Background and Purpose
Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition characterized by impairments in social interaction, communication, and behavioral challenges. These core deficits significantly affect children’s day-to-day functioning as well as their overall quality of life. While numerous interventions have been developed to address communication difficulties in children with ASD, traditional approaches such as Applied Behavior Analysis (ABA) often require sustained, long-term commitment and may fall short in fully engaging children in intrinsically motivating ways.
In recent years, alternative therapies—particularly physical activity programs—have gained attention as complementary treatments. Emerging evidence indicates that physical exercise can enhance cognitive and emotional outcomes in children, including those diagnosed with ASD. Specifically, physical activity has been linked to improvements in executive functioning, emotional regulation, and social behavior.
A promising development in this field is the use of active video games, or exergames, which combine physical activity with interactive video gameplay. Exergames provide a platform that simultaneously targets motor and cognitive skills development while sustaining high levels of motivation and engagement. This study was designed to examine the relative effectiveness of exergames compared to traditional physical exercise programs in enhancing social communication skills in children with ASD.
The primary research questions addressed were: Do either intervention types lead to statistically significant reductions in communication disorder severity relative to a control group receiving standard therapy? If so, which intervention yields superior outcomes? Additionally, the study evaluated whether improvements were maintained over time by instituting a 30-day post-intervention follow-up assessment.
 
 
Methods
This quasi-experimental study recruited 45 children diagnosed with ASD, aged 8 to 12 years. Participants were selected purposively based on rigorous inclusion and exclusion criteria, specifically excluding those with major health problems or prior experience with active video games. Children were randomly allocated into three groups of 15 each: an active video game (exergame) group, a traditional exercise group, and a no-additional-intervention control group.
The intervention period spanned eight weeks. The traditional exercise group attended structured exercise sessions comprising a 10-minute warm-up, 25 minutes of aerobic and stretching exercises, followed by a 10-minute cool-down. The exergame group followed the same scheduling but replaced the aerobic/stretching component with 25 minutes of active gameplay using the Nintendo Switch Ring Fit Adventure—a platform encouraging full-body movement and interaction. The control group continued with their usual therapy regimen, including ABA, without additional physical exercise.
Social communication was measured using the Gilliam Autism Rating Scale – Second Edition (GARS-2), a validated instrument assessing autism-related behaviors and communication abilities. Assessments were conducted at baseline (pre-test), immediately post-intervention (post-test), and 30 days after intervention completion (follow-up).
 
Results
Analysis of covariance (ANCOVA), controlling for baseline baseline scores, revealed a significant main effect of group on social communication disorder severity (F (2,41) = 12.22, p < 0.0001, η² = 0.82), demonstrating that intervention type strongly influenced outcomes. Post hoc comparisons indicated that both the exergame and traditional exercise groups scored significantly lower on communication disorder severity post-intervention compared with controls, confirming the positive impact of physical activity interventions.
Notably, the exergame group outperformed the traditional exercise group, with a mean difference of 4.18 points favoring exergames (p = 0.016). The traditional exercise group also showed superior performance relative to controls, with a mean difference of 3.17 points (p = 0.015). This suggests that, while both physical activity modalities benefit social communication in children with ASD, exergames may offer enhanced efficacy.
Follow-up data analysis revealed no significant differences between post-test and 30-day follow-up scores within any group, indicating that the improvements achieved were sustained over time.
 
Conclusion
The evidence strongly supports active video games as an engaging, effective, and sustainable intervention to enhance social communication in children with ASD. Relative to traditional exercise, exergames produced superior improvements and maintained these effects at one-month follow-up. Given these findings, therapists, healthcare providers, and educators should contemplate incorporating exergame interventions into individualized therapy and educational plans for children with ASD. Such interventions offer a dual advantage of promoting physical health while simultaneously addressing cognitive and social domains aligned with the core challenges of ASD.
 
Article Message
This study underscores the potential of physical activity to improve social communication skills in children on the Autism Spectrum, particularly through technology-based, interactive exergames. These interventions capitalize on the natural attraction to video games and hold promise for improving communication and physical engagement, ultimately fostering higher motivation and more meaningful social interactions.
Ethical Considerations
The study was conducted in compliance with the University of Isfahan Ethics Committee (Code: IR.UI.REC.1402.166). Written informed consent was obtained from all participants or legal guardians prior to enrollment.
Authors' Contributions
All authors equally contributed to all phases of the research process.
Conflict of Interest
The authors declare no conflicts of interest.
 
Acknowledgments
The authors gratefully acknowledge the invaluable support from all participants and staff who aided in the execution of this study.