R E S E A R C H A R T I C L E

The Effects of Aerobic Exercise

on Academic Engagement in
Young Children With Autism
Spectrum Disorder
Kathryn N. Oriel, PT, EdD; Cheryl L. George, PhD; Rebecca Peckus, DPT; Amanda Semon, DPT
Department of Physical Therapy, Lebanon Valley College, Annville, Pennsylvania.

Purpose: To determine whether participation in aerobic exercise before classroom activities improves aca-
demic engagement and reduces stereotypic behaviors in young children with autism spectrum disorder.
Methods: This study employed a within-subjects crossover design, using a treatment condition (aerobic
exercise) and a control condition, across 4 classrooms. The treatment condition included 15 minutes of
running/jogging followed by a classroom task. The control condition included a classroom task not pre-
ceded by exercise. The number of stereotypic behaviors, percentage of on-task behavior, and correct/incorrect
responses were measured. The Wilcoxon signed rank test was used to compare differences between condi-
tions. Results: Statistically significant improvements were found in correct responding following exercise (P
< .05). No significant differences were found for on-task behavior or stereotypic behaviors. Conclusions:
Consistent with findings in older children, these results indicate that aerobic exercise prior to classroom ac-
tivities may improve academic responding in young children with autism spectrum disorder. (Pediatr Phys
Ther 2011;23:187–193) Key words: aerobic exercise, attention, autism spectrum disorder, child, educational
activities, physical therapy/methods, special education, stereotypic movement disorder/therapy

INTRODUCTION includes autistic disorder, Asperger syndrome, pervasive

Autism is defined as “a neurobehavioral syndrome
marked by qualitative impairments of social interaction
and communication, and by restricted, repetitive, and
stereotyped patterns of behavior.”1(p257) Stereotypic behav-
ior may involve toe walking, hand-and-arm flapping, rock-
ing or spinning the body, or finger flicking.2 According to
the National Institute of Child Health and Human Develop-
ment, health care providers envision autism on a spectrum,
as a group of disorders with similar features.3 This group
0898-5669/110/2302-0187
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Copyright C 2011 Wolters Kluwer Health | Lippincott Williams &
developmental disorder not otherwise specified, Rett syn-
drome, and childhood disintegrative disorder. With the
prevalence of autism spectrum disorder (ASD) on the rise,
the need for effective educational interventions for this
population is increasing.4
While the importance of physical activity in children
with ASD has been described in the literature and is cur-
rently recommended by the National Center for Physical
Activity and Disability, children with ASD typically present
with decreased physical activity levels and tolerance and
developmental delay.5-8 This may be a result of the lim-
ited physical activity opportunities available for children
with ASD.5 The limited opportunities may be attributed
to the social and behavioral deficits that are often present

Wilkins and the Section on Pediatrics of the American Physical
Therapy Association
Correspondence: Kathryn N. Oriel, PT, EdD, Department of Physical
Therapy, Lebanon Valley College, 101 N College Ave, Annville, PA 17003
(oriel@lvc.edu).
Grant Support: This study was funded by the PLEET Grant through
Lebanon Valley College.
DOI: 10.1097/PEP.0b013e318218f149
in children with ASD that make participation with peers
difficult.9 Although few studies have explored the physical
activity patterns of children with ASD,5 social constraints,
more than existing impairments, could be the limiting fac-
tor affecting physical activity.10
The effect of exercise on stereotypic behaviors in chil-
dren with ASD has been explored in the literature. Kern
et al11 examined the effect of exercise on 3 children with

Pediatric Physical Therapy Effects of Aerobic Exercise on Academic Performance in ASD 187
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins and the Section on Pediatrics of the American Physical Therapy
Association. Unauthorized reproduction of this article is prohibited.
 ASD between 7 and 11 years of age. Results indicated
that stereotypic behaviors decreased following vigorous
jogging (mildly strenuous, with the child showing in-
creased breathing rate and/or flushed face) for 15 minutes,
although little or no reduction was observed following mild
exercise (ball playing, where an adult gently threw a ball
to a child from a distance of 2-3 m, at a rate of 10-12
times per minute).11 Watters and Watters12 found similar
results in 5 boys with ASD between 9 and 11 years of age.
They found that the greatest decrease in stereotypic behav-
ior was found following physical activity (jogging in the
schoolyard alongside teachers for 8-10 minutes) as com-
pared with academic work or television viewing. Similarly,
a study examining three 11-year-old children (2 males and
1 female) with ASD found that stereotypic behaviors de-
creased after 15 minutes of continuous jogging. This study
also examined carryover of the decreased stereotypic be-
haviors and found that the behavior carryover was limited
to 90 minutes postintervention.13
Petrus et al4 conducted a current, systematic review
of studies measuring the effects of exercise on stereotypic
behaviors of children with ASD. The 7 studies included a
total of 25 subjects. Twenty-two were older children (6-15
years old) with ASD, and 3 were younger children (3-5
years old). In the 3 studies including younger children,
the exercise programs involved walking versus jogging,
jogging, and jogging versus ball playing.11,14,15 Only jog-
ging resulted in a decrease in stereotypic behaviors.15
Three of the 7 studies also measured academic performance
following exercise.4 Watters and Watters12 reported no ef-
fect on academic responding following exercise, but 2 stud-
ies did report improved academic responding following
jogging.15,16 In addition, Rosenthal-Malek and Mitchell16
documented an increase in on-task behavior after aerobic
exercise.
The effect of exercise on academic performance was
examined by Kern et al.15 They found that jogging, at
a speed that increased the subjects’ breathing rate and
elicited flushed faces, decreased stereotypic behavior and
increased appropriate play (ie, on-task time) and academic
performance.15 Similar results were found by Elliot et al17
in their study examining 6 adults with ASD. These re-
searchers found that aerobic activity increased appropriate
behavior and decreased off-task time in this population.
Powers et al18 found similar results in an 8-year-old child
with ASD. They reported a decrease in stereotypic behavior
and an increase in on-task performance following a roller
skating intervention for 10 minutes.
Aerobic exercise has been shown to improve correct
responding, improve on-task time, and reduce stereotypic
behaviors in older children (6-15 years old) with ASD, al-
though few studies have explored such an effect in young
children (3-5 years old).4,11-18 The purpose of this study
was to determine whether participation in aerobic exer-
cise before classroom activities improves academic engage-
ment and reduces stereotypic behaviors in young children
with ASD.
188 Oriel et al
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METHODS
Study Design
This study used a within-subjects crossover design,
with a treatment condition and a control condition, across
4 early intervention classrooms. Two of the 4 classes were
randomly assigned to the treatment condition and 2 to
the control condition for the first 3 weeks of the study.
During the subsequent 3 weeks of the study, each class re-
ceived the opposite condition. The treatment condition in-
cluded 15 minutes of running/jogging followed by a class-
room task. The control condition included participation
in a classroom task that was not preceded by aerobic exer-
cise. The number of stereotypic behaviors demonstrated,
the percentage of on-task behavior, and the numbers of
correct/incorrect responses given during academic tasks
for each child were recorded throughout the duration of
the study, regardless of condition, to allow for comparison.
According to Spencer et al,19 the crossover design
minimizes the effects of preexisting differences between
classrooms, such as academic levels of students, age/grade
levels, as well as differences in curricula. In this design,
each student receives both treatments and serves as his or
her own control, which also minimizes the possibility of
differential attrition within treatment conditions. Finally,
teacher effects are accounted for since teachers provide the
instruction in both conditions.19 In special education class-
room research studies, the crossover design has been used
successfully “to address problems inherent in between-
classrooms matching.”19-23
Participants
This study was approved by the Institutional Review
Board at Lebanon Valley College. A purposive sample of
convenience was used. The participants in this study were
recruited from 4 early intervention autistic support class-
rooms. The 24 children in these early intervention class-
rooms had a diagnosis of ASD and were between the ages of
3 and 6 years. The families of all children attending these
classes were sent a letter explaining the study and a consent
form. All children who returned a signed parental consent
form were included in the study. Ultimately, 7 males and
2 females between the ages of 3 and 6 years (mean age,
5.2 years) participated. Seven of the children had a formal
diagnosis of autism, while 1 had a diagnosis of intellec-
tual disability, and 1 had a diagnosis of developmental
delay. Although 2 of the children had a primary diagno-
sis of intellectual disability and developmental delay, all
children in the early intervention autistic support class-
rooms met the educational criteria for ASD as defined by
the Individuals with Disabilities Education Improvement Act
of 2004.24 Otherwise, they would not be enrolled in these
classrooms.
To qualify for enrollment in these early interven-
tion autistic support classrooms, children must present
with more severe symptoms along the continuum of ASD.
Pediatric Physical Therapy
 Characteristics of the children participating in this study
included resistance to change in environment or change in
routine, lack of social interaction with peers, lack of eye
contact, and absence or delay in communication. Some of
the children in this study used speech to communicate,
while others were nonverbal. In addition, some children
used sign language as a means to communicate.
Treatment Condition
The treatment condition consisted of 15 minutes
of running/jogging as a group. A consistent period of
running/jogging was maintained through the use of
prompts that were established by the child’s classroom
teacher (ie, edible reinforcements, verbal cueing). If the
researchers were unable to prompt a child to run, jumping
on a minitrampoline was used as an alternate mode of sus-
tained aerobic activity. The researchers returned the child
to running/jogging as quickly as possible. An increased
breathing rate and observation of a flushed face were used
to substantiate sufficiently strenuous activity,16 since mea-
surement of heart rate was not tolerated by the participants
in the study. The researchers also completed an exercise
log after each session, which included the amount of time
exercised, motivational strategies used to maintain run-
ning/jogging, and any additional comments regarding the
child’s performance.
When the 15 minutes of running or jogging was com-
plete, the children participated in gentle seated stretching
and were given a cup of water. The children were then as-
sisted back to their classroom by either a classroom aide or
their teacher. The children began their classroom activity
immediately upon returning to the class.
Control Condition
The control condition consisted of participation in
a classroom task that was not preceded by exercise.
Classroom teachers were asked to discourage aerobic ac-
tivity prior to the classroom task being assessed while chil-
dren participated in the control condition.
The early intervention classrooms were highly struc-
tured, beginning with either 1:1 academic probing of stu-
dents or “table time” with up to 4 children at each ta-
ble. Academic probes addressed a variety of skill sets
(ie, learning readiness, communication, motor skills, and
academic).25 Examples of academic probes included solv-
ing a 4- to 6-piece puzzle, putting shapes in a container,
cutting a piece of paper, communicating a word given a
teacher prompt (eg, “say (or sign) ‘cereal’,” or asking stu-
dent to hand the teacher the correct picture from 3 to 5
picture cards). During academic probing, the student was
also asked to respond to teacher directives such as “stand
up” and “go to table.” Table time primarily consisted of
writing tasks. Children would write or trace their names,
or Velcro letters to spell their names.
Classroom tasks remained the same in both the treat-
ment and control conditions. No attempt was made to
change classroom tasks in either condition.
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Classroom Data Collection
Before beginning this study, the second researcher re-
ceived permission to videotape children with ASD during
academic tasks. This videotape was used solely to train un-
dergraduate student observers. Training began with review
of definitions for the behaviors to be recorded (ie, cor-
rect and incorrect academic responding, on-task behavior,
stereotypic behavior). Then, student observers practiced
recording data while watching the videotape. Practice con-
tinued until students were reliably recording classroom
data.
Undergraduate student observers and the second re-
searcher were randomly assigned to observe 1 or 2 children
per session. Whenever possible, 2 observers would be as-
signed to observe and independently record data for the
same child, to ensure interrater reliability. Observers were
assigned to different children each session. In the event
that a child was absent, that observer would then inde-
pendently collect data on another child, which provided
additional reliability data.
The second researcher and student observers were all
blind to who exercised prior to classroom instruction. All
observers collected 2 sets of classroom observation data
per session; each set was 15 minutes in length.
Dependent Measures
Four dependent variables were measured: (1) cor-
rect academic responses, (2) incorrect academic responses,
(3) stereotypic behaviors, and (4) on-task behavior. A
correct academic response was scored, using a frequency
count, when a child responded correctly to a directive
given by the teacher. An incorrect academic response in-
volved an incorrect response or no response to a directive
given by the teacher. A frequency count was also taken
of stereotypic behaviors observed; in these classrooms,
the stereotypic behaviors included hand-and-arm flapping,
body rocking, and toe walking.
Children were considered to be on task when seated
and producing academic responses. Children were con-
sidered to be off task when they did not produce an aca-
demic response and were engaged in disruptive behavior
(eg, crying, out of seat, playing with objects). When off-
task behavior would begin, the observer would note the
time, followed by noting the time again when the child
resumed on-task behavior. Then, the percentage of time
on task was calculated by subtracting the time off task and
dividing by 15 minutes. Table 1 displays the operational
definitions.
Data Analysis
Interrater reliability. Intraclass correlation coefficients
were calculated to examine reliability between raters in the
measurement of correct/incorrect responses, on-task time,
and number of stereotypic behaviors observed.
Treatment versus control condition. The Wilcoxon
signed rank test was used to compare differences between
correct/incorrect responses, on-task time, and number of
Effects of Aerobic Exercise on Academic Performance in ASD 189
 TABLE 1
Operational Definitions

Term Definition

Correct academic response A child responds correctly to a directive given by the teacher
Incorrect academic response A child responds incorrectly or provides no response to a directive given by the teacher
Stereotypic behavior Behaviors conducive to autism spectrum disorder, such as hand-and-arm flapping, body rocking, and toe walking
On-task behavior Percentage of time the child is seated and is consistently responding to teacher directives

Fig. 1. Percentage of correct responding during the control and treatment phases for each participant.

stereotypic behaviors in the traditional and exercise con-
dition. This nonparametric test was used because the para-
metric assumptions of homogeneity and normality were
not met. The SPSS statistical program was used and the
level of significance was set at α = .05.
RESULTS
Interrater Reliability
Participants were observed by more than 1 rater to
establish interrater reliability on 83% of observations (10
of the 12 days). Intraclass correlation coefficients (2,k)
were calculated for correct responses, incorrect responses,
time on task, and number of stereotypic behaviors ob-
served, and were found to be 0.97, 0.84, 0.96, and 1.0,
respectively. These rates were consistent with other stud-
ies that reported interrater reliability. Researchers reported
collecting interrater reliability data in 50% to 100% of the
sessions and reported reliability rates ranging from 70% to
100%.11,13-15
Treatment Condition Versus Control Condition
Correct/incorrect responses. Seven of the 9 partici-
pants improved in correct responding following the ex-
ercise condition. The mean percentage of correct respond-
ing was found to be 71.49 on control days versus 82.57
on treatment days. These improvements were found to be
statistically significant (P < .05). Figure 1 displays the
mean differences for correct responding between the con-
trol and treatment phases of the study for each of the 9
participants.
On-task time. No significant differences were found
between the 2 conditions for on-task behavior. The mean
percentage of time on task during control days was 94.48
versus 95.92 on treatment days. While statistical signifi-
cance was not observed, visual analysis of the data revealed
that 5 of the 9 participants improved in on-task time fol-
lowing the exercise condition. Figure 2 displays the mean
differences for time on task between the control and treat-
ment phases of the study for each of the 9 participants.
Stereotypic behaviors. No significant differences were
observed between conditions for stereotypic behaviors,
although only 5 of the 9 participants demonstrated stereo-
typic behaviors on at least 1 observation day. Table 2
provides a summary of the total number of stereotypic
behaviors observed during the treatment and control con-
ditions. While no statistical significance was observed, 4
of the 5 participants demonstrated fewer stereotypic be-
haviors during the intervention phase of the study. Table
3 summarizes the results of this study.

190 Oriel et al Pediatric Physical Therapy

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 Fig. 2. Percentage of time spent on task during the control and treatment phases for each participant.
DISCUSSION
In this study, 7 of the 9 participants improved in cor-
rect responding following the treatment condition. It is
important to note that the 2 children who did not improve
in correct responding may not have expended as much en-
ergy when exercising. Exercise logs indicate that these 2
children were more difficult to motivate to exercise and,
thus, spent less time exercising than their peers.
While we found statistically significant improvements
in correct responding following 15 minutes of running,
similar to other studies described in the literature in which
jogging continued for 20 minutes, shorter durations of ex-
ercise should be explored.15,16 It would be beneficial to
educators and school-based physical therapists to know
whether shorter durations of exercise are capable of pro-
ducing the same gains in academic responding, as shorter
durations of exercise would be even more feasible to imple-
ment during the school day. Although academic respond-
ing was not measured by Celiberti et al,14 they found de-
creased stereotypic behaviors following jogging for 6 min-
utes in a 5-year-old boy with ASD. Further research is
warranted to determine the duration of exercise needed as
well as the intensity to produce academic and behavioral
changes in young children with ASD.16
Whereas statistically significant improvements were
not observed in the amount of time on task or in stereotypic
behaviors, the trends observed were encouraging. Five of
the 9 participants (55.6%) improved in on-task time. This
trend is consistent with the few other studies that have
examined the effect of exercise on on-task time in children
with ASD.17,18 Similar findings of improved on-task time
have also been described in children developing typically
after exercise.26
Given that the children participating in this study
were all enrolled in early intervention autistic support
classrooms, it was unexpected that only 5 of the 9 chil-
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TABLE 2
Total Number of Stereotypic Behaviors Observeda
Participant Control Condition Treatment Condition
1 1 0
2 4 0
3 0 2
4 4 0
5 2 0
a Four children exhibited no stereotypic behaviors during observation
times.
dren demonstrated stereotypic behaviors. Even among
the 5 children who demonstrated stereotypic behaviors,
the stereotypic behaviors observed were few (Table 2).
Those stereotypic behaviors observed included hand-and-
arm flapping, rocking, and toe walking. Whereas stereo-
typic behaviors were observed, there were less stereotypic
behaviors observed following exercise. The total number
of stereotypic behaviors across participants decreased from
11 during the control days to 2 during the treatment days,
which may be a clinically significant finding.
The few stereotypic behaviors observed may have
been a direct result of the structure provided within these
autistic support classrooms. Teachers used immediate and
consistent verbal prompts (eg, “quiet hands”) when stereo-
typic behavior began. Use of these prompts may be reduc-
ing or minimizing the demonstration of stereotypic behav-
iors, such as hand flapping, over time.
Further research should also examine the duration of
treatment effects. In this study, improvements in academic
responding continued for 30 minutes following aerobic
exercise. Kern et al15 found that self-stimulatory behav-
ior always decreased following jogging and did not re-
turn to baseline until 90 minutes later. While these re-
searchers also reported that on-task behavior and academic
Effects of Aerobic Exercise on Academic Performance in ASD 191
 TABLE 3
Summary of Results
Data Wilcoxon Signed Rank Test
Z P
Correct/incorrect responses −2.016
On-task time −0.84
Stereotypic behaviors −1.361
a Statistically significant finding.
responding always increased following jogging, the du-
ration of these behaviors was not reported. Similarly,
Rosenthal-Malek and Mitchell16 found statistically signifi-
cant increases in correct responding and number of tasks
completed following aerobic exercise but did not examine
the duration of these effects.
Although the results of this study are encouraging,
limitations must be noted. This study was of a short dura-
tion, so it is unclear whether improvements in academic re-
sponding would increase, maintain, or decrease over time.
The lack of measurement of exercise intensity was also a
limitation of this study. Whereas the measurement of heart
rate using a pulse oximeter was the original intent of the
authors, the participants in this study were unable to toler-
ate the use of the device. The device was given to the class-
room teachers 4 weeks before the initiation of the study
in an attempt to improve participant tolerance of its use,
although when the study began, the teachers continued to
report an increase in inappropriate behaviors with the use.
While we used observation to monitor increased breathing
and flushed faces; consistent with Rosenthal-Malek and
Mitchel,16 using a more objective means to quantify exer-
cise intensity should be considered in future studies.
Finally, since few studies have examined the effect of
aerobic exercise on the academic performance of young
children with ASD, further research is recommended
to replicate these results. The National Autism Center’s
National Standards Project lists exercise as an emerging
treatment for individuals with ASD and recommends fur-
ther research in this area.25 Findings from this report also
recommend that treatments be applied in the “real world”
versus laboratory settings to determine whether the results
found in laboratory settings will generalize.25 Therefore, it
is recommended that future studies of the effects of aerobic
exercise on the academic performance of young children
with ASD be conducted by physical therapists and teachers
who educate and support these children daily.
CONCLUSION
Results of this study indicate that aerobic exercise
prior to classroom activities may improve academic re-
sponding in young children with ASD. These preliminary
results are consistent with similar findings in older chil-
dren. Results of this study help substantiate the impor-
tance of aerobic exercise in young children with ASD. The
15 minutes of aerobic exercise was feasible and easy to
192 Oriel et al
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Intraclass Correlation Coefficient
.044a 0.97/0.84
.401 0.96
.174 1.0
implement, offering a strategy for improving academic re-
sponding.
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Pediatric Physical Therapy Effects of Aerobic Exercise on Academic Performance in ASD 193
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Association. Unauthorized reproduction of this article is prohibited.