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The effectiveness and sustained effects of exercise therapy to improve executive function in children and adolescents with autism: a systematic review and meta-analysis

This study rigorously examines the efficacy and sustained impact of exercise therapy on enhancing executive function among children and adolescents diagnosed with autism spectrum disorder (ASD). Furthermore, it conducts a comprehensive analysis of five distinct subgroups, categorized by variations in school age, exercise cycles, exercise characteristics, dimensions of executive function, and the administration of medication. A systematic search was conducted across the PubMed, EmBase, Cochrane Library, Web of Science, and SPORTDiscus databases to identify randomized controlled trials published from the inception of the library until October 20, 2024, focusing on the effects of exercise therapy on the enhancement of executive function in children and adolescents with ASD. Sixteen studies were systematically evaluated and included in the meta-analysis, revealing that exercise therapy led to a significant improvement in executive function among children and adolescents with ASD (SMD = 0.41, 95% CI [0.30, 0.52], P = 0.00), along with some evidence of sustained improvement (SMD = 0.74, 95% CI [0.29, 1.20], P = 0.00). Subgroup analyses indicated that exercise did not significantly enhance executive functioning in preschool-aged patients with ASD, and working memory did not exhibit a significant improvement across various dimensions of executive functioning. Furthermore, no differences were observed in analyses of different exercise cycles, exercise characteristics, or the use of medication among subjects.

CONCLUSION

Exercise interventions improve executive function in children and adolescents with ASD, with sustained post-intervention effects. Limited impact on working memory and observed heterogeneity highlights the need for more precise intervention designs and rigorous research.

WHAT IS KNOWN

• Exercise therapy is widely considered a promising non-pharmacological intervention for improving cognitive functions in children and adolescents with autism spectrum disorder (ASD). • Prior studies suggest exercise benefits executive function in ASD, but evidence on sustained effects and subgroup differences remains limited.

WHAT IS NEW

• This meta-analysis confirms that exercise therapy significantly and sustainably improves executive function in children and adolescents with ASD, with greater benefits observed in school-aged participants. • For the first time, subgroup analyses reveal age-dependent effects and confirm that working memory shows limited responsiveness to exercise, regardless of medication use or exercise characteristics.

Optimal exercise intensity for improving executive function in patients with attention deficit hyperactivity disorder: systematic review and network meta-analysis

This study aimed to compare and rank the effectiveness of optimal exercise intensity in improving executive function in patients with ADHD (Attention deficit hyperactivity disorder, ADHD) through a comprehensive comparison of direct and indirect evidence. A systematic search was performed in five electronic databases to explore the optimal exercise intensity for improving executive function in patients with ADHD by directly and indirectly comparing a variety of exercise intervention intensities. In addition, the isolated effects of exercise on improving executive function in patients with ADHD were explored through classical meta-analysis of paired direct comparisons. Twenty-nine studies were retrieved and included in this study. Classical paired meta-analysis showed that for the patients with ADHD in the age group of 7-17 years, statistical difference was observed for all the parameters of exercise interventions (intensity, frequency, period, and training method), the three dimensions of executive function, the use of medication or not, the high and low quality of the methodological approach. Network meta-analysis showed that high-intensity exercise training was optimal for improving working memory (97.4%) and inhibitory function (85.7%) in patients with ADHD. Meanwhile, moderate-intensity exercise training was optimal for improving cognitive flexibility (77.3%) in patients with ADHD. Moderate to high intensity exercise training shows potential for improving executive function in these patients. Therefore, we recommend applying high-intensity exercise intervention to improve executive function in patients with ADHD to achieve substantial improvement.

Single Exercise for Core Symptoms and Executive Functions in ADHD: A Systematic Review and Meta-Analysis

OBJECTIVES

A systematic review and meta-analysis of studies of single exercise on core symptoms and executive function in adolescents with ADHD.

METHODS

Four databases were searched for studies of the effects of single exercise on core symptoms and executive functioning in adolescents with ADHD.

RESULTS

Thirteen studies were included, and a single session of exercise had small effect-size improvements in core symptoms and executive function in adolescents with ADHD: 10 to 13 year olds in the early adolescent-elementary school years and 18 to 24 year olds in the late adolescent-college years. Moderate-intensity continuous training, high-intensity interval training, single sessions of less than 30 minutes, and single sessions of 30 minutes and more significantly improved cycling training, attention, inhibition, substance use, and pre-study abstinence.

CONCLUSIONS

A single session of exercise had an overall ameliorative effect on core symptoms and executive function in adolescents with ADHD.

Psychosocial interventions seem redact kinesiophobia after anterior cruciate ligament reconstruction but higher level of evidence is needed: a systematic review and meta-analysis

PURPOSE

Psychosocial interventions have shown potential in reducing the fear of re-injury after anterior cruciate ligament reconstruction (ACLR), but this has not been systematically reviewed. The aim of this study was to assess the available evidence on the effect of psychosocial interventions on kinesiophobia after ACLR.

METHODS

Two independent researchers conducted a systematic search in the electronic databases including Scopus, PubMed, Web of Science (WOS), SPORTDiscus, PsycINFO, and CINAHL from their inception until May 2022. They included studies that utilised a randomised controlled study design with a control group, and measured kinesiophobia using the Tampa Scale for kinesiophobia in patients who underwent primary ACLR. The outcome of interest was the mean and standard deviation of kinesiophobia. Extracted data were analysed using Comprehensive Meta-Analysis software, version 3.0 (CMA.V2), employing a random-effects model to calculate the overall effect estimates of psychosocial interventions on Kinesiophobia. The standardised mean difference with 95% confidence intervals (CIs) was computed based on the mean and standard deviation in each group.

RESULTS

This systematic review and meta-analysis included 5 randomised controlled trials with a total of 213 patients who underwent ACLR. The results of the meta-analysis showed that psychosocial intervention was more effective than non-psychosocial comparators in reducing kinesiophobia among patients who underwent a primary ACLR (5 trials, MD 0.56, 95% CI 0.28-0.83, p < 0.001). The heterogeneity score was zero (I2 = 0%; n.s. for Cochran's Q test), indicating no significant variation among the studies.

CONCLUSIONS

Psychosocial interventions can alleviate kinesiophobia in patients with primary ACLR. Although the limited number of reviewed studies and their methodological limitations precludes drawing a definitive conclusion regarding the effectiveness of psychosocial interventions on kinesiophobia, these promising findings can serve as a basis for developing psychological strategies to manage kinesiophobia in patients with primary ACLR and can also guide future research this issue.

LEVEL OF EVIDENCE

II.

TRIAL REGISTRATION

This trial is registered in PROSPERO on December 2021 (CRD42021282413).