Health care providers consider medication type, dose, and timing when writing prescriptions and instructing families. These same considerations are important when we prescribe exercise as a medical intervention. In this month’s edition of Pediatrics, a meta-analysis by Huang et al looks at just how effective a prescription for exercise can be in children with attention deficit hyperactivity disorder (ADHD). The article entitled, “Chronic Exercise for Core Symptoms and Executive Function in ADHD: A Meta-Analysis,” examines the effects of chronic exercise interventions (CEIs) in children with ADHD on executive function (EFs) (inhibition, working memory and cognitive flexibility) and core symptoms (impulsivity and hyperactivity) (10.1542/peds.2022-057745).
If you review the abstract of this article, you will find the conclusion to be short and sweet:
“CEIs have small to moderate beneficial effects on overall core symptoms and EFs in children and adolescents with ADHD.”
However, this one sentence does not tell the full story, and I encourage you to look at the detailed results more closely, particularly Tables 2 and 3 which give a great summary of their findings. For example:
When looking at exercise type, Huang and co-authors classified exercise interventions into 2 types of skills:
- Closed skill: using repetitive movements (e.g., running, swimming)
- Open skill: including complex movements and task demands (e.g., basketball, soccer)
Closed skill activities exerted a large positive effect on core symptoms but only a moderate positive effect on executive function. However, open skill activities showed a large positive effect on executive function, but an insignificant effect on core symptoms.
When looking at exercise dose (i.e., duration and intensity), longer bouts of moderate intensity exercise had greater positive effects on executive function than shorter bouts of high intensity exercise.
These benefits are in addition to the role physical activity plays in overall maintenance of physical and mental health for all children and adolescents. This may be particularly important in children with ADHD given their added risk of anxiety, depression, and other mental health conditions. For your patients with ADHD who continue to struggle with core symptoms or executive function, while medication is the first line of treatment for ADHD per the AAP Guidelines on this disorder,1 consider using the information contained in this article to deliver an individualized exercise “prescription.” It can only help.
One limitation is that this study only looked at the effects of chronic exercise on ADHD symptoms, and there is an additional body of literature looking at the effects of acute exercise on ADHD symptoms. But that is a blog for another day.
Reference:
- Wolraich ML, Hagan JF, Jr, Allan C, et al. Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics. 2019;144(4)doi:10.1542/peds.2019-2528
