head for Case D were decreased by 32.3 s and 145.9 s, respectively. Overall, the frequency and duration of stereotyped behaviors of both Child B and Child D were decreased at different intervention stages, indicating that exercise intervention has a positive effect on children\u0026rsquo;s stereotyped behaviors.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows the changes in the communication behaviors of Case B and D at different stages. It can be found that the average communication number of Case B is 9.81 times, and the number of positive communications increased from 3 times to 18 times, while the average communication number of Case D is 8.38 times, and the number of positive communications increased from 2 times to 14 times. It is obvious that compared with those of children before the intervention, both the number of positive communication times of the children in one week and the average number of active communication times during the entire intervention period increased significantly after the intervention. This result indicates that physical intervention can effectively improve the communication ability of children with ASD.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Discussion","content":"\u003cp\u003eThis study explored the effects of exercise intervention on the physical and mental health of children with ASD, and the main findings are as follows.\u003c/p\u003e\u003cp\u003eAfter the intervention, the physical activity level of both the two children was increased, especially in terms of reducing sedentary behavior and increasing low-intensity physical activity, which should be related to the design of the intervention program. During the intervention, children were encouraged to increase their physical activity level through intervention time based on the characteristics of children\u0026rsquo;s motor development. This result is ascribed to the duration and frequency of the intervention, which is similar to that of Jozkowski\u0026rsquo;s study \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e17\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eFurthermore, the health and physical fitness level of the children improved after the physical intervention, which was more prominent in body composition, muscle strength and flexibility. The possible reasons are that, on the one hand, the learning of motor skills can directly promote the improvement of children\u0026rsquo;s neuromuscular coordination and recruitment ability, improve the coordination and integration ability of the brain\u0026rsquo;s nervous system pathways, and thus promote the development of muscle fitness. In addition, the intervention content design of this study requires children to practice and repeat many times. The improvement of motor skills can often make children more involved in repeated practice activities, so that the body gradually develops good adaptability to exercise load \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e18\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. On the other hand, with the improvement of the basic motor skills the physical activity participation level of the children has increased, which is conducive to the development of their healthy physical fitness. Therefore, the intervention effect of the intervention program on muscle fitness is also achieved through the indirect way of promoting physical activity.\u003c/p\u003e\u003cp\u003eIn terms of the level of movement development, the movement level of the children was improved after the intervention, especially the object control skill level which was improved significantly. After Debolt conducted regular exercise intervention on three cases, the children\u0026rsquo;s basic motor skills have been improved\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e19\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. After Colombo conducted standing jump and two-handed hitting exercises on two cases, the children\u0026rsquo;s standing jump and two-handed hitting abilities also have significantly improved\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e20\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. In this study, the improvement in the children\u0026rsquo;s motor development review may be related to targeted practice, which provides more opportunities for learning and practice.\u003c/p\u003e\u003cp\u003eAt the same time, the development of basic motor skills in childhood was the cornerstone for participating in various leisure activities and acquiring advanced motor skills, and the proficiency of motor skills was positively correlated with the level of physical activity and health in adolescence and adulthood\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e21\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. According to dynamic system theory, children\u0026rsquo;s development patterns and trajectories changed over time as a result of the interaction of different factors\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e22\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. For autistic individuals, their development process was complex, and the interaction between the environment and the organism played an important role\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e23\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e24\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIn addition, the children also showed some improvement in core symptoms after the intervention, which may be related to the influence of family and school. Family and school are the main places for autistic children to engage in activities\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e25\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. Due to the defects in core symptoms, children with ASD face major challenges in integrating into daily life\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e26\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e27\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. In terms of family environment, the consistency of parents or guardians with school goals and the way of implementation will affect the development of autistic children. In schools, targeted basic motor skills programs suitable for children with ASD are carried out to meet their personalized development needs. During the intervention process, attention is paid to children\u0026rsquo;s sports participation, which can gradually guide them to acquire specific sports skills\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e28\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e29\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. As the practice deepens, children gradually transition from the initial autism and bystander state to parallel, parallel perception and meaningful participation, and can discuss activities related to basic motor skills in daily life. For example, when a child passes by the playground, the children can take the initiative to say the introduction of the social situation in the running teaching process, such as \u0026ldquo;Teacher, I can run here.\u0026rdquo; When children with ASD strengthen the skills which they have learned, they will establish a connection between their daily life and the intervention content. Moreover, Family and school are considered as the main learning places for children with ASD, and thus, parents, guardians and teachers need to give children with ASD appropriate guidance. In the intervention stage, teachers can use key response teaching methods and prompting strategies based on the actual performance of children to further create situations and encourage children to participate in teaching more attentively and patiently.\u003c/p\u003e\u003cp\u003eZhang Wenjing\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e30\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, Liu Jianan\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e31\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e, and others believe that in individualized education and teaching, teachers should focus on the interests and actual conditions of autistic children, and the design of teaching should consider the two questions of \u0026ldquo;why\u0026rdquo; and \u0026ldquo;how to do it\u0026rdquo;, and use a variety of interactive strategies to pay attention to the attention and motor interests of autistic children. For example, Case B had a strong sense of music. After two weeks of intervention, Case B could walk to the teacher before each class, imitate the warm-up activities accompanied by music at the beginning, and further take the initiative to express his willingness to help the teacher turn on the speakers. After the teacher gave positive feedback, Case B would focus more on the warm-up activities. For example, if the speaker was turned on at an inappropriate time, the teacher would remind Case B to establish a sense of rules. Before the intervention, Case D could not understand the verbal instructions to turn on the speakers before class and during the stretching and relaxation session. After structured teaching, Case D could understand what should be done in a certain time period and position until he established the correct awareness. In summary of the whole process, the teacher gave positive feedback and support based on Case D\u0026rsquo;s performance. After Case D received full attention in the one-on-one session, she would become more confident in interacting with the teacher and gradually increased the time which she participated in interactive activities with the teacher.\u003c/p\u003e\u003cp\u003eFrom the measurement results, the physical and mental health of children with ASD improved after the intervention, which indirectly reflects that they participate in sports. By participating in sports, they could recognize, learn and consolidate skills, which has a positive impact on the physical and mental health of children with ASD to a certain extent. The targeted design of exercise programs for children with ASD and the development of their perceptual abilities after intervention increased their motivation and interest in exercise\u003csup\u003e[\u003c/sup\u003e\u003csup\u003e32\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e33\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. For example, it is directly reported by the parents and teachers of Case B that the children with ASD after 4 weeks of intervention would like to participate in the intervention on their own initiative, and could also say to teachers and parents, \u0026ldquo;I like sports\u0026rdquo; and \u0026ldquo;Let\u0026rsquo;s go to the sports room.\u0026rdquo; This phenomenon was also reflected in the fact that after the intervention, when Case B was able to see the teacher, he held the teacher\u0026rsquo;s hand and went to the gym. During the test, the attention of the children with ASD was more focused, waiting for the research team to demonstrate and then repeat the same action, which was in sharp contrast to the indifference in the pre-test. Additionally, this study also found that during the intervention process, the attention of parents and teachers can also increase the organic connection between home and school. Children\u0026rsquo;s participation in activities depends on their acceptance and trust in the activities, which to a certain extent also establishes the connection from home to school in the daily life of autistic children. It can be seen that by creating specific situations, the core symptoms of children with ASD can be improved, thereby promting their all-round development.\u003c/p\u003e\n"},{"header":"4. Conclusions and Limitations","content":"\u003cp\u003eAfter the 16-week exercise intervention program, the physical activity and health fitness levels of the two children were significantly improved, including sedentary behavior, low-intensity physical activity, body composition, muscle strength and flexibility. Furthermore, their motor development level and object control skills were significantly improved, and there was also a certain improvement of the stereotyped and communication behavior. At the same time, The results also show that the exercise intervention program developed for individual cases is a new method that can effectively help autistic children recover physically and mentally. This study aims to enrich the relevant research on individual autistic children and provide a reasonable reference for the development of personalized and rational exercise intervention for children with ASD.\u003c/p\u003e\u003cp\u003eHowever, the following issues are still need to be paid attention to in the following studies. First, it needs to be paid attention to the impact of the establishment of self-awareness on the enthusiasm of children with ASD in sports participation. In view of the individual problems of children ASD, personalized education is adopted to provide them with different situations. Interactions in different situations require children to establish a correct self-concept. Facing the challenges of conflicts between rules and individual spontaneous behaviors that children encounter in different situations, the establishment of self-awareness helps them overcome their initial fear and avoidance of things. Therefore, in the intervention process and personalized education, it is important to study the impact of self-awareness on basic motor skills, behavioral control, and social interaction. for children with ASD.\u003c/p\u003e\u003cp\u003eSecond, social interaction skills and their changes during the interaction process also have a great impact on the physical and mental recovery of children with ASD. The creation of a family atmosphere and the guidance and support of parents and teachers are very important for children to fully engage in sports, and furthere, can consolidate the skills they have learned in the process. It can be seen that studying the interaction among children with ASD, teachers, parents, and peers is also an important factor in deepening autistic children's understanding skills, and further achieving internalization.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cb\u003eEthics and dissemination\u003c/b\u003e\u003c/p\u003e\u003cp\u003e The study was conducted according to the guidelines of the Declaration of Helsinki and was approved by the Ethics Committee of Shanghai University of Sport (protocol code 102772020RT054 on May 9, 2020), the trial registration of which was included the report of a trial registration number (ChiCTR2200056090).\u003c/p\u003e\u003ch2\u003eInformed Consent Statement\u003c/h2\u003e\u003cp\u003eInformed consent was obtained from all parents or guardian of the participants involved in the study.\u003c/p\u003e\u003ch2\u003eConflicts of Interest\u003c/h2\u003e\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis work was supported by the Hainan Higher Education Educational Reform Research Project (Grant Nos. Hnjg2024-30), Hainan University Innovation and Entrepreneurship Education Project (Grant No. hdcxcy2023-3), Open Project of Hainan Provincial Key Laboratory of Sports and Health Promotion (Grant No. HNYJZ2023004), 2024 Youth Scholar Support Fund Program of Hainan University, and Annual Planning Project of Philosophy and Social Sciences in Hainan Province, HNSK(YB)25\u0026ndash;52.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eYu Xing: Conceptualization, Methodology, Software, Formal Analysis, Data Curation, Writing \u0026ndash; Original Draft, Project Administration, Funding Acquisition.; Haoyan Liu: Validation, Resources, Supervision; Liang Li,Yongming He: Investigation, Project Administration, Funding Acquisition; Xueping Wu: Conceptualization, Validation, Writing \u0026ndash; Review \u0026amp; Editing, Visualization, Project Administration.\u003c/p\u003e\u003ch2\u003eAcknowledgments\u003c/h2\u003e\u003cp\u003eWe would like to thank the teachers of Shanghai and Wuhu School for their support and also thank the children who contributed to this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe date presented in this study are available on request the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cspan\u003eXing Y. 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The problems about individualized educational program of children with autism. Journal of Suihua University, 2017, (1): 70\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eBarnett LM, Van Beurden E, Morgan PJ, et al. Childhood motor skill proficiency as a predictor of adolescent physical activity. Journal of adolescent health, 2009, 44(3): 252\u0026ndash;259.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eBattaglia G, Agr\u0026ograve; G, Cataldo P, et al. Influence of a specific aquatic program on social and gross motor skills in adolescents with autism spectrum disorders: Three case reports. Journal of functional Morphology and Kinesiology, 2019, 4(2): 27.\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Autism spectrum disorder, Children, Physical activity, Movement development, Health-related fitness","lastPublishedDoi":"10.21203/rs.3.rs-7390564/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7390564/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective and setting\u003c/strong\u003e: Physical intervention program has been revealed to be efficatcious to assist the physical and mental rehabilitation of children (primary student) with autism spectrum disorder (ASD). Therefore, this study aims to explore the effects of exercise intervention on the physical and mental rehabilitation of children with ASD, and provide a reference for expanding behavioral intervention methods for autism.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDesign\u003c/strong\u003e: According to the physical and mental characteristics of children with ASD, a 16-week, three-stage rehabilitation program was designed and implemented. During the training period, measurement methods such as ActiGraph GT3X+, Health Related Physical Fitness (HRPF), Test of Gross Motor Development 3 (TGMD-3), and ABC Behavior Observation Scale were used to evaluate the effects of rehabilitation training at each stage.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: After completing the targeted intervention, the physical acvtivity of the two children was significantly promoted at a healthy physical fitness level, including the decreased sedentary behavior (\u003cem\u003eM\u003c/em\u003e\u003csub\u003echange\u003c/sub\u003e=290.07 d/min, 218.16 d/min), the increased low-intensity physical activity (\u003cem\u003eM\u003c/em\u003e\u003csub\u003echange\u003c/sub\u003e=367.39 d/min, 158.19 d/min), the increased moderate/high-intensity physical activity (\u003cem\u003eM\u003c/em\u003e\u003csub\u003echange\u003c/sub\u003e=135.05 d/min, 36.45 d/min), and the increased total physical activity (\u003cem\u003eM\u003c/em\u003e\u003csub\u003echange\u003c/sub\u003e=502.44 d/min, 194.64 d/min). In terms of healthy physical fitness level, the body mass index (BMI) of the the children with ASD was decreased (\u003cem\u003eM\u003c/em\u003e\u003csub\u003e\u003cem\u003echange\u003c/em\u003e\u003c/sub\u003e=0.7, 4.92), together with the increased grip strength (\u003cem\u003eM\u003c/em\u003e\u003csub\u003echange\u003c/sub\u003e=1.8, 4.2) and forward bending in the new sitting position (\u003cem\u003eM\u003c/em\u003e\u003csub\u003echange\u003c/sub\u003e=4.3, 5.6). In terms of basic motor skills, the total score of the children with ASD was increased (\u003cem\u003eM\u003c/em\u003e\u003csub\u003echange\u003c/sub\u003e=4, 10), especially the object control skill score (\u003cem\u003eM\u003c/em\u003e\u003csub\u003echange\u003c/sub\u003e=4, 7). In terms of the physical behavior, the frequency and duration of stereotyped behaviors of the two children were decreased. In addition, the positive communication times of the two children were also increased (\u003cem\u003eM\u003c/em\u003e\u003csub\u003echange\u003c/sub\u003e=14, 12).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: After the 16-week exercise intervention, the physical activity and healthy fitness levels of autistic children were significantly improved, especially in terms of sedentary behavior, low-intensity physical activity, body composition, muscle strength and flexibility, movement development level and object control skills. Furthermore, the behavior was improved to some extent, while the communication ability was also effectively promoted. In the following stage, it is suggested to further optimize the personalized exercise intervention program that adapts to the physical and mental characteristics of autistic children, and strengthen the organic interaction between schools and families, so as to ultimately improve the overall health of children.\u003c/p\u003e","manuscriptTitle":"How physical intervention program influence physical and mental rehabilitation of children with autism spectrum disorder: A case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-17 12:37:26","doi":"10.21203/rs.3.rs-7390564/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-10-12T13:57:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"86659198604889874441650211016051684025","date":"2025-10-07T17:55:13+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-06T15:30:09+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-03T20:27:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-03T15:14:09+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-03T15:13:54+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2025-08-17T05:28:29+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fad2f47f-20aa-4ad9-806b-16a45e426956","owner":[],"postedDate":"October 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-17T12:37:26+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-17 12:37:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7390564","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7390564","identity":"rs-7390564","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}