Trampoline exercise reduces anxiety and improves motor skills in children with autism spectrum disorder: A randomized controlled trial

Background: Anxiety affects approximately 40% to 50% of children with autism spectrum disorder (ASD), yet evidence-based nonpharmacological interventions remain limited. Trampoline exercise, which combines vestibular stimulation and aerobic activity, may offer dual benefits by reducing anxiety and improving motor skills in this population. To examine the effects of an 8-week trampoline exercise program on anxiety, motor performance, and physiological outcomes (heart rate variability, HRV) in children with mild-to-moderate ASD. Methods: This assessor-blinded, randomized controlled trial (Registered at Chinese Clinical Trial Registry: ChiCTR2500104402; Date: June 17, 2025) enrolled 50 children with mild-to-moderate ASD (aged 9–14 years) from Shandong Special Education Rehabilitation Center, China. Participants were allocated 1:1 to an 8-week trampoline intervention group (IG, n = 25; 3 sessions/wk, 30 min/session) or a resistance training control group (CG, n = 25). Primary outcomes: anxiety (screen for child anxiety related disorders [SCARED] questionnaire) and HRV root mean square of successive differences (RMSSD). Secondary outcomes: standing long jump (SLJ), one-leg stance with eyes closed (OLS), and BMI (body mass index). Between-group differences were analyzed via Mann–Whitney U tests; effect sizes were reported as Cliff δ (thresholds: small = 0.11, medium = 0.28, large = 0.43). Results: All 50 participants completed the intervention and assessments. Compared with CG, IG showed significantly greater reductions in SCARED scores (Δ = −9.4 vs Δ = 0, false discovery rate-corrected P  < .001, δ = −0.92) and improvements in HRV (RMSSD: Δ = +8.51 ms vs Δ = +1.45 ms, false discovery rate-corrected P  = .003, δ = −0.66). Standing long jump (SLJ) improved markedly in IG (Δ = +15.0 cm vs CG Δ = +4.0 cm, false discovery rate-corrected P  < .001, δ = −0.68). However, one-leg stance with eyes closed (OLS) showed no significant between-group difference after false discovery rate correction (Δ = +0.65 seconds vs Δ = +1.14 seconds, false discovery rate-corrected P  = .076, δ = −0.37). BMI remained stable in both groups (false discovery rate-corrected P  = .348). Conclusion: Trampoline exercise significantly reduces anxiety and enhances lower limb explosive power in children with mild-to-moderate ASD, with effect sizes exceeding clinical thresholds. Its low cost (<$100) and high adherence (85%) support integration into school-based interventions. Future studies should explore long-term effects (3–6 months) and neural mechanisms via functional magnetic resonance imaging.