Although I no longer main­tain a clin­i­cal prac­tice, for years I worked with chil­dren with ADHD and their fam­i­lies. One thing I heard from many par­ents was that their child responded well to phys­i­cal exer­cise, that it helped their chil­dren burn off excess energy and main­tain a calmer and more focused state.

Indeed, evi­dence from sev­eral large-scale exper­i­men­tal stud­ies sug­gests that phys­i­cal activ­ity train­ing can have a pos­i­tive influ­ence on children’s cog­ni­tive func­tion­ing. Sys­tem­atic research on the impact of phys­i­cal activ­ity on youth with ADHD is rel­a­tively lack­ing, how­ever, despite the pos­i­tive anec­do­tal reports that one fre­quently hears from par­ents. A study pub­lished recently online in the Jour­nal of Atten­tion Dis­or­ders begins to rem­edy this sit­u­a­tion by exam­in­ing the effects of an extended phys­i­cal activ­ity train­ing pro­gram on chil­dren with ADHD.

Par­tic­i­pants were 21 chil­dren (19 boys) rang­ing in age from 7 to 12 years. All chil­dren were diag­nosed with either the com­bined or hyperactive-impulsive sub­type of ADHD. (Chil­dren with the inat­ten­tive sub­type were excluded because the authors antic­i­pated greater ben­e­fits of exer­cise in youth for whom hyper­ac­tiv­ity was an impor­tant part of their
symp­tom pic­ture.) Chil­dren were assigned to either the phys­i­cal activ­ity pro­gram group or a con­trol group; these assign­ments were not done ran­domly, how­ever. Instead, because of recruit­ment dif­fi­cul­ties, par­tic­i­pants in the activ­ity group were all from the same school while chil­dren in the con­trol group were recruited from dif­fer­ent areas. As the authors acknowl­edge, the absence of ran­dom assign­ment is an impor­tant lim­i­ta­tion of the study.

Chil­dren in the exer­cise group com­pleted a 45-minute exer­cise rou­tine 3 times per week dur­ing the school day over a 10-week period. All ses­sions were super­vised by a phys­i­cal edu­ca­tion teacher and included a com­bi­na­tion of aer­o­bic activ­ity, strength train­ing, and motor skills train­ing. The objec­tive was to main­tain mod­er­ate to vig­or­ous inten­sity in
each ses­sion; this was mon­i­tored using a heart rate monitor.

Mea­sures
A vari­ety of mea­sures were col­lected on the activ­ity and con­trol group before and after the 10-week exer­cise pro­gram. The dif­fer­ent domains mea­sured were:

• Fit­ness and motor per­for­mance — Mea­sures of motor abil­i­ties and mus­cu­lar strength
• Behav­ioral mea­sures — Children’s behav­ior was assessed via the Child Behav­ior Check­list and the Teacher Report Form. These are widely-used, stan­dard­ized behav­ior mea­sures that assess chil­dren in mul­ti­ple domains, includ­ing behav­iors directly related to ADHD.
• Neu­ropsy­cho­log­i­cal mea­sures — Children’s atten­tion and response inhi­bi­tion, i.e., the abil­ity to refrain from impul­sive respond­ing, were mea­sured using the Test of Every­day Atten­tion for Children.

Results

• Impact on Fitness

Not sur­pris­ingly, chil­dren in the exer­cise group showed sig­nif­i­cant gains rel­a­tive to con­trols on mea­sures of motor skills and mus­cu­lar strength.
Behavior

• Behav­ioral Ratings

Par­ent rat­ings on the Child Behav­ior Check­list showed sig­nif­i­cant reduc­tions for chil­dren in the exer­cise group on 3 of the CBCL sub­scales: Total Prob­lems, Thought Prob­lems, and Atten­tion Prob­lems.
It is impor­tant to note, how­ever, that even though the exer­cise group had lower scores on these scales at the end of the pro­gram, after con­trol­ling for their base­line scores, aver­age scores remained in a clin­i­cally ele­vated range.
For teacher rat­ings, a ten­dency for improve­ment in the exer­cise group was reported on all scales. This included sta­tis­ti­cally sig­nif­i­cant reduc­tions in prob­lem scores on the Anxiety-Depression scale and the Social Prob­lems scale.

• Neu­ropsy­cho­log­i­cal Functioning

Some improve­ments were also evi­dent on neu­ropsy­cho­log­i­cal func­tion­ing as mea­sured by the Test of Every­day
Atten­tion for Chil­dren. Results on this mea­sure were con­sis­tent with chil­dren in the exer­cise group show­ing bet­ter audi­tory sus­tained attention.

Sum­mary and Impli­ca­tions
Results from this study pro­vide ini­tial evi­dence that a sys­tem­atic and rig­or­ous phys­i­cal activ­ity pro­gram may be ben­e­fi­cial to youth with ADHD. As dis­cussed above, youth who par­tic­i­pated in the exer­cise group showed
sig­nif­i­cant improve­ments rel­a­tive to con­trols in a num­ber of areas, based on reports from par­ents and teach­ers as well as on a mea­sure of neu­ropsy­cho­log­i­cal functioning.

Although these find­ings sug­gest that exer­cise may be help­ful in address­ing some symp­toms of ADHD, as well as dif­fi­cul­ties that often accom­pany ADHD, it is impor­tant to put these pos­i­tive find­ings into an appro­pri­ate per­spec­tive. First, even though the activ­ity pro­gram was asso­ci­ated with improve­ments in sev­eral areas, chil­dren con­tin­ued to show clin­i­cally ele­vated dif­fi­cul­ties even in areas where improve­ments were seen. Thus, there was no evi­dence that the exer­cise pro­gram reduced children’s dif­fi­cul­ties into the nor­ma­tive range.

Sec­ond, as the authors note, the absence of ran­dom assign­ment lim­its the con­clu­sions that can be drawn from this study. The authors also sug­gest cau­tion because par­ents and teach­ers were not blind to children’s sta­tus, and expec­ta­tions of pos­i­tive results from the exer­cise pro­gram may have biased their ratings.

These issues all need to be addressed in a follow-up study that includes a larger sam­ple, ran­dom assign­ment, and, ide­ally, rat­ings from observers who do not know which chil­dren received the pro­gram and which did not. In
the mean­time, a vig­or­ous phys­i­cal activ­ity pro­gram could cer­tainly be valu­able for many chil­dren with ADHD for a vari­ety of rea­sons, even if the ulti­mate impact of exer­cise on core ADHD symp­toms is not yet known.

Ref­er­ence: Ver­ret, et.al., A phys­i­cal activ­ity pro­gram improves behav­ior and cog­ni­tive func­tions in chil­dren with ADHD: An exploratory study. (2010). Jour­nal of Atten­tion Dis­or­ders. pub­lished on Sep­tem­ber 13, 2010 as doi 10:1177/1087054710379735

Read more posts by Dr. Rabiner on other fac­tors impact­ing ADHD:

• ‘West­ern’ Style Diet Increases Risk of ADHD
• A Con­trolled Trial of Herbal Treat­ment for ADHD

– Dr. David Rabiner is a child clin­i­cal psy­chol­o­gist and Direc­tor of Under­grad­u­ate Stud­ies in the Depart­ment of Psy­chol­ogy and Neu­ro­science at Duke Uni­ver­sity. His research focuses on var­i­ous issues related to ADHD, the impact of atten­tion prob­lems on aca­d­e­mic achieve­ment, and atten­tion train­ing. He also pub­lishes Atten­tion Research Update, a com­pli­men­tary online newslet­ter that helps par­ents, pro­fes­sion­als, and edu­ca­tors keep up with the lat­est research on ADHD.

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