Optimizing exercise interventions for motor skills enhancement in attention deficit hyperactivity disorder: Evidence from meta-analysis

Objective This meta-analysis aimed to evaluate effects of physical exercises on gross and fine motor skills in children and adolescents with attention deficit hyperactivity disorder (ADHD), and to explore the influencing factors and dose–response relationships for optimizing exercise parameters. Data sources Six electronic databases were searched from inception to 20 June 2025, with an updated search performed on 27 January 2026. Methods The effect sizes were estimated using Hedge's g within three-level random-effects modeling frameworks. Subgroup analyses were performed to examine potential moderators, while restricted cubic splines were employed to characterize dose–response relationships. Results Twenty-one studies with 850 participants were included. Physical exercises showed moderate positive effects on both gross motor skills (Hedge's g = 0.62, 95% CI: 0.48–0.76) and fine motor skills (Hedge's g = 0.72, 95% CI: 0.54–0.90). Significant improvements were observed in subcomponents of gross motor skills (locomotion, object control, body coordination, and strength) and fine motor skills (manual dexterity, hand-eye coordination, and handwriting). Moderator analyses indicated that longer session durations (>45 min) and higher frequencies (≥3 sessions/week) were associated with greater benefits. Fine motor skills (∼1350 min) appeared to require greater cumulative exercise exposure than gross motor skills (∼810 min) to achieve substantial gains. Conclusion Physical exercise is an effective intervention for improving motor skills in children and adolescents with ADHD. However, the effectiveness of interventions appears to be moderated by motor subcomponents and dose parameters. Tailored programs, specific motor skill targets and dose parameters, should be integrated into clinical and educational practices to maximize outcomes.