Effect of Aquatic Training Versus Land Exercises on Motor Function in Children With Autism Spectrum Disorder: A Randomized Controlled Trial.

Children with autism spectrum disorder often struggle with motor skills, sensory processing, and daily functioning, and physiotherapists have long debated which type of exercise setting helps most. This trial compared aquatic training against land-based exercises in fifty young children, aged three to five, split into two equal groups and treated three times a week for three months. Both groups improved over the course of treatment on measures of autistic traits, motor skills, and quality of life.

But when the two groups were compared directly, the aquatic training group showed greater improvement on the autism rating scale, quality of life scores, and specific motor measures like standing balance, movement skills, and overall gross motor ability. This is an interesting signal because water-based therapy is not always the default choice in paediatric rehabilitation, and this trial suggests it may offer added benefit over land exercises for this age group. The main limitation is that this is a single trial with a fairly small number of children, so the findings need replication before they can be treated as settled.

If you're a parent of a young child with autism, you may have wondered whether swimming pool based therapy offers anything beyond typical land-based exercise programs. This study looked at fifty children between three and five years old, dividing them into two groups: one did supervised exercises in water, the other did similar exercises on land, three times a week for three months. Both groups showed improvement in motor skills, autism-related behaviors, and quality of life by the end of the program.

However, when researchers compared the two groups directly, the children doing water-based therapy showed larger improvements, particularly in balance, movement skills, and overall physical function, as well as quality of life and autism trait scores. This is a promising but early finding. It comes from one trial with a relatively small number of children, so it cannot yet tell us whether these results would hold up in a larger, more diverse group of children, or over a longer period of time.

It adds useful information to a field that is still building its evidence base.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

For clinicians weighing aquatic versus land-based intervention for young children with autism spectrum disorder, this randomised trial offers a direct head-to-head comparison rather than a single-arm observation. Fifty children aged three to five were randomised to either aquatic training or land-based exercises, 25 per group, each receiving 45-minute sessions three times weekly for three months, with outcomes assessed using the Childhood Autism Rating Scale, the Peabody Developmental Motor Scale, and the Arabic Pediatric Quality of Life Inventory. Both groups improved within themselves across all three measures, which on its own cannot be attributed solely to the intervention type given the lack of a no-treatment comparator.

The key contribution is the between-group comparison: the aquatic group showed significantly greater improvement in CARS-2, PedsQL, and specific PDMS-2 subdomains including stationary and locomotor age equivalents and gross motor quotient, with reported p-values under 0.001. The main limitation for applying this to practice is the small sample size from a single trial, meaning these results, while statistically clear within this cohort, have not yet been replicated. The abstract does not report adverse events, so no safety conclusions can be drawn, and whether benefits persist beyond three months remains unaddressed.