Introduction

Attention Deficit Disorder with Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that affects executive functions such as inhibition, working memory, and cognitive flexibility. These skills are essential for learning, daily functioning, and social participation. The number of ADHD diagnoses and medication treatments has increased significantly in recent years worldwide. ADHD is one of the most common neurodevelopmental disorders in childhood. According to a meta-analysis published in 2023, the estimated prevalence of ADHD was 7.6% among children aged 3–12 years. Supportive interventions should begin as soon as difficulties in attention, hyperactivity, or impulsiveness are observed. Particular attention should be paid to healthy lifestyle habits such as sleep, nutrition and physical activity. (Käypä hoito 2025.)

So far, there is relatively little research made about medication-free treatments available for children with ADHD. The aim of this blog article was to gather information about the effects of various physical activity-interventions on ADHD children. To answer this, PICO framework was utilized to develop the research question: How does physical exercise affect executive functions in children with ADHD?

This article is part of a series produced within the course Professional in Physiotherapy, which is included in the physiotherapy degree programme. The article was created as part of the evidence-based physiotherapy section of the course. In small groups, students practice elements of a systematic literature review, including systematic information retrieval, critical appraisal using the PEDro Scale tool, and writing up the results in the form of a scientific article.

Methods

PICO is a tool used to select studies and narrow down the extracted data. The abbreviation PICO is derived from the words Patient, Intervention, Comparison and Outcome. The literature search was conducted in PubMed using the search term: ADHD AND children AND (exercise OR physical activity) AND executive functions. The eligibility criteria included randomized controlled trials published within the past ten years, written in English and available in full text. The focus was on children between ages 6–12, diagnosed with ADHD. Thus, in this mini review the patients were children diagnosed with ADHD and aged between 6-12 years of age. The intervention consisted of some form of programmed physical exercise compared to no programmed physical exercise in control groups. The measured outcome in the selected studies was the change in executive functions among these children.

The initial raw search from PubMed provided 133 studies, which were narrowed down with automation filters: full text availability, English language, randomized controlled trial and publication within the past ten years. The filters excluded 123 studies, leaving 10 studies. Out of these 10, five studies were excluded: one did not focus on ADHD, three did not primarily investigate physical exercise interventions, and one did not target executive functions. The remaining five articles were retrieved for full-text assessment. After reviewing the full texts, one study was excluded due to scope limitations. Consequently, four randomized controlled trials investigating different forms of physical exercise were included in the final review.

Quality Assessment

The methodological quality of the included studies was evaluated using the PEDro scale, which assesses internal validity and statistical reporting (score range 0–10). Bustamante et al. (2016) achieved a PEDro score of 7 out of 10, indicating good quality with appropriate randomization and between-group comparisons. Memarmoghaddam et al. (2016) scored 6 out of 10, reflecting moderate-to-good quality, although some criteria related to blinding and allocation concealment were not met. Benzing and Schmidt (2019) received a score of 7 out of 10, showing good internal validity and comprehensive outcome reporting. Huang et al. (2025) obtained a score of 6 out of 10, suggesting good overall quality but with some methodological limitations similar to those of the earlier studies. Across all four trials, the main methodological weaknesses were the lack of participant and therapist blinding, an expected limitation in exercise interventions, and limited reporting on concealed allocation. Overall, the studies demonstrated good methodological quality.

Results

The four research articles chosen for this minireview were investigating the effects of different forms of physical activity – such as inline skating, structured exercise programs, and exergaming – on executive functions of children with ADHD. A total of 150 children aged 6–12 years participated in these four studies. The studies were conducted in Switzerland, the United States, Iran, and Taiwan between 2016 and 2025. Intervention durations ranged from 6 to 12 weeks, with session frequencies from 2 to 5 times per week.

Bustamante et al. (2016) examined whether a ten-week exercise program could improve behavior and cognitive skills in children with ADHD and disruptive behavior disorders compared to a sedentary program. In this randomized controlled trial, the exercise program proved feasible and led to modest improvements in hyperactivity and verbal working memory, but no significant changes in executive function compared to control group. According to the study results, the exercise program had no significant effect on executive function compared to the control group. This means that although both the exercise and control groups showed some improvement, the exercise intervention did not enhance executive function more than the control group. (Bustamante et al. 2016.)

Memarmoghaddam et al. (2016) examined the effects of a selected exercise program on executive function in children with ADHD, focusing on cognitive and behavioral inhibition. Forty boys aged 7¬-11 were randomly assigned to an exercise group or a control group; the exercise group participated in twenty-four 90-minute sessions over eight weeks, while the control group received no intervention. Participants’ performance was assessed before and after the program. The results showed that the exercise program significantly improved both cognitive and behavioral inhibition compared to control group. (Memarmoghaddam et al. 2016.)

Benzing and Schmidt (2019) examined the effects of an 8-week exergaming program, which involved interactive video games requiring different kinds of physical movement, on executive functions in children with ADHD. There were 51 participants, divided into intervention and control groups. The intervention group engaged with exergaming three times per week at least 30 minutes per session. The participants were assessed before and after the intervention. The results showed significant improvements in inhibition and cognitive flexibility in the intervention group compared to the control group. (Benzing and Schmidt 2019.)

Huang et al. (2025) conducted a 12-week study in Taiwan with 24 children with ADHD, who were randomly assigned into an intervention group and a wait-list control group. The intervention was a programmed inline skating exercise twice a week, 80 minutes at a time. The control group had the same intervention after the initial 12 weeks. The study showed significant improvements in executive functions such as inhibition and spatial working memory, as well as in motor proficiency. The participants were assessed three times during the study: baseline, posttest and a 12-week follow-up. The positive results were sustained over the follow-up period. (Huang et al. 2025.)

Conclusions:

The reviewed studies indicate that physical exercise is a promising complementary intervention for improving executive functions in children with ADHD. Exercise appears to have the strongest and most consistent effects on inhibition, with improvements shown in inline skating, structured exercise programs, and exergaming. In all studies in this mini review, except Bustamante et al. (2016), exercise improved executive function in children with ADHD compared to the control group. However, it should be noted that Bustamante’s control group had programmed cognitive activities such as arts, puzzles and other intellectual games, while other control groups lacked programmed activity altogether.

Medication use among participants in Huang et al.’s study was not controlled, which may affect the reliability of the findings since the participants’ conditions were not fully comparable across studies. Additionally, the exercise interventions between studies were heterogeneous and could therefore only be evaluated at a general level. There was a limited number of RCT studies available on this topic. In the future, new studies that would consider various forms of physical activity will be needed to complement the existing knowledge. There should be more detailed information on how strength training affects ADHD symptoms. This area has so far been relatively under-researched.

Overall physical activity is a promising, non-pharmacological intervention for improving executive functions in children with ADHD. Exercise programs that are structured, cognitively engaging, and sustained may offer the greatest benefits, particularly for inhibitory control. Given the low risk and additional physical health benefits, physiotherapists and educators should consider incorporating physical activity interventions as part of multimodal ADHD management.

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Authors:

Veera Hihnala, Physiotherapy student, Savonia University of Applied Sciences

Sonja Leutonen, Physiotherapy student, Savonia University of Applied Sciences

Venla Nurmi, Physiotherapy student, Savonia University of Applied Sciences

Juho Rahikainen, Physiotherapy student, Savonia University of Applied Sciences

Marja Äijö PT, PhD, Principal lecturer of Gerontology and Rehabilitation, Savonia University of Applied Sciences

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References:

OpenAI. (2025). ChatGPT (GPT-5). https://chat.openai.com. ChatGPT was used as a supporting tool for Finnish English translation. The text was checked and edited by the students.

Benzing, V., & Schmidt, M. (2019). The effect of exergaming on executive functions in children with ADHD: A randomized clinical trial. Scandinavian Journal of Medicine & Science in Sports, 29(8), 1243–1253. https://doi.org/10.1111/sms.13446

Bustamante, E. E., Davis, C. L., Frazier, S. L., Rusch, D., Fogg, L. F., Atkins, M. S., & Marquez, D. X. (2016). Randomized controlled trial of exercise for ADHD and disruptive behavior disorders. Medicine & Science in Sports & Exercise, 48(7), 1397–1407. https://doi.org/10.1249/MSS.0000000000000891

Huang, C.-Y., Chen, W.-F., Tsai, C.-L., Chen, P.-L., Hsu, P.-J., & Pan, C.-Y. (2025). Effects of inline skating exercise on symptoms, executive functions, and motor proficiency in children with ADHD: A randomized controlled trial. Occupational Therapy International. https://doi.org/10.1155/oti/4254970

Duodecim 2025. ADHD (attention deficit hyperactivity disorder). Käypä hoito. Retrieved October 3, 2025, from https://www.kaypahoito.fi/hoi50061

Memarmoghaddam, M., Torbati, H. T., Sohrabi, M., Mashhadi, A., & Kashi, A. (2016). Effects of a selected exercise program on executive function of children with attention deficit hyperactivity disorder. Journal of Medicine and Life, 9(4), 373–379. https://pubmed.ncbi.nlm.nih.gov/27928441/

Picture, Wikimedia Commons 2018. https://commons.wikimedia.org/wiki/File:Fooladshahr_%2835%29..jpg