Objective:

To propose a precision-informed framework for exercise interventions in Autism Spectrum Disorder (ASD) that considers the multidimensional nature of exercise dose, including factors such as motor complexity and social integration, and its clinical applications.

Approach:

• Framework Proposal: The review proposes a framework that conceptualizes exercise in ASD as a structured developmental exposure, emphasizing the importance of dose architecture over modality labels.
• Synthesis of Evidence: It synthesizes ASD-specific clinical evidence with indirect evidence from broader exercise neuroscience and animal models, distinguishing established clinical findings from hypothesis-generating mechanisms.
• Examination of Variability: The review examines how exercise responses may differ according to developmental stage, pubertal changes, and gender-associated traits.

Key Findings:

• Exercise interventions can improve multiple ASD-relevant outcomes, including motor performance, executive functions, and social functioning, as supported by systematic reviews and meta-analyses.
• The effective 'dose' of exercise extends beyond traditional metrics to include factors like motor complexity, cognitive demand, social embeddedness, sensory load, predictability, progression rate, and adherence burden.
• There is a lack of evidence on how exercise responses differ by gender and developmental timing, particularly for autistic females, highlighting a gap in the existing literature.

Interpretation:

The review emphasizes the need for a nuanced understanding of exercise interventions in ASD, focusing on individualized plans and the mechanistic pathways that may underlie the observed benefits.

Limitations:

• Existing literature often treats exercise as a generic intervention without specifying critical therapeutic elements, which limits understanding of its efficacy.
• There is limited integration of developmental stage and gender-related differences in the evidence base, particularly concerning autistic females.
• Clinical translation is hindered by short intervention periods, modest sample sizes, and a focus on broad symptom change rather than functional targets.

Conclusion:

The review emphasizes the importance of standardized dose reporting, developmental stratification, and safety monitoring in future ASD exercise research to enhance clinical applicability.