Discover SPARK

The Challenge of Physical Fitness for Autistic People

Marina Sarris

Date Revised: March 22, 2024

Children and adults with autism are at a greater risk for an inactive lifestyle and obesity than others. There may be many reasons for this, but one thing is clear: autistic people often face unique challenges to physical fitness.

The core features of autism ─ social, communication, sensory, and behavior differences ─ can make joining a game of kickball at recess or playing pickup basketball at the gym a struggle.

Besides that, many people across the autism spectrum also face problems with motor (muscle) skills, such as balance and coordination.1-3 Motor challenges are common in autism, but they are “underdiagnosed and poorly managed,” according to some researchers.2

In fact, motor problems often start in infancy. Autistic youngsters may be late to sit, crawl or walk, or have unusual ways of accomplishing those milestones, according to research.

“It is very common for children with autism to have some motor delays that are recognized by the parents before the delays in social and communication skills are apparent,” says Paul H. Lipkin M.D., a pediatric neurodevelopmental specialist at Kennedy Krieger Institute and pediatrics professor at Johns Hopkins medical school.

In older children, signs of motor problems may include trouble with using a spoon, toothbrush, or pencil; riding a bike; and fastening buttons. They may seem clumsy and have an unusual way of walking.

An analysis of children and teens in the SPARK autism study found that 87 percent had problems with balance and coordination. That analysis used data from almost 12,000 SPARK participants ages 5 to 15.3

Comparing Motor Skills Between Autistic and Non-Autistic Youth

Another study used a test of motor skills to compare children with autism to both typically developing children and to children with ADHD.4 Children with autism scored the poorest in balance and in catching a ball. They put less emphasis on what they saw when trying to catch a ball, and more emphasis on input from their own muscles.

Some researchers have suggested that motor planning problems may be common in autism.5 Motor planning involves knowing what you want your body to do and coordinating your movements to do it. For example, before you pick up a ball, you plan to bend down, grab the ball between your hands, bring it to your chest and straighten your body.

Nonetheless, doctors do not consider motor problems to be a trait of autism, and some autistic people are, in fact, good athletes.

Physical Fitness and Weight Problems in Autism

Motor skills may be one of the factors that affect people’s level of physical activity, which in turn may influence their weight.

Beginning in the toddler years, autistic children have a higher risk of being overweight or obese than other children in the United States.6-7 They also tend to be less physically active. This pattern continues as they age. Teenagers with autism are less likely to exercise and more likely to be overweight and obese than typically developing youth. That is especially true of autistic teens with more significant support needs.8

Autistic adults also have higher rates of obesity, as well as health conditions that can be caused or worsened by obesity, such as diabetes, high cholesterol, and high blood pressure.9 A study of autistic adults ages 18 to 77 in SPARK found that 73 percent experienced obesity or being overweight, which are risk factors for heart disease.10

Theories abound as to why obesity is more common in autism. Some people with autism take medications, such as certain antipsychotics, which may cause weight gain. The study of SPARK adults found a link between those medicines and diabetes, but not with weight problems.10

Many autistic people have extremely picky eating habits, insisting on eating only a few foods that may be high in calories.11

Barriers to Sports for People With Autism

Some youth face barriers to sports and exercise. Safety can be one such barrier. Nearly one in four children on the spectrum wander or run away from safe places each year, which can put them in danger.12 Caregivers may keep children who wander indoors more often to protect them.

Another barrier may be understanding the rules and social conventions of games, and finding teammates who accept their differences. Playing sports often requires youth to follow complex instructions, wait their turn to play or get the ball, and interact with many players all at once.

Some autistic youth struggle to understand their coaches because of the literal way they may interpret language. “When I was a kid and did t-ball, the coach told me to keep my eye on the ball, so I put my actual eye on the ball. Turns out, that’s not what he meant,” Jas, 12, told researchers in Canada who were studying physical activity in autistic teens. “I find activity overwhelming sometimes because there is so much new info, so much to remember, all at the same time…, Jas added.13

Most children learn the ins and outs of sports, from high-fives to the offside rule in soccer, in physical education (P.E.) class. But these classes are often noisy, fast-paced, and crowded, which may overwhelm autistic children with sensory and social differences. And it can be hard to get individual instruction with 30 other students in the class.

Some teens say that they were bullied or excluded in gym class or on the playground, according to the study by researchers in Canada. “It’s hard to enjoy being active when you’re always being picked on. You just learn to hate activity,” 12-year-old Allan told them.13

Making Physical Activity Fun for Autistic Students

Brian Wagner, a special educator in Maryland, understands the problems that students with autism face in the gym. Wagner taught physical education at Kennedy Krieger High School, a nonpublic school for students with developmental conditions, before becoming an assistant principal there.

Some of his students came from schools where they did not get the attention or accommodations that he provided in his small class. He often heard that a new student “hates” P.E. class, he says. At a previous school, that student may have struggled to learn skills or understand the rules of a game, while classmates became impatient. “These students think, ‘I can’t do this so why am I even bothering to try?'” he says.

To help them, Wagner broke down complex motor skills into small tasks and taught them step-by-step. He also adjusted the rules of a game as necessary to help students who struggled to remember them. In this way, he hoped to make physical activity fun.

His advice? “Accept all children where they are starting ─ find that place first ─ build rapport before focusing on skills and stamina, and build skills and stamina at a pace that keeps the child participating. It’s a marathon, not a sprint,” he says.

Finding Help in P.E. Class and Beyond

U.S. special education law requires that students with disabilities receive physical education and, if necessary, special, or adapted P.E. in which an instructor modifies the teaching, equipment, or environment to help the student. The special education team, of which parents are members, determines the need for special help in P.E. class. Parents can ask the team to consider such assistance, along with occupational and physical therapy, if needed.

School occupational therapists often work on hand skills, and physical therapists address the gross motor skills used to walk, run, and jump.

To maintain fitness, Wagner recommends building movement into the student’s day and finding activities that interest them. “The challenge is getting the kids hooked,” he says.

Autistic teens are more likely to be active if they find meaning, “a sense of identity,” and pleasure in the activity, the Canadian study found. For example, Daniel, 13, found that “doing taekwondo allows me to be me, and even if I start rocking or head banging, I don’t feel like I am always being judged by people because they just get it.”13

And a 14-year-old reported that walking his dog takes him to his “happy place.” He told researchers, “Being active is the only time where I feel free. Free from always being told what to do, how to do it, when to do it. Free from teachers, therapists, and parents telling me how to live my life. Free from doing the same routine of school, home, doing homework, being a loner, getting beat up.”

“Being active just allows me to be, me.”13


  1. Green D. et al. Dev. Med. Child Neurol. 51, 311-316 (2009) PubMed
  2. Miller H.L. et al. Dev. Med. Child Neurol. 66, 16-22 (2024) PubMed
  3. Bhat A.N. Phys. Ther. 100, 633-644 (2020) PubMed
  4. Ament K. et al. J. Autism Dev. Disord. 45, 742-751 (2015) PubMed
  5. Dziuk M.A. et al. Dev. Med. Child Neurol. 49, 734-739 (2007) PubMed
  6. Egan A.M. et al. Child Obes. 9, 125-131 (2013) PubMed
  7. Hill A.P. et al. Pediatrics 136, 1051-1061 (2015) PubMed
  8. McCoy S.M. and K. Morgan Autism 24, 387-399 (2020) PubMed
  9. Croen L.A. et al. Autism 19, 814-823 (2015) PubMed
  10. Bishop L. et al. Autism Res. 16, 569-579 (2023) PubMed
  11. Curtin C. et al. Harv. Rev. Psychiatry 22, 93-103 (2014) PubMed
  12. T-Pederson C. et al. Curr. Opin. Pediatr. 33, 464-470 (2021) PubMed
  13. Jachyra P. et al. Autism 25, 613-626 (2021) PubMed