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

March 17, 2026 updated by: Monira Aldhahi, Princess Nourah Bint Abdulrahman University

Effects of Adapted Aquatic Exercise on Behavioral Outcomes, Flexibility, and Handgrip Strength in Male Children With Autism Spectrum Disorder: A Randomized Clinical Trial

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.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Actual)

35

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • 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

Exclusion Criteria:

  • 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

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Adapted Aquatic Exercise Group
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
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.
Other: Control Group (Academic Instruction Only)
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
Standard academic education provided by the school without participation in structured physical activity or aquatic exercise programs during the study period.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Handgrip Strength
Time Frame: Baseline and 16 weeks
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
Time Frame: Baseline and 16 weeks
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
Time Frame: Baseline and 16 weeks
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

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Princess Nourah Bint Abdulrahman University

Collaborators

Aksaray University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

December 1, 2025

Primary Completion (Actual)

February 5, 2026

Study Completion (Actual)

February 6, 2026

Study Registration Dates

First Submitted

February 7, 2026

First Submitted That Met QC Criteria

February 7, 2026

First Posted (Actual)

February 13, 2026

Study Record Updates

Last Update Posted (Actual)

March 19, 2026

Last Update Submitted That Met QC Criteria

March 17, 2026

Last Verified

March 1, 2026

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • PNU-11

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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