Intervention effects of long-term exercise on executive function in children and adolescents with attention-deficit
Haiyan Wang1, Jilan Zhou2, Lei Zhao3
1Department of Physical Education, China University of Petroleum (East China), Qingdao, China.
Background:
Attention-deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children and is often associated with executive function impairments. We aimed to examine the effects of long-term exercise on executive function in children and adolescents with ADHD using a three-level meta-analysis.
Methods:
We searched five databases (Embase, The Cochrane Library, PubMed, Web of Science, and China National Knowledge Infrastructure) from inception to 7 June 2025, for randomised controlled trials on long-term exercise and executive function in children and adolescents with ADHD. We used ROB 2 to assess the risk of bias. We used a three-level meta-analysis with restricted maximum likelihood as the primary model to synthesise non-independent effect sizes. We conducted influence analysis to identify influential cases, and sensitivity analyses using an aggregated two-level random-effects model and robust variance estimation. We assessed evidence quality with GRADEpro.
Results:
We included 15 studies. We derived the primary estimate from the outlier-removed three-level model because three influential effect sizes were identified, and we conducted subsequent secondary analyses on the same data set. The results showed that long-term exercise may improve executive function in children and adolescents with ADHD (Hedges' g = -0.52; 95% confidence interval = -0.87, -0.18; P = 0.003), with low-certainty evidence. Sensitivity analyses yielded effects in a similar direction and of comparable magnitude. Intervention duration (F = 4.72; P = 0.033) and age (F = 5.36; P = 0.023) were identified as moderating factors for the improvement of executive function in children and adolescents with ADHD through long-term exercise.
Conclusions:
Long-term exercise may benefit executive function in children and adolescents with ADHD, although the certainty of the evidence was low. Findings on age and intervention duration should be interpreted cautiously because some subgroup strata included only a small number of effect sizes.
Registration:
PROSPERO: CRD42024627175.
