The effects of exergaming on executive functions in children with ADHD: a systematic review and meta-analysis of...

A growing number of studies have investigated the effectiveness of exergaming on the executive functions (EFs) in children with ADHD. Whilst some studies have shown beneficial effects, other studies provide mixed effects and there has yet to be a focused synthesis of the literature on this topic.

A systematic review (PROSPERO; CRD42024549395) was conducted following PRISMA guidance, drawing from eligible studies across eleven databases. Studies were screened based on eligibility criteria by two independent reviewers. Risk of bias (Cochrane ROB2) and certainty of evidence (GRADE criteria) were independently assessed by two reviewers. The Synthesis Without Meta-analysis (SWiM) using vote counting based on direction of effect was conducted on studies with incomplete data. Separate meta-analyses were performed for each EF process using random-effect meta-analysis.

A total of 2,263 studies were identified. After removing duplicates and non-RCTs automatically, 1,546 studies were screened by title and abstract resulting in 35 full texts being retained for detailed screening with 4 studies meeting all inclusion criteria. Two studies in the SWiM showed beneficial effects on overall EFs. Meta-analyses on two studies found exergaming was beneficial for inhibition (SMD = -5.07; 95%-CI [-14.08, 3.95]), working memory (SMD = -0.31; 95%-CI [-0.88, 0.26]), and cognitive flexibility (SMD = -0.84; 95%-CI [-1.50, -0.19]). The mean drop-out rate was 13.82% indicating high adherence. Implementation data identified that a console, game license, a room, television, and supervision from trainers/parents are needed to implement exergaming across different settings and contexts.

The results indicate that although the direction of effects shows positive trends, the evidence remains insufficient and imprecise to determine the clear conclusion whether exergaming can increase EFs and adherence to PA in children with ADHD. Future research with high-quality measurement of the outcome and completely reporting outcome data is necessary to strengthen the evidence and to inform the implementation.