School of Occupational Therapy

Touro University Nevada

OCCT 643 Systematic Reviews in Occupational Therapy

Critically Appraised Topic Project

EVIDENCE TABLE WORKSHEET

Name: Austin Lepper and Kerielle Williams
Date: 10-13-2014
Focus Question: For children with autism, does physical exercise reduce self-stimulatory behaviors?
Rationale for inclusion/exclusion criteria applied to determine which articles should be included in the evidence table:
Inclusion criteria consisted of autism and physical exercise and autism and exercise.
Exclusion criteria consisted of studies involving participants older than 18 years of age, studies that were conducted prior to the year
2000, and studies that were not in English.

Author/
Year
Chan,
Sze, Siu,
Lau,Cheu
ng, &
Fatemi,
(2013)

Study
Objectives
-To compare the
effect of a
traditional
Chinese Chanbased mind-body
exercise, Nei
Yang Gong, with
that of the
conventional
Progressive
Muscle
Relaxation
(PMR) technique
in enhancing the
self-control of
children with
ASD.

Level/Design/
Subjects
Level I
Design:
-Randomized
Control Trial (RCT)
Participants:
-46 children
-6 participants
dropped out of the
study; leaving 40
participants total
-Aged 6-17 y/o
-20 children in each
the control and
experimental
groups
-36 males and 4
females
-Participants selfcontrol was
measured by 3
neuropsychological
tests and parental
rating on
standardized

Intervention and
Outcome Measures
Intervention:
Intervention
-Nei Yang Gong,
exercise set
comprised of 5 types
of movements,
including tranquil
stand, shoulder
relaxation, nasal
bridge, Q-circulating
movements, and
passive Dan Tian
breathing
-Sessions also
incorporated specific
pieces of music to
facilitate childrens
mastery of technique
and to keep them
engaged
Setting
-Chinese University
of Hong Kong ,
Hong Kong, China
Who Delivered
- A clinical

Results
-The results of
the repeated
measures
ANOVAs
showed that
there were
significant and
marginally
significant Time
(Pre vs. Post) by
Group.

Study
Limitations
Possible sources
of bias
-participants
were strictly
from the Chinese
culture

Representative
ness of sample
-gender (almost
all males)
-intelligence
-Subsequent post level: 6 children
hoc t tests
in each group
confirmed that
had IQ below 70
the four
neuropsychologi
cal test measures
were consent,
indicating that
the autistic
children in the
experimental
group showed
better selfcontrol than

Implications for OT
Clinical and
Community-Based
Practice of OT
- Therapists should be
aware of these
encouraging findings
that confirm the
potential clinical
applicability of this
Chinese mind-body
exercise in enhancing
the self-control of
individuals with
various brain
disorders, such as
ASD.
Program
Development
-Nei Yang Gong
should not be applied
as a core component
of professional service
at this point as the
evidence base for this
intervention is
preliminary.

questionnaires, and
the underlying
neural mechanism
was assessed by the
participants brain
EEG activity during
an inhibitorycontrol task before
and after
intervention
- Participants were
IQ-matched and
ASD children were
randomly assigned
to receive group
training twice per
week for 4 weeks
-Participants were
matched into pairs
according to their
age and level of
intelligence
-Pretest and posttest
ability to selfcontrol was
measures before
and after the
intervention

psychologist, with
over 10 years clinical
experience training
children with ASD
Frequency
-Two group
participated in
training classes twice
per week for 4
weeks; each session
lasting 1 hour
Duration
-Study was
completed over a 4
weeks
Outcome Measures:
-ATEC (Autism
Treatment
Evaluation
Checklist)
-sLORETA method
-Tower of London
test
-Childrens Color
Trails test
-Five Point test
-Autism Diagnostic
Interview-Revised

those in the
control group
after the one
month
intervention.

Societal Needs
-Enhancing
community support
programs for children
and adolescence that
have ASD will benefit
from Nei Yang Gong
by encouraging
appropriate exercise to
diminish unwanted,
adverse social
behaviors.
Healthcare Delivery
and Health Policy
-Due to low
representativeness of
sample and all male
participants, results
are preliminary.
Education and
Training of OT
Students
-The clinical
reasoning and
creativity that are
already part of entrylevel education would
allow for an
introduction of the

Magnuss
on,
Cobham,
McLeod,
(2012)

-To investigate if
an individualtailored, highintensity
exercise program
would have a
positive effect on
the physical
fitness and
behaviors of

Inclusion Criteria
-Children with
ASD, children
between the ages of
6-17

-Chinese version of
Weschler
Intelligence Scale for
Children 4th Edition

Level III

Intervention:
Intervention
-5 categories of
interventions tested
for physical exercise
test for youth with
ASD
-Categories consisted
of cardiorespiratory
fitness, upper body

Design: Cohort
Participants:
-2 females
-4 males
-Aged 9-15 y/o
-Pre intervention
measurements

The benefits of
engaging
individuals with
ASD in an
individuallytailored, highintensity
exercise program
improves all
physical fitness

Representative
ness of sample
-Small size (only
6 participants)
-More males
than females
Possible sources
of bias
-Individual-

concept of Nei Yang

Gong.
Refinement,
Revision, and
Advancement of
Factual Knowledge
or Theory
-Future studies should
include female
participants in
addition to male
participants.
-Future studies should
consider the effects of
ongoing regular
treatment the
participants have in
addition to Nei Yan
Gong.
Clinical and
Community-Based
Practice of OT
-the educational
components of this
intervention regarding
physical exercise
techniques are
recommended for all
clients with or without

children and
adolescents with
ASD

compared to post
intervention
measures
Inclusion Criteria
-Sufficient
receptive language
and good general
health
Exclusion Criteria
--Subjects that did
not have medical
clearance from the
general practitioner

strength, lower body

strength, abdominal
strength and
endurance, hamstring
and lower back
flexibility, and
standing balance
Setting
-Exercise and
Rehabilitation Clinic
at the University of
Auckland, Auckland,
New Zealand
Who Delivered
- Researchers
Frequency
-2 times per week
totaling 16 exercise
sessions and 2
testing sessions
Duration
-8 to 12 weeks and
sessions were
approximately 1 hour

and behavioral
outcomes for
cardiorespiratory
fitness and
abdominal
strength as well
as positive
behaviors in
physical activity.
-All subjects
exhibited overall
improvement in
the measures of
physical fitness
with statistically
significant
changes in
cardiorespiratory
fitness and
abdominal
strength.

-All subjects
improved their
Outcome Measures: upper and lower
-General Health
body strength,
Assessment
although not
-Behavior Screening statistically

ization of each
subjects
program could
limit the
generalizability
of the findings to
less structure,
more generic
exercise
programs

ASD
Program
Development
-this intervention
should be used in
conjunction with other
evidence-based
research techniques
Societal Needs
-this intervention
educates the
participants about the
impairments they
must face and teaches
them several physical
exercise techniques
that can be practiced
daily
Healthcare Delivery
and Health Policy
-Results should be
considered
preliminary
-Further accumulation
of evidence with a
larger, more
representative sample
is necessary
Education and

Aksay &
Alp
(2014)

-To compare
non-ASD
children with
children with
ASD in regards
to physical
activity and
health

Level III
Design: CaseControl
Participants:
-23 children
-17 males
-7 females

Questionnaire
-Modified Bruce
Protocol
-Modified Romberg
Test
-1 RM Bench Press
Test
-1 RM Leg Press
Test
-Maximal Curl-Up
Test
-Sit-and-Reach Test

significant

Intervention:
Intervention
-Broch Port Physical
Fitness Test and The
Movement
Assessment Battery
for Children, the
BPTF consists of 27
subtests, 2 muscle

The participants
overall scores
increased
significantly on
the push-up and
pull-up tests.
Improvements
were observed in
both females and

Limited
financial
resources
Insufficient
educated
personnel
-The study used
a student of the

Training of OT
Students
-introduction to the
concept of these
particular physical
exercise plans would
enhance entry-level
education and add to
the skill of an entrylevel OT
Refinement,
Revision, and
Advancement of
Factual Knowledge
or Theory
-Further studies with
more stringent study
designs are needed.
Randomized control
trials are ideal.
Clinical and
Community-Based
Practice of OT
-Therapists should
implement a physical
activity program
involving training
three times a week to
improve motor skills

-Aged 14 to 17 y/o
-Participants were
chosen from 96
children diagnosed
with autism

power endurance and

flexibility to
determine the
childrens level of
physical ability.
Setting
Inclusion Criteria
-Tracks, in sport
- Children with
halls, gymnasiums,
ASD who had at
fitness gyms, and
least 10 severe
game fields
crises per week
- Ethics Committee
-Data were taken
of the Inonu
from a baseline test, University of
pre-test, midMalatya, Turkey
program test, and a Who Delivered
post-test.
-A student from the
department of
exercise and sport
education for
handicapped people
Frequency
-50 min exercise
plan implemented 3
times a week
Duration
-36 weeks
Outcome Measures:
-Movement

males in
flexibility tests.
The average
number of
severe crisis in
children with
ASD had
decreased.

university to
administer the
assessment
Unclear rules in
the daily
programs
-The BPTF had
to be adapted to
meet the needs
of the children
with ASD,
causing the rules
to be unclear.

and positively affected

physical performance.
Program
Development
-Further research
regarding the
effectiveness of the
Broch Port Physical
Fitness Test and the
Movement
Assessment Battery
for Children is needed
prior to further
program development
Societal Needs
-use of the Broch Port
Physical Fitness Test
and the Movement
Assessment Battery
for Children for those
individuals with ASD
may decrease
unwanted behaviors in
social situations
Healthcare Delivery
and Health Policy
-further research is
warranted prior to
advising healthcare

Assessment Battery
for Children
(MABC)
-MABC: ball
throwing, ball
catching, ball rolling,
ring throwing, ring
catching, static test,
dynamic test, and
flexibility test
-Brockport physical
fitness test (BPTF)
-BPTF: push-up,
pull-up, sit-up,
flexibility
-Baseline test at the
beginning of the
study, a pre-test in
the 12th week, a midprogram test in the
24th week, and a
post-test in the 36th
week of study. The
intervention could be
replicated in
practice.

policy-makers
Education and
Training of OT
Students
- Broch Port Physical
Fitness Test and the
Movement
Assessment Battery
for Children would be
a topic more
appropriate for
continuing education
rather than entry-level
education
Refinement,
Revision, and
Advancement of
Factual Knowledge
or Theory
-after protocols are
finalized, more
rigorous, randomized
control trials should
be conducted to
solidify the
evidentiary basis for
implementing Broch
Port Physical Fitness
Test and the

Pan
(2010)

-To determine
the effectiveness
of a 10 week
water exercise
swimming
program on the
aquatic skills and
social behaviors
of boys with
autism spectrum
disorder

Level II
Design:
Experimental
repeated measure
design
Participants:
-16 participants
-16 males
-8 males had ASD
-8 males had
Aspergers
-Aged 6 to 9 y/o
-Each participant
was assessed 3
times, once at study
entry to serve as
baseline, a second
time after 10
weeks, and a third
time after another
10 weeks.

Intervention:
Intervention
-Each session
divided into 4
categories: social and
floor warm-up
activities, one-two
small group
instruction, whole
group game and
activities, cool down
activity
-Addressed motor
and social skills
Setting
-A local indoor
hydrotherapy and
swimming pool in
Kaohsiung city,
Taiwan.
Who Delivered
-4 researcher
assistants
Frequency

WESP improved
the aquatic skills
in 4/5 stages and
decreased the
total antisocial
behavior
problems in
children with
ASD.
The results
showed that
improvement of
the majority of
scores was not
different
between two
groups of
children with
ASDs.
Results indicate
that the
environment
provided enables
individuals to

Representative
ness of sample
-Small sample
size
-Small age range
-Only male
participants

Movement
Assessment Battery
for Children into
interventions with
children with ASD
Clinical and
Community-Based
Practice of OT
-Therapists should
utilize WESP during
interventions with
children with ASD in
order to develop
physical skills
possibly enhance their
behavioral and social
skills in the future.
Program
Development
-The specific training
on the 4 categories of
the intervention could
be used as a guide for
OTs to use in practice
and could be used to
help develop future
protocols when
working with children
with ASD.

-2 groups each with

8 participants
Inclusion Criteria
-Diagnosis of mild
ASD or Aspergers
Syndrome
-Ages 6 to 9 years
old
-Follow
instructions
-parental consent

-20 sessions (two

sessions per week,
90 minutes per
session)
Duration
-10 week water
exercise swimming
program (WESP)

develop physical
skills within the
intervention
process and
enhances their
behavioral and
social skills in
the future.

-Small statistical
Outcome Measures: and meaningful
-Humphries
differences
Assessment of
between the
Aquatic Readiness
groups
(HAAR)
-Foundations of
Halliwick Method
-TEACCH Model
-School Social
Behavior Scale
-Aquatic skills
and
social behaviors
were measured

Societal Needs
-Therapists can easily
incorporate this
simple intervention
program into their
clinical practices or
include them in a
home exercise
program designed to
provide further
training for clients
with ASD in a real-life
environment.
Healthcare Delivery
and Health Policy
-Due to low
representativeness
from the larger ASD
population, it would
be advisable to
accumulate further
evidence before
recommending this
physical exercise
program to address
appropriate
interventions with
ASD clients.
Education and

Training of OT
Students
-Knowledge of the
interventions included
in physical exercise
programs, specifically
in regards the benefits
it will have on
children with ASD,
should be included in
the general education
and training for OT
students.
Refinement,
Revision, and
Advancement of
Factual Knowledge
or Theory
-The results of this
study showing that
physical exercise
programs can be an
effective treatment
strategy for reducing
negative behaviors
and improving daily
functioning is strong
enough evidence to
justify further research

Pan
(2010)

-To evaluate the

efficacy of a 14week aquatic
program on
physical fitness
and
aquatic skills for
children with
autism spectrum
disorders (ASD)
and their siblings
without
a disability
-To understand
the effects of
aquatic
intervention on
the aquatic skills
and physical
fitness
components of
children with
ASD and their
siblings without
a disability

Level II
Design: Repeated
measures design

Intervention:
Intervention
-Sessions were
divided into 4 parts;
Participants:
first 10 min were
-30 participants
structured social and
-2 groups of 15
floor warm up
each
activity, 35 min were
-15 participants had where children
ASD
worked individually
-15 participants
or in pairs working
were siblings of
on treatment goals,
those with ASD
15 min of group
-10 females
games activities, last
-20 males
10 min were cool
-Aged 7 to 12 y/o
down activity
Setting
-Families were
-A local indoor
contacted to
hydrotherapy and
participate in the
swimming pool in
study using several Kaohsiung City,
strategies, including Taiwan
an autism resource
Who Delivered
center, local
-A researcher and 2
Autism support
trained observers and
groups and
2 graduate students
available media
Frequency
(direct contact, e2 sessions per week,

Representative
ness of sample
-small age range
-only assessed
motor skills
Significant
overall group
differences were
found on
muscular
strength and
endurance as
well as aquatic
skills.
The aquatic
program used in
this
study resulted in
a significant
increase in all
subtests of
physical fitness
and aquatic
skills except
subtest of body
composition

Possible sources
of bias
-Future research
is warranted
-Incorporate
motor skills
accomplished on
land

in this area.
Clinical CommunityBased
-OTs should know
that children with
ASD can
respond to a training
stimulus as physical
fitness components
especially muscular
strength/endurance
and more advanced
aquatic skills improve,
which is an important
factor when designing
an appropriate clientcentered intervention
plan.
Program
Development
-These types of
physical exercise
programs should be
implemented in
conjunction with other
effective intervention
techniques for
children with ASD.
Societal Needs

mail
announcement,
autism list serves).
Inclusion Criteria
-At least 1 sibling
with ASD
-Ages 7 to 12 years
of age
-No history or
ongoing medical
intervention
-Able to follow
instructions
-Parental consent

60 min sessions
Duration
14 week aquatic
program
Outcome Measures:
-Progressive Aerobic
Cardiovascular
Endurance Run
(PACER)
-Humphries
Assessment
of Aquatic Readiness
(HAAR)
-Curl-up Test
-Sit-n-Reach Test
-Bioelectrical
Impedance Analysis
(BIA)
-Halliwick Method
-Measure physical
fitness and aquatic
skills

-In order to maximize

the rehabilitation and
overall treatment of
individuals with ASD,
this study suggests
that individuals should
receive additional
treatment in order to
improve patient
performance quickly
and effectively, thus
maximizing
rehabilitation
potential.
Healthcare Delivery
and Health Policy
-Although results
from this study are
preliminary, they are
statistically significant
enough to impact
health care and the
way OTs administer
physical exercise
programs with
children with ASD.
Education and
Training of OT
Students

-The completion of
more evidence0based
and rigorous research
studies, perhaps more
guidelines can be
established and taught
to OT students
regarding how to
decrease unwanted
behaviors in children
with ASD.
Refinement,
Revision, and
Advancement of
Factual Knowledge
or Theory
-Aquatic exercise
program can be
proposed as an
effective and practical
rehabilitation
programs currently
available to this
population.
FragalaPinkham,
Haley,
ONeil

-To evaluate the

effectiveness of
a 14-week
aquatic exercise

Level II
Design: Nonrandomized control
trial design

Intervention:
Intervention
-Lower body and
trunk strengthening

At baseline,
there were no
significant
differences

Representative
ness of sample
- Small sample
size

Clinical and
Community-Based
Practice of OT
-Practicing therapists

(2011)

program for
children with
autism spectrum
disorders (ASD.

Participants:
-12 participants
-7 participants in
aquatic exercise
group
-5 participants in
control group
-Aged 6 to 12 y/o
-11 males
-1 female
-Scale at pre- and
post-test to provide
information about
the swimming
abilities of their
child.
Inclusion Criteria
-Child diagnosed
with ASD
-Ages 6 to 12 years
old
-Medically able to
participate
-No medication or
intervention
changes anticipated

using foam bar bells,

cuff weights, aquatic
noodles, and water
resistance
-Individuals
participated in
swimming laps,
shallow water
running, jumping
and hopping
activities
Setting
-YMCA
Who Delivered
-A pediatric physical
therapist
Frequency
-The 40-minute
program consisted of
2030 minutes of
aerobic activities, 5
10 minutes of
muscular strength
and endurance
training and 5
minutes of cool
down and stretching
activities
Duration

between the
intervention and
control groups
on demographic
variables or on
any of the other
pre-test baseline
scores for the
outcomes
measures of the
Swimming
Classification
Scale levels,
cardiorespiratory
endurance, MPEDI scores or
isometric pushup scores.
-After the 14week
intervention, no
significant
between-group
differences were
found.

- Lack of
randomization
Possible sources
of bias
-Swimming
Classification
Scale and the
YMCA Water
Skills Checklist
have not been
validated

should be aware that

this type of program
has potential to
promote fitness and
physical activity for
children with autism.
Opportunities to be
physically active and
to improve fitness and
swimming skills may
assist children with
developing more
active lifestyles,
improving health and
preventing chronic
conditions.
Program
Development
-Results of this study
are not strong enough
to inform OTS to
implement this
physical exercise
program as the sole
therapeutic
intervention in
remediating behaviors
of children with ASD.
Societal Needs

-No need for

constant monitoring
-Able to follow
directions and
comply with fitness
testing

-2 times per week for

14 weeks
Outcome Measures:
-Swimming
Classification Scale
-YMCA Water Skills
Checklist
-Willcoxin Signed
Ranks Test
-Cardiorespiratory
endurance & muscle
endurance were
measured

-Due to the
occurrence of ASD in
children, OTs need to
learn how to address
physical activity in the
context most effective
with the client in order
to maximize societal
need.
Healthcare Delivery
and Health Policy
-Future research is
needed in order to
determine if this
physical exercise
program is effective in
those with ASD as
part of a therapeutic
intervention.
Education and
Training of OT
Students
-Knowledge on the
intervention of ASD
rehabilitation
specifically in regards
to negative behaviors
and ways to teach
these clients

Todd &
Reid
(2006)

-The purpose of
the study was to
investigate the
outcomes of an
intervention
package
on participation

Level IV
Design: Changing
conditions design
Participants:
-3 participants
-3 males
-Aged 15-20 y/o

Intervention:
Intervention
- The intervention
consisted of three
main components:
self-monitoring
board, edible

The results
suggest that
interventions
can be
developed to
promote
sustained

appropriate social
interactions, should be
included in the
general education and
training of OT
students.
Refinement,
Revision, and
Advancement of
Factual Knowledge
or Theory
-This program and the
concepts behind it
should be utilized by
more OTs, as it uses
purposeful activity to
promote appropriate
behaviors and make
changes in the way in
which clients with
ASD respond to
therapy.
Representative Clinical and
ness of sample
Community-Based
-All 3
Practice of OT
participants were -Therapists should
Canadian
implement
instructional strategies
Possible sources into their intervention

in two physical
activities:
Inclusion Criteria
snowshoeing and -Diagnosed with
Walking/jogging. autism
-Attending a school
for students with
intellectual
disabilities.
-Ability to perform
the physical activity
-Classroom
teachers belief that
student
would benefit from
physical activity
-Parental consent.

reinforcement, and
verbal
encouragement/
directions.
-This intervention
could easily be
replicated.
Setting
-Outdoors in Canada
Who Delivered
-Researcher and 2
classroom teaching
assistants
Frequency
-30 min of physical
activity twice per
week
Duration
- 31 sessions over a
span of 6 months
Outcome Measures:
-Treatment and
Education of Autistic
and Related
CommunicationHandicapped
Children (TEACCH
Program)

participation in
physical
activity for
individuals with
autism.

of bias
-School director
choose all of the
participants

plans with children

ASD.
-OT sessions should
include selfmonitoring, verbal
cueing, and edible
reinforcers when
working with children
with ASD.
Program
Development
-These 3 categories in
this physical exercise
intervention are
practical
considerations in
enhancing positive
behaviors in those
children with ASD.
Societal Needs
-There is a societal
need for research
studies to continue to
be conducted in order
to determine the most
effective
Healthcare Delivery
and Health Policy
-Results of this study

should be considered
preliminary and
should not be used to
inform policy makers
about payment for
services for this
specific program.
Education and
Training of OT
Students
-The completion of
more evidence-based
research studies,
perhaps more
guidelines can be
established and taught
to OT students
regarding how to
improve behaviors in
children with ASD.
Refinement,
Revision, and
Advancement of
Factual Knowledge
or Theory
-This study confirms
results consistent with
other articles and
reviews, stating that

Lochbau
m&
Crews
(2003)

-To conduct
exercise-training
programs
following
standard
guidelines with
individuals with
autism to
stimulate future
researchers to
implement
similar programs

Level III
Design: Cohort
Participants:
-5 participants
-Aged 16 to 21 y/o

Intervention:
Intervention
-2 distinct forms of
physical activity
were used: stationary
cycling to improve
-Programs with pre- cardiovascular
and posttest
endurance and
measures
weight training to
conducted for each improve muscular
form of fitness
strength
-Stationary cycling Setting
resistance and
-University of North
weight lifted for 3
Carolina at
specific movements Greensboro
were the dependent Who Delivered
variables for the
-School psychologist
investigation
Frequency
-Frequency was both
Inclusion Criteria
pre and post outcome
-Individuals with
measurements
autism and mild
Duration
mental retardation
-18 sessions in 6
-Not on medication weeks
-Parental consent

The results were

recorded as a
statistical
fitness change.
Aerobic fitness
increased over
the 18 training
sessions. Both
aerobic and
muscular
strength-training
programs
produce positive
fitness gains.

Representative
ness of sample
-Small sample
size

physical activity
improves performance
but not disability in
children with ASD.
Clinical and
Community-Based
Practice of OT
-OTs should include
physical activity when
working with clients
with ASD.
Incorporating physical
activity in an ASD
clients intervention
plan will provide a
promising outlook for
improved stereotypic
behaviors that are
seen in individuals
with ASD.
Program
Development
-The treatment
program devised for
this study could be
used as a guide for
OTs to use in practice
and could be used to
help develop future

-Attended a school
designed for
children with
special needs
-Free of orthopedic
impairments

Outcome Measures:
-Aerobic Fitness
and muscular
strength were
measured
-Aerobic fitness was
determined using the
PWC150 (power
work capacity)
fitness test, a valid
and reliable indicator
of change in aerobic
capacity.
-Muscular-strength
changes were
determined both pre
and post training as
measured by onerepetition maximal
lifts as performed on
Nautilus equipment.
-Diagnostic and
Statistical Manual of
Mental Disorders
(DSM-IV) criteria

protocols to facilitate
improvement in
positive behaviors in
children with ASD.
Societal Needs
- With further
research, this
intervention has the
potential to maximize
the number of
individuals with ASD
who can receive
physical exercise in
therapeutic
rehabilitation, can be
used in the home
environment as
well as during
inpatient rehabilitation
in the hospital setting.
Healthcare Delivery
and Health Policy
- It is advisable to
recommend further
accumulation of
evidence before
changing healthcare
delivery or policies.
Education and

Pan

Primary

Level III

Intervention:

Results indicated Representative

Training of OT
Students
- Knowledge on the
interventions included
in rehabilitation in
children with ASD,
specifically in regards
to the use of physical
exercise, should be
included in the
general education and
training of OT
students.
Refinement,
Revision, and
Advancement of
Factual Knowledge
or Theory
- This study design
may be used as a
framework for
developing future
studies; however, this
study contains several
limitations that should
be more carefully
controlled in future
studies.
Clinical and

(2008)

Purpose -To
compare MVPA
of elementary
school students
with and without
ASD during
inclusive
physical
education and
recess

Design: CaseControl
Participants:
-48 participants
-24 students with
ASD
-24 students
without disabilities
-Aged 7 to12 y/o

Intervention
-Physical education
lessons were given to
student in grade 1-2
and 3-6
-Types of physical
education included:
hula-hoop, soccer,
ball games, free play,
swimming,
Inclusion Criteria
jogging/walking,
Secondary
-Students
foot-soft ball, dodge
Purpose
-Diagnosis of mild
ball, table-tennis,
-To quantify the to moderate ASD or badminton,
contribution
Aspergers
basketball, aerobic
physical
syndrome
dance, jump rope,
education
-No co-occuring
gymnastics, and high
and recess makes conditions nor
jump
to the total
gross motor
Setting
physical
difficulties
-Playground in a
education and
crowded urban city
recess time
-Participants were
in Southern Taiwan
available,
taken from
Who Delivered
health-related
convenience
-Classroom teachers
guidelines, and
sample of 14
and physical
daily total school elementary schools education specialists
time MVPA for
-All students
Frequency
Taiwanese
followed regular
-1 to 2 lessons each
students
daily school routine week

that students
with and without
ASD spent a
larger percentage
of time in MVPA
during physical
education
compared with
recess period,
relative to the
amount of time
spent in those
settings.
-Activity level of
students with
and without
ASD under
regular
conditions were
similar during
physical
education
-Significant
difference for
percentage of
time spent in
MVPA between
physical

ness of sample
-Small sample
size
-Same
geographical are
of high social
and economic
deprivation in a
large urban city
-Assessment of
only 1 or 2
physical
education units
per student
Potential for
bias
-Possible
cultural and
educational
setting may have
bias
-Differences in
social skills,
behaviors,
cognitive
abilities, and
gross motor
skills were not

Community-Based
Practice of OT
-Practicing therapists
should know that
appropriate
engagement in MVPA
during physical
education and recess
can make a significant
contribution to daily
recommended MVPA
and should be
implemented in OT
interventions with
children with ASD.
Program
Development
-Physical exercise
programs should be
incorporated into an
intervention program
when treating children
with ASD.
Societal Needs
-Physical exercise
facilitation with
appropriate parent
education can be used
in the home as well as

physical activity

Duration
-40 min each lesson,
totaling 38 lessons
over 5 days
Outcome Measures:
-DSM-IV-Revised
-Identification
Standard for
Students with
Special Needs
-Accelerometer

education and
recess setting

considered

the school setting as

completed in the
study.
Healthcare Delivery
and Health Policy
- The results
are moderate to the
support of the
intervention.
It is advisable to
obtain
more supportive
research
prior to making
recommendations for
policy change.
Education and
Training of OT
Students
- Children with ASD
are a high risk
population and it is
recommended that OT
students receive the
proper training during
their school course
work and they should
be educated on the
importance of

physical activity
implementation in
their intervention.
Refinement,
Revision, and
Advancement of
Factual Knowledge
or Theory
- Further research is
warranted with this
population and the
interventions that are
found successful in
children with ASD.