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Exercise as a Treatment for ADHD

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.

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.


  • Impact on Fit­ness

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

  • 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,, 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:

Rabiner_David– Dr. David Rabin­er is a child clin­i­cal psy­chol­o­gist and Direc­tor of Under­grad­u­ate Stud­ies in the Depart­ment of Psy­chol­ogy and Neu­ro­science at Duke Uni­ver­sity. He pub­lishes Atten­tion Research Update, an online newslet­ter that helps par­ents, pro­fes­sion­als, and edu­ca­tors keep up with the lat­est research on ADHD, and teach­es the online course  How to Nav­i­gate Con­ven­tion­al and Com­ple­men­tary ADHD Treat­ments for Healthy Brain Devel­op­ment.

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2 Responses

  1. kirk horton says:

    We have for­got­ten, as a soci­ety, that atten­tion is a learned skill. It does not come nat­u­ral­ly to all chil­dren. Because of our genet­ic endow­ment, the abil­i­ty to attend varies with each indi­vid­ual; some indi­vid­u­als have greater capac­i­ty than oth­ers, but every­one can learn to improve atten­tion. Every­one.

    If atten­tion dif­fi­cul­ties vast­ly affect one’s life, per­haps it should be labeled a dis­or­der, but that would mean that very few peo­ple would be diag­nosed. That of course would pre­vent the phar­ma­ceu­ti­cal com­pa­nies from sell­ing vast amounts of ADHD med­ica­tion — more in the US than any oth­er nation on the plan­et.

    As a for­mer ele­men­tary school prin­ci­pal, I am quite aware that atten­tion dif­fi­cul­ties are just the tip of the ice­berg. ADHD chil­dren can’t fil­ter out dis­trac­tions, fin­ish tasks on-time, use their mem­o­ry opti­mal­ly, etc. A pill doesn’t teach these skills, but as an edu­ca­tor, I can.

    I found and used Play Atten­tion ( and ADHD Nan­ny ( We’ve been very suc­cess­ful with these approach­es. Hap­py par­ents, bet­ter grades, and bet­ter stu­dents.

    It’s just impor­tant to know that med­i­cine teach­es noth­ing. Par­ents and teach­ers must active­ly par­tic­i­pate to help change a child’s life.

  2. Sophie says:

    Thanks for exer­cise to get pre­oc­cu­pied. It gives ADHD diag­nosed to keep on focus.On the oth­er side, exer­cise pro­motes your brain to release sev­er­al impor­tant chem­i­cals such as endor­phins that reg­u­late mood and in a way affects focus and atten­tion span. Exer­cise group is indeed ben­e­fi­cial.

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