Healthy Body, Healthy Mind?: The Effectiveness of Physical Activity to Treat ADHD in Children

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Key points

  • Structured physical activity has the potential to be an effective treatment of ADHD in children.

  • Incontrovertible data from animal studies indicate that exercise enhances brain development and behavioral functioning.

  • Studies suggest that, acutely, physical activity may lead to gains in neuropsychological functioning, including processing speed and some executive functions.

  • After long-term (ie, ≥5 weeks) moderate–vigorous exercise interventions, research suggests that children’s ADHD-related

Target of Treatment

Emerging research suggests considerable potential for enhanced physical activity, in particular regular moderately intensive aerobic exercise, to be beneficial to the core inattentive and hyperactive/impulsive symptoms of ADHD, an array of neuropsychological deficits associated with the disorder, and perhaps academic difficulties. In addition, improved physical health and fitness that results from such exercise programs may increase status with peers and, in turn, improve peer relations.

Need for Treatment

At

Theoretic Overview

Data paint a picture of ADHD as an etiologically heterogeneous neurodevelopmental disorder that varies with regard to behavioral phenotypes as well as underlying genetic and neural substrates. Children with ADHD present with an array of executive11 and nonexecutive12 neurocognitive deficits with differing patterns of weaknesses across children.13, 14, 15 Consistent with neurocognitive data, structural neuroimaging data indicate that youth with ADHD have smaller overall brain size16 and delays

Empirical support for the use of exercise in children with ADHD

Several preliminary studies have been published throughout the past decade examining both the acute and chronic effects of exercise on children with ADHD (Table 1). Studies examining acute effects have typically had participants walk or run on a treadmill or pedal on a cycle ergometer, so that exercise intensity could be well controlled. Studies examining chronic exercise interventions have varied widely in the types of exercise, the frequency and duration of exercise sessions, and program

Who Is Most Likely to Respond?

Research into the efficacy of aerobic exercise as an intervention for ADHD is in its infancy. As such, determinations, such as “who is most likely to respond,” are little more than speculations. Because it is likely that a program of exercise is most beneficial if it becomes part of a lifestyle change, family involvement and certain family characteristics might be important. Studies in childhood obesity, which might be informative, point to the effectiveness of family-based interventions.

Future directions

Collectively, the findings from extant studies are promising, but methodologically robust RCTs that more rigorously assess the utility of exercise as a treatment of children with ADHD are needed. Key unanswered questions remain around the intensity and duration of exercise required to yield clinical benefits, the magnitude and persistence of improvements to core ADHD symptoms, and whether improvements span behavioral, emotional, social, cognitive, and academic function. Furthermore, it is

Summary

Data from animal studies provide convincing evidence that physical exercise enhances brain development and neurobehavioral functioning in areas believed to be impaired in children with ADHD, and studies in patients with dementia demonstrate clear evidence of exercise-related benefits in neurocognitive functioning. To a lesser but still compelling extent, results from studies in typically developing children and adults indicate beneficial effects of exercise on neurocognitive functions that are

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      PA was a semi-active control group in this study, matched on several characteristics of the NFB training: number of sessions (30), duration of sessions (20 min), duration of exercises (2 min), reinforcement (not fully identical to NFB; for PA, use of stickers), progress report (within and between sessions; for PA, changes in maximum heart rate [HRmax]) and one-to-one instruction. However, since PA may have some beneficial effects on ADHD symptoms (Neudecker et al., 2019) - although evidence from more stringent RCT designs is lacking - we choose for a relative low-intensity training compared to recommendations in the literature (Halperin et al., 2014). Results at post-intervention, indeed showed no evidence of any specific effects of PA, with neglectable post-pre differences (Geladé et al., 2016).

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    This work was supported by grant #’s R01 MH68286 and R33MH085898 from the National Institute of Mental Health to J.M. Halperin. The content is solely the responsibility of the authors and does not necessarily represent the official view of the National Institute of Mental Health.

    Disclosure Statement: The authors report no conflicts of interest.

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