Effects of Exercise Intervention in Children With Attention‐Deficit/Hyperactivity Disorder: The Mediating Role of Executive Function

ABSTRACT This randomized controlled trial investigated a 20‐session combined aerobic and physical‐cognitive exercise program in 66 children with ADHD (aged 6–9 years, 29 medicated), evaluating impacts on core symptoms, executive functions, and functional impairment through SNAP‐IV, BRIEF, and WEISS‐P assessments. Participants were randomly allocated to either the intervention group (six weekly 90‐min sessions) or the wait‐list control group during summer vacation. Results from mixed‐design ANOVA demonstrated significant group × time interactions across all dimensions of the SNAP‐IV and WEISS‐P scales, as well as global executive composite (GEC), behavioral regulation index (BRI), and specific subdomains including inhibition, shifting, initiation, and organization in the BRIEF scale ( p < 0.05). Stratified analyses indicated that significant group × time interactions in pharmacological participants were found in the inattention and hyperactivity/impulsivity dimensions of SNAP‐IV, the BRI dimension of BRIEF, and all dimensions of WEISS‐P. In contrast, nonpharmacological participants in the intervention group maintained stability, while those in the control group deteriorated. Mediation analysis identified that executive functions significantly mediated the relationship between exercise intervention and the improvement of core symptoms and functional impairment. In conclusion, the 20‐session combined exercise intervention during summer vacation appears to attenuate symptom progression in children with ADHD, with executive functions serving as a mediator. Clinical Trials Registry Site and Number : China Clinical Trials Center (ChiCTR2100049462)