Play, physical activity, and exercise interventions for behavioral and social outcomes in autism spectrum disorder: a narrative review

Autism spectrum disorder (ASD) is characterized by persistent difficulties in social communication and interaction, alongside restricted and repetitive patterns of behavior. Growing evidence suggests that play, physical activity (PA), and exercise may contribute to improvements in behavioral regulation and social functioning in individuals with ASD. However, findings across studies remain heterogeneous with respect to intervention type, intensity, and targeted outcomes, making it challenging to draw unified conclusions. This narrative review aimed to synthesize and discuss existing literatures on play-based, PA, and exercise interventions targeting behavioral and social outcomes in individuals with ASD. Overall, the literature indicated that PA and exercise programs-particularly those incorporating social interaction, task-oriented play, or group-based formats-were associated with meaningful improvements in both sociobehavioral domains. Potential mechanisms underlying these effects included enhanced executive functioning, improved self-regulation, neurobiological adaptations, and increased opportunities for social learning. Nevertheless, variability in study design, outcome measures, and methodological quality limits the generalizability of findings. Future research should prioritize well-designed trials with standardized outcome measures and clearly defined intervention parameters to strengthen the evidence base and inform clinical and educational practice.