What Every Exercise Physiologist Should Understand About Autism
Understanding Autism
It is estimated that 1 in 40 Australians are autistic1, representing nearly 700,000 people nationally. This increase is likely due to expanded diagnostic criteria, increased community awareness and access to supports such as the NDIS. With autism and neurodivergence now representing such a significant section of the population, it is imperative that clinicians understand the unique strengths and difficulties that autistic people face so that we can provide high-quality care.
Your role as an Exercise Physiologist
As an Exercise Physiologist, it is highly likely that you will work with autistic clients. With nearly 3% of the population diagnosed as autistic and the aetiology of autism highly genetic, the population will only grow in future generations. Currently, 41% of NDIS participants have a primary disability of autism. ASD is not only associated with differences in communication and behaviour but also neurological and motor functions. Research shows that among autistic children, nearly half demonstrate motor impairments2, and clinical levels of impairment are seen in 35- 50% of all autistic young people3. It is now said that differences in motor processing and reduced motor ability are key specifiers of autism. We also know that autistic people demonstrate sensory differences that change the way that they interact with the world – in a large population cohort of autistic children (N = 25,627), 74% had atypical sensory processing4, and this prevalence has been repeated in adults5. It is important to recognise that sensory differences represent both hypersensitivity and hyposensitivity, meaning that many autistic people require more input, not less. There is therefore an important role for you to play as Exercise Physiologists. As an expert in clinical exercise prescription, you are perfectly placed to provide individualised support to address key challenges related to motor skills, access to physical activity and sensory differences. Due to the unique characteristics, experiences and barriers to participation that autistic people face, tailored exercise has significant positive benefits.
What does it mean to be a neuro-affirming professional?
Neuro-affirming practice involves recognizing neurodiversity as differences to understand rather than deficits to fix and working with a strength-based approach to champion authenticity and allow autistic people to live life on their terms. As an Exercise Physiologist, you can do this by: 1. Understanding your client – not just their clinical goals, but their interests, communication and sensory preferences and lifestyle. 2. Adapting your way of communicating, teaching and prescribing to match their learning and communication style. 3. Working collaboratively with them and their support to set goals and establish routines that work for them and include their voice. 4. Recognising strengths and encouraging authenticity (masking is exhausting). 5. Changing your approach – we all get it wrong sometimes. A good clinician seeks feedback and adapts their approach to achieve a better outcome.
Exercise Prescription
While for the most part exercise considerations should reflect those of the general population, many autistic people require tailored approaches that suit their learning style, communication style and sensory needs. Here are some key strategies I employ with autistic clients:
1. Embed your exercise program into their native language
This means you need to consider not just their communication style, but also their everyday life and interests. For example, utilizing visuals for someone who communicates using a visual device and using words, phrases or pictures that are family can be very effective. Adapting your language to include their interests can also improve program interest and adherence; instead of a “cross-body cable exercise”, it’s “Thor’s Hammer”, or instead of counting with numbers, count something meaningful to your client. Another key communication strategy is clearly articulating what the plan is, and what is coming next. Many autistic people experience high levels of anxiety when facing uncertainty, so collaborating to make a plan is essential. Include them in this process – we know that when tasks are interesting and self-selected, autistic people experience higher levels of engagement and satisfaction.
2. Adapt a dynamic systems approach, rather than a prescriptive motor learning model
The most common way that motor skills are taught is founded in motor program theory6. This typical involves using sequential steps or cues that are combined to execute a movement. Where this fails many autistic and neurodivergent people is that it is highly specific and often results in low repetitions of complete practice. Many autistic people need the opportunity to practice skills with a high level of repetition to achieve mastery. For example, throwing can be taught a) by using 3-step cues such as point, step and throw (the motor program model), or b) by practicing throwing with a big tub of balls and allowing intrinsic and environmental feedback to guide performance. Dynamic systems theory7 suggests that the interaction of the person, task and environment introduce a process called “self-organisation” where an autistic person learns the way that makes most sense to them. This approach is often more successful due to increased number of repetitions and lower demands and is in line with a neuro-affirming model of care. This sometimes means that you need to cue less, not more! Provided a few simple, consistent cues and setting up the environment for successful repetition can work to autistic strengths and increase autonomy and enjoyment.
3. Regulation first, learning second
Sensory and emotional dysregulation because of an overstimulating world is common with autism. Without first meeting the needs of the central nervous system, it is very hard to create a safe learning environment. This means you may need to spend longer building rapport and understanding your client prior to cueing them to complete exercises. It is important to understand your client’s sensory preferences, triggers, and strategies so you can support them to engage in your exercise program. Some examples of activities to start a session with and build regulation include:
• Deep pressure such as squeezes, wall pushes or dragging a heavy object for
proprioceptive input and down regulation
• Gentle spinning, rolling or swinging for vestibular input
• Jumping, climbing, ball slams and running for upregulation
• Dual tasking such as standing on a balance disc and popping bubbles/catching aball for multisensory seeking.
It is important that your regulation activities both match the sensory needs of your client but also require little attention or instruction to be completed. Once you have calmed the nervous system through appropriate regulating activities, you can then increase psychological demand. I often complete strength and conditioning activities first and move on to skills later to improve concentration and increase learning opportunities.
Application
In your next session, consider the following:
1) Consider the environment and its impact on sensory and emotional regulation. Start with rapport and regulating activities that provide appropriate sensory input to calm the nervous system. This includes calming, as well as upregulating tasks.
2) Give choices and make a plan for the session in their native communication style so that everyone knows what to expect. Include personal interests and strengths.
3) Start with familiar tasks that require less cueing and progress towards new skills once everyone is engaged and well-regulated (including you!).
4) Use a dynamic approach that minimises pauses and staggers cueing to prioritise high repetition practice.
5) Return to regulation when things go awry- physical activity is a high sensory experience and when dysregulated no-one is ready to learn or participate.
References
1. Autism Spectrum Australia, Facts and figures about autism, Aspect,
2. Kangarani-Farahani, M., Malik, M. A., & Zwicker, J. G. (2024). Motor impairments in
children with autism spectrum disorder: A systematic review and meta-analysis. Journal of autism and developmental disorders, 54(5), 1977-1997.
3. Licari, M. K., Alvares, G. A., Varcin, K., Evans, K. L., Cleary, D., Reid, S. L., ... &
Whitehouse, A. J. (2020). Prevalence of motor difficulties in autism spectrum disorder: Analysis of a population‐based cohort. Autism Research, 13(2), 298-306.
4. Kirby, A. V., Bilder, D. A., Wiggins, L. D., Hughes, M. M., Davis, J., Hall‐Lande, J. A., ...
& Bakian, A. V. (2022). Sensory features in autism: Findings from a large population‐ based surveillance system. Autism Research, 15(4), 751-760.
5. Chen, Y., Jenkins, C. A., Charlton, R. A., Happé, F., Mandy, W., & Stewart, G. R.
(2026). “Utterly overwhelming”—A mixed-methods exploration of sensory processing differences and mental health experiences in middle-aged and older autistic adults. Autism in Adulthood, 8(2), 175-187.
6. Keele, S. W., & Summers, J. J. (1976). The structure of motor programs. In Motor
control (pp. 109-142). Academic Press.
7. Kamm, K., Thelen, E., & Jensen, J. L. (1990). A dynamical systems approach to
motor development. Physical therapy, 70(12), 763-775.
