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Objective: An increasing number of studies suggest possible beneficial effects of exercise in alleviating ADHD functional outcomes. The current study provides a quantitative meta-analysis of the available studies investigating this relationship. Method: Studies reporting on the effects of physical exercise on motor skills and executive functions in children with ADHD were identified through Cochrane, PsycInfo, PubMed, Web of Science databases. Ten publications were selected. Random-effects model was used to calculate effect sizes. Results: There was a significant effect of exercise on ADHD functional outcomes (g = 0.627). Longer exercise intervention duration was consistently associated with larger effect sizes. Effect sizes were not related to exercise intensity, mean age of participants, or gender distribution. Conclusion: Results suggest that exercise has a modest positive impact on ADHD functional outcomes, such as executive functions and motor skills, with longer interventions yielding better results.
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Journal of Attention Disorders
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DOI: 10.1177/1087054715627489
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Article
Introduction
With a prevalence rate of 3% to 5%, ADHD is one of the
most frequently diagnosed neurodevelopmental disorders
in school-aged children (Faraone, Pucci, & Coghill, 2009;
Gordon Millichap, 2011). Its essential features are develop-
mentally inappropriate levels of inattention and/or hyperac-
tivity–impulsivity (Gordon Millichap, 2011). Children with
ADHD often show co-occurring disruptive behaviors, and
are at a higher risk to develop anxiety, depression, and
learning disorders (Barkley, 2006; Weiss & Hechtman,
1993). Frequently co-occurring neurocognitive sequels of
ADHD include impaired executive functioning (EF), slower
and more variable response speed, increased aversion to
delay, and motor skills deficits (Boonstra, Oosterlaan,
Sergeant, & Buitelaar, 2005; Piek, Pitcher & Hay, 1999;
Willcutt, 2010).
Currently, central nervous system stimulant medication
and behavioral interventions are two treatment options that
are empirically supported and universally recognized as
effective for amelioration of ADHD symptoms. However,
up to 30% of children do not respond favorably to medica-
tion or are unable to tolerate frequent occurring side effects,
including insomnia, appetite suppression, growth retarda-
tion, and headaches (Connor, 2006; Wigal, Emmerson,
Gehricke, & Galassetti, 2013). Moreover, medication does
not yield a long-term benefit, as its effectiveness is limited
to the period of active drug administration (Chronis, Jones,
& Raggi, 2006; Pelham & Fabiano, 2008).
Behavioral interventions such as behavioral parent train-
ing and behavioral classroom management provide an alter-
native evidence-based approach (Pelham & Fabiano, 2008;
The Multimodal Treatment Study of Children with Attention-
Deficit/Hyperactivity Disorder (MTA) Cooperative Group,
1999). Although this treatment modality offers improvement
in specific areas that are affected less by pharmacological
interventions, such as parenting behavior and family func-
tioning, the effects are hard to maintain after termination of
treatment (Chronis et al., 2006). Furthermore, behavioral
interventions are relatively difficult to implement, costly
both in terms of financial expenditures and time, and may be
less effective than stimulants (MTA Cooperative Group,
1999). Behavioral interventions may also pose a heavy bur-
den on the adults in charge of implementation, that is, teach-
ers and/or parents, as behavioral interventions require
627489JAD
XXX10.1177/1087054715627489Journal of Attention DisordersVysniauske et.al
research-article2016
1
Vilnius University Children’s Hospital, Lithuania
2
Vrije Universiteit Amsterdam, The Netherlands
3
Leiden University, The Netherlands
Corresponding Author:
Ruta Vysniauske, Physical Medicine and Rehabilitation Centre, Vilnius
University Children’s Hospital, Affiliate of Vilnius University Hospital
Santariskiu Klinikos, Santariskiu 7, Vilnius, LT-08406 Lithuania.
Email: kaminsku.ruta@gmail.com
The Effects of Physical Exercise on
Functional Outcomes in the Treatment of
ADHD: A Meta-Analysis
Ruta Vysniauske
1
, Lot Verburgh
2
, Jaap Oosterlaan
2
, and Marc L. Molendijk
3
Abstract
Objective: An increasing number of studies suggest possible beneficial effects of exercise in alleviating ADHD functional
outcomes. The current study provides a quantitative meta-analysis of the available studies investigating this relationship.
Method: Studies reporting on the effects of physical exercise on motor skills and executive functions in children with
ADHD were identified through Cochrane, PsycInfo, PubMed, Web of Science databases. Ten publications were selected.
Random-effects model was used to calculate effect sizes. Results: There was a significant effect of exercise on ADHD
functional outcomes (g = 0.627). Longer exercise intervention duration was consistently associated with larger effect sizes.
Effect sizes were not related to exercise intensity, mean age of participants, or gender distribution. Conclusion: Results
suggest that exercise has a modest positive impact on ADHD functional outcomes, such as executive functions and motor
skills, with longer interventions yielding better results. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Keywords
ADHD, exercise, executive function, motor performance, children
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2 Journal of Attention Disorders
long-term commitment to keep up high levels of fidelity and
intensity (Chronis et al., 2001).
Having in mind the pervasive and chronic nature of
ADHD and limitations of traditional treatments, there is a
rising need for an approach that could be used as an alter-
native or an adjunct to existing treatments. Physical exer-
cise seems to stand out as a promising intervention.
Findings from behavioral, neurocognitive, neuroimaging,
and physiological studies suggest that physical exercise
might not only temporarily improve the symptoms of
ADHD but also touch on the underlying physiological
mechanisms and potentially change the developmental tra-
jectory of the brain (Berwid & Halperin, 2012). Most of the
studies examining the relationship between physical exer-
cise and functional outcomes in ADHD population have
focused on EF and motor skills. The current study provides
a meta-analysis of findings available so far.
Physical exercise is defined as body movement induced
by contraction of skeletal muscle resulting in increased
energy expenditure with the intention to improve or main-
tain physical fitness (Howley, 2001). Exercise interven-
tions are relatively easy to implement and follow, because
such interventions can be offered in a highly protocolled
fashion, have essentially no side effects, and are much
more affordable financially in comparison with medication
or behavioral interventions. Maintenance of exercise after
the intervention period requires commitment of the par-
ents, but the parental involvement is not as complex as
required for behavioral parent training. First of all, physical
exercise interventions have to be implemented only during
a limited time period during the day, whereas behavioral
parent training requires parental vigilance to monitor target
behaviors and take action whenever the child exhibits target
behaviors. Second, it does not require continuous and costly
supervision from a behavioral therapist as the procedure is
easily mastered after initial demonstration. Finally, physical
exercise programs could be scheduled directly after school
at sports clubs or even at schools. This way it would require
almost no commitment of the parents.
Several distinct lines of research provide evidence for
the potential utility of physical exercise in developing new
strategies for treating ADHD. One line of evidence comes
from neuropharmacological studies showing that stimulant
medications act as dopaminergic and noradrenergic ago-
nists (Wigal et al., 2013). Given the effectiveness of medi-
cation in treating the core symptoms of ADHD, it has been
argued that catecholamine dysfunction resulting in unbal-
anced and dysregulated levels of dopamine and norepineph-
rine might be central underlying mechanism of the disorder
(Lenz, 2012; Solanto, 2002; Wigal et al., 2013).
Behaviorally, these deficits translate into disturbed EF
(Arnsten & Casey, 2011). As physical exercise produces an
increase in dopamine and norepinephrine and affects their
regulation, it has been suggested that it may improve EF in
ADHD (Gapin, Labban, & Etnier, 2011; Lenz, 2012; Wigal
et al., 2013). Another line of evidence comes from experi-
mental studies on healthy adults and typically developing
children showing that physical exercise improves EF
(Hillman et al., 2009; Sibley & Etnier, 2003; Verburgh,
Königs, Scherder, & Oosterlaan, 2014).
It is generally agreed that moderate-to-vigorous exercise
intensity appears to be the most effective regarding EF and
motor functioning (Best, 2010). However, optimal duration
of exercise intervention is still being discussed. The effects
of acute exercise on EF have been well documented (Sibley
& Etnier, 2003; Verburgh et al., 2014). In their meta-analy-
sis on the immediate effects of physical exercise, Chang,
Labban et al. (2012) found that benefits of exercise on EF
are larger when physical activity is maintained for at least
20 min. However, the effects of long-term / chronic physi-
cal exercise are still unknown, mainly due to the lack of
available studies (Verburgh et al., 2014). Furthermore,
although research on type of exercise still is scarce, it has
been suggested that exercise interventions that require com-
plex and controlled movement and cognition have greater
impact on functional outcomes in comparison with repeti-
tive aerobic or treadmill exercises (Best, 2010).
Research consistently shows that majority of children
with ADHD have deficits both in EF and in gross and fine
motor skills (Keiser, Schoemaker, Albaret, & Geuze, 2015;
Pennington & Ozonoff, 1996; Shallice et al., 2002; Willcutt,
Doyle, Nigg, Faraone, & Pennington, 2005). This finding
might suggest that children with ADHD would possibly
benefit from physical exercise even more than healthy chil-
dren given that they have more room to improve. Motor and
executive control systems follow similar developmental tra-
jectories (Diamond, 2000) and are related to parallel fron-
tal–subcortical circuits (Mahone & Wodka, 2008). For
instance, inhibitory control is crucial for generating motor
responses leading to completion of goal-directed behavior
(Vasserman, Bender, & MacAllister, 2013).
EFs are defined as the top-down cognitive processes that
enable organization, planning, and control of goal-directed
behavior (Banich, 2009; Schreiber, Possin, Girard, & Rey-
Casserly, 2013). Three core EFs are usually identified: inhibi-
tion, working memory, and cognitive flexibility (Lehto,
Juujarvi, Kooistra, & Pulkkinen, 2003). A meta-analysis of 83
studies has shown that children with ADHD exhibit significant
deficits in response inhibition, working memory, planning, and
vigilance (Willcutt et al., 2005). Motor skills define the ability
to co-ordinate movements to achieve intended goals. Children
with ADHD show difficulties in sustaining simple motor acts
and controlling their movements; they require more time for
motor tasks in comparison with their peers (Keiser et al.,
2015). Moreover, it has been reported that approximately 50%
of children with ADHD also have comorbid Developmental
Coordination Disorder (DCD), which indicates motor–percep-
tual impairment (Gillberg & Kadesjö, 2009).
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Vysniauske et al. 3
Although there are already a few meta-analyses concern-
ing the relationship between physical exercise and depres-
sion, anxiety, and mental health outcomes in general (e.g.,
Ahn & Fedewa, 2011; Bartley, Hay, & Bloch, 2013; Cooney
et al., 2013; Stanton & Reaburn, 2014), there is no meta-
analysis that would focus on the effects of physical exercise
in ADHD. Here we provide a comprehensive meta-analysis
of existing studies on the effects of physical exercise on the
alleviation of the ADHD functional outcomes—EF and
motor skills. We also aim to identify shortcomings of already
used study designs and establish potential moderators.
Method
This meta-analysis was conducted in accordance with the
Preferred Reporting Items for Systematic Reviews and
Meta-Analyses (PRISMA) guidelines (Moher, Liberati,
Tetzlaff, Altma, & The PRISMA Group, 2009).
The Search Process
The electronic literature search was conducted simultane-
ously and independently by two authors, using combina-
tions of the following search terms: (ADHD OR “attention
deficit” OR hyperactiv*) AND (sport* OR exercis* OR
“physical activity”). The databases examined were
PubMed, PsycINFO, Web of Science, and Cochrane
Central Register of Controlled Trials. The search was a
priori restricted to studies conducted in humans with age
span ranging from 0 to 18 years and published in English
up to January 1, 2015. Subsequently, references from
retrieved studies were examined to locate any additional
relevant studies. For detailed information on the study
search and selection process, see the PRISMA flow chart
in Figure 1.
Inclusion Criteria
After duplicate removal, the titles, abstracts, and keywords
of identified studies were screened for relevance. The deci-
sion on final inclusion was based on full text articles.
Studies were included if (a) the study tested the effects of a
physical exercise intervention on ADHD symptoms as com-
pared with the effects of a no-exercise condition (either
control group, pretest measure, or both); (b) the study
design was a randomized controlled trial, quasi-experimen-
tal study or clinical trial; (c) participants had a diagnosis of
ADHD of any subtype or met criteria for clinical levels of
ADHD symptoms on validated rating scales; (d) the study
included children and adolescents up to the age of 18; (e)
the results on ADHD-related functional outcomes or core
symptoms were reported; and (f) an exercise intervention
was implemented.
Coding of Studies
Studies that met the inclusion criteria were coded for par-
ticipant and study design characteristics by two indepen-
dent authors (R.V. and L.V.). The following data were
extracted from each study when possible: participant char-
acteristics including mean age, gender, and stimulant medi-
cation use; total number of participants; diagnostic
assessment procedures; study design (crossover, parallel or
single-group pretest–posttest); randomization (yes/no);
intervention characteristics (frequency: total number of
exercise sessions; intensity: moderate, vigorous, unknown;
and duration: total time in minutes); and geographic region
of study. The results pertaining to ADHD functional out-
comes were further categorized into two subgroups: EFs
and motor skills. Other possible measures of ADHD-related
outcomes, such as ADHD core symptoms (e.g., Kang, Choi,
Kang, & Han, 2011), behavior (e.g., McKune, Pautz, &
Lombard, 2003), social skills (e.g., Smith et al., 2013),
memory (e.g., Craft, 1983), and academic performance
(e.g., Pontifex, Saliba, Raine, Picchietti, & Hillman, 2013),
were originally considered but later renounced due to a lack
of studies (i.e., less than two studies per outcome) necessary
for conducting a quantitative meta-analysis.
Effect Size
All effect sizes were based on standardized differences in
performance of individuals in the exercise condition versus
a no-exercise comparison, that is, control group or pretest
measure. In some studies, healthy children were considered
as a control group (e.g., Craft, 1983; Pontifex et al., 2013;
Tantillo, Kesick, Hynd, & Dishman, 2002). However, to
increase homogeneity of study designs included in the cur-
rent meta-analysis, for those studies only the group of chil-
dren with ADHD diagnosis was taken into account and such
studies were treated as having a single-group pretest–post-
test design.
Effects from individual studies were categorized into
one of the two outcome domains for ADHD functional out-
comes listed above. Some studies used more than one mea-
sure for representing the same construct or provided
separate results for test subscales. In such cases, multiple
effect sizes were averaged so that each study would contrib-
ute only one effect size per outcome domain. This was done
to facilitate statistical independence of the data (Lipsey &
Wilson, 2001).
Effect sizes were computed with regard to study design
characteristics and available data. When possible, calcula-
tion was based on exercise and control group means and
standard deviations. However, when means and standard
deviations were not reported, effect sizes were calculated
using F, t, p, and r values (Rosenthal, 1994). In line with
recommendations by Morris (2008), Ashford, Davids, and
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4 Journal of Attention Disorders
Bennett (2009), Borenstein, Hedges, Higgins, and Rothstein
(2009), and Ray and Shadish (1996), effect sizes were com-
puted differently for specific study designs. In exceptional
cases, when pre–post correlation was not reported, it was set
to ρ = 0.5. This value represents moderate correlation that is
consistent with approximate typical test–retest reliability for
psychometric tests (Nigg, Lewis, Edinger, & Falk, 2012).
Statistical Analyses
Data were entered into Comprehensive Meta-Analysis,
Version 2.2.064 (CMA, Biostat Inc, Englewood, New
Jersey) for calculation of effect sizes and further analysis of
results. Statistical significance was set at p < .05. The direc-
tion of the effect was calculated so that positive effect sizes
would indicate beneficial effect of exercise on ADHD func-
tional outcomes.
Prior to calculating an overall effect size estimate, each
effect size was weighted by the inverse of its variance
(Ashford et al., 2009). An overall cumulative meta-analysis
was conducted for ADHD functional outcomes (i.e., motor
skills and EF outcomes combined). Statistical significance
of the pooled effect sizes was assessed using a z test.
Between-trial heterogeneity was assessed by calculating
I
2
statistic, which expresses the ratio of observed variance
between outcomes to the total observed variance in effect
sizes (Huedo-Medina, Sanchez-Meca, Marin-Martinez, &
Botella, 2006). I
2
values were interpreted as low (25%),
moderate (50%), and high (75%; Higgins, Thompson,
Deeks, & Altman, 2003). Following recommendations by
Field and Gillett (2010), random-effects model was used, a
priori, given the expected heterogeneity of sample charac-
teristics, implementation of exercise interventions, and
assessments of ADHD functional outcomes.
Potential moderators that could account for variability
across studies were examined. Subgroup analyses were con-
ducted for categorical variables, such as specific outcomes
(EF, motor skills), study design (single-group pretest–posttest,
Figure 1. PRISMA flow chart depicting study search and selection process.
Note. PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Moher, Liberati, Tetzlaff, Altma, & The PRISMA Group, 2009).
a
Three studies included measures for both motor skills and executive functions.
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Vysniauske et al. 5
crossover, and parallel groups), and exercise intensity (moder-
ate, moderate-to-vigorous and vigorous). Meta-regression
analyses were conducted for the potential continuous modera-
tor variables: exercise duration, percentage of girls included in
the sample, and mean age of participants.
Publication bias was examined based on funnel plot
asymmetry inspection and quantified by the Eggers linear
regression method (Egger, Davey Smith, Schneider, &
Minder, 1997). Next, in the case of publication bias, the
trim-and-fill procedure was performed (Duval & Tweedie,
2000). The purpose of this method is to provide an estimate
of the effect size after taking the potential bias into account
(Borenstein, 2005).
Results
Description of Studies
A total of 10 studies and 54 effect sizes (total N = 300) were
included in the meta-analysis. The number of participants in
studies ranged from 14 to 84. The mean age of participants
across all studies was 9.3 (SD = 1.9). Girls comprised 20%
of the total study population. Table 1 provides design and
participant characteristics of the included studies.
Stimulant medication users comprised 41% of the total
population across studies. However, medication use was not
included as a moderator in meta-regression analysis due to
great variability in strategies used to account for possible
medication effects in individual studies (i.e., stopping vs. con-
tinuing the medication intake; different time intervals between
discontinuing medication and experimental procedures, etc.).
The majority of studies provided exercise interventions
of moderate intensity (n = 4), two studies implemented
moderate-to-vigorous exercise approach (n = 2), one
study used a vigorous exercise condition, and another one
implemented both types of interventions (moderate and vigor-
ous) for boys and girls, respectively (Tantillo et al., 2002).
These effect sizes were assumed to be independent and consid-
ered as four separate studies (as in Sonuga-Barke et al., 2013).
Two studies (Craft, 1983; Kosari, Hemayat-Talab, Arab-
Ameri, & Keyhani, 2013) did not report on exercise intensity.
Participants received one to 36 sessions of exercise (M =
10, SD = 13.6), and total exercise intervention duration
ranged from 10 to 1,540 min (M = 492, SD = 641.8). EF out-
comes were reported in seven studies, motor skills outcomes
in six studies. In case a study involved outcome measures for
both EF and motor skills, the effect sizes were averaged
within the study prior to conducting an overall meta-analysis
on ADHD functional outcomes. Characteristics of exercise
interventions and outcome measures are presented in Table 2.
Overall Effects
A significant and medium-sized effect of physical exercise
on ADHD functional outcomes was found (g = 0.627, 95%
confidence interval [CI] = [0.273, 0.982], p = .001; see
Figure 2 for a forest plot), indicating that physical exercise
has a positive effect on ADHD functional outcomes. The
test of heterogeneity indicated considerable and statistically
significant heterogeneity across the effect sizes included in
the meta-analysis (I
2
= 78%, p < .001).
Publication Bias
Visual inspection of the funnel plot revealed evidence for
bias toward publication of positive study results. Eggers
test confirmed this (p = .004). A trim-and-fill estimation
suggested that the addition of three studies would be suffi-
cient to result in a non-significant aggregated Hedge’s g of
0.280 (95% CI = [−0.142, 0.701]).
Table 1. Summary of Design and Participant Characteristics of Studies Included in Meta-Analyses (Ordered by Year of Publication).
Study Country
Study
design Randomized n
Female
(%)
Participants’
M age
Medication
use (%)
Craft (1983) The United States Single group No 31 0 8.6 0
Tantillo, Kesick, Hynd, and Dishman
(2002)
The United States Crossover Yes 18 44 10.0 100
Medina et al. (2010) Brazil Single group No 25 0 9.5 64
Ahmed and Mohammed (2011) Saudi Arabia Parallel group Yes 84 36 13.9 n/r*
Chang, Liu et al. (2012) China Parallel group Yes 40 8 10.4 50
Verret, Guay, Berthiaume, Gardiner,
and Béliveau (2012)
Canada Parallel group No 21 10 9.1 67
Kosari, Hemayat-Talab, Arab-Ameri,
and Keyhani (2013)
Iran Parallel group No 20 0 8.8 n/r*
Pontifex, Saliba, Raine, Picchietti, and
Hillman (2013)
The United States Crossover Yes 20 30 9.5 0
Smith et al. (2013) The United States Single group No 14 57 6.7 0
Chang et al. (2014) China Parallel group No 27 15 8.4 48
Note. n/r = not reported.
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6 Journal of Attention Disorders
Subgroup Analyses
Stratification by outcome (EFs vs. motor skills) revealed
significant point estimates for studies reporting EF out-
comes (g = 0.535, 95% CI = [0.022, 1.048], p = .041) and
Table 2. Summary of Exercise Intervention and Outcome Characteristics of Studies Included in Meta-Analyses (Ordered by Year of
Publication).
Study
Exercise
Number of effect
sizes per outcome
Intensity
Total duration
(minutes)
Total number
of sessions
Executive
function
Motor
skills
Craft (1983) N/R 10 1 1
Tantillo, Kesick, Hynd, and Dishman (2002) Moderate 26.23
a
1 1
Vigorous 26.23
a
1 1
Moderate 19.55
b
1 1
Vigorous 19.55
b
1 1
Medina et al. (2010) Vigorous 30 1 11
Ahmed and Mohammed (2011) Moderate 1,540 30 1
Chang, Liu et al. (2012) Moderate 30 1 7
Verret, Guay, Berthiaume, Gardiner, and Béliveau (2012) Moderate-to-vigorous 1,350 30 5 3
Kosari, Hemayat-Talab, Arab-Ameri, and Keyhani (2013) N/R 810 18 4
Pontifex, Saliba, Raine, Picchietti, and Hillman (2013) Moderate 20 1 3
Smith et al. (2013) Moderate-to-vigorous 1,080 36 10 2
Chang et al. (2014) Moderate 1,440 16 1 2
a
Mean duration of exercise for boys.
b
Mean duration of exercise for girls.
Figure 2. Forest plot for random-effects meta-analysis of the functional ADHD outcomes (executive function and motor outcomes)
after exercise intervention.
Note. CI = confidence interval.
a
Vigorous exercise condition, boys.
b
Moderate exercise condition, boys.
c
Vigorous exercise condition, girls.
d
Moderate exercise condition, girls.
for those examining motor skills outcomes (g = 0.818, 95%
CI = [0.357, 1.279], p = .001). The difference between
these two estimates was not significant (p = .42). High and
significant heterogeneity was found both among studies
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Vysniauske et al. 7
reporting EF–related outcomes (I
2
= 84%, p < .001) and
motor skills (I
2
= 75%, p < .001).
Studies using single-group pretest–posttest and cross-
over designs did not yield significantly larger effect sizes
than parallel group studies. In fact, the aggregated effect
sizes from studies with parallel group designs were the larg-
est (g = 1.345, 95% CI = [0.465, 2.225], p = .003) when
compared with aggregated effect sizes from studies with
crossover designs (g = 0.402, 95% CI = [−0.111, 0.914], p =
.125) and single-group pretest–posttest designs (g = 0.148,
95% CI = [−0.086, 0.382], p = .216). Similarly, exercise
intensity did not prove to be a significant moderator either.
Results are summarized in Table 3.
Meta-Regression
A series of meta-regression analyses investigated moderat-
ing effects of exercise duration, gender distribution, and
mean age of participants. It was found that longer exercise
intervention duration was associated with larger effect sizes
(Tau-squared = 0.234, Q
b
= 6.391, p = .01). The gender dis-
tribution and mean age were not significantly associated
with outcomes (p = .11 and p = .14 respectively).
Discussion
The main goal of current meta-analysis was to determine
the magnitude of impact that physical exercise has on EFs
and motor skills in children with ADHD. The obtained
results based on 10 studies and a total of 300 participants
indicate that moderate-to-vigorous physical activity moder-
ately and significantly improves functional outcomes for
children with ADHD when compared with control
conditions.
Subgroup analysis revealed that the use of EFs versus
motor skills as outcomes did not have a significant
influence on the pooled effect size. Nevertheless, physical
exercise had a somewhat larger effect on motor skills (g =
0.818) in comparison with EFs (g = 0.535). This was
expected given that motor skills measured in the included
studies, namely, speed, lack of motor persistence, strength,
object control, and so on, are directly targeted and trained
during exercise interventions. It is important to note that the
effect of exercise on motor skills is large and comparable
with the effect sizes generated by stimulant medication,
which range from 0.83 for sustained-release formulas to
0.90 for immediate-release formulas (Faraone, Biederman,
& Mick, 2006). Etnier et al. (1997) reported an even larger
effect size (d = 1.47) for the effects of exercise on motor
skills in healthy individuals of all ages following an exer-
cise intervention. This finding is extremely important given
the fact that children with ADHD manifest atypical motor
development which impedes their ability to perform well on
various daily and school tasks (Mahone & Wodka, 2008).
The effect of exercise on EFs was moderate and signifi-
cant, yet the interpretation of this outcome is not straight-
forward. The problem is that many tasks used for measuring
EFs involve a combination of EF skills (e.g., the Test of
Everyday Attention requires a range of skills such as inhibi-
tion and mental shifting). Some of the studies included in
the current meta-analysis reported composite scores of EF,
whereas others provided separate scores for different
aspects of EF. Due to a small amount of studies available, it
was decided to pool all results together and use composite
EF scores. However, there is evidence that not all EFs are
equally sensitive to the effect of exercise (Gapin & Etnier,
2010). Therefore, in the future, it would be important to use
measures that tap into one single aspect of EF to better
understand which functions are affected most by physical
activity.
Despite initial concerns regarding quality of included
study designs, crossover and single-group pretest–posttest
Table 3. Summary of Results Grouped by Moderators: Type of Outcome Measure, Study Design, and Exercise Intensity.
Selection K
Effect size Test result Heterogeneity statistics
g SE z p Q df (Q) I
2
p
Outcome
Executive functions 7 0.535 0.262 2.043 .041 38.005 6 84% .000
Motor skills 9 0.818 0.235 3.479 .001 31.544 8 75% .000
Study design
Crossover 5 0.402 0.261 1.536 .125 13.536 4 70% .009
Parallel groups 5 1.345 0.449 2.996 .003 25.629 4 84% .000
Single group 3 0.148 0.119 1.238 .216 1.645 2 0% .439
Exercise intensity
a
Moderate 6 0.558 0.272 2.049 .040 24.852 5 80% .000
Moderate-to-vigorous 2 0.490 0.241 2.032 .042 0.323 1 0% .570
Vigorous 3 0.683 0.431 1.585 .113 10.276 2 81% .006
a
One study (Kosari, Hemayat-Talab, Arab-Ameri, & Keyhani, 2013) did not report exercise intensity and was not included in this subgroup analysis.
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8 Journal of Attention Disorders
designs did not produce significantly different effect size
estimates from methodologically more rigorous between-
group studies. This finding is important as it justifies the
decision to pool results from different study designs to
avoid loss of data. If the moderator analyses were more reli-
able (e.g., if there were more studies included in the meta-
analysis), this particular result could strengthen the
conclusion that exercise is an effective intervention given
that effects from methodologically sound studies are as
large as those from methodologically weaker studies.
Furthermore, the use of moderate, moderate-to-vigorous,
or vigorous exercise intensity did not significantly affect the
derived effect sizes. However, an important limitation in
this subgroup analysis was that some of the included studies
did not consistently check and report objective physiologi-
cal measures (e.g., heart rate) of participants to ensure that
exercise intensity was appropriately maintained.
Research in mature populations suggests that catechol-
amine response to exercise in women is smaller than in men
(Davis, Galassetti, Wasserman, & Tate, 2000) and it is well
established that girls and boys follow different develop-
mental trajectories. Besides, the manifestation of ADHD
symptoms among the genders is different (Mahone &
Wodka, 2008), although meta-regression analysis showed
that studies with larger proportion of girls did not yield
lower effect sizes. Also, although cognitive functioning in
childhood seems to be more sensitive to exercise effects
than in adolescence (Best, 2010), mean age of study was not
found to be a significant moderator either.
The only variable that was established to be consistently
associated with larger effect sizes was longer exercise inter-
vention duration. It is interesting to compare this finding
with results from Verburgh et al. (2014) who reported a
small and insignificant effect size (d = 0.160) of chronic
exercise on EFs in healthy preadolescent children, whereas
the effect of acute exercise in the same population was mod-
erate and significant (d = 0.570).
Although the findings of this meta-analysis are promis-
ing, the limitations of these results are equally important.
There are several general methodological concerns. First of
all, multiple subgroup and meta-regression analyses
increase the risk of false negative and false positive findings
due to the small number of studies they are based on
(Thompson & Higgins, 2002). Therefore, the moderator
analyses in this study should be regarded as explorative.
Moreover, the scarce amount of studies and study design
characteristics such as small study samples, lack of control
groups and blinding procedures, insufficient methodologi-
cal rigor, and inconsistent reporting, all limit the reliability
and generalizability of the findings of this meta-analysis.
Just as the literature investigating the effects of exercise on
cognitive functioning in healthy populations, the studies
included in this meta-analysis can also be described as
being limited by a lack of consistency in methodology and
by failure to use theory-driven designs (Chang, Labban
et al., 2012). All in all, research in the field is still in its
infancy, and there are many methodological issues to tackle.
Moreover, evidence for publication bias was detected.
According to McLeod and Weisz (2004), population effects
might be overestimated due to publication bias if unpub-
lished studies that usually yield smaller effects are not
included in the analysis. The current meta-analysis only
included published studies. Also, we had to exclude some
published studies with insignificant results due to a lack of
available data and no response from the authors on the
request to provide the data; thus, the detected publication
bias seems a plausible and true phenomenon. When cor-
rected for publication bias by performing a trim-and-fill
procedure (Duval & Tweedie, 2000), the magnitude of the
effect size dropped to 0.280. This suggests that the observed
aggregated effect size (g = 0.627) is an overestimation of
the true effect. However, it is problematic to distinguish
between the effects of study heterogeneity and publication
bias with sparse data (Peters et al., 2010).
Implications for Future Research
Given that the interaction between exercise and ADHD
functional outcomes is complex and supposedly influenced
by a great variety of factors, future research should aim at
untangling the conditions under which exercise yields the
best outcomes. Based on the results and important informa-
tion that was missing in some studies included in the current
meta-analysis, we would like to provide some guidelines for
future studies.
First of all, research should focus on carefully conducted
experimental studies aimed at identifying specific exercise
parameters that generate the best results including exercise
type (acute vs. chronic), intensity (moderate vs. vigorous),
duration, and frequency. It is especially important to study the
effect that exercise duration has on specific outcomes as it
appears to be an important moderator of the effect. Another
problem is the lack of reporting of objective exercise intensity
measures. Moreover, a greater variety of exercise modalities
(i.e., aerobic exercise, yoga, etc.) should be explored as most
of the studies included in this meta-analysis used only indi-
vidual treadmill exercise. For example, yoga has been shown
to improve cognitive performance in typically developing
children (Manjunath & Telles, 2001) and therefore might be a
promising type of exercise in children with ADHD.
Second, as already mentioned here and in narrative
reviews (e.g., Best, 2010; Wigal et al., 2013), to confirm
hypotheses on underlying physiological mechanisms that
mediate the effect of exercise, future studies should actually
measure the physiological changes (e.g., catecholamine
levels) that accompany exercise among children with
ADHD in addition to evaluating functional outcomes, such
as motor skills or EFs.
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Vysniauske et al. 9
Finally and most importantly, future research should
focus more on the behavioral outcomes and use standard-
ized ADHD diagnostic tests to see how exercise affects
ADHD symptoms. This step is crucial in determining the
usefulness of exercise interventions in the context of empir-
ically validated treatments such as stimulant medication
and behavior modification.
Conclusion
This meta-analysis established that exercise has a moderate
and significant dose-response effect on motor skills and EFs
in children with ADHD. Motor skills seem to be especially
sensitive to the impact of exercise.
This is an important finding given that children with
ADHD have deficits in EF and motor skills. However,
methodological limitations, such as the lack of methodolog-
ically sound studies investigating exercise effects in chil-
dren with ADHD, make these results too weak to justify any
clinical recommendations at this point. It also impedes any
attempts to identify and analyze the predictors of better
response to exercise.
We hope that the current meta-analysis serves its pur-
pose in attracting more scientific attention to the topic and
provides important directions for future research by estab-
lishing a moderate positive effect of exercise, highlighting
shortcomings of available studies and methodological
inconsistencies between these studies. If the effects of exer-
cise for ADHD are better substantiated in the future, we
might be looking at a powerful complementary or alterna-
tive treatment.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
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Author Biographies
Ruta Vysniauske is a graduate of MSc clinical psychology at
Leiden University (the Netherlands) and clinical child psycholo-
gist at Vilnius University Children’s Hospital, Affiliate of Vilnius
University Hospital Santariskiu Klinikos (Lithuania).
Lot Verburgh is a post-doctoral researcher at the Clinical
Neuropsychology section of Vrije Universiteit Amsterdam (the
Netherlands). Her research concentrates on the relationship
between sports, physical activity, and neurocognitive functioning
in children.
Jaap Oosterlaan is a professor of clinical neuropsychology at the
Vrije Universiteit Amsterdam (the Netherlands) and the director
of Follow Me, a follow-up program at the Emma’s Children’s
Hospital Academic Medical Center and Vrije Universiteit Medical
Center Amsterdam. His research focuses on disruptive behavior
disorders and medical conditions affecting the central nervous sys-
tem in children.
Marc L. Molendijk is a post-doctoral researcher and assistant
professor at the Clinical Psychology unit of Leiden University
(the Netherlands) and the Leiden Institute of Brain and Cognition
(Leiden University Medical Center, the Netherlands). His main
research interest is on the relation between biology and
behavior.
at Universidad de Navarra-Biblioteca on March 15, 2016jad.sagepub.comDownloaded from
... If children with ADHD do not receive effective and timely intervention, at least 60-70% will carry symptoms and psychosocial problems into adulthood (Wilens and Spencer, 2010;Groß et al., 2015;Banaschewski et al., 2017). Given that established treatments for ADHD (i.e., behavior therapy and/or medication) cannot address the whole range of problems, alternative and/or supplementary interventions should be looked for (Rommel et al., 2015;Vysniauske et al., 2020;Welsch et al., 2021). ...
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... Reviews and meta-analyses typically face some limitations, such as a small number of studies (Biddle et al., 2019;Schuch et al., 2019;Andermo et al., 2020;Lambez et al., 2020;Carter et al., 2021;Liang et al., 2021), differences in methodologies (Lambez et al., 2020;Vysniauske et al., 2020;Dhir et al., 2021;Seiffer et al., 2021), differences between studies in assessing PA and mental health outcomes (Biddle et al., 2019;Andermo et al., 2020;Liang et al., 2021;Ruhland and Lange, 2021;Welsch et al., 2021), studies with low or moderate quality and high risk of bias (Rodriguez-Ayllon et al., 2019;Vysniauske et al., 2020;Carter et al., 2021;Dhir et al., 2021;Seiffer et al., 2021;Welsch et al., 2021), and non-representative samples (Biddle et al., 2019;Ganjeh et al. . /fnbeh. . ...
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Studies have shown that physical activity (PA) can provide a helpful, low-risk, and cost-effective intervention for children and adolescents suffering from mental health problems. This longitudinal study aimed to assess whether PA prevents the development of mental health problems, such as attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. Data were analyzed from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) collected from more than 15.000 children and adolescents at three different time points over a period of more than 10 years. Parents scored the PA of the study participants on three frequency levels according to WHO recommendations, and mental health problems were assessed by means of the Strengths and Difficulties Questionnaire (SDQ). The total problem score (SDQ-Total) and the hyperactivity/inattention symptoms sub-scale (SDQ-H/I) were used in an autoregressive cross-lagged model to examine their relationship with PA. The results showed that PA of boys and girls at preschool age was inversely associated with the occurrence of mental health problems and, in particular, ADHD symptoms about 6 years later. Higher levels of PA were associated with better general mental health and fewer ADHD symptoms at the next time point (Wave 1). These effects were not observed from preadolescence (Wave 1) to adolescence (Wave 2), neither for girls nor for boys. These findings indicate that medium-to-high PA may be a supportive factor for good mental health in children in preschool and elementary school. Future studies will have to show whether PA may be a helpful add-on for interventional programs for improving general mental health and alleviating ADHD symptoms among children and adolescents.
... The evidence linking ADHD and lifestyle factors is scarce, but present Vysniauske et al., 2020). For example, it was observed that poor sleep quality influences symptoms and could lead to cognitive conditions that mimic ADHD symptomatology (Becker et al., 2019;Lugo et al., 2020;Sedky et al., 2014). ...
... For example, it was observed that poor sleep quality influences symptoms and could lead to cognitive conditions that mimic ADHD symptomatology (Becker et al., 2019;Lugo et al., 2020;Sedky et al., 2014). The impact of exercise on cognition has been shown in some studies, with a positive effect mainly in improving executive functions (Den Heijer et al., 2017;Vysniauske et al., 2020). Symptoms of ADHD might also be influenced by nutritional deficiencies (Hawkey and Nigg, 2014;Tseng et al., 2018) and additives in the diet, such as artificial food dyes (Nigg et al., 2012). ...
Article
Current treatments for Attention-Deficit/Hyperactivity Disorder (ADHD) in adults are limited by lack of response and side effects in about one third of the individuals. Changes towards a healthier lifestyle could have a positive impact beyond the relief of specific symptoms. However, it is not clear if nutritional interventions influence mental health and cognition. The objective of this study was to summarize the available literature addressing the impact of different diets in ADHD. The most promising dietetic approaches in ADHD are diets considered to be healthy (Mediterranean-type; DASH) and the Few-Foods Diet for children. Studies should take into account the presence of multiple confounders, biases associated with difficulties in blinding participants and researchers, and search for possible mechanisms of action, so we can have better evidence to guide clinical mental care of adults with ADHD.
... Nos últimos anos, os profissionais de Fisioterapia tornaram-se mais interessados em atividades físicas e intervenções de exercícios que possam ser direcionados a crianças com TDAH. Estudos demonstraram que as atividades físicas podem melhorar os problemas comportamentais, além de auxiliar em seu desempenho cognitivo (Jeoung, 2014;Vysniauske et al., 2020;Goetz et al., 2017). ...
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Physiotherapy is one of the areas that can act in the process of diagnosis and monitoring of Attention Deficit/Hyperactivity Disorder (ADHD). In this sense, the objective was to outline the studies and development of technologies on the subject and the physiotherapeutic approaches already registered in databases. The search was conducted from January to July 2022, the descriptors used were "ADHD AND Physiotherapy" being performed on the World Intellectual Property Organization (WIPO) patent database and articles and abstracts: Scopus Web of Science, PubMed, The Lens and ScienceDirect. Using the Scopus Web of Science, PubMed, The Lens and ScienceDirect article bases and the descriptors “ADHD AND Physiotherapy”. It is concluded that the role of physiotherapy in the development and monitoring of people with ADHD, from diagnosis, with exercises and activities that help in motor, neurological and cognitive progression, becomes relevant for promoting health and quality of life for these patients.
... According to the results of the study investigating the effects of a physical exercise-based rehabilitation program on the motor skills of children with ADHD, Pan et al. stated that significant improvements were achieved in locomotor skills and hand coordination while other motor proficiency skills did not improve (19). Vysniauske et al., based on the results of a meta-analysis investigating the effects of physical activity-based rehabilitation applications on the motor skills of children with ADHD uncovered that the studies including children with ADHD were focused on a single skill and usually were found to be effective in improving a specific motor proficiency skill (endurance, hand-eye coordination, fine motor skills), however, were not effective in improving many motor skill parameters simultaneously (20). While the results of our study are in accordance with the literature in that they show the effectiveness of an intervention approach in improving motor skills of children with ADHD, they also are positively distinct in showing the effectiveness of the intervention program in improving all parameters of motor skills. ...
Article
Attention Deficit and Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized with problems such as; atypical attention skills increased impulsive behaviors at least two of the child’s areas of daily living. In studies investigating developmental aspect of the said problems of children with ADHD, it was stated that the children usually do not demonstrate normal development regarding the motor proficiency and may fall behind their peers in exhibiting normal motor performance. These problems in motor skills are said to cause a hindered development in complex skills which may result in; distorted body image, increased anxiety and poor social communication skills. This study’s aim was to investigate effects of a Visual-Praxis-based Occupational Therapy program (VPOT) on motor proficiency of children with ADHD. The 58 children who were included to the study were assigned numbers from 1 to 58 and randomized into two groups (the intervention group and the control group). Both groups were subjected to the Bruninks-Oserestry Test of Motor Proficiency 2–Brief Form (BOT2-BF). After the initial assessment, the participants in the intervention group were admitted into the VPOT program for a duration of 8 weeks with twice-weekly sessions of 45 minutes. End of the program, BOT2-BF was applied once more. The participants mean age was 8.44±1.39 years. There were no differences between the intervention and the control group in terms of age. When the BOT2-BF results for the intervention group were analyzed, it was found that there were significant differences between pre- and post-intervention scores of all sub-scores and the total score. Due to approaching the motor development aspect of ADHD within the context of motor proficiency and visual perception, this study can be considered to be one of the innovative and pioneer studies in the field and is positively unique regarding the usage of the intervention approach that was used.
... Although medication helps to control ADHD symptoms and has demonstrated improvements in cognitive function in children and adolescents with ADHD (Yildiz, Sismanlar, Memik, Karakaya, & Agaoglu, 2011), ADHD medication has several negative side effects which may contribute to poor adherence; including sleep problems, mood disturbances, weight loss and headaches (Catalá-López et al., 2017;Toomey, Sox, Rusinak, & Finkelstein, 2012;Yildiz et al., 2011). With regards to non-pharmacological lifestyle management, physical activity has been suggested to be a potential intervention for the management of ADHD symptoms and behaviours (Gapin & Etnier, 2014;Vysniauske, Verburgh, Oosterlaan, & Molendijk, 2020;Welsch et al., 2021); yet physical activity is not commonly used by healthcare providers as an additional or alternative ADHD management technique. ...
Article
Attention-deficit/hyperactivity disorder (ADHD), one of the most common neurodevelopmental disorders in children and adolescents, is typically managed with medications which are associated with negative side effects. Therefore, non-pharmacological treatments, such as physical activity, are an attractive option. The aim of this meta-analysis was to explore the effects of acute physical activity on cognition in children and adolescents with ADHD. A comprehensive search of three literature databases yielded 14 studies for inclusion. An overall meta-analysis was conducted alongside sub-group analyses for cognitive domain, physical activity characteristics, and timing of cognitive measurements. Results revealed a small beneficial effect of physical activity on cognitive function (SMD = 0.18, [0.12,0.25], p < 0.01). Sub-group analyses revealed beneficial effects of physical activity on the domains of cognitive flexibility (SMD = 0.21, [0.09,0.32], p < 0.01), attention (SMD = 0.20, [0.09,0.32], p = 0.001), and inhibitory control (SMD = 0.18, [0.03,0.33], p = 0.02), but not memory (p = 0.87). Cognitive benefits also differed depending on physical activity duration (<10 min, p = 0.27; 11–20 min, SMD = 0.23, [0.14,0.31], p < 0.01; >20 min, SMD = 0.13, [-0.00,0.26], p = 0.05), and modality (running, SMD = 0.21, [0.12,0.29], p < 0.01; ‘other’, SMD = 0.39, [0.18,0.61], p < 0.01; cycling, p = 0.35), and the timing of cognitive measurement following physical activity (immediately, SMD = 0.17, [-0.01,0.35], p = 0.06; 2–10 min, SMD = 0.21, [0.12,0.30], p < 0.01; >10 min, SMD = 0.19, [-0.09,0.47], p = 0.19). Overall, physical activity has a positive acute effect on subsequent cognition in children and adolescents with ADHD, though effects may be domain specific and influenced by the duration and modality of physical activity. These findings have practical implications for those interested in using physical activity to enhance cognition in children and adolescents with ADHD.
... An example of this research is the study of the effects of exercise on the cognitive capacity of children diagnosed with ADHD where improvements in the behavioral and cognitive symptoms of the disorder have been observed [7,109,162,163]. Physical activity, whether acute or chronic, has even been suggested as a treatment to improve brain development in this population [164], given the possible regulation of neurotransmitters involved in this disorder, such as dopamine and norepinephrine [162,165]. Seeing that an acute aerobic exercise intervention shows positive effects, both in children with disorders and in children with typical development, it seems that exercise could be a valid tool for cognitive stimulation in both populations. ...
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It is widely accepted that physical exercise can be used as a tool for the prevention and treatment of various diseases or disorders. In addition, in the recent years, exercise has also been successfully used to enhance people's cognition. There is a large amount of research that has supported the benefits of physical exercise on human cognition, both in children and adults. Among these studies, some have focused on the acute or transitory effects of exercise on cognition, while others have focused on the effects of regular physical exercise. However, the relation between exercise and cognition is complex and we still have limited knowledge about the moderators and mechanisms underlying this relation. Most of human studies have focused on the behavioral aspects of exercise-effects on cognition, while animal studies have deepened in its possible neuro-physiological mechanisms. Even so, thanks to advances in neuroimaging techniques, there is a growing body of evidence that provides valuable information regarding these mechanisms in the human population. This review aims to analyze the effects of regular and acute aerobic exercise on cognition. The exercise-cognition relationship will be reviewed both from the behavioral perspective and from the neurophysiological mechanisms. The effects of exercise on animals, adult humans, and infant humans will be analyzed separately. Finally, physical exercise intervention programs aiming to increase cognitive performance in scholar and workplace environments will be reviewed.
Article
This umbrella review addresses the relation between physical activity (PA) for children and youth with Attention Deficit Hyperactivity Disorder (ADHD) and positive outcomes. A systematic literature search in Medline, PsychInfo, and ERIC revealed 338 records, and 20 review articles were included in the analysis. The review articles referred to 130 different and mainly small empirical studies. Overall, the reviews suggest that PA can function as an effective intervention for children and youth with ADHD on: 1) cognition, 2) social-emotion and behavioural regulation, 3) fitness and motor control, and 4) neural function. However, results are mixed and the quality of the intervention (intensity, duration, frequency, length and type of exercise), participant and environmental characteristics, and relational aspects are discussed here as aspects that could affect the outcome.
Article
Background Poorer quality of life (QoL) is commonly observed in children with Attention-deficit/Hyperactivity Disorder (ADHD). Parents of children with ADHD also perceived elevated levels of parenting stress. Previous research has documented the positive effects of physical activity (PA) on managing ADHD symptoms. It is critical to implement ADHD management with broader functioning from both children’s and parents’ perspectives. Objective This study aimed to examine whether PA would exert an influence on QoL of children with ADHD and parenting stress of their parents. Methods Forty-three children with ADHD (6-11 years) were randomly assigned to the PA intervention and waitlist control groups. Children in the intervention group participated in a 12-week PA program. Parent-reported QoL and parenting stress were assessed before and immediately after the intervention. Analysis of covariance with a mixed factorial design of 2 (time: before vs. after intervention) × 2 (group: PA intervention vs. waitlist control) was conducted to examine changes of QoL and parenting stress over the 12 weeks. Results Compared to the control group, parents of children in the intervention group reported significant reduced overall parenting stress (p = .021, η² = 0.142) and child domain of parenting stress (p = .024, η² = 0.138) after the intervention. No significant improvement in QoL was documented in either group. Conclusions The participation of PA intervention positively impacts parenting stress perceived by parents of children with ADHD, which provides further evidence of the family-wide benefits of the PA intervention.
Chapter
Childhood development is a critical indicator of healthy, successful adult life. Attaining important cognitive milestones, leading to high academic achievement is associated with increased adult health, occupational success, mental health as well as a range of other important outcomes. Exercise in children is an important mediator of cognitive development, with effects on executive functioning, neurophysiology, language, and academic achievement. A combination of cognitively engaging activity and aerobic exercise seems to be the optimal application, with the largest impacts on cognition. In this chapter, the evidence surrounding physical activity and childhood cognitive development is discussed, with practical recommendations for prescribers provided.
Article
Attention-deficit/hyperactivity disorder (ADHD) is a neurobehavioral disorder that typically begins in childhood and often persists into adulthood. Up to 7% of children between the ages of 4 and 17 years are affected by the disorder, with approximately 2/3 of those diagnosed currently taking medication to help manage the symptoms. ADHD symptoms include abnormal levels of inattention, hyperactivity, and/or impulsivity. The most common treatment modality for ADHD is stimulant-type medications that work to regulate dopamine and norepinephrine levels in the brain. Exercise has also been shown to help control ADHD symptoms through the regulation of dopamine and norepinephrine. This article briefly compares the pharmacological mechanisms of ADHD medications with the physiological mechanisms of exercise relative to ADHD. Recommendations for the concomitant use of both treatment modalities are also provided.
Article
Nearly 200 studies have examined the impact that either acute or long-term exercise has upon cognition. Subsets of these studies have been reviewed using the traditional narrative method, and the common conclusion has been that the results are mixed. Therefore, a more comprehensive review is needed that includes all available studies and that provides a more objective and reproducible review process. Thus, a meta-analytic review was conducted that included all relevant studies with sufficient information for the calculation of effect size (W = 134). The overall effect size was 0.25, suggesting that exercise has a small positive effect on cognition. Examination of the moderator variables indicated that characteristics related to the exercise paradigm, the participants, the cognitive tests, and the quality of the study influence effect size. However, the most important finding was that as experimental rigor decreased, effect size increased. Therefore, more studies need to be conducted that emphasize experimental rigor.