Optimizing exercise prescription parameters for ADHD in children: A systematic review and meta-analysis

This study aimed to systematically evaluate the effects of physical exercise on children with Attention Deficit Hyperactivity Disorder (ADHD) and provide evidence for optimal exercise prescription.

Systematic review and meta-analysis of randomized controlled trials following PRISMA guidelines.

We searched databases including PubMed, Web of Science, Cochrane Library, ScienceDirect, and EBSCO from inception to July 20, 2025, incorporating 20 randomized controlled trials with 48 effect sizes. We conducted meta-analysis and subgroup analysis using a random-effects model.

Physical exercise may yield modest improvements in ADHD symptoms (SMD = 0.27, 95% CI [0.00-0.54]). Therapeutic and alternative exercise modalities (SMD = 0.45, 95% CI [0.26-0.65]) showed greater effects than Aerobic and Endurance Training (SMD = 0.16, 95% CI [0.00-0.32]). Mid-term interventions (12-24 weeks, SMD = 0.28, 95% CI [0.11-0.46]) outperformed short-term programs. Mid-frequency (twice weekly, SMD = 0.52, 95% CI [0.33-0.71]) and long duration sessions (60-90 min, SMD = 1.01, 95% CI [0.71-1.31]) demonstrated optimal effectiveness.

Physical exercise serves as a potentially beneficial adjunctive treatment for improving ADHD symptoms in children. Exploratory subgroup analyses suggest that therapeutic and alternative exercise modalities lasting 12-24 weeks, performed twice weekly for 60-90 min per session, may be associated with larger effect sizes, though these findings require further confirmation. These findings provide important references for clinical practice in managing ADHD in children.