As of 2016, the Centers for Disease Control and Prevention states that approximately 9.4% (6.1 million) of children 2-17 yr of age have been diagnosed with attention deficit hyperactivity disorder (ADHD). Recent studies have looked at physical activity (PA) as a possible alternative and/or adjunct treatment option for children with ADHD. There is no clear picture on the amount of PA needed to elicit an improvement or what type of exercise is most beneficial.
The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were used to search six databases to identify studies that assessed the relationship between PA and executive functioning (EF) in children with ADHD. Cochrane's Risk of Bias tool was used, and dose response using MET levels was attempted. Eligibility criteria included (a) peer-reviewed, experimental, quantitative study designs that included a control group or a within-subject design; (b) published in English between January 1997 and December 31, 2019; (c) children 5-18 yr of age; and (d) assessed the relationship between PA and EF in children with ADHD.
A total of 49 full-text manuscripts were identified, with 24 studies being included in the final review. Although results should be interpreted with caution because of variability across studies and a high risk of bias, there seems to be consensus that acute and training PA positively influence inhibition and cognitive flexibility. More rigorous study protocols that clearly identify which EF component they are assessing and how they are addressing areas of bias will provide a more cohesive representation of the evidence on how to effectively incorporate PA to enhance EF in children with ADHD. Dose response using MET levels is also needed to improve our knowledge of how much exercise is needed to affect EF in this population.
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