Effects of physical activity on attentional domains in ADHD

Attention difficulties represent a core symptom of ADHD in children. Nevertheless, current literature regarding attention deficits and detailed examinations of attentional subdimensions remains limited. To inform targeted strategies for specific attentional domains, this review examined the impact of physical activity on attention in individuals with ADHD.

This study conducted a systematic search of four databases, namely PubMed, Scopus, ProQuest, and Web of Science, to identify relevant literature. Two researchers independently screened the studies, assessed their quality, and extracted the relevant data; subsequently, a meta-analysis was performed using Stata 18.

Given that attention is a multidimensional construct, we classified it into general attention, selective attention, and sustained attention, and evaluated the impacts of physical activity on these three distinct domains. This meta-analysis employed a random-effects model to conduct a stratified analysis of 11 studies. Among them, 5 studies involving a total of 278 participants assessed the effects of physical activity on overall attention problems; the pooled estimate (Hedges' g = -0.67, 95% confidence interval: [-1.15, -0.18], p = 0.01) indicated a statistically significant moderate-to-large effect. Another 4 studies, including 215 participants, evaluated the effects of physical activity on selective attention; the pooled analysis result (Hedges' g = 1.36, 95% confidence interval: 0.30-2.43, p = 0.01) demonstrated a statistically significant large effect. However, this estimate was based on limited evidence, exhibited substantial heterogeneity (I² = 87.7%), and was rated as low-certainty evidence; therefore, this finding should be interpreted with caution. In addition, 4 studies with a total of 133 participants were included; their pooled analysis found no statistically significant overall effect, with considerable uncertainty in the estimate (Hedges' g = -0.56, 95% confidence interval: -1.52 to 0.39, p = 0.25), precluding definitive conclusions regarding sustained attention. Exploratory subgroup analysis indicated that the effect reached statistical significance only in the low-frequency subgroup (fewer than 3 sessions per week); however, the between-subgroup comparison was not statistically significant (Qb(1) = 0.18, p = 0.67), and intervention frequency cannot be considered an established moderator.

Physical activity significantly improved overall attention issues in ADHD patients, with notable enhancement in selective attention. However, the improvement in sustained attention did not reach statistical significance. Exploratory subgroup analysis indicated that the effect reached statistical significance only in the low-frequency subgroup; however, the between-subgroup comparison was not statistically significant (Qb(1) = 0.18, p = 0.67), and intervention frequency cannot be considered an established moderator.