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A client books a 7pm Tuesday session. She comes twice, cancels the next four and stops replying. Hmmmmm…something is up.
The story we may tell ourselves is that she lost interest. Another possible reason is that the gym at seven o’clock on a Tuesday evening is unbearable. The music, the lighting, the queue for the squat rack, the not knowing whether the machine she needs will be free. None of that is about motivation, it’s about feeling comfortable within the environment.
There are around 1.2 million autistic people and 2.2 million people with ADHD in England. Most of them are adults, and most of the adults have never had an official diagnosis. Which means a good number of them could already be in your sessions.
Two words get mixed up constantly in this subject area and there is a clear distinction that’s easy to remember. A person is neurodivergent. A group is neurodiverse. One client on your books is not neurodiverse, your client base is.
On autism specifically, the UK community norm is identity-first language. Autistic person, autistic adult, not person with autism. That preference has been measured repeatedly, including in a survey of 3,470 UK residents run with the National Autistic Society, and the group most out of step with it is professionals, who are roughly twice as likely as autistic adults to reach for person-first wording. Preference is not universal, so the honest position is identity-first as your default and then ask.
What to drop: functioning labels, severity labels, suffers from, risk of autism, special needs. And never describe exercise as treating, managing or improving somebody’s autism or ADHD, because it does not and the claim will cost you the client’s trust from just a slip of the tongue.
Roughly 1.2 million autistic people and 2.2 million people with ADHD live in England. Those are estimates built from research rather than counts of diagnoses, and the gap between the two is a story on its own.
The NHS England independent ADHD taskforce puts adult ADHD prevalence at around two to three per cent of the population, while English health records recognise ADHD in 0.74 per cent of men and 0.20 per cent of women. Something between two thirds and nine tenths of the people the prevalence figure describes are not showing up in the records at all.
The waiting lists explain part of it. The National Autistic Society reported 227,813 people in England waiting for an autism assessment in September 2025, of whom 205,182 had already waited longer than the thirteen weeks NICE recommends, with an average wait of over sixteen months. Adult ADHD waits run to several years in some services.
For us as trainers, a sizeable share of our client base is most likely neurodivergent, and many of them have no piece of paper saying so. They may be in the middle of a multi-year wait, or have decided that disclosing to a fitness professional is not something they want to do. If you only adjust for the clients who have told you, you are designing for the smallest group in the gym.
Activity Alliance surveys over two thousand UK adults every year. Seventy-six per cent of disabled people say they want to be more active. Only 43 per cent feel they have the chance to be as active as they want, against 69 per cent of non-disabled people. Among disabled women it falls to 39 per cent.
That is how people feel. Sport England’s Active Lives data shows the same gap in what they actually do. Around 39 per cent of disabled adults are inactive against roughly 20 per cent of non-disabled adults, and inactivity climbs as the number of impairments rises.
One thing to remember; those surveys report disability and long-term conditions, not neurodivergence, and there is no routine UK statistic for activity levels among autistic or ADHD adults. Even so, the pattern is hard to argue with. What’s missing is not the will to train. It’s somewhere decent to do it.
A 2026 systematic review and meta-analysis pooled the trials of exercise in adults with ADHD. Fourteen studies made the review, eight of them could be pooled.
A single bout of exercise improved inhibitory control with a Hedges’ g of 0.55, and moved core ADHD symptoms by 0.23, which is not much, but it is something. For chronic exercise, meaning a training programme rather than one session, the authors could only offer a narrative synthesis because the results were too mixed to pool (Xu et al., 2026).
This tells us that a session helps somebody think more clearly straight afterwards. Which is useful, and a good reason to schedule a client’s session before the part of the day they find hardest rather than after it. Importantly, what we can’t say is that twelve weeks of training changes ADHD.
A 2025 integrative review of clinical trials of exercise for autistic people found reasonable randomised evidence in children and adolescents for social and communication skills, executive functioning and sleep-related behaviour, and then stated what the evidence does not cover. There is very limited randomised evidence on exercise for autistic adults, for autistic girls and women, for autistic people with a co-occurring intellectual disability, or for reducing anxiety and low mood in any autistic population (Rivera et al., 2025).
A 2025 meta-review in World Psychiatry covering 256 randomised trials and 12,233 people found large effects on attention and moderate effects on hyperactivity and impulsivity in children and adolescents with ADHD, and stated that there is no meta-analytic evidence for physical activity as a first-line treatment for any mental disorder (Vancampfort et al., 2025).
Physical activity sits alongside whatever else somebody is doing. It is not a substitute for medication, therapy or diagnosis, and a coach who implies otherwise is out of their depth and their scope at the same time.
Sensory adjustment gets filed under autism and then forgotten for everybody else, which the data does not support.
A 2025 study of 492 adults compared autistic adults, adults with ADHD, adults with both and a comparison group on auditory hyper-reactivity. It was markedly elevated in both the autistic and the ADHD groups against comparison adults, with effect sizes running from 0.46 to 0.84, and the difference between autism alone and ADHD alone was small. The authors also describe a loop in which hyper-vigilance feeds sound sensitivity, which feeds anxiety, which feeds hyper-vigilance (Dwyer et al., 2025).
A commercial gym is close to a worst-case scenario for this. Music at a volume set by whoever got to the desk first, dropped plates, hand dryers, a spin class through a wall, tannoy announcements and forty people at six o’clock. None of that is about your programming.
The things you can do about it include booking off-peak, agreeing the music before the session rather than during it, letting your client know that ear defenders or loop earplugs are welcome, warning before anything loud happens, and picking a quiet corner in the gym to use every session.
Qualitative work with autistic adults has described difficulty starting and stopping tasks, sometimes called autistic inertia, as one of the most disabling parts of daily life. It has very little to do with motivation and quite a lot to do with transitions.
A client who turns up late, cancels repeatedly, and is somehow still sitting on the leg press three minutes after the set finished is not being flaky. They are stuck in the transition, and reading it as flakiness could cost you a client.
What helps is predictability. The same day and the same time every week. The plan sent in advance so the session has already been rehearsed in their minds before it starts. Explicit transitions, so that instead of drifting you say we finish this set, then we are moving to the rack. Always give advance warning of any change, including a substitute trainer or a piece of kit being out of service.
Related UK work on everyday executive function in autistic adults found that self-reported difficulty varies enormously with context, motivation and anxiety, and is often far larger in real life than in the lab. In practice, the client who, some days, cannot get out of the house is often the same one who logs every set in a spreadsheet and knows their own numbers better than you do. Nothing about them changed. The circumstances did.
Interoception is the sense of what is happening inside the body. Hunger, thirst, heart rate, breathlessness, the feeling that a set is nearly done.
A 2025 study at King’s College London compared thirty adults with diagnosed ADHD against fifty-seven typically developed adults and found lower interoceptive accuracy, lower confidence in their own readings and lower self-reported accuracy, after controlling for age, autistic traits, alexithymia, low mood and social functioning (Göz Tebrizcik et al., 2025). Related work in autistic adults points less at whether signals are detected and more at how negatively they are evaluated.
Both are small or self-report studies, so their findings should not be generalised too far. But the coaching implication stands to reason. If a client’s internal read on effort is unreliable, an RPE scale is a shaky way to prescribe, and “listen to your body” is asking someone who does not “hear” that well to make a judgement call.
The workaround is to prescribe with things that don’t depend on it. Load and reps. Reps in reserve anchored to a demonstrated technical breakdown point rather than to a feeling. Timed intervals. Scheduled drinks and rest breaks rather than waiting for thirst. Then teach the internal read as a skill over time, which is a much better use of it.
A 2025 UK study interviewed seventeen autistic adults aged between thirty-six and fifty-nine twice each about physical activity. Three things shaped whether they took part including assumptions about what exercise is supposed to look like, trust, and sensory sensitivity. The paper names a lack of understanding among movement professionals as a direct barrier and calls for co-produced, neurodivergent-informed practice (McLeod et al., 2025).
Seventeen people is a small study, but it is the most direct feedback our profession has been given on this, so we should listen to it.
It’s all about trust. If you agree a plan and then change it on the spot because you fancied doing something different, it can be seen as a break in trust, no matter what the reasoning.
Monotropism is the idea that attention pools deeply into a small number of interests rather than spreading thinly across many, and autistic adults describing task immersion talk about it as valuable rather than as a fault.
Coaches instinctively try to break it. Don’t. A client who wants to spend eleven weeks getting a deadlift right, who reads every study on it and arrives with questions, is a great client. Your job is helping them get into it and helping them come out of it. Leave the middle alone.
It also makes the depth of your own knowledge invaluable to them. A client who has read every paper on their programme will know within a session or two whether you have done the same. So you may need to be on your toes.
Almost all of this comes down to a handful of decisions made before you start a session, which is the good news. None of it requires you to know anything about the person’s neurology, and none of it makes the session worse for anyone else in the gym.
The table below provides a list of each barrier with what it tends to look like on the gym floor and the change we need to make to accommodate. Work down the left-hand column with a specific client in mind rather than reading it as a list.
| The Barrier | What It Looks Like in a Session | What to Change |
|---|---|---|
| Auditory hyper-reactivity | Flinching at dropped weights, losing cues over the music, cutting a session short | Book off-peak, agree the music, welcome ear defenders or loops out loud, warn before anything loud |
| Task initiation and transitions | Late arrivals, repeated cancellations, stalling between exercises | Same day and time weekly, plan sent in advance, spoken transition warnings, notice of any change |
| Interoceptive difference | Inconsistent RPE, overshooting or stopping early, not noticing thirst or fatigue | Prescribe by load and reps, anchor effort to technique, schedule drinks and rest, retire listen to your body |
| Low trust from past experience | Agreeing to everything, masking, then quietly not returning | Ask preferences openly at the start, offer real choices, honour the plan you agreed |
| The facility itself | Avoiding changing rooms, refusing the busy free weights area, cancelling in the car park | Off-peak booking, a changing alternative, one consistent equipment corner, a choice of one-to-one or small group |
| Communication mismatch | Long silences, blunt answers read as rudeness, exhaustion after a chatty session | Agree the format up front, written summaries, permission to skip the small talk |
Your job is the training session, the environment, the communication and consistency. It’s a big job that just takes a little forethought to get right.
Now, what’s not your job: diagnosing, speculating about whether somebody seems autistic or has ADHD, commenting on medication, or presenting exercise as a treatment. NICE guidance puts medication first-line for adults with ADHD and asks health professionals to encourage regular exercise as part of general health, which is where you come in.
Signpost rather than advise. Send them to their GP for anything about assessment or medication, to the National Autistic Society or ADHD UK for peer support, and to a registered dietitian if eating is restricted or highly selective. That last one comes up more often than you would think, and it is well outside your scope or practice.
Many of us find our clients never mention being neurodivergent. Given the waiting lists, plenty of them may not know they are.
Which is the argument for making the adjustments the default criteria for a session rather than the exception. An off-peak slot, a plan sent in advance, a warning before the music changes, a consistent corner of the gym and effort prescribed by something more reliable than a feeling. None of it costs anything, and all of it works for the client who hasn’t told you.
Yes, the research is thin in places, we recognise that. And most of the good trial evidence is in children. The research into adults is small, and some of it is a single interview study. However, three quarters of disabled people want to be more active and fewer than half feel they get the chance. With this new-found knowledge and approach to training, you can help.
Dwyer, P., Williams, Z.J., Lawson, W. and Rivera, S.M. (2025). A Trans-Diagnostic Investigation of Attention and Diverse Phenotypes of Auditory Hyperreactivity in Autism, ADHD, and the General Population. Journal of Attention Disorders, 30(1), pp.57-81. Click here to review the full research article.
Göz Tebrizcik, B., Georgescu, A.L., Pick, S. and Dommett, E.J. (2025). Interoceptive Abilities in Adults with Attention Deficit Hyperactivity Disorder. Biological Psychology, 202, 109161. Click here to review the full research article.
McLeod, J., Roderick, M., Hanley, M., Riby, D.M. and Jachyra, P. (2025). Perspectives and Experiences of Physical Activity Among Autistic Adults in Middle Adulthood. Autism, 29(12), pp.3058-3071. Click here to review the full research article.
Rivera, R.A., Robertson, M.C. and McCleery, J.P. (2025). Exercise Interventions for Autistic People: An Integrative Review of Evidence from Clinical Trials. Current Psychiatry Reports, 27(5), pp.286-306. Click here to review the full research article.
Vancampfort, D., Firth, J., Stubbs, B., Schuch, F., Rosenbaum, S., Hallgren, M., Deenik, J. and Ward, P.B. (2025). The Efficacy, Mechanisms and Implementation of Physical Activity as an Adjunctive Treatment in Mental Disorders: A Meta-Review. World Psychiatry, 24(2), pp.227-239. Click here to review the full research article.
Xu, S., Zhao, C. and Hu, L. (2026). The Effects of Acute and Chronic Exercise on Executive Functions and Core Symptoms in Adults with ADHD: A Systematic Review and Meta-Analysis. Psychology of Sport and Exercise, 84, 103088. Click here to review the full research article.
The adjustments we suggest to your sessions in this week’s article are mostly environmental, and they may help more clients than you realise. What they do not give you though, is the knowledge to deal with clients who divulge information you weren’t expecting.
Our Mental Health First Aid qualification is designed to help in these situations. Recognising when somebody is struggling, having a conversation without making it worse, knowing your limits and knowing where to point them next, are all skills you can learn to handle situations that may otherwise be quite frightening.
This Week's Special Offer: Get Get started on the UK's leading Mental Health First Aid at Work course and save £100 when you pay in full upfront. Use code MHFA25 at checkout. From just £299 or £67/month. Offer Ends 11th September!
Mental Health First Aid – Live-Virtual
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