Abstract Background Children with autism spectrum disorder (ASD) exhibit deficits in executive function (EF). Cycling exercise has previously shown to be effective in improving EF. However, the role of different components (e.g., spatial updating and dynamic balance) driving these positive effects remains unclear. This study examined the cognitive effect of cycling interventions with varying navigation and balance demands through a heart rate variability (HRV) mediating model. Methods Fifty-one children with ASD (M age = 8.78 years; SD = .54) were randomized into four groups: Learning to Bicycle (LTB, n = 13), Bicycle Treadmill (BT, n = 12), Cycling with Training Wheels (TW, n = 14), and Stationary Cycling (SC, n = 12). The interventions lasted for 8 sessions over 2 weeks. EF (Tower of London, TOL; Corsi Block Tapping Task, CBTT; Go/No-go, GNG; Children’s Color Trails Test, CCTT) and HRV (RMSSD) were assessed at baseline (T1), mid-intervention (T2) and post-intervention (T3). Results All EF domains improved significantly in LTB and TW ( ps < .001, d = .56–2.15) and so did HRV in LTB ( ps < .001, d = 1.24). HRV partially mediated EF improvements in LTB ( β = .35–1.62) and TW ( β = .31–1.38), but not in BT and SC. BT showed modest to moderate EF gains ( d = .07–.97), while SC showed minimal effects ( d = .00–.59). Conclusions Cycling interventions with spatial updating and dynamic balance components benefited EF the most in children with ASD, with HRV as a partial mediator. These findings provided insight into optimizing exercise interventions to address EF deficits in children with ASD. Trial registration NCT07295912 (registered retrospectively on 19th Dec 2025 at https://clinicaltrials.gov/ct2/show/NCT07295912 . We acknowledge that best practice is prospective registration per ICMJE guidelines).
Tse et al. (Fri,) studied this question.
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