Abstract
BackgroundPrevious studies found that exercise interventions have positive effects on executive functions of the general population. However, studies seldom target executive functions of children and adolescents with attention-deficit hyperactivity disorder (ADHD). This study aimed to synthesise empirical studies regarding the effects of exercise interventions on executive functions of children and adolescents with ADHD.MethodsA systematic search of the relevant literature was conducted in March 2020 through six electronic databases: CINAHL Complete, Eric, MEDLINE, PsychINFO, SPORTDiscus with Full Text, and Web of Science. Randomised controlled trials/quasi-experimental designs that applied exercise interventions and assessed executive functions through neurocognitive tasks among children and adolescents with ADHD were included. Altogether, 314 studies were identified, from which 31 full texts were independently assessed by two authors for eligibility. Finally, 21 studies underwent systematic reviews and 15 were selected for meta-analysis. Data extraction procedures and risk of bias analysis were conducted by two independent authors using the Physiotherapy Evidence Database (PEDro) scale.ResultsThe findings indicated that exercise interventions improved overall executive functions of children and adolescents with ADHD (SMD = 0.611, 95% CI [0.386 to 0.836], p < 0.01). Exercise interventions had a moderate-to-large positive effect on inhibitory control (g = 0.761, 95% CI [0.376 to 1.146], p < 0.01) and cognitive flexibility (g = 0.780, 95% CI [0.331 to 1.228], p < 0.001). Likewise, during the subgroup analysis, intervention intensity and sessions of exercise (acute vs chronic) significantly moderated exercise intervention rather than intervention type.ConclusionsChronic sessions of exercise interventions with moderate intensity should be incorporated as treatment for children with ADHD to promote executive functions.
Highlights
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition commonly diagnosed during childhood [1]
The current review investigated the impact of exercise interventions on Executive functions (EFs) of children and adolescents with attentiondeficit hyperactivity disorder (ADHD) based on the outcome data of 15 studies
The meta-analysis revealed that exercise intervention has a positive moderate-to-large effect on overall EFs, inhibitory control, and cognitive flexibility in children and adolescents with ADHD
Summary
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition commonly diagnosed during childhood [1]. ADHD is associated with age-inappropriate behaviours, including hyperactivity, impulsivity, and inattention [4]. Executive dysfunction is an endophenotype of ADHD symptoms [5], yielding cooccurring medical and psychiatric illnesses [6], including behavioural sleep problems [7], physical inactivity [8], motor abnormalities, and impairments [9]. The social and economic costs of untreated ADHD symptoms are considerable, including academic underachievement, unemployment, delinquency and higher rates of divorce than the general population [11, 12]. Previous studies found that exercise interventions have positive effects on executive functions of the general population. Studies seldom target executive functions of children and adolescents with attentiondeficit hyperactivity disorder (ADHD).
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