The impact of physical play-based games on executive functions and social behaviors in children with autism spectrum disorder: a systematic review and meta-analysis

Objective To conduct a systematic review and meta-analysis examines the impact of physical play-based games on executive functions and social behaviors in children with Autism Spectrum Disorder (ASD),and to compare the differences in effects across intervention types and dosages through subgroup analysis. To our knowledge, this is the first meta-analysis to concurrently evaluate these two domains in this population. Methods Six databases (CNKI, Wanfang, PubMed, Cochrane Library, Web of Science, Embase) were searched from inception to December 20, 2025, for randomized controlled trials (RCTs) and non-RCTs on physical play-based Games interventions for children with ASD. Two researchers independently screened studies, extracted data, and assessed using the Cochrane Risk of Bias tool (RoB 2) for randomized controlled trials and the ROBINS-I tool for non-randomized studies. Meta-analysis was performed using STATA 18.0 with a random-effects model. Effect sizes were expressed as standardized mean differences (SMD) with 95% confidence intervals (CI). Results Twelve studies involving 520 children with ASD were included. Meta-analysis showed that physical play-based games significantly improved social behavior in children with ASD (SMD = 0.68, 95% CI [0.49, 0.88], P < 0.001). However, the improvement in executive function did not reach statistical significance (SMD ≈ 0.31, 95% CI [-0.04, 0.67], P > 0.05). Given the limited number of studies (n=4) and the marginal nature of this finding, this result should be interpreted with caution and requires confirmation in future research. Subgroup analysis indicated that traditional physical play-based games, high-frequency (≥4 sessions/week), and longer-duration (≥60 minutes/session) interventions showed numerically larger effect sizes, but the differences between subgroups were not statistically significant. Conclusion physical play-based games are an effective intervention for improving social behavior in children with ASD, with a moderate and consistent effect. Structured group-based physical play-based games are recommended in practice, with adjustments based on individual child characteristics. Further high-quality research is needed to verify long-term effects and generalization.