Intervention effect of a single exercise session on executive function in children and adolescents with attention deficit hyperactivity disorder: a three-level meta-analysis

OBJECTIVE: This study aimed to systematically evaluate the effects of a single exercise session on executive function in children and adolescents with attention deficit hyperactivity disorder (ADHD) using a three-level meta-analysis approach. METHODS: Relevant studies were retrieved from six databases including CNKI (China National Knowledge Infrastructure), Wanfang, PubMed, Web of Science, Embase, and the Cochrane Library with the searches conducted up to 6 March 2025. This study employed the Cochrane Risk of Bias 2.0 (RoB 2.0) tool to assess the risk of bias and utilized GRADEpro to evaluate the evidence quality. The metafor package in R 4.3.0 was utilized for an effect size synthesis, heterogeneity testing, an influence analysis, and a publication bias assessment. RESULTS: A total of 12 studies were included. Low-quality evidence suggests that a single exercise session can improve executive function in children and adolescents with ADHD (g = 0.17, 95% CI [0.05, 0.29], P = 0.007). Exercise type, duration, intensity, age, control group conditions, and study design were not considered moderating factors (all P > 0.05). No publication bias was detected (P > 0.05). CONCLUSION: A single exercise session may serve as a feasible and accessible intervention to support executive function in children and adolescents with ADHD. These findings offer preliminary support for incorporating physical activity into nonpharmacological treatment strategies. However, given the currently limited evidence quality, further high-quality, large-scale randomized controlled trials are necessary to confirm these effects and inform clinical practice.