The therapeutic effects of physical activity on children with attention deficit hyperactivity disorder: A systematic review and meta-analysis

Background: Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder in children, characterized by symptoms of inattention, hyperactivity, and impulsivity. Traditional treatments include pharmacological and behavioral therapies, which may have limitations. Physical activity has emerged as a potential non-pharmacological intervention for ADHD. This systematic review and meta-analysis aimed to evaluate the therapeutic effects of physical activity on ADHD symptoms, dropout rates, and social impairment in children. Methods: Adhering to the PRISMA guidelines, 4 electronic databases (PubMed, Embase, Web of Science, and Cochrane Library) were searched on July 18, 2024, without time or language restrictions. Randomized controlled trials involving children diagnosed with ADHD and examining the effects of physical activity interventions were included. Data extraction and quality assessment were independently conducted by 2 reviewers. Heterogeneity was assessed using chi-square statistics and the I 2 value, and both fixed- and random-effects models were employed as appropriate. Sensitivity analysis and publication bias were also evaluated. Results: Out of 1103 articles initially identified, 7 studies met the inclusion criteria. The meta-analysis showed that physical activity significantly alleviated ADHD symptoms (Hedges’ g = ‐0.37, 95% CI [‐0.72, ‐0.02], I 2 = 45.2%). Physical activity did not significantly affect dropout rates (Hedges’ g = 0.44, 95% CI [‐0.33, 1.2], I 2 = 0.0%). However, it significantly reduced social impairment (Hedges’ g = ‐0.54, 95% CI [‐0.98, ‐0.10], I 2 = 0.0%). Sensitivity analysis confirmed the stability and robustness of these findings. Funnel plots indicated no significant publication bias. Conclusion: Physical activity is an effective alternative treatment for ADHD, improving core symptoms and social impairment without affecting dropout rates. Incorporating physical activity into comprehensive ADHD management plans can enhance the overall well-being and quality of life for children with ADHD.