Adapted Aquatic Exercise and Behavioral Outcomes, Flexibility, and Handgrip Strength in Children With Autism Spectrum Disorder

NCT07410897 | Completed DMC

• 1 other identifier: PNU-11
• Study Type: interventional
• Target: 35
• Locations: 1 country
• Sites: 1

Brief Summary

This randomized clinical trial studied whether an adapted aquatic exercise program could improve behavior and physical abilities in children with autism spectrum disorder (ASD). Thirty-five boys aged 6 to 12 years with mild ASD participated in the study. Participants were randomly assigned to either an aquatic exercise group or a control group. The aquatic exercise group took part in a structured, individualized swimming and water-based exercise program twice per week for 16 weeks, while the control group continued their regular academic education without additional exercise. The program focused on water safety, breathing control, and basic swimming movements. Outcomes were measured before and after the 16-week period. Autism-related behaviors were evaluated using the Autism Behavior Checklist. Physical abilities were assessed using flexibility (sit-and-reach test) and handgrip strength measurements. The study aimed to determine whether regular participation in adapted aquatic exercise could reduce autism-related behaviors and improve motor skills that are important for daily life activities in children with ASD.

Conditions

Autism Spectrum Disorder

Outcome Measures

Primary Outcomes (3)

• Handgrip Strength

  Handgrip strength was measured using a calibrated handgrip dynamometer. Participants performed maximal voluntary contractions, and the highest valid value (kilograms) was recorded.

  Baseline and 16 weeks

• Autism-Related Behaviors

  Autism-related behaviors were assessed using the Autism Behavior Checklist (ABC), a 57-item questionnaire completed by classroom teachers familiar with the participants' daily behavior patterns. Higher total scores indicate greater severity of autism-related behaviors.

  Baseline and 16 weeks

• Flexibility

  Flexibility will be assessed using the sit-and-reach test with a standardized sit-and-reach box. Participants perform three trials, and the best score (in centimeters) is recorded for analysis. The score represents the maximum forward reach distance. The scale is continuous, with higher values indicating greater flexibility. Typical values range from negative values (unable to reach the toes) to approximately 30-40 cm, depending on performance.

  Baseline and 16 weeks

Study Arms (2)

Adapted Aquatic Exercise Group

EXPERIMENTAL

Participants in this group participated in a 16-week adapted aquatic exercise program in addition to their regular academic instruction. The program was delivered twice per week for 50 minutes per session and focused on water safety, breathing control, limb propulsion, and progressive freestyle swimming skills using individualized, one-to-one instruction.

Behavioral: Adapted Aquatic Exercise Program

Control Group (Academic Instruction Only)

OTHER

Participants in this group continued to receive their regular academic instruction only and did not participate in any structured physical or aquatic exercise programs during the study period.

Other: Academic Instruction

Interventions

Adapted Aquatic Exercise Program BEHAVIORAL

A structured adapted aquatic exercise program conducted over 16 weeks, with two 50-minute sessions per week. Sessions were delivered individually by certified adapted swimming instructors and included water familiarization, pool safety, breathing exercises, upper- and lower-limb propulsion, and progressive freestyle swimming skills.

Adapted Aquatic Exercise Group

Academic Instruction OTHER

Standard academic education provided by the school without participation in structured physical activity or aquatic exercise programs during the study period.

Control Group (Academic Instruction Only)

Eligibility Criteria

• Age: 6 Years - 12 Years
• Sex: male
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• Male children aged 6 to 12 years
• Clinical diagnosis of mild autism spectrum disorder confirmed by a licensed -child psychiatrist according to DSM-5 criteria
• Medical clearance for participation in aquatic exercise
• Ability to follow verbal and visual instructions
• Ability to imitate fine and gross motor movements
• Independent in toileting
• Not participating in structured sports or exercise programs other than standard academic instruction
• Written informed consent provided by a parent or legal guardian

You may not qualify if:

• Severe autism spectrum disorder
• Orthopedic, neurological, or medical conditions that contraindicate participation in aquatic exercise
• Current participation in structured physical training or sports programs outside of school
• Inability to safely participate in water-based activities

Sponsors & Collaborators

• Princess Nourah Bint Abdulrahman University: lead
• Aksaray University: collaborator

Study Sites (1)

Aksaray University

Aksaray, Turkey (Türkiye)

Location

MeSH Terms

Conditions

Autism Spectrum Disorder

Condition Hierarchy (Ancestors)

Child Development Disorders, Pervasive; Neurodevelopmental Disorders; Mental Disorders

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: Due to the nature of the exercise intervention, participants and instructors could not be blinded. However, outcome assessment and data analysis were conducted by researchers who were blinded to group allocation.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Prof

Model Details: Participants were stratified by speech impairment status and randomly assigned to either an adapted aquatic exercise group or a control group. Both groups were followed concurrently over a 16-week intervention period.

Study Record Dates

• First Submitted: February 7, 2026
• First Posted: February 13, 2026
• Study Start: December 1, 2025
• Primary Completion: February 5, 2026
• Study Completion: February 6, 2026
• Last Updated: March 19, 2026

Record last verified: 2026-03

Locations

TU (1)