Exercise: applications to childhood ADHD

The impact of the physical activity intervention on sleep in children and adolescents with neurodevelopmental disorders: a systematic review and meta-analysis

Objective

The purpose of this review was to synthesize the current literature on the relationship between sleep and physical activity in children and adolescents with neurodevelopmental disorders.

Methods

Articles were searched in PubMed, Web of Science, EBSCO, Cochrane, and Embase until April 2024. The meta-analysis was performed using Review Manager 5.3.

Results

Our results show that measuring sleep parameters by means of different measuring tools yields different results. Most studies have found no association between sleep and physical activity in children with neurodevelopmental disorders, especially when measured subjectively, such as parent reports and sleep logs. Physical activity interventions had a significant effect on sleep efficiency, wake after sleep onset, and sleep duration when measured objectively using instruments such as wrist actigraphy. Meta-analysis showed that children and adolescents with neurodevelopmental disorders who participated in mind-body activities (SMD = -3.01, 95%CI = -4.15~-1.87, p < 0.001, I2 = 99%) showed significant improvements in sleep, which were sessions lasting more than 12 weeks (SMD = -1.01, p < 0.01, I2 = 97%), performed at least 3 times per week (SMD = -0.81, 95%CI = -1.53~-0.10, p = 0.03, I2 = 95%), and lasted for more than 60 min per session (SMD = -1.55, 95%CI = -2.67~-0.43, p = 0.007, I2 = 97%). However, the results of these subgroup analyses must be interpreted with caution because of the small number of studies included.

Conclusion

Our results show that measuring sleep parameters by means of different measuring tools yields different results. There was difficulty in interpreting many of the studies included in this meta-analysis, in view of the non-standardization of protocol, especially the ability range of the cohort, duration of the study, recommended exercises, whether the caregivers or researchers supervised the exercise regime/activity, and the practicality of continuing the exercise long-term by caregivers.

Systematic review registration

Identifier, CRD42024541300.

Optimal exercise intensity for improving executive function in patients with attention deficit hyperactivity disorder: systematic review and network meta-analysis

This study aimed to compare and rank the effectiveness of optimal exercise intensity in improving executive function in patients with ADHD (Attention deficit hyperactivity disorder, ADHD) through a comprehensive comparison of direct and indirect evidence. A systematic search was performed in five electronic databases to explore the optimal exercise intensity for improving executive function in patients with ADHD by directly and indirectly comparing a variety of exercise intervention intensities. In addition, the isolated effects of exercise on improving executive function in patients with ADHD were explored through classical meta-analysis of paired direct comparisons. Twenty-nine studies were retrieved and included in this study. Classical paired meta-analysis showed that for the patients with ADHD in the age group of 7-17 years, statistical difference was observed for all the parameters of exercise interventions (intensity, frequency, period, and training method), the three dimensions of executive function, the use of medication or not, the high and low quality of the methodological approach. Network meta-analysis showed that high-intensity exercise training was optimal for improving working memory (97.4%) and inhibitory function (85.7%) in patients with ADHD. Meanwhile, moderate-intensity exercise training was optimal for improving cognitive flexibility (77.3%) in patients with ADHD. Moderate to high intensity exercise training shows potential for improving executive function in these patients. Therefore, we recommend applying high-intensity exercise intervention to improve executive function in patients with ADHD to achieve substantial improvement.

Network meta-analysis of the effects of different cognitive trainings on the cognitive function of patients with mild cognitive impairment

OBJECTIVE

Examining the relationship between the responses of a number of different cognitive trainings on cognitive functioning in middle-aged and elderly patients with mild cognitive impairment.

METHODS

Randomized controlled experimental studies published publicly from the time of inception to October 30, 2023 were searched through Web of Science, PubMed, Embase, and Cochrane library databases. Traditional and network meta-analyses were performed using Stata 17.0 software.

RESULTS

Fifty papers on 4 types of cognitive training were included. Traditional meta-analysis showed that virtual reality training (SMD = 0.53, 95%CI: [0.36,0.70], P = 0.00), neuropsychological training (SMD = 0.44, 95%CI: [0.18,0.70], P = 0.00), cognitive strategy training (SMD = 0.26, 95%CI: [0.16,0.36], P = 0.00), and cognitive behavioral therapy (SMD = 0.25, 95%CI: [0.08,0.41], P = 0.00) all had significant improvement effects on the cognitive function of middle-aged and elderly patients with mild cognitive impairment. Network meta-analysis revealed neuropsychological training as the best cognitive training, and subgroup analysis of cognitive function subdimensions showed that neuropsychological training had the best effects on working memory, lobal cognitive function, memory, and cognitive flexibility improvement. Meanwhile, virtual reality training had the best effects on processing speed, verbal ability, overall executive function, spatial cognitive ability, and attention improvement.

CONCLUSION

Cognitive training can significantly improve the cognitive function of middle-aged and elderly patients with mild cognitive impairment, and neuropsychological training is the best intervention, most effective in interventions lasting more than 8 weeks.

Effects of rope skipping exercise on working memory and cardiorespiratory fitness in children with attention deficit hyperactivity disorder

Introduction

Children with Attention Deficit Hyperactivity Disorder (ADHD) exhibit deficits in working memory (WM) and cardiorespiratory fitness (CRF), both of which are closely associated with the core symptoms of ADHD. This study aimed to investigate the effects of rope skipping exercise (RSE) on the WM and CRF of children with ADHD, to provide a theoretical foundation for the optimization of exercise intervention programs tailored to children with ADHD.

Methods

This study recruited 55 children (age range 6-12 years) and randomly assigned them into three groups: the ADHD with RSE (AWRSE, n=22, mean age: 10.18 ± 1.10 years), the ADHD with sports game (SG) (AWSG, n=16, mean age: 9.38 ± 0.96 years), and the typically developing (TD) control group (CG, n=17, mean age: 8.94 ± 0.56 years). The AWRSE underwent a RSE intervention, while the other two groups participated in SG. The exercise intervention lasted for 8 weeks, with sessions held twice a week for 60 minutes each, at a moderate-to-vigorous-intensity (64-95% HRmax). All children in each group underwent pre-test and post-test, including height, weight, BMI, n-back, and 20mSRT. One-way analysis of variance (Ony-way ANOVA) and paired sample t-test were used to analyze inter- and intra-group differences respectively.

Results

Before the intervention, children with ADHD exhibited a significantly lower VO2max compared to the TD children (p<0.05), and there was no significant difference in the other indicators between the groups (p>0.05). After the intervention, no significant inter-group differences were found across all indices for the three groups of children (p > 0.05). The AWRSE had significant improvements in the accuracy of 1-back task, Pacer (laps), and VO2max (p<0.05), with the level of CRF approaching that of TD children. A significant decrease in response time for the 1-back task was observed in the CG.

Conclusion

An 8-week RSE intervention is an effective therapeutic approach for children with ADHD, significantly enhancing their WM and CRF.

Can an active lifestyle reduce the risk of obesity in adulthood among adolescents with Attention-Deficit/Hyperactivity Disorder symptoms? An ambispective cohort study

Various studies have associated Attention-Deficit/Hyperactivity Disorder (ADHD) with obesity, but the role of physical activity in this connection is uncertain. This study examined whether adopting an active lifestyle can mitigate the link between adolescent ADHD and the risk of adult obesity. Longitudinal data from the Add Health Study (Waves I, III, and V) were used. Participants self-reported ADHD symptoms (hyperactivity/impulsivity, inattention, combined) during Wave III and self-assessed their recent moderate-to-vigorous physical activity. An "active lifestyle" required meeting activity criteria in both adolescence (Wave I) and adulthood (Wave III-V). Of 2609 participants, 1.42 % exhibited combined ADHD symptoms. A non-linear relationship was observed between inattentive/hyperactive scores and body mass index (BMI) and waist circumference (WC). Individuals with ≥ 6 hyperactivity/impulsivity symptoms had higher BMI (1.29 kg/m²) and WC (1.27 cm) at adulthood. Logistic regressions indicate that, compared to individuals without ADHD maintaining an active lifestyle, both inactive participants with and without ADHD show an elevated risk of obesity (odds ratio [OR]=1.56 to 2.63) and abdominal obesity in adulthood (OR = 1.51 to 2.50). Mediation analysis models further confirm these findings, suggesting that physical activity may explain this association. Though exact mechanisms warrant further exploration, adopting an active lifestyle offers promise for reducing obesity risk among individuals with ADHD symptoms.

Single Exercise for Core Symptoms and Executive Functions in ADHD: A Systematic Review and Meta-Analysis

OBJECTIVES

A systematic review and meta-analysis of studies of single exercise on core symptoms and executive function in adolescents with ADHD.

METHODS

Four databases were searched for studies of the effects of single exercise on core symptoms and executive functioning in adolescents with ADHD.

RESULTS

Thirteen studies were included, and a single session of exercise had small effect-size improvements in core symptoms and executive function in adolescents with ADHD: 10 to 13 year olds in the early adolescent-elementary school years and 18 to 24 year olds in the late adolescent-college years. Moderate-intensity continuous training, high-intensity interval training, single sessions of less than 30 minutes, and single sessions of 30 minutes and more significantly improved cycling training, attention, inhibition, substance use, and pre-study abstinence.

CONCLUSIONS

A single session of exercise had an overall ameliorative effect on core symptoms and executive function in adolescents with ADHD.

Physical and Extracurricular Activity in Adolescents With and Without ADHD: Examining Group Differences and the Role of Cognitive Disengagement Syndrome Symptoms

OBJECTIVE

This study examined extracurricular and physical activity related to ADHD (diagnosis and symptoms) and cognitive disengagement syndrome (CDS) symptoms.

METHODS

Participants were 302 adolescents (ages 12-14) with and without ADHD and primary caregivers. ADHD diagnosis was determined with parent interview. Questionnaires provided information on parent-reported demographic characteristics, ADHD symptoms, and extracurricular activity involvement; and adolescent-reported ADHD and CDS symptoms and indices of physical activity.

RESULTS

Although ADHD diagnosis and symptom dimensions were correlated with less extracurricular and physical activity involvement, CDS symptoms were most often independently associated with these outcomes. Females and adolescents from lower income homes also often had less involvement in extracurricular and physical activity.

CONCLUSIONS

Findings point to the need for more research in this area, careful assessment of risk factors (i.e., CDS symptoms, economic burden), and interventions that address inactivity in adolescents with ADHD, including those that address inequity related to income and sex.

Complementary and Integrative Treatments for Attention-Deficit/Hyperactivity Disorder in Youth

First-line psychopharmacologic and psychosocial treatments for attention-deficit/hyperactivity disorder in children are effective but limited by tolerability and accessibility problems. Many complementary and integrative strategies have been investigated as alternative or adjunctive treatments for the disorder, and the literature has progressed to meta-analyses for several. Although heterogeneity of study methods and risk of bias pervades the literature, we conclude that Omega-3 supplementation, dietary restriction of artificial food colorings, and physical activity can be considered evidence-based. Additionally, meditation, yoga, and sleep hygiene are safe, partially effective, cost effective and sensible adjunctive treatment strategies.

Effects of Physical Activity on Inhibitory Function in Children with Attention Deficit Hyperactivity Disorder: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis aimed to systematically evaluate the effect of physical activity (PA) on inhibitory function in children with ADHD. Experimental studies on the effect of PA on the inhibitory function of children with ADHD were retrieved. The data were obtained from PubMed, The Cochrane Library, Web of Science, EBSCO (MEDLINE, APA Psyclnfo, ERIC), Embase, Scopus, and ProQuest. The search period was from the date of inception of the respective databases to 4 May 2022, and Reviewer Manager software (version 5.3) was used for analysis. Eleven articles and 713 samples were included in the meta-analysis. Results revealed that PA can significantly improve the inhibitory function of children with ADHD (SMD = 0.78, 95% CI: 0.45−1.10, p < 0.001). Subgroup analysis showed that the effectiveness of PA as an intervention in improving the inhibitory function of children with ADHD was moderated by the frequency, intensity, duration, type, and length of intervention. Based on the findings, PA can effectively improve interference suppression inhibitory function in children with ADHD. Longitudinal open-skill exercise for 60 min or more, two times/week has the best effect on improving inhibitory function in children with ADHD.

Chronic Exercise for Core Symptoms and Executive Functions in ADHD: A Meta-analysis

BACKGROUND AND OBJECTIVES

The effects of chronic exercise interventions (CEIs) on core symptoms and executive functions (EFs) of attention-deficit/hyperactivity disorder (ADHD) and how different characteristics of CEIs could modify the effect remain unclear. We synthesized the current evidence on the effects of CEIs on core symptoms and EFs in children and adolescents with ADHD.

METHODS

Data sources include PubMed, Embase, Web of Science, Cochrane Library, and China National Knowledge Infrastructure from database inception to July 31, 2022. Study selection includes randomized controlled trials that reported on the effects of CEIs on core symptoms and/or EFs in ADHD aged 6 to 18 years.

RESULTS

Twenty-two randomized controlled trials were included. CEIs had a small beneficial effect on overall core symptoms (standardized mean difference [SMD] = -0.39, 95% confidence interval [CI]: -0.64 to -0.14), as well as inattention (SMD = -0.32, 95% CI: -0.63 to -0.004) among children and adolescents with ADHD. Closed-skill exercise showed a large improvement in core symptoms (SMD = -0.83, 95% CI: -1.30 to -0.35), whereas open-skill exercise did not. Additionally, CEIs had a moderately beneficial effect on overall EFs (SMD = -0.68, 95% CI: -0.91 to -0.45) and a moderate-to-large effect on the specific domains of EFs. The pooled effects on overall core symptoms and EFs were not significantly modified by study population (children or adolescents), exercise session duration (≤50 or >50 minutes per session, median), or total exercise sessions (<24 or ≥24 sessions, median).

CONCLUSIONS

CEIs have small-to-moderate beneficial effects on overall core symptoms and EFs in children and adolescents with ADHD.

Treatment of ADHD: Drugs, psychological therapies, devices, complementary and alternative methods as well as the trends in clinical trials

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders having a high influence on social interactions. The number of approved treatments and clinical trials for ADHD have increased markedly during the recent decade. This analytical review provides a quantitative overview of the existing pharmacological and non-pharmacological methods of ADHD treatments investigated in clinical trials during 1999-2021. A total of 695 interventional trials were manually assessed from clinicaltrial.gov with the search term « ADHD», and trial data has been used for analysis. A clear majority of the studies investigated non-pharmacological therapies (∼80%), including many behavioral options, such as social skills training, sleep and physical activity interventions, meditation and hypnotherapy. Devices, complementary and other alternative methods of ADHD treatment are also gaining attention. The pharmacological group accounts for ∼20% of all the studies. The most common drug classes include central nervous system stimulants (e.g., methylphenidate hydrochloride, lisdexamfetamine dimesylate, amphetamine sulfate, mixed amphetamine salts, a combination of dexmethylphenidate hydrochloride and serdexmethylphenidate chloride), selective noradrenaline reuptake inhibitors (atomoxetine, viloxazine), and alpha2 adrenergic receptor agonists (guanfacine hydrochloride, clonidine hydrochloride). Several studies investigated antidepressants (e.g., bupropion hydrochloride, vortioxetine), and atypical antipsychotics (e.g., quetiapine, aripiprazole) but these are yet not approved by the FDA for ADHD treatment. We discuss the quantitative trends in clinical trials and provide an overview of the new drug agents and non-pharmacological therapies, drug targets, and novel treatment options.

Dimensions of physical activity as related to child attention-deficit/hyperactivity disorder symptoms and impairment

In efforts to explore adjunct/alternative treatments for ADHD, this study investigated the associations between dimensions of physical activity (PA) and children's ADHD symptoms and impairment. Current evidence-based treatments include medication and behaviour management, but there is widespread consensus that more treatment options are desirable. Although there is increasing support for PA as an adjunct/alternative to existing treatment for ADHD, the interplay of specific dimensions of PA has not been studied. Fifty-one parents of children aged 6-12 years with ADHD filled out questionnaires. Hierarchical regression analysis indicated that only some dimensions of PA explained a statistically significant portion of the variance in ADHD symptoms, beyond that explained by typical demographic variables. PA dimensions did not account for a statistically significant portion of ADHD impairment. Refining the measurement of how long children have engaged in PA is a key step in generating evidence for PA as an adjunct or alternate treatment for ADHD, and developing guidelines to manage parental expectations for this treatment in the benefit of their children.

Effects of physical exercise on attention deficit and other major symptoms in children with ADHD: A meta-analysis

PURPOSE

To explore the effects of physical exercise intervention on the cardinal symptoms, motor skills and executive function among children with attention deficit hyperactivity disorder (ADHD).

METHODS

Literature searches for randomized controlled trials (RCTs) were performed in PubMed, The Cochrane Library, Web of Science, Embase, CNKI, CBM, VIP and Wanfang databases from the time of database construction to March 28, 2021. Screening was conducted based on inclusion and exclusion criteria. The Cochrane bias risk assessment tools were used to evaluate methodological quality. Relevant data were analyzed with RevMan5.3.5 software, and Stata16.0 was used for publication bias tests.

RESULTS

A total of 15 RCTs with 734 subjects were included. The meta-analysis showed that physical exercise can improve the attention of ADHD children (standardized mean difference [SMD] = -0.60, 95% confidence interval [CI] [-1.10, -0.11], p < 0.01), executive function (SMD = 1.22, 95% CI [0.61, 1.82], p < 0.01), and motor skills (SMD = 0.67, 95% CI [0.22, 1.12], p < 0.01). There were no significant effects on hyperactivity (SMD = 0.06, 95% CI [-0.26, 0.37], p = 0.72), depression (SMD = -0.72, 95% CI [-1.55, 0.11], p = 0.09), social problems (SMD = -0.27, 95% CI [-0.64, 0.09], p = 0.14), or aggressive behavior (SMD=-0.24, 95% CI [-0.69, -0.21], p = 0.30). Intervention duration and frequency might be the source of heterogeneity.

CONCLUSION

Physical exercise can help alleviate the symptoms of ADHD in children. Specifically, it can improve attention, executive function, and motor skills.

A framework for incorporating physical activity in treatment: Competencies, guidelines, and implications for family therapists

Physical activity can have a profound impact on the cognitive, emotional, and social aspects of our clients' lives, and can even boost and sustain therapy outcomes. And yet, family therapists may not be trained or educated in the importance of physical activity nor how to assess, educate, and collaborate with health professionals to incorporate physical activity in treatment. As the evidence grows on the connection between physical activity and biopsychosocial functioning and more family therapists enter medical and healthcare settings, a framework for physical activity competencies is needed. As such, the purpose of this conceptual and empirical review paper is to (a) review the important brain-boosting benefits of physical activity for mental, cognitive, and social health, (b) provide a framework for the domains for family therapists for incorporating exercise in assessment and treatment, and finally, (c) outline recommendations for practice, education and supervision, and research for family therapists.

Device-Based Movement Behaviors, Executive Function, and Academic Skills among African American Children with ADHD and Disruptive Behavior Disorders

Background: Physical activity (PA) has been identified as a promising intervention to improve executive function (EF) and reduce ADHD symptoms in children. Few African American children with ADHD and Disruptive Behavior Disorders (DBDs) from families with low incomes are represented in this literature. The purpose of this study is to test the relationships between PA and sedentary time (ST), and EF and academic skills among African American children with ADHD and DBD from low-income families. Methods: Children (n = 23, 6–13 years old) wore an ActiGraph for one week to measure PA and ST. EF was measured through parent report and direct neuropsychological tests. Academic skills were measured with the Curriculum-Based Measurement System. Bivariate correlations tested relationships between PA, ST, EF, and academic skills. Results: A significant correlation was observed between vigorous PA time and parent reported EF (r = −0.46, p = 0.040). Light PA and moderate PA were not related to EF or academic skills, and neither was ST. Conclusions: Vigorous PA may prove useful as an adjunct treatment to improve EF in African American children with ADHD and DBD in low-income neighborhoods. Research using experimental and longitudinal designs, and examining qualitative features of PA experiences, will be critical for understanding relationships between PA, academic skills, and EF in this population.

Effects of Physical Activity, Exercise and Sport on Executive Function in Young People with Attention Deficit Hyperactivity Disorder: A Systematic Review

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that negatively affects the inattention, disorganization, and/or hyperactivity–impulsivity in children and adolescents who suffer from it, included cases being reported that continue into adulthood. This disorder impairs social, academic, emotional, psychological, and health system functioning due to its high cost of treatment. The present systematic review aims to analyze the effects of physical activity, exercise, and sports on the executive function in children and adolescents diagnosed with ADHD through the scientific literature. The results show that the practice of physical activity, exercise, or sport produces improvements in executive function in children and adolescents diagnosed with ADHD, mainly through aerobic exercise. A 20 min session of physical activity, sport, or exercise leads to improvements in executive functions in children and adolescents with ADHD. It can be concluded that the practice of physical activity, exercise, and sport generate improvements on executive functions in children and adolescents with ADHD, mainly through aerobic exercise.

The effect of physical activity with and without cognitive demand on the improvement of executive functions and behavioral symptoms in children with ADHD

Background: Purposeful physical activities improve cognitive functions. Two possible mechanisms are available for this intervention including the impact of the physical component of exercise and goal-directedness as a cognitive component. In the present study, we aimed to compare the effect of physical activity with and without cognitive demand on executive functions and behavioral symptoms in children with ADHD.Methods: Thirty children with ADHD were randomly assigned to two equal groups of physical activity training with and without cognitive demand. Exercise for cognitive improvement and rehabilitation (EXCIR) or running, as an aerobic exercise, were used for intervention in two groups. Executive functions and ADHD symptoms were measured in three sessions including baseline, post-intervention, and follow-up assessments, using 1-back, Wisconsin Card Sorting, and Go/No-Go tests and Conner's Teacher and Parent Rating scales. Repeated measures ANOVAs were used for analysis.Results: The results showed physical activity with cognitive demand, compared to the physical activity without cognitive demand, has a better and longer impact on the improvement of executive functions and ADHD symptoms.Conclusions: Cognitive rehabilitation with combined physical and cognitive tasks has a beneficial and lasting impact on impaired executive functions and behavioral symptoms in children with ADHD.

Comparison of the effects of treadmill and vibration training in children with attention deficit hyperactivity disorder: A randomized controlled trial

OBJECTIVE

The aim of this study was to compare the effects of treadmill training (TT) and whole body vibration training (WBVT) on attention, severity of attention deficit hyperactivity disorder (ADHD) symptoms and impairment of executive function behaviors, and quality of life in children with ADHD.

METHODS

Thirty children (7-11 years of age) with ADHD were randomly assigned to either the 'TT' group or the 'WBVT in addition to TT' group (TT + WBVT). Both groups received TT for 8 weeks (3 days/week). The TT + WBWT group also received WBVT for 15 minutes. Stroop Test TBAG form, Behavior Rating Inventory of Executive Function (BRIEF), Conners' Rating Scale (CRS) and Pediatric Quality of Life Inventory (PedsQL) were applied at baseline and after 8 weeks of training.

RESULTS

All assessment results significantly improved in both groups at the end of the program compared to baseline values (p < 0,05). There were significant differences between groups regarding improvements in CTRS-R/L and BRIEF-Teacher form in favor of the TT + WBVT group.

CONCLUSIONS

The findings suggest that exercise training including TT and WBVT might be used in the treatment of ADHD but further research is required to provide evidence of the effectiveness of the whole body vibration training in the management of ADHD.

Recovery of BDNF and CB1R in the Prefrontal Cortex Underlying Improvement of Working Memory in Prenatal DEHP-Exposed Male Rats after Aerobic Exercise

Early-life exposure to di-(2-ethylhexyl)-phthalate (DEHP) has been suggested to relate to hyperactivity, lack of attention, and working memory deficits in school-age children. Brain-derived neurotrophic factor (BDNF) and endocannabinoids are induced by aerobic exercises to provide beneficial effects on brain functions. This study investigated the mechanisms underlying working memory impairment and the protective role of exercise in prenatal DEHP-exposed male rats. Sprague Dawley dams were fed with vehicle or DEHP during gestation. The male offspring were trained to exercise on a treadmill for 5 weeks, which was followed by an assessment of their working memory with a T-maze delayed non-match-to-sample task. The expressions of BDNF, dopamine D1 receptor (D1R), cannabinoid receptor 1 (CB1R), and fatty acid amide hydrolase (FAAH) in the prefrontal cortex were detected by Western blot. The results showed that DEHP-exposed rats exhibited working memory impairments without significant alterations in locomotor activities. The reduced expressions of prefrontal BDNF and CB1R were obtained in the DEHP-exposed rats, while D1R and FAAH were barely affected. Importantly, aerobic exercise during childhood-adolescence prevented the impairment of working memory in the DEHP-exposed rats by recovering the BDNF and CB1R expressions in the prefrontal cortex. These findings suggest that exercise may provide beneficial effects in ameliorating the impairment of working memory in the prenatal DEHP-exposed male rats at late adolescence.

Promising effect of a family rugby programme for children with ADHD: Promoting parent-child relationship and perceptual change on child's behaviors

BACKGROUND AND PURPOSE

This study explored the effectiveness of a family-based rugby programme to improve the parent-child relationship for children with ADHD and their parents.

MATERIALS AND METHODS

A total of 17 Chinese families (12 fathers and 13 mothers) of children (in early primary grades) with ADHD participated in this study. Mixed methods, including questionnaires, parent focus groups, parental reflective journals, and interviews with children, were adopted.

RESULTS

Quantitative data suggested a trend of parental perceptual change on their children's ADHD behaviors. Thematic analysis on the qualitative data further suggested the family rugby programme served as "a family play context" that helped promote parent-child relationship for the Chinese children with ADHD and their parents. Participating children experienced "a different self" and better self-control when playing rugby.

CONCLUSION

There is a promising effect of the use of rugby as an alternative family-based approach for children with ADHD and their parents.

Relationship between Health-Related Quality of Life and Physical Activity in Children with Hyperactivity

The main purpose of this paper was to evaluate the relationship between health-related quality of life (HRQoL) and the frequency of physical activity in Spanish children aged 8 to 14 years with attention deficit hyperactivity disorder (ADHD). Sample selection was performed using the data obtained from the children’s questionnaire of the National Health Survey of Spain 2017 that is carried out with the children’s parents, and that had an initial size of 6106 participants. After the application of the inclusion and exclusion criteria, the sample size was reduced to 496 subjects. Results show significant differences between the different levels of physical activity frequency, as well as a positive correlation of the average between HRQoL and ADHD. In conclusion, the practice of physical activity may contribute to the improvement of HRQoL in children with ADHD, possibly achieving greater benefits at higher levels of physical activity practice.

The Effects of Physical Exercise on Functional Outcomes in the Treatment of ADHD: A Meta-Analysis

Objective: An increasing number of studies suggest possible beneficial effects of exercise in alleviating ADHD functional outcomes. The current study provides a quantitative meta-analysis of the available studies investigating this relationship. Method: Studies reporting on the effects of physical exercise on motor skills and executive functions in children with ADHD were identified through Cochrane, PsycInfo, PubMed, Web of Science databases. Ten publications were selected. Random-effects model was used to calculate effect sizes. Results: There was a significant effect of exercise on ADHD functional outcomes (g = 0.627). Longer exercise intervention duration was consistently associated with larger effect sizes. Effect sizes were not related to exercise intensity, mean age of participants, or gender distribution. Conclusion: Results suggest that exercise has a modest positive impact on ADHD functional outcomes, such as executive functions and motor skills, with longer interventions yielding better results.

Potential Social and Neurocognitive Benefits of Aerobic Exercise as Adjunct Treatment for Patients With ADHD

Objective: The aim of the article is to review the evidence that aerobic exercise may be a useful adjunct treatment for ADHD. Method: Studies on physical, cognitive, and psychosocial aspects of aerobic exercise that are relevant to ADHD are reviewed and evaluated. Results: Stimulant medication, the main pharmacotherapy for ADHD, and aerobic exercise both act on catecholamine pathways. Aerobic exercise has been shown to be beneficial in preclinical studies on spontaneous hypertensive rats, an animal model of ADHD, and in clinical trials of children with ADHD, as an adjunct treatment to medication. Social and neurocognitive function in children and adults seem to be positively affected by exercise as well. Nevertheless, no controlled clinical trials in adults with ADHD have been conducted. Conclusion: Aerobic exercise may be a useful non-medication adjunct therapy for ADHD. The clinical effectiveness of aerobic exercise for ADHD in children and adults warrants further clinical studies.

Attention-deficit hyperactivity disorder

Attention-deficit hyperactivity disorder (ADHD), like other psychiatric disorders, represents an evolving construct that has been refined and developed over the past several decades in response to research into its clinical nature and structure. The clinical presentation and course of the disorder have been extensively characterised. Efficacious medication-based treatments are available and widely used, often alongside complementary psychosocial approaches. However, their effectiveness has been questioned because they might not address the broader clinical needs of many individuals with ADHD, especially over the longer term. Non-pharmacological approaches to treatment have proven less effective than previously thought, whereas scientific and clinical studies are starting to fundamentally challenge current conceptions of the causes of ADHD in ways that might have the potential to alter clinical approaches in the future. In view of this, we first provide an account of the diagnosis, epidemiology, and treatment of ADHD from the perspective of both the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and the eleventh edition of the International Classification of Diseases. Second, we review the progress in our understanding of the causes and pathophysiology of ADHD on the basis of science over the past decade or so. Finally, using these discoveries, we explore some of the key challenges to both the current models and the treatment of ADHD, and the ways in which these findings can promote new perspectives.

Physical exercise in attention deficit hyperactivity disorder - evidence and implications for the treatment of borderline personality disorder

A growing body of literature indicates a potential role for physical exercise in the treatment of attention deficit hyperactivity disorder (ADHD). Suggested effects include the reduction of ADHD core symptoms as well as improvements in executive functions. In the current review, we provide a short overview on the neurophysiological mechanisms assumed to underlie the beneficial effects of exercise. Further, we review the current evidence from experimental studies regarding both acute exercise and long-term interventions in ADHD. While the positive effects observed after acute aerobic exercise are promising, very few well-designed long-term intervention studies have been conducted yet. Moreover, although exercise effects have not yet been studied in borderline personality disorder (BPD), in the end of this paper we derive hypotheses why exercise could also be beneficial for this patient population.

Effects of Exercise on Cognitive Performance in Children and Adolescents with ADHD: Potential Mechanisms and Evidence-based Recommendations

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder with a complex symptomatology, and core symptoms as well as functional impairment often persist into adulthood. Recent investigations estimate the worldwide prevalence of ADHD in children and adolescents to be ~7%, which is a substantial increase compared to a decade ago. Conventional treatment most often includes pharmacotherapy with central nervous stimulants, but the number of non-responders and adverse effects call for treatment alternatives. Exercise has been suggested as a safe and low-cost adjunctive therapy for ADHD and is reported to be accompanied by positive effects on several aspects of cognitive functions in the general child population. Here we review existing evidence that exercise affects cognitive functions in children with and without ADHD and present likely neurophysiological mechanisms of action. We find well-described associations between physical activity and ADHD, as well as causal evidence in the form of small to moderate beneficial effects following acute aerobic exercise on executive functions in children with ADHD. Despite large heterogeneity, meta-analyses find small positive effects of exercise in population-based control (PBC) children, and our extracted effect sizes from long-term interventions suggest consistent positive effects in children and adolescents with ADHD. Paucity of studies probing the effect of different exercise parameters impedes finite conclusions in this regard. Large-scale clinical trials with appropriately timed exercise are needed. In summary, the existing preliminary evidence suggests that exercise can improve cognitive performance intimately linked to ADHD presentations in children with and without an ADHD diagnosis. Based on the findings from both PBC and ADHD children, we cautiously provide recommendations for parameters of exercise.

Exercise Interventions in Children and Adolescents With ADHD: A Systematic Review

OBJECTIVE

Exercise has attracted attention as a potential helpful intervention in children with ADHD. Effects are emphasized on cognition, social-emotional, and motor development.

METHOD

A systematic literature search was conducted using the electronic databases Web of Science, PubMed, Scopus, and ERIC to analyze the efficacy of different types of exercise interventions in children and adolescents with ADHD. Seven studies examining the acute and 14 studies examining the long-term effects were included.

RESULTS

The largest effects were reported for mixed exercise programs on ADHD symptomatology and fine motor precision. However, because of the large differences in the study designs, the comparability is limited.

CONCLUSION

At this time, no evidence-based recommendation can be formulated regarding frequency, intensity, or duration of exercise. Nevertheless, some first trends regarding the effects of certain types of exercise can be identified. When focusing on long-term health benefits in children and adolescents with ADHD, qualitative exercise characteristics might play an important role.

Effects of Physical Exercise Intervention on Motor Skills and Executive Functions in Children With ADHD: A Pilot Study

OBJECTIVE

This study examined the effect of a 12-week table tennis exercise on motor skills and executive functions in children with ADHD.

METHOD

Fifteen children with ADHD received the intervention, whereas 15 children with ADHD and 30 typically developing children did not. The Test of Gross Motor Development-2, Stroop, and Wisconsin Card Sorting Test (WCST) were conducted before and after the intervention.

RESULTS

After the intervention, the ADHD training group scored significantly higher in the locomotor as well as object-control skills, Stroop Color-Word condition, and WCST total correct performance compared with the ADHD non-training group, and we noted improvements in the locomotor as well as object-control skills, Stroop Color-Word condition, and three aspects of the WCST performances of the ADHD training group over time.

CONCLUSION

A 12-week table tennis exercise may have clinical relevance in motor skills and executive functions of children with ADHD.

Exercise ameliorates neurocognitive impairments in a translational model of pediatric radiotherapy

Background

While cranial radiation therapy (CRT) is an effective treatment, healthy areas surrounding irradiation sites are negatively affected. Frontal lobe functions involving attention, processing speed, and inhibition control are impaired. These deficits appear months to years after CRT and impair quality of life. Exercise has been shown to rejuvenate the brain and aid in recovery post-injury through its effects on neurogenesis and cognition.

Methods

We developed a juvenile rodent CRT model that reproduces neurocognitive deficits. Next, we utilized the model to test whether exercise ameliorates these deficits. Fischer rats (31 days old) were irradiated with a fractionated dose of 4 Gy × 5 days, trained and tested at 6, 9, and 12 months post-CRT using 5-choice serial reaction time task. After testing, fixed rat brains were imaged using diffusion tensor imaging and immunohistochemistry.

Results

CRT caused early and lasting impairments in task acquisition, accuracy, and latency to correct response, as well as causing stunting of growth and changes in brain volume and diffusion. Exercising after irradiation improved acquisition, behavioral control, and processing speed, mitigated the stunting of brain size, and increased brain fiber numbers compared with sedentary CRT values. Further, exercise partially restored global connectome organization, including assortativity and characteristic path length, and while it did not improve the specific regional connections that were lowered by CRT, it appeared to remodel these connections by increasing connectivity between alternate regional pairs.

Conclusions

Our data strongly suggest that exercise may be useful in combination with interventions aimed at improving cognitive outcome following pediatric CRT.

Attention Improves During Physical Exercise in Individuals With ADHD

The present study examined the effects of physical exercise on attentional processes in individuals diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), compared to healthy controls. Unlike previous studies typically comparing performance on baseline measures with post-exercise performance, this study examined the effects of physical exercise on attention while participants were engaged in a continuous performance task. Fourteen individuals diagnosed with ADHD (71% females, mean age = 24.8) and 17 controls (76% females, mean age = 22.6) completed the Conners Continuous Auditory Test of Attention (CATA). All participants completed the test twice, at baseline in a sitting position and while walking on the treadmill at a speed of 5 km/h. The order of administration was counterbalanced for each group. A 2 × 2 ANOVA with repeated measures detected a group by activity interaction on several measures of the CATA. Specifically, compared to baseline, the ADHD group demonstrated faster reaction times during physical exercise (25.4 ms faster) and decreased omission errors (1.5% better), whereas controls showed the opposite pattern (15.9 ms slower and 0.88% worse, respectively). Importantly, the ADHD group’s overall relatively lower performance on these measures was only evident in the resting condition, attaining scores similar to controls during exercise. These results suggest a possibly hypoactive attentional system in ADHD that could potentially be enhanced by arousal through engagement in physical exercise.

Acute Effects of Aerobic Exercise on Executive Function and Attention in Adult Patients With ADHD

Aerobic exercise can improve cognitive functions in healthy individuals and in various clinical groups, which might be particularly relevant for patients with ADHD. This study investigated the effects of a single bout of aerobic exercise on attention and executive functions in adult patients with ADHD, including functional MRI to examine the underlying neural mechanisms. On two different days, 23 adult patients with ADHD and 23 matched healthy controls performed in a flanker task, while functional MR images were collected, following 30 min of continuous stationary cycling with moderate intensity as well as after a control condition (watching a movie). Behavioral performance and brain activation were tested for differences between groups and conditions and for interactions to investigate whether exercise improves executive function to a greater extent in patients compared to healthy controls. Exercise significantly improved reaction times in congruent and incongruent trials of the flanker task in patients with ADHD but not in healthy controls. We found no changes in brain activation between the two conditions for either group. However, a subgroup analysis of ADHD patients with a higher degree of cardiorespiratory fitness revealed decreased activation in premotor areas during congruent trials and in premotor and medial frontal cortex during incongruent trials in the exercise compared to the control condition. Our results indicate exercise-induced improvements in attention and processing speed in patients with ADHD, demonstrating that adult patients with ADHD may benefit from an acute bout of exercise. These findings could be of high relevance for developing alternative treatment approaches for ADHD. In addition, results of the current study contribute to elucidate the neurophysiological mechanisms underlying the beneficial effects of exercise on cognition and to better understand the role of cardiorespiratory fitness on these effects.

Effect of physical exercises on attention, motor skill and physical fitness in children with attention deficit hyperactivity disorder: a systematic review

Children with attention deficit hyperactivity disorder (ADHD) are educated in classrooms along with typically developing children. Those with ADHD, however, find it difficult to participate in routine educational and recreational activities as they encounter problems associated with behaviour, attention, motor skills and physical endurance. Traditionally, the management of children with ADHD has focussed primarily on problems with cognition and has been heavily dependent on pharmaceutical interventions and, to a lesser extent, on non-pharmaceutical measures. More recently, experts have increasingly advocated the use of exercises in alleviating symptoms associated with ADHD. The primary objective of this review was to summarize research that examined the role of exercises on deficits related to attention, motor skills and fitness in children with ADHD. A search of the available literature was conducted using a combination of relevant key words in the following databases: PubMed, MEDLINE, Google Scholar, Embase and Cochrane review. The search filtered 3016 studies of potential relevance, of which 2087 were excluded after screening titles and abstracts as per the inclusion criteria. Thirty-four (34) studies were analysed in greater depth, and 16 were excluded after detailed consideration as they did not match the inclusion (PEDro score > 4) and exclusion criteria. Three (3) additional studies were excluded as they lacked exercise prescription details such as intensity, duration and frequency of exercise. Finally, 15 studies were analysed with a focus on the effects of physical exercises on attention, hyperactive behaviour, motor skills and physical fitness in ADHD children. Overall, the studies reviewed were of moderate-to-high quality and reported benefits of a variety of exercise programmes in improving motor skills, physical fitness, attention and social behaviour in children with ADHD. However, there was limited information regarding school-based programmes, the effects of structured exercise programmes independently or in combination with cognitive-based therapies, and the long-term benefits of exercises in alleviating behavioural problems in these children.

Acute and chronic effect of physical activity on cognition and behaviour in young people with ADHD: A systematic review of intervention studies

BACKGROUND

Young people with attention deficit hyperactivity disorder (ADHD) often have learning and behavioral control difficulties.

AIM

The aim of this review is analyse the acute and chronic effect of physical activity (PA) on the cognition and behaviour of children and adolescents with ADHD.

METHODS

Studies were identified in five databases (PubMed, SPORTDiscus, ProQuest, Web of Science, and SCOPUS), from January 2000 through to January 2017. A total of 16 interventional studies met the inclusion criteria.

RESULTS/CONCLUSIONS

PA practice of 20-30 min (intensity 40-75%) produces a positive acute effect on processing speed, working memory, planning and problem solving in young people with ADHD. However, these effects on behaviour are contradictory and vary depending on age. Chronic PA practice (≥30 min per day, ≥40% intensity, ≥three days per week, ≥five weeks) further improves attention, inhibition, emotional control, behaviour and motor control. The results must be treated with caution, because only 25% of the studies used confounders.

IMPLICATION

More research is needed to justify the causes of these effects. It is necessary to establish programs with regard to the duration, intensity, kind of exercise, and time of PA to improve cognition and behaviour in young people with ADHD taking into account potential confounders.

Adult ADHD: Risk Factor for Dementia or Phenotypic Mimic?

Attention-deficit hyperactivity disorder (ADHD) has historically been considered a disorder of childhood and adolescence. However, it is now recognized that ADHD symptoms persist into adulthood in up to 60% of individuals. Some of the cognitive symptoms that characterize ADHD (inability to provide sustained attention or mental effort, difficulty organizing or multi-tasking, forgetfulness) may closely resemble symptoms of prodromal dementia, also often referred to as mild cognitive impairment (MCI), particularly in patients over age 50. In addition to the overlap in cognitive symptoms, adults with ADHD and those with MCI may also share a number of behavioral and psychiatric symptoms, including sleep disturbances, depression, and anxiety. As a result, both syndromes may be difficult to distinguish clinically in older patients, particularly those who present to memory clinics with subjective cognitive complaints and fear the onset of a neurodegenerative process: is it ADHD, MCI, or both? Currently, it is unclear whether ADHD is associated with incipient dementia or is being misdiagnosed as MCI due to symptom overlap, as there exist data supporting either possibility. Here, we aim to elucidate this issue by outlining three hypothetical ways in which ADHD and MCI might relate to each other, providing an overview of the evidence relevant to each hypothesis, and delineating areas for future research. This is a question of considerable importance, with implications for improved diagnostic specificity of early dementia, improved accuracy of disease prevalence estimates, and better identification of individuals for targeted treatment.

Sweat it out? The effects of physical exercise on cognition and behavior in children and adults with ADHD: a systematic literature review

As attention-deficit/hyperactivity disorder (ADHD) is one of the most frequently diagnosed developmental disorders in childhood, effective yet safe treatment options are highly important. Recent research introduced physical exercise as a potential treatment option, particularly for children with ADHD. The aim of this review was to systematically analyze potential acute and chronic effects of cardio and non-cardio exercise on a broad range of functions in children with ADHD and to explore this in adults as well. Literature on physical exercise in patients with ADHD was systematically reviewed based on categorizations for exercise type (cardio versus non-cardio), effect type (acute versus chronic), and outcome measure (cognitive, behavioral/socio-emotional, and physical/(neuro)physiological). Furthermore, the methodological quality of the reviewed papers was addressed. Cardio exercise seems acutely beneficial regarding various executive functions (e.g., impulsivity), response time and several physical measures. Beneficial chronic effects of cardio exercise were found on various functions as well, including executive functions, attention and behavior. The acute and chronic effects of non-cardio exercise remain more questionable but seem predominantly positive too. Research provides evidence that physical exercise represents a promising alternative or additional treatment option for patients with ADHD. Acute and chronic beneficial effects of especially cardio exercise were reported with regard to several cognitive, behavioral, and socio-emotional functions. Although physical exercise may therefore represent an effective treatment option that could be combined with other treatment approaches of ADHD, more well-controlled studies on this topic, in both children and adults, are needed.

Cognitively and physically demanding exergaming to improve executive functions of children with attention deficit hyperactivity disorder: a randomised clinical trial

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is one of the most common mental disorders observed in childhood and adolescence. Its key symptoms - reduced attention, poor control of impulses as well as increased motor activity - are associated with decreased executive functions performance, finally affecting academic achievement. Although drug treatments usually show some effect, alternative treatments are continually being sought, due to lack of commitment and possible side effects. Cognitive trainings are frequently used with the objectives of increasing executive function performance. However, since transfer effects are limited and novelty and diversity are frequently ignored, interventions combining physical and cognitive demands targeting a broader range of cognitive processes are demanded.

METHODS

The aim of the study is to examine the effects of a cognitively and physically demanding exergame on executive functions of children with ADHD. In a randomised clinical trial, 66 girls and boys diagnosed with ADHD (age 8-12) will be assigned either to an 8-week exergame intervention group (three training sessions per week à 30 min) or a waiting-list control group. Before and afterwards, the executive function performance (computer-based tests), the sport motor performance and ADHD symptoms will be assessed.

DISCUSSION

The current study will offer insights into the effectiveness of a combination of cognitive and physical training using exergaming. Positive effects on the executive functions, sport motor performance and ADHD symptoms are hypothesized. Beneficial effects would mean a large degree of scalability (simple and cost-effective) and high utility for patients with ADHD.

TRIAL REGISTRATION

KEK BE 393/15 (March 8, 2016); DRKS00010171 (March 14, 2016).

Maintained Physical Activity Induced Changes in Delay Discounting

Those who discount the subjective value of delayed rewards less steeply are more likely to engage in physical activity. There is limited research, however, showing whether physical activity can change rates of delay discounting. In a two-experiment series, treatment and maintenance effects of a novel, effort-paced physical activity intervention on delay discounting were evaluated with multiple baseline designs. Using a lap-based method, participants were instructed to exercise at individualized high and low effort levels and to track their own perceived effort. The results suggest that treatment-induced changes in discounting were maintained at follow-up for 13 of 16 participants. In Experiment 2, there were statistically significant group-level improvements in physical activity and delay discounting when comparing baseline with both treatment and maintenance phases. Percentage change in delay discounting was significantly correlated with session attendance and relative pace (min/mile) improvement over the course of the 7-week treatment. Implications for future research are discussed.

The effects of physical activity on impulsive choice: Influence of sensitivity to reinforcement amount and delay

Impulsive choice is a diagnostic feature and/or complicating factor for several psychological disorders and may be examined in the laboratory using delay-discounting procedures. Recent investigators have proposed using quantitative measures of analysis to examine the behavioral processes contributing to impulsive choice. The purpose of this study was to examine the effects of physical activity (i.e., wheel running) on impulsive choice in a single-response, discrete-trial procedure using two quantitative methods of analysis. To this end, rats were assigned to physical activity or sedentary groups and trained to respond in a delay-discounting procedure. In this procedure, one lever always produced one food pellet immediately, whereas a second lever produced three food pellets after a 0, 10, 20, 40, or 80-s delay. Estimates of sensitivity to reinforcement amount and sensitivity to reinforcement delay were determined using (1) a simple linear analysis and (2) an analysis of logarithmically transformed response ratios. Both analyses revealed that physical activity decreased sensitivity to reinforcement amount and sensitivity to reinforcement delay. These findings indicate that (1) physical activity has significant but functionally opposing effects on the behavioral processes that contribute to impulsive choice and (2) both quantitative methods of analysis are appropriate for use in single-response, discrete-trial procedures.

The effects of physical exercise in children with attention deficit hyperactivity disorder: a systematic review and meta-analysis of randomized control trials

OBJECTIVE

The aim of this systematic review and meta-analysis was to examine the evidence for the effectiveness of exercise interventions on attention deficit hyperactivity disorder (ADHD)-related symptoms such as inattention, hyperactivity/impulsivity, anxiety and cognitive functions in children and adolescents.

METHOD

Five databases covering the period up to November 2014 (PubMed, Scopus, EMBASE, EBSCO [E-journal, CINAHL, SportDiscus] and The Cochrane Library) were searched. Methodological quality was assessed using the Cochrane tool of bias. Standardized mean differences (SMD) and 95% confidence intervals were calculated, and the heterogeneity of the studies was estimated using Cochran's Q-statistic.

RESULTS

Eight randomized controlled trials (n = 249) satisfied the inclusion criteria. The studies were grouped according to the intervention programme: aerobic and yoga exercise. The meta-analysis suggests that aerobic exercise had a moderate to large effect on core symptoms such as attention (SMD = 0.84), hyperactivity (SMD = 0.56) and impulsivity (SMD = 0.56) and related symptoms such as anxiety (SMD = 0.66), executive function (SMD = 0.58) and social disorders (SMD = 0.59) in children with ADHD. Yoga exercise suggests an improvement in the core symptoms of ADHD.

CONCLUSIONS

The main cumulative evidence indicates that short-term aerobic exercise, based on several aerobic intervention formats, seems to be effective for mitigating symptoms such as attention, hyperactivity, impulsivity, anxiety, executive function and social disorders in children with ADHD.

Physical activity intervention (Movi-Kids) on improving academic achievement and adiposity in preschoolers with or without attention deficit hyperactivity disorder: study protocol for a randomized controlled trial

BACKGROUND

The prevention of obesity and improvement of academic achievement in children are concerns of industrialized societies. Obesity has been associated with psychological disorders, including attention deficit hyperactivity disorder, whose prevalence has been estimated at 6.8 % in Spanish children and adolescents. It is known that physical activity is positively related to academic achievement and negatively related to the risk of obesity in children. However, studies to test the effectiveness of physical activity interventions in improving academic achievement in preschool children are scarce and have some weaknesses that threaten their validity. Moreover, very few studies have examined their effectiveness in improving symptoms of attention deficit hyperactivity disorder. This paper outlines a two-year multidimensional preschool intervention (Movi-Kids) aimed at preventing obesity and improving academic achievement in children with or without attention deficit hyperactivity disorder.

METHODS/DESIGN

Twenty-one schools from Ciudad Real and Cuenca, Spain, were randomized to intervention and control groups. In the first academic year, children in the third grade of preschool and the first grade of primary school in the intervention group received the Movi-Kids intervention. In the second academic year, schools were crossed over to the other group. The intervention included children, parents and teachers, and the school environment, and consisted of: (i) three hour-long sessions of recreational non-competitive physical activity after school, weekly, (ii) educational materials for parents and teachers addressing sedentary lifestyle risks and (iii) playground modifications to promote physical activity during breaks. Primary outcome measures of this study were academic achievement (intelligence, cognition, memory, attention and perception), assessed by the Battery of General and Differential Aptitudes, and adiposity measures (body mass index, waist circumference, triceps skinfold thickness and body fat percentage). Secondary outcome measures were: attention deficit hyperactivity disorder risk, motor skills, health-related quality of life and sleep quality. These variables will all be measured in both groups at baseline and at the end of the first and second academic years.

DISCUSSION

It seems reasonable that an intervention to promote physical activity based on playground games will be useful for simultaneously improving academic achievement and controlling obesity.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01971827 .

Effects of the combination of wheel running and atomoxetine on cue- and cocaine-primed reinstatement in rats selected for high or low impulsivity

BACKGROUND

Aerobic exercise and the attention-deficit/hyperactivity disorder medication, atomoxetine (ATO), are two monotherapies that have been shown to suppress reinstatement of cocaine-seeking in an animal model of relapse. The present study investigated the effects of combining wheel running and ATO versus each treatment alone on cocaine-seeking precipitated by cocaine and cocaine-paired cues in rats with differing susceptibility to drug abuse (i.e., high vs. low impulsive).

METHODS

Rats were screened for high (HiI) or low impulsivity (LoI) based on their performance on a delay-discounting task and then trained to self-administer cocaine (0.4 mg/kg/inf) for 10 days. Following 14 days of extinction, both groups were tested for reinstatement of cocaine-seeking precipitated by cocaine or cocaine-paired cues in the presence of concurrent running wheel access (W), pretreatment with ATO, or both (W+ATO).

RESULTS

HiI rats acquired cocaine self-administration more quickly than LoI rats. While both individual treatments and W+ATO significantly attenuated cue-induced cocaine seeking in HiI and LoI rats, only W+ATO was effective in reducing cocaine-induced reinstatement compared with vehicle treatment. There were dose-dependent and phenotype-specific effects of ATO with HiI rats responsive to the low but not high ATO dose. Floor effects of ATO and W on cue-induced reinstatement prevented the assessment of combined treatment effects.

CONCLUSIONS

These findings demonstrated greater attenuation of cue- versus cocaine-induced reinstatement by ATO and W alone and recapitulate impulsivity phenotype differences in both acquisition of cocaine self-administration and receptivity to treatment.

Association of symptoms of attention-deficit/hyperactivity disorder with symptoms of excessive exercising in an adult general population sample

BACKGROUND

An increasing number of studies suggest that physical activity can alleviate symptoms of ADHD in children. In adults there are currently insufficient data available on this subject. Interestingly, ADHD and forms of excessive exercising have both been shown to occur more frequently in adult athletes. The aim of the present study was to empirically investigate the association of ADHD and excessive exercising in the adult general population.

METHODS

For diagnosis of adult and childhood ADHD a large representative sample of the German general population (n = 1,615) completed a retrospective assessment of childhood ADHD and a self-report assessment of adult ADHD. Excessive exercising as well as putative mediating variables such as eating related psychopathology, depression, and anxiety were assessed using standardized self-rating instruments.

RESULTS

Individuals with childhood only ADHD had a significantly higher frequency of excessive exercising (9.0%) than individuals without ADHD (2.7%). Excessive exercising was significantly associated with childhood only ADHD compared to no ADHD with an odds ratio of 3.239 even after controlling for socio-demographic variables, BMI, eating related and general psychopathology.

CONCLUSIONS

Our data show that excessive exercising is significantly overrepresented in individuals in which ADHD symptoms in childhood have not persisted into adulthood. We thus hypothesize that a subgroup of individuals might suppress ADHD symptoms by excessive sporting activities. Although in healthy adults physical activity has been associated with immediate and long term improvements in cognitive functioning, studies empirically investigating associations between the effects of physical activity and adult ADHD are rare. Further studies are warranted to explore the potential role of physical activity in the treatment of ADHD in adults.

Der Einfluss von Sport auf kognitive Funktionen bei Kindern mit ADHS

Der positive Einfluss sportlicher Aktivitäten auf kognitive und exekutive Funktionen (EF) wurde mittlerweile vielfach aufgezeigt. EF stellen zugleich ein zentrales Defizit bei ADHS dar, weshalb betroffene Kinder und Jugendliche im Besonderen von sportlichen Aktivitäten profitieren könnten. Dieser Überblicksbeitrag verfolgt das Ziel, den aktuellen Forschungsstand zum Einfluss von sportlichen Aktivitäten auf Kognitionen allgemein und im Besonderen auf EF für Kinder und Jugendliche mit ADHS aufzuzeigen sowie auf einer theoretisch-konzeptionellen Ebene Erklärungsansätze zu liefern. Es wird deutlich, dass eine heterogene Befundlage vorliegt, die unter anderem mit einer zu geringen Differenzierung der sportlichen Aktivitäten begründet wird. Interessante sportspezifische Erklärungen stammen aus der aktuellen Kognitionsforschung an gesunden Kindern und Jugendlichen, wo eine physiologische und/oder kognitive Aktivierung durch sportliche Aktivitäten diskutiert wird. Die gewonnenen Erkenntnisse fließen in ein Rahmenmodell von Tomporowski, Lambourne und Okumura (2011) ein, welches für den Anwendungsbereich von ADHS adaptiert wurde, und wo bereits identifizierte Mediatoren und Moderatoren im Sport-Kognitions-Zusammenhang beinhaltet sind.