Exercise and ADHD
Common ADHD term definitions that may be referred to throughout this blog:
Inhibition: Ability to stop a response, relates to impulsivity/self-control
Cognitive Flexibility/Set-Shifting: Ability to shift attention or sustain attention
Working Memory: Ability to hold and manipulate task relevant information
Executive Function: Ability to control behaviour towards a goal across time (organisation, planning, time management, self-monitoring)
What is ADHD? (DSM-5-TR Criteria)
In children up to 16 years old: six or more symptoms of inattention and/or hyperactivity-impulsivity
Adolescents 17 years and older and Adults: 5 or more symptoms of inattention and/or hyperactivity-impulsivity
Several symptoms were present before age 12
Several symptoms are present in two or more settings (e.g., home, school or work, in other activities)
There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
ADHD Inattention Symptoms
Forgetful in daily activities
Has trouble organising tasks and activities
Has trouble holding attention on tasks or play activities
Does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
ADHD Hyperactivity-Impulsivity Symptoms
Fidgets with or taps hands or feet, or squirms in seat
Talks excessively
Blurts out an answer before a question has been completed
Interrupts or intrudes on others (e.g., butts into conversations or games)
Has trouble waiting their turn
Current Treatment
Current first line treatment for ADHD is stimulant medication, but these medications have some associated side effects including, insomnia and appetite suppression. Stimulant medications are rarely 100% effective and don’t address the increased cardiometabolic risks in people living with ADHD (2.5 times more likely to be diagnosed with T2DM and 2 times more likely to be diagnosed with hypertension). This is where exercise can be paired with stimulant medication as it is well documented that exercise positively impacts this cardiometabolic conditions and can positively impact ADHD which is detailed below.
Benefits of Exercise for ADHD
Research has demonstrated exercise has a positive impact on, attention, hyperactivity, impulsivity, anxiety, executive function and social disorders. When comparing non-pharmacological interventions exercise was shown to be more effective than cognitive behavior therapy, cognitive training and neurofeedback. There appears to be a dose-response relationship with longer intervention duration shown to be more effective at managing ADHD symptoms. This highlights the importance of creating lifestyle changes rather than implementing short-term interventions.
Impact of Different Training Modalities
Different training modalities can be more effective at positively impacting different areas as summarised below:
Perceptual-Motor Training (Motor Skills): Motor Ability, Inhibition, Working Memory
Cognitive-Motor Training (Dual Task Training): Inhibition, Working Memory, Cognitive Flexibility
Aquatic Exercise (inc. swimming): Motor Ability, Attention, Social Problems, Cognitive Flexibility
Optimal Dose of Exercise
Improvements in all aspects of executive function were reported after children with ADHD engaged in acute aerobic exercise lasting 20–30 minutes with at least moderate intensity (60-70% HRmax).
Furthermore, chronic exercise that lasts at least 45 minutes and in the range of moderate to high intensity (i.e., 60% - 90% HRmax), 3 days/week for 6–12, elicits additional benefits in inhibition and set-shifting.