This review pooled 22 randomized controlled trials of children and adolescents with ADHD, aged 6 to 18. In total, 1,309 young people took part. The trials ran in Asia, North America, Europe, Africa and Oceania. Seven of the 22 trials included only boys. The exercise programs lasted 6 to 72 weeks. They met 1 to 7 times a week, for 15 to 180 minutes a session. Activities included running, swimming, cycling, yoga, taekwondo, soccer, table tennis and exergaming. Control groups got education, medication, neurofeedback, or no exercise.
Compared with controls, the exercise groups showed a small improvement in core ADHD symptoms and in inattention. The change in hyperactivity and impulsivity was not clear enough to rule out chance. Exercise had a moderate benefit on executive functions overall. This covered holding back responses, switching between tasks and working memory.
The type of exercise seemed to matter. Closed-skill activities such as running, swimming or cycling showed a large improvement in core symptoms. Open-skill activities did not. When exercise alone was compared with controls, the effect was not clear. It became clear once one trial that used medication as the control was removed. Results did not change much by age group, session length or total number of sessions.
The authors rated only 3 of the 22 trials as low risk of bias and 19 as moderate risk. Measures and programs varied across studies. Some groups, such as by sex or ADHD subtype, could not be checked. Studies not in English or Chinese were left out.
The authors suggest exercise be considered as a complementary approach for children and teens with ADHD, with closed-skill, moderate-intensity activities such as running, swimming or cycling showing the clearest benefit for core symptoms.
Talk to a clinician about your own situation.
The numbers Stats and what the terms mean
The statistics behind the plain-language claims above.
- Huang, 2022: overall core ADHD symptoms, exercise versus controls, SMD = −0.39, 95% CI: −0.64 to −0.14.
- Huang, 2022: inattention, SMD = −0.32, 95% CI: −0.63 to −0.004.
- Huang, 2022: hyperactivity and impulsivity (not significant), SMD −0.41, 95% CI −0.92 to 0.09.
- Huang, 2022: core symptoms with closed-skill exercise, SMD = −0.83, 95% CI: −1.30 to −0.35.
- Huang, 2022: core symptoms with open-skill exercise (not significant), SMD −0.17, 95% CI −0.42 to 0.08.
- Huang, 2022: overall executive functions, SMD = −0.68, 95% CI: −0.91 to −0.45.
- Huang, 2022: holding back responses (inhibition), SMD −0.88, 95% CI −1.43 to −0.34.
- Huang, 2022: switching between tasks (cognitive flexibility), SMD −0.71, 95% CI −0.99 to −0.42. The paper's discussion gives a different figure, SMD −0.81, 95% CI −1.17 to −0.45.
- Huang, 2022: working memory, SMD −0.50, 95% CI −0.74 to −0.26.
- Huang, 2022: exercise only versus control on core symptoms, SMD −0.25, 95% CI −0.68 to 0.19, and with the medication-control trial removed, SMD −0.45, 95% CI −0.73 to −0.16.
- Huang, 2022: how much the studies disagreed, I2 41.6% for core symptoms (low) and I2 54.4% for executive functions (moderate).
What the terms mean:
- SMD the standardized mean difference, the size of the gap between groups in a common unit. Roughly, 0.2 is small, 0.5 is moderate and 0.8 is large. A minus sign shows the direction of the change, not its size.
- 95% CI the range the true effect most likely falls in. If it crosses zero, the result may be down to chance.
- I2 how much the studies' results disagreed with each other, from 0% (agree) upward.
Source: Huang H, Jin Z, He C, et al.. Chronic Exercise for Core Symptoms and Executive Functions in ADHD: A Meta-analysis. Pediatrics (2022). doi:10.1542/peds.2022-057745