Exercise for core ADHD symptoms and executive functions in children and adolescents with ADHD: A network and
Meng Zhang1, Changshuang He1, Xiang Gao1
1School of Exercise and Health, Shanghai University of Sport, Shanghai 200438, China.
Purpose:
The purpose of this study was to identify the most effective exercise modalities and the recommended doses for alleviating core attention-deficit/hyperactivity disorder (ADHD) symptoms and enhancing executive functions (EFs) in children and adolescents with ADHD.
Methods:
A systematic search for randomized controlled trials involving exercise interventions in children and adolescents with ADHD (aged 6-18 years) was conducted across 8 electronic databases from inception to August 23, 2025. Outcomes included core ADHD symptoms and EFs. Two independent reviewers assessed the quality of the literature and evidence. A Bayesian arm-based multilevel dose-response network meta-analysis was conducted using a random effects model.
Results:
A total of 39 studies involving 1836 participants were included. Compared with the control group, closed-skill exercises (Hedges'g = -0.54, 95% credible interval (95%CrI): -0.74 to -0.35, surface under the cumulative ranking curve (SUCRA) = 0.71) demonstrated the most significant improvement in core ADHD symptoms, while open-skill exercises (Hedges'g = -0.68, 95%CrI: -0.84 to -0.53, SUCRA = 0.87) exhibited the greatest efficacy in enhancing EFs. The overall exercise dose was positively correlated with the improvement in core ADHD symptoms, with an estimated minimum dose of approximately 660 metabolic equivalents (METs)-min/week (95%CrI: 470-1162 METs-min/week) required to achieve the minimal clinically important difference (MCID). An inverted U-shaped dose-response relationship was observed for EFs, where the minimum overall exercise dose to achieve the MCID was estimated to be approximately 740 METs-min/week (95%CrI: 600-1000 METs-min/week), with no clear additional benefits observed beyond roughly 1210 METs-min/week (95%CrI: 1090-1530 METs-min/week).
Conclusion:
Closed-skill and open-skill exercises were, respectively, the most effective modalities for improving core ADHD symptoms and EFs. Based on our exploratory models, a minimum overall exercise dose of approximately 600-800 METs-min/week (roughly 20-25 min/day of 4.5 METs moderate-intensity exercise) may be sufficient to achieve improvements in both core ADHD symptoms and EFs.
More Related Videos
Related Concept Videos
Attention-Deficit/Hyperactivity Disorder
Diagnostic Criteria and Symptoms
To diagnose ADHD, symptoms must manifest before age 12 and be evident across multiple settings.
Dose-Response Relationship: Overview
Dose-Response Relationship: Potency and Efficacy
Stimulants
Cocaine can be administered via snorting, injection, or smoking. It primarily functions by blocking the reuptake of dopamine, resulting in a euphoric high characterized by an intense sensation of happiness and...
Drug Dosing: Infants and Children
CNS Stimulants: Cocaine, Amphetamines and Cannabinoids


