The Impact of Exercise Interventions on Sustained Attention for Children and Adolescents With ADHD: A Systematic Review and Meta-Analysis.
Cognitively engaging exercise gives a big, fast lift to sustained attention in kids with ADHD.
01Research in Context
What this study did
The team pooled 11 small studies of kids and teens with ADHD. All studies tested exercise programs meant to sharpen sustained attention.
Some programs were plain aerobic, like running or cycling. Others added thinking games, such as tag with rules or dance routines.
In total, 540 children were tracked. The authors used meta-analysis to find the average benefit.
What they found
Exercise gave a large boost to sustained attention scores. The effect size was 1.02, which teachers notice.
Cognitively engaging exercise beat plain aerobic. It scored almost half a point higher.
Programs with at least 12 sessions worked best. Shorter plans still helped, just not as much.
How this fits with other research
Gabriely et al. (2020) also lifted attention in ADHD, but used short mindfulness sessions. Both studies show you can train attention without pills.
García-Gómez et al. (2016) looked at horseback riding and saw no attention gain. The key gap: riding is low on thinking rules, so it lines up with Mengping’s finding that only cognitively engaging moves shine.
Spaniol et al. (2018) got small gains using computer attention games with autistic students. The smaller effect fits because autism attention profiles differ from ADHD, so the papers don’t truly clash.
Why it matters
You can add thinking-heavy exercise to any behavior plan. Try 20-minute sessions of obstacle courses with color rules, or dance routines that change steps each week. Aim for three times a week over a month. Track attention with simple duration measures, like math problems completed before off-task behavior. Parents and teachers like the zero-cost, zero-side-effect profile, and the large effect means you should see change quickly.
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02At a glance
03Original abstract
PURPOSE: Studies have consistently shown that exercise interventions are beneficial for improving attention in children and adolescents. Nevertheless, the evidence regarding its impact on the sustained attention (SA) of children and adolescents with attention-deficit hyperactivity disorder (ADHD) is unclear. This study synthesises empirical studies on the effects of exercise interventions on the SA of children and adolescents with ADHD. METHODS: Following PRISMA guidelines, a systematic search of the literature was conducted in April 2024, and the updated search was conducted until September 2025 in six electronic databases: CINAHL Complete, Embase, Medline, PsychINFO, SPORTDiscus, and Web of Science. Randomised controlled trials and non-randomised comparison studies that applied exercise interventions and assessed SA using neurocognitive tasks among children and adolescents with ADHD were included. Meta-analyses were performed using a random-effects model, and Hedges' g was used to express the effect size index. The quality assessment was conducted using the Physiotherapy Evidence Database (PEDro) scale. RESULTS: 11 studies with adequate to high methodological quality were included, originating from four regions and published between 2012 and 2023. In total, 540 children and adolescents with ADHD aged 5-18 years were included. The meta-analytic findings indicated that exercise interventions improved their sustained SA (g = 0.877). Subgroup analysis revealed that cognitively engaging exercises (g = 0.980) produced significant training effects than aerobic exercise on SA. Meta-regression indicated that older children (5-18 years) interventions with more total sessions (12-144 sessions), generated greater benefits. CONCLUSION: Exercise interventions positively affect the SA of children and adolescents with ADHD.
Journal of autism and developmental disorders, 2025 · doi:10.1007/s00429-021-02247-2