Quality, Rigor, and Outcomes of Antecedent Exercise Strategies for Supporting Autistic Individuals: A Synthesis and Multilevel Meta-Analysis

Physical activity is a promising strategy for strengthening behavior and social engagement through its physiological and psychological benefits. Antecedent Exercise (AE) is a structured behavioral intervention aimed at mitigating meltdowns and promoting adaptive behaviors in Autistic individuals. This synthesis and multilevel meta-analysis of 34 studies, including diverse settings and exercise types, provides a nuanced examination of AE's effectiveness. AE demonstrated moderate efficacy with effect sizes of −0.342 ( SE = 0.089, p < .005, 95% CI [−0.517, −0.168]) for reducing meltdowns, and a substantial improvement of 0.806 ( SE = 0.166, p < .005, 95% CI [0.481, 1.13]) for increasing adaptive behaviors. Special education settings such as day centers and schools yielded robust outcomes, thus highlighting AE's effectiveness in an educational context. Interventions involving accessible activities like aerobic exercise routines and jogging also showed to be effective. Despite variability in study rigor and some indications of publication bias, AE appears to be a scalable intervention for educators and clinicians. Future research should address the long-term maintenance effects and optimal implementation strategies for maximizing AE's benefits in educational and clinical settings. This evidence supports the integration of AE into practices for improving the quality of life and educational outcomes for Autistic individuals.