To compare the relative effects of different interventions on repetitive stereotyped behaviors in children with autism spectrum disorders, and to compare the roles of different interventions, to provide an evidence-based basis for developing effective Exercise prescription.

Literature from domestic and international databases such as Cochrane Library, PubMed, Web of Science, MEDLINE, PsycINFO, Embase, China Knowledge, Baidu Academic, and Wanfang was searched. The search encompassed the period from the inception of the database to July 21, 2024, with analysis conducted using RevMan 5.3 and Stata 15.0.

A total of 10 studies were included in the analysis. Meta-regression analyses revealed that exercise interventions can effectively ameliorate repetitive and stereotyped behaviors in children with Autism Spectrum Disorder (ASD). Further subgroup analyses demonstrated significant differences in the effects of these interventions based on varying intervention cycles and the ages of the participants. To delve deeper into the impact of different interventions, reticulated Meta-analyses were conducted. The results indicated that ball games (SMD = −5.35 [-6.92, −3.77]), karate training (SMD = −0.93 [-1.68, −0.17]), and bicycle riding (SMD = −0.97 [-1.90, −0.04]) interventions played a significant role in reducing repetitive and stereotyped behaviors in children with ASD. Additionally, the cumulative probability ranking (SUCRA) results suggested that ball games may be the most effective means of improving these behaviors in children with ASD (SUCRA = 79).

Ball games showed the highest SUCRA ranking (79 %), but their clinical application is limited by significant heterogeneity (I ²  = 78 %), small sample size (10 RCTs, n = 245), and tool-specific effects (SMD = -4.2 in RBS-R vs. −1.1 in GARS-2). Subgroup analyses highlighted age (5–8 years) and duration ( > 9 weeks) as critical factors. Additionally, potential biases (e.g., unclear allocation concealment in 30 % of studies) and the need for larger, multi-center trials should be noted. Sports interventions may be optimized by combining ball games with karate or cycling.