# Physical Activity Improves Executive Functions in Children with ADHD - Savonia AMK

> Exercise has a positive impact on executive functioning in children with ADHD.

## Introduction
Attention Deficit 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. As one of the most common neurodevelopmental disorders in childhood, with an estimated prevalence of 7.6% among children aged 3–12 years (based on a 2023 meta-analysis), it requires early intervention. Supportive measures should include healthy lifestyle habits such as sleep, nutrition, and physical activity.

## Research Objective and Methodology
This article explores medication-free treatments for children with ADHD, specifically focusing on the effects of physical activity interventions on executive functions. The research question was developed using the PICO framework (Patient, Intervention, Comparison, Outcome): *How does physical exercise affect executive functions in children with ADHD?*

The literature search was conducted in PubMed using the terms: `ADHD AND children AND (exercise OR physical activity) AND executive functions`. Eligibility criteria included:
* Randomized controlled trials (RCTs)
* Published within the past ten years
* English language
* Full-text availability
* Participants aged 6–12 years diagnosed with ADHD

After screening 133 initial studies, four RCTs were selected for the final review.

## Methodological Quality Assessment
The studies were evaluated using the PEDro scale (0–10):
* **Bustamante et al. (2016):** 7/10 (Good quality)
* **Memarmoghaddam et al. (2016):** 6/10 (Moderate-to-good quality)
* **Benzing and Schmidt (2019):** 7/10 (Good internal validity)
* **Huang et al. (2025):** 6/10 (Good overall quality)

Common methodological weaknesses included the lack of participant and therapist blinding and limited reporting on concealed allocation.

## Review of Findings
The four studies involved 150 children aged 6–12 years across Switzerland, the United States, Iran, and Taiwan, with intervention durations ranging from 6 to 12 weeks.

* **Bustamante et al. (2016):** Investigated a ten-week exercise program. Results showed modest improvements in hyperactivity and verbal working memory, but no significant enhancement in executive function compared to a control group that engaged in cognitive activities.
* **Memarmoghaddam et al. (2016):** An eight-week exercise program for 40 boys. Results showed significant improvements in both cognitive and behavioral inhibition compared to the control group.
* **Benzing and Schmidt (2019):** An 8-week exergaming program. Results showed significant improvements in inhibition and cognitive flexibility in the intervention group.
* **Huang et al. (2025):** A 12-week inline skating program. Results showed significant, sustained improvements in inhibition, spatial working memory, and motor proficiency.

## Conclusion
Physical exercise is a promising, low-risk, non-pharmacological intervention for improving executive functions in children with ADHD. Structured, cognitively engaging, and sustained exercise programs appear to offer the greatest benefits, particularly for inhibitory control. Physiotherapists and educators should consider incorporating these interventions into multimodal ADHD management. Future research is needed to explore the specific effects of strength training and to standardize exercise protocols.

## 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

## References
* 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.
* 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.
* Duodecim 2025. ADHD (attention deficit hyperactivity disorder). *Käypä hoito*.
* 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*.
* 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.
* OpenAI. (2025). ChatGPT (GPT-5).
* Wikimedia Commons (2018). Image file: Fooladshahr (35).