What if exercise for children with neurodevelopmental disorders could happen at home, through a game console, Zoom, or WhatsApp? This review finds some encouraging improvements—but only five studies qualified. Neurodevelopmental disorders are a group of disorders that appear early in development and are characterized by impairments in cognitive function, motor function, verbal communication, social skills, and behaviors.

They include autism spectrum disorder, attention deficit hyperactivity disorder, specific learning disorder, intellectual disability, motor disorder, communication disorder, and tic disorder. The prevalence differs considerably from country to country, and many patients have two or more comorbid disorders.

The effects remain for a lifetime in many people. Several studies have shown the effectiveness of exercise interventions for children with neurodevelopmental disorders. For children with autism spectrum disorder, exercise intervention improved motor skills, social functioning, and muscular strength and endurance.

For children with attention deficit hyperactivity disorder, aerobic exercise was useful in relieving inattention, hyperactivity, impulsivity, anxiety, executive dysfunction, and social disorders. However, the limited number of therapists and geographical conditions reduce opportunities for non-drug interventions, and the COVID-19 pandemic affected the availability of many services.

The COVID-19 pandemic led to a rapid shift to telemedicine services and had a significant negative impact on the health and well-being of children with neurodevelopmental disorders. Children with attention deficit hyperactivity disorder had significantly worse behavioral symptoms and mood states, while parental stress increased during the pandemic compared to before.

The pandemic affected the mental health of parents with autism spectrum disorder children, including loss of confidence and depression, and anxiety states were significantly higher than before the pandemic. Web-based interventions could provide an opportunity to receive effective interventions at a distance with less burden on therapists.

They can be self-directed or therapist-assisted programs aiming at improving knowledge and providing support, care, and treatment. However, few systematic reviews had investigated web-based interventions focused on exercise interventions in children with neurodevelopmental disorders.

The purpose of this systematic review was to examine effects on social skills, motor functions, and physical activity. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The inclusion criteria were patients with neurodevelopmental disorders aged eighteen years or younger, a web-based intervention, exercise training, publication from 1994 to 2022, and English language.

The interventions were home-based and web-based interventions offered through websites, apps, or social media. The review excluded observational studies, reviews, meta-analyses, study protocols, and studies without social skills, motor function, or physical activity outcomes.

The review obtained 660 relevant articles from PubMed, but 645 were excluded during the first screening based on titles and abstracts. At the second screening, ten more articles were excluded because of discrepancies in subjects, age, intervention methods, and outcome measures.

Finally, five full-text articles were included in the review, and the characteristics of the five included studies were summarized in Table 1. Cohen’s Kappa coefficient was zero point four three for the first screening and zero point six one for the second screening.

Figure One traces the review’s selection process: six hundred sixty records were identified, six hundred forty-five were excluded during title and abstract screening, and fifteen full-text articles were reviewed. A further ten were excluded for reasons including mismatched participants, age, interventions, or outcomes, leaving five full-text articles in the review.

This matters because it makes the evidence base transparent and shows how the authors narrowed a broad search to the studies analyzed. Across the five extracted papers, the intervention targets were attention deficit hyperactivity disorder in one paper, developmental coordination disorder in two papers, and autism spectrum disorder in two papers.

The participants ranged in age from eight to fourteen years, and the percentage of females ranged from eighteen point six percent to fifty-two point four percent. Diagnosis used the International Classification of Diseases, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the Developmental Coordination Disorder Questionnaire in several studies.

Three studies used interventions based on video games, with one offered via Zoom and one offered via WhatsApp. All of these interventions were designed to provide exercise. The active video games included Xbox Kinect, Xbox three-sixty, PlayStation three, Racket Sports, and Cross Board seven.

The Zoom intervention included home-based exercises, dance activities, and fitness activities. The WhatsApp-based intervention included home-based exercises, fun games, dance, daily housework, meditation, and fitness activities. Table one summarizes the five full-text articles included in the review, covering ADHD, DCD, and ASD.

It organizes each study by design, sample, participant characteristics, outcome measures, intervention schedule, technology or activity type, and reported results. The table shows that findings ranged from significantly improved executive functions and motor abilities to no differences in physical activity or motor coordination, while the ASD studies reported positive physical-activity effects from Zoom- or WhatsApp-based interventions.

One of the five studies measured executive function using the E-Prime Software. The E-Prime Software was used as a computer-based executive function test to measure inhibition, switching, and updating. The exergaming intervention for children with attention deficit hyperactivity disorder showed a significant improvement in reaction times in inhibition and switching.

Figure two summarizes risk of bias across the five included studies and seven assessment domains. The study-by-domain grid uses green for low risk, yellow for unclear risk, and red for high risk, while the bar chart aggregates these judgments by domain.

The authors report low risk for incomplete outcome data and selective reporting across all articles, unclear risk for blinding outcome assessment, and high risk in most articles for blinding participants and personnel. The review included three studies using active video game interventions, one study using a Zoom-based intervention, and one study using a WhatsApp-based intervention.

Three of the five studies showed improvements in motor function, executive function, or physical activity. Because the review used only PubMed, the number of studies and samples included was very small and limited. Because the outcome measures and their units differed, a meta-analysis could not be performed.

The included studies differed in study design, intervention methods, and monitoring during intervention. The review could not investigate the different clinical characteristics of children with developmental coordination disorder compared with children with autism spectrum disorder and attention deficit hyperactivity disorder.

More research work is needed in future trials, although the review has the potential to be useful in future research and intervention development. Web-based exercise may improve motor function, executive function, or physical activity, particularly for children with autism spectrum disorder or attention deficit hyperactivity disorder.

But the evidence is small, varied, and not yet strong enough for firm conclusions.