Effects of aerobic exercise on executive function in children and adolescents with attention deficit hyperactivity disorder: a systematic review and meta-analysis of randomized controlled trials.

Background: The benefits of aerobic exercise on the executive function of children and adolescents have been confirmed to a certain extent. However, the effects of such interventions on the executive function of children and adolescents with attention deficit hyperactivity disorder (ADHD) require further exploration. This study is a systematic review of randomized controlled trials (RCTs) of aerobic exercise interventions for children and adolescents with ADHD, aiming to provide valuable intervention suggestions to enhance the executive function of children and adolescents with ADHD.

Method: A comprehensive search was conducted across multiple databases, including PubMed, Web of Science, EMbase, Cochrane Library, ProQuest, Scopus, CNKI, Wanfang, and VIP databases, to identify relevant RCTs. We established detailed inclusion and exclusion criteria, followed by literature screening, data extraction, quality assessment, and data analysis conducted by two independent researchers. Literature screening was performed using EndNote X9. Risk of bias assessment (RoB1) and meta-analysis were conducted using Review Manager 5.4. Network meta-analysis was performed using Stata 17.0.

Results: A total of 16 studies were included in the analysis, involving 668 participants diagnosed with ADHD, including 343 in the experimental group and 325 in the control group. The age range of the participants was between 6 and 18 years. The results of the meta-analysis show that aerobic exercise interventions have a moderate effect size positive impact on inhibitory control (SMD = - 0.69, 95% CI: -1.04, - 0.34, p < 0.05), working memory (SMD = - 0.52, 95% CI: -0.82, - 0.21, p < 0.05), and cognitive flexibility (SMD = - 0.64, 95% CI: -0.83, - 0.45, p < 0.05) in children and adolescents with ADHD. Subgroup analyses indicate that the effectiveness of aerobic exercise interventions is moderated by factors such as intervention period, frequency, session duration, intensity and the choice between acute or chronic exercise. The results of the network meta-analysis showed that ball-based aerobic exercise [SMD = - 1.00, 95% CI = (- 1.98, - 0.03)] performed the best in improving inhibitory control among children and adolescents with ADHD, with a SUCRA value of 65.1%. It is important to note that most of the measurement tools for executive function employed reaction time as the evaluation criterion, which means that a more negative effect size corresponds to greater improvement.

Conclusion: Aerobic exercise interventions can significantly improve the executive functions of children and adolescents with ADHD. To achieve the best intervention effects, it is recommended to engage in chronic aerobic exercise, with a period lasting no less than 12 weeks, scheduled 3 to 5 times per week, each session lasting 60 min or more, and maintaining intensity at moderate or moderate-to-vigorous levels. Additionally, different types of aerobic exercise have varying effects on the inhibitory control abilities of this population, which requires attention.