The impact of exercise interventions concerning executive functions of children and adolescents with attention-deficit/hyperactive disorder: a systematic review and meta-analysis.

Children and adolescents with attention-deficit hyperactivity disorder (ADHD) often struggle with executive functions, the mental skills involved in planning, self-control, and shifting between tasks. Since exercise has shown benefits for executive functions in the general population, researchers wanted to know whether the same held true for young people with ADHD specifically. This systematic review and meta-analysis pooled data from trials testing exercise interventions against comparison conditions, assessing executive function through cognitive tasks. Across 21 reviewed studies, with 15 contributing to the pooled statistical analysis, exercise interventions were associated with improvements in overall executive function, including inhibitory control and cognitive flexibility.

Interestingly, how intense and how frequent the exercise was seemed to matter more than what type of exercise was used, though this is a secondary, less certain observation. The main limitation is that the evidence base, while synthesised across multiple studies, remains drawn from a fairly small number of trials with likely variation in design and quality.

If your child has ADHD, you may wonder whether physical activity could help with things like focus, self-control, or switching between tasks, skills that researchers call executive functions. This review combined findings from a number of studies that tested exercise programmes in children and teens with ADHD and measured these skills using cognitive tests. Overall, the review found that exercise programmes were linked to improvements in executive functions, including the ability to control impulses and to flexibly adapt to new demands.

The researchers also noticed that exercise done more intensely and over a longer, repeated schedule (rather than a single session) seemed more closely tied to these improvements than the specific type of exercise chosen. It's worth keeping in mind that this is based on a relatively small collection of studies, and the quality and design of those studies likely varied, so the findings should be seen as encouraging rather than conclusive proof that exercise will improve executive function for every child with ADHD.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This review addresses a specific clinical question: does exercise improve executive function in children and adolescents with ADHD, and if so, what intervention characteristics matter? For physiotherapists involved in paediatric care or multidisciplinary ADHD management, this informs how exercise might be considered as a component of broader intervention, though the abstract does not establish it as a standalone treatment recommendation. Across 21 systematically reviewed studies and 15 included in meta-analysis, pooled results showed a moderate-to-large effect on overall executive function (SMD=0.611, 95% CI 0.386-0.836), with similar moderate-to-large effects for inhibitory control (g=0.761) and cognitive flexibility (g=0.780). Subgroup analysis indicated that intervention intensity and whether sessions were acute or chronic moderated outcomes more than exercise type, though this subgroup finding rests on fewer studies and should be treated as less certain than the headline pooled estimate. The review used randomised controlled trials and quasi-experimental designs, with risk of bias assessed via the PEDro scale, but the abstract does not report specific risk-of-bias ratings or heterogeneity statistics.

This limits confidence in the precision and generalisability of the pooled effect, and the review does not establish long-term functional or behavioural outcomes beyond the neurocognitive task measures used.