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Child Psychiatrist /Adult Psychiatrist

A Single Exercise Session Improves Adolescent ADHD Symptoms, Executive Function

Single exercise sessions of 30 minutes or less led to small, but significant, improvements in ADHD core symptoms and executive function among adolescents.

ADHD Symptoms

A single session of exercise had small effect-size improvements in core symptoms and executive function among adolescents with attention-deficit/hyperactivity disorder (ADHD), according to results from a systematic review and meta-analysis published in the Journal of Attention Disorders. In particular, high-intensity interval training, single exercise sessions of 30 minutes or less, and cycling exercises were most effective for symptom improvement.

While medications for ADHD are effective in improving attention, hyperactivity, and executive function in ADHD, these therapies can have adverse side effects and recent drug-shortages have left many patients without an effective treatment option. To investigate the utility of exercise interventions for ADHD symptoms, investigators conducted a systematic review and meta-analysis of publication databases from inception through July 2023 for randomized controlled trials (RCTs) or crossover RCTs that included adolescents with ADHD who underwent a single session of exercise intervention (aerobic, resistance, or aerobic + resistance) for ADHD symptom management.

The investigators included a total of 13 studies with a pooled sample size of 437 participants, who were primarily boys/men (71.6%) with a mean age range of 10 to 24 years. Core symptoms of ADHD (inattention and impulsivity) were primarily assessed with Conner’s Continuous Performance Test and the Barkley Adult ADHD Rating Scale-Modified, while executive function was evaluated with the Stroop Test and Flanker Task. All single exercise sessions were open chain (eg, swimming, cycling, running), were moderate to vigorous in intensity, and ranged from 10 to 40 minutes in duration. Control groups mainly watched videos.

The investigators found that single-session exercise had small effect-size improvements in core symptoms of hyperactivity and attention (standardized mean difference [SMD], 0.35; 95% CI, 0.08-0.63; P =.01) and executive function (SMD, 0.28; 95% CI, 0.13-0.43; P =.00) among adolescents with ADHD. When stratified by age, the investigators observed small effect-size improvements in core symptoms and executive function among participants aged 10 to 13 years (standardized mean difference [SMD], 0.30; 95% CI, 0.12-0.48; P =.00) and 18 to 24 years (SMD, 0.42; 95% CI, 0.12-0.72; P =.01). However, single-session exercise did not significantly improve ADHD symptoms among participants 14 to 17 years of age (SMD, 0.16; 95% CI, -0.08 to 0.40; P =.65).

When stratified by exercise type, high-intensity interval training was more effective in improving core symptoms and executive function (SMD, 0.44; 95% CI, 0.08-0.80; P =.02) relative to moderate-intensity continuous training (SMD, 0.27; 95% CI, 0.13-0.41; P =.00). Additionally, exercise sessions under 30 minutes were more effective (SMD, 0.35; 95% CI, 0.19-0.51; P =.00) than sessions of 30 minutes or more (SMD, 0.22; 95% CI, 0.00-0.44; P =.05), and cycling led to greater symptom improvements (SMD, 0.40; 95% CI, 0.17-0.63; P =.00) than running (SMD, 0.11; 95% CI, -0.04 to 0.27; P =.91).

The investigators concluded, “This study supports the role of exercise in improving core symptoms and executive functioning in adolescent ADHD and provides additional evidence-based treatment options for a large number of adolescent patients with ADHD who are not amenable to medication.”

These findings may be limited by the small number of relevant studies and heterogeneity in the reliability and sensitivity of assessment standards.

Note: This article originally appeared on Psychiatry Advisor

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