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Liu C, Liang X, Sit CHP. Physical Activity and Mental Health in Children and Adolescents With Neurodevelopmental Disorders: A Systematic Review and Meta-Analysis. JAMA Pediatr 2024; 178:247-257. [PMID: 38285440 PMCID: PMC10825789 DOI: 10.1001/jamapediatrics.2023.6251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/24/2023] [Indexed: 01/30/2024]
Abstract
Importance Children and adolescents with neurodevelopmental disorders experience mental health issues and are encouraged to be brought together in real-life treatment. However, physical activity, which is a promising method for boosting mental health, has only been examined in children and adolescents with certain types of neurodevelopmental disorders. Objective To examine the association of physical activity interventions with mental health (ie, cognitive function, psychological well-being, internalizing, and externalizing problems) in children and adolescents with neurodevelopmental disorders and to identify possible moderators. Data Sources Studies were searched from inception to May 2023 through Web of Science, PsycINFO, SPORTDiscus, MEDLINE, CINAHL, and ERIC. Study Selection Randomized clinical trials or nonrandomized designs applying physical activity interventions and reporting at least 1 mental health outcome in children and adolescents aged 5 to 17 years with neurodevelopmental disorders were included. Two independent reviewers selected and assessed the studies. Data Extraction and Synthesis Random multilevel meta-analysis using Hedges g was performed. Data extraction and risk-of-bias assessment were conducted by multiple reviewers. Heterogeneity, publication bias, sensitivity analysis, and moderator analysis were examined to substantiate the results. Main Outcomes and Measures The main outcomes were mental health related to cognitive function, psychological well-being, internalizing, or externalizing problems measured by neurocognitive tasks or subjective questionnaires. Results A total of 76 studies involving 3007 participants were included in systematic review, 59 of which were used for meta-analysis. The findings indicated that physical activity interventions were associated with significant benefits for overall mental health (g, 0.67; 95% CI, 0.50-0.85), cognitive function (g, 0.74; 95% CI, 0.53-0.95), psychological well-being (g, 0.56; 95% CI, 0.16-0.96), internalizing (g, 0.72; 95% CI, 0.34-1.10), and externalizing problems (g, 0.58; 95% CI, 0.28-0.89). Moderators were also identified: frequency, total sessions, and total duration for overall mental health; total sessions, and total duration for cognitive function; session duration and frequency for psychological well-being; physical activity type for internalizing problems; and session duration for externalizing problems. Moderator analyses showed that type of neurodevelopmental disorder did not modify the associations between physical activity and overall mental health or its subgroups. Conclusions and Relevance The findings in this study suggest that children and adolescents with different types of neurodevelopmental disorders may be grouped together when performing physical activity interventions, which were confirmed to be beneficial to overall mental health and its subgroups in this new diagnostic population, but that physical activity interventions should be tailored when targeting different mental health domains.
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Affiliation(s)
- Chang Liu
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Xiao Liang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Cindy H. P. Sit
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
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Mehren A, Philipsen A. [Is Physical Activity a Treatment Option for ADHD?]. ZEITSCHRIFT FUR KINDER- UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2024; 52:124-133. [PMID: 38335974 DOI: 10.1024/1422-4917/a000963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Is Physical Activity a Treatment Option for ADHD? Abstract: Physical activity as an option for the prevention and treatment of psychiatric disorders is increasingly becoming the focus of research. In particular, because of improvements in cognitive functioning, attentional performance, impulsivity, and hyperactivity, physical exercise could be a promising treatment option for attention deficit hyperactivity disorder (ADHD). In this narrative review, we present and evaluate the current state of research on exercise effects in children and adolescents as well as in adults with ADHD. While studies of the short-term effects of a single bout of physical activity indicate robust effects on attention and inhibitory control, results on the impact on further symptoms of ADHD as well as in adults are mixed. Randomized controlled trials of longer-term physical activity are scarce and show high heterogeneity. Nevertheless, they are encouraging for further research in this area.
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Affiliation(s)
- Aylin Mehren
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Bonn, Deutschland
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, The Netherlands
| | - Alexandra Philipsen
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Bonn, Deutschland
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Li D, Li L, Zang W, Wang D, Miao C, Li C, Zhou L, Yan J. Effect of physical activity on attention in school-age children with ADHD: a systematic review and meta-analysis of randomized controlled trials. Front Physiol 2023; 14:1189443. [PMID: 37576338 PMCID: PMC10415683 DOI: 10.3389/fphys.2023.1189443] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
Background: Attention problems are one of the core symptoms of Attention-deficit/hyperactivity disorder (ADHD) in children. Previous studies have shown that physical activity intervention has a positive impact on executive function in children and adolescents with ADHD, but there is limited research on attention problems in school-aged children with ADHD. There are still uncertainties about the appropriate physical activity interventions to improve attention problems in this population. This study conducted a Meta-analysis of randomized controlled trials (RCTs) related to physical activity intervention for attention problems in school-aged children with ADHD, providing a certain reference for precise intervention in attention problems for this population. Methods: We systematically searched the following databases up to October 2022: PubMed, Embase, Web of Science, and Cochrane Library, to identify RCTs that investigated the effects of physical activity interventions on children with ADHD. Two investigators independently conducted literature screening, extraction, and quality assessment. We performed a meta-analysis using Stata 15.1. Results: In total, we included 10 studies in this meta-analysis. The results indicated that physical activity intervention had a moderate effect in improving attention problems in school-aged children with ADHD (SMD = -0.48, 95% CI: 0.85, -0.07, p < 0.05). Furthermore, subgroup analysis showed that the effect of physical activity intervention was moderated by intervention type, frequency, and period, rather than the physical activity environment or single intervention time. Conclusion: Our study suggests that cognitively engaging exercise is more effective in improving attention problems in school-aged children with ADHD. Specifically, when cognitive-engaging exercise is used as the type of physical activity and the intervention frequency is less than 3 times per week, with an intervention period of less than weeks, it is most beneficial for improving attention problems in school-aged children with ADHD. However, we should also consider individual differences in children with respect to their ADHD symptoms and accurately evaluate each child's specific symptoms before intervention. Systematic Review Registration: identifier (CRD42022363255).
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Affiliation(s)
- Dong Li
- School of Physical Education, Guangzhou Sport University, Guangzhou, China
- Department of International Culture Education, Chodang University, Muan, Republic of Korea
| | - Lan Li
- Universuty of Maine at Presque Isle, Presque Isle, ME, United States
| | - Wanli Zang
- Postgraduate School, University of Harbin Sport, Harbin, China
| | - Deng Wang
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science (INEF), Universidad Politécnica de Madrid (UPM), Madrid, Spain
| | - Chuyuan Miao
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Chenmu Li
- School of Physical Education, Guangzhou Sport University, Guangzhou, China
| | - Li Zhou
- School of Sports and Health, Guizhou Medical University, Guiyang, China
| | - Jin Yan
- Centre for Active Living and Learning, University of Newcastle, Callaghan, NSW, Australia
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Qiu H, Liang X. Change in Sleep Latency as a Mediator of the Effect of Physical Activity Intervention on Executive Functions Among Children with ADHD: A Secondary Analysis from a Randomized Controlled Trial. J Autism Dev Disord 2023:10.1007/s10803-023-06018-2. [PMID: 37256478 DOI: 10.1007/s10803-023-06018-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 06/01/2023]
Abstract
This study aimed to explore the potential mediating role of sleep quality in the effect of physical activity (PA) intervention for improving executive functions (EFs) in children with attention-deficit hyperactivity disorder (ADHD). Participants aged 6 to 12 years old with a formal ADHD diagnosis were recruited from a local hospital. A total of 80 eligible children with ADHD were randomized to an intervention group for 12 consecutive weeks of PA training (three times per week, 60 min per session) (n = 40; Mage = 8.37, 75% boys) or a wait-list control group (n = 40; Mage = 8.29, 80% boys). Three core EFs (inhibitory control, working memory, and cognitive flexibility) were assessed by neurocognitive tasks, and sleep quality was measured by the Chinese version of the Pittsburgh Sleep Quality Index. The bootstrapping method was used to test PA intervention effects on EFs and on potential variables of sleep quality after intervention and to test whether there were indirect effects of the intervention on EFs via mediators of sleep. The results showed that the PA intervention had a direct effect on sleep latency reduction (β = - 0.26, 95%CI - 0.47 to - 0.06) and cognitive flexibility improvement (decrease in completion time) (β = - 0.30, 95%CI - 0.50 to - 0.09). Furthermore, change in sleep latency significantly mediated the effects of PA intervention on cognitive flexibility (β = - 0.084, 95%CI - 0.252 to - 0.001). The findings suggest that sleep latency could be a crucial behavioral mediator of PA intervention in improving cognitive flexibility among children with ADHD.
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Affiliation(s)
- Hui Qiu
- Department of Educational Administration and Policy, The Chinese University of Hong Kong, Hong Kong, China
| | - Xiao Liang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China.
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Svedell LA, Holmqvist KL, Lindvall MA, Cao Y, Msghina M. Feasibility and tolerability of moderate intensity regular physical exercise as treatment for core symptoms of attention deficit hyperactivity disorder: a randomized pilot study. Front Sports Act Living 2023; 5:1133256. [PMID: 37255729 PMCID: PMC10225649 DOI: 10.3389/fspor.2023.1133256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/21/2023] [Indexed: 06/01/2023] Open
Abstract
Background Attention deficit hyperactivity disorder (ADHD) is associated with sedentary lifestyle, low quality of life and low physical fitness. Studies in children with ADHD have shown that regular physical exercise can help reduce core ADHD symptoms, but evidence for this is lacking in adults. Although guidelines recommend multi-modal treatment, central stimulants (CS) remain the mainstay of treatment. CS are effective in the short-term, but their long-term efficacy remains to be established. There is thus huge unmet need for developing non-pharmacological treatment options, and for well-designed randomized controlled trials (RCTs). Objective The study aimed to test the feasibility and tolerability of structured moderate-intensity 12-week physical exercise program for adults with ADHD, as a prelude to an adequately powered RCT which includes long-term follow-up. Materials and methods Fourteen adults with ADHD were recruited, 9 randomized to an intervention group and 5 to a control group. The intervention group received physiotherapist-led 50-minute mixed exercise program, three times a week for 12 weeks, and the control group treatment as usual. Participants were assessed at baseline and after 6 and 12 weeks using clinical and physical evaluations, self-rating questionnaires, and functional magnetic resonance imaging (fMRI) together with paradigms that tested attention, impulsivity and emotion regulation. Results Three participants (21%) dropped out shortly after inclusion before receiving any intervention, while roughly 80% completed the intervention according to protocol. One participant from the intervention group participated in less than 60% of treatment sessions, and one who had done baseline fMRI was unwilling to do post-intervention imaging. Four participants in the intervention group (67%) reported increased stress in prioritizing the intervention due to time-management difficulties. Overall, consistent trends were observed that indicated the feasibility and potential benefits of the intervention on core ADHD symptoms, quality of life, body awareness, sleep and cognitive functioning. Conclusion Physiotherapist-led twelve-week regular physical exercise is a feasible and potentially beneficial intervention for adults with ADHD. There was a 20% drop-out initially and 67% of those who completed the intervention reported stress with time management difficulties due to participation. A third arm was thus added to the planned RCT where cognitive intervention administered by an occupational therapist will be given together with physical exercise.Clinical Trial Registration: https://clinicaltrials.gov, identifier NCT05049239.
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Affiliation(s)
- L. A. Svedell
- Department of Psychiatry, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - K. L. Holmqvist
- Department of Neurology and Rehabilitation Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - M. A. Lindvall
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Y. Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - M. Msghina
- Department of Psychiatry, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Huang H, Jin Z, He C, Guo S, Zhang Y, Quan M. Chronic Exercise for Core Symptoms and Executive Functions in ADHD: A Meta-analysis. Pediatrics 2023; 151:190271. [PMID: 36510746 DOI: 10.1542/peds.2022-057745] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The effects of chronic exercise interventions (CEIs) on core symptoms and executive functions (EFs) of attention-deficit/hyperactivity disorder (ADHD) and how different characteristics of CEIs could modify the effect remain unclear. We synthesized the current evidence on the effects of CEIs on core symptoms and EFs in children and adolescents with ADHD. METHODS Data sources include PubMed, Embase, Web of Science, Cochrane Library, and China National Knowledge Infrastructure from database inception to July 31, 2022. Study selection includes randomized controlled trials that reported on the effects of CEIs on core symptoms and/or EFs in ADHD aged 6 to 18 years. RESULTS Twenty-two randomized controlled trials were included. CEIs had a small beneficial effect on overall core symptoms (standardized mean difference [SMD] = -0.39, 95% confidence interval [CI]: -0.64 to -0.14), as well as inattention (SMD = -0.32, 95% CI: -0.63 to -0.004) among children and adolescents with ADHD. Closed-skill exercise showed a large improvement in core symptoms (SMD = -0.83, 95% CI: -1.30 to -0.35), whereas open-skill exercise did not. Additionally, CEIs had a moderately beneficial effect on overall EFs (SMD = -0.68, 95% CI: -0.91 to -0.45) and a moderate-to-large effect on the specific domains of EFs. The pooled effects on overall core symptoms and EFs were not significantly modified by study population (children or adolescents), exercise session duration (≤50 or >50 minutes per session, median), or total exercise sessions (<24 or ≥24 sessions, median). CONCLUSIONS CEIs have small-to-moderate beneficial effects on overall core symptoms and EFs in children and adolescents with ADHD.
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Affiliation(s)
| | - Zhijuan Jin
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | | | | | - Yiwen Zhang
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Minghui Quan
- School of Exercise and Health.,Shanghai Frontiers Science Research Base of Exercise and Metabolic Health, Shanghai University of Sport, Shanghai, China
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Li D, Wang D, Cui W, Yan J, Zang W, Li C. Effects of different physical activity interventions on children with attention-deficit/hyperactivity disorder: A network meta-analysis of randomized controlled trials. Front Neurosci 2023; 17:1139263. [PMID: 37021131 PMCID: PMC10067581 DOI: 10.3389/fnins.2023.1139263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/17/2023] [Indexed: 04/07/2023] Open
Abstract
Background Previous studies have shown that physical activity interventions positively affect core symptoms and executive functioning in children with attention-deficit/hyperactivity disorder (ADHD). However, comparisons between different physical activity interventions still need to be made. This study is the first to analyze the effects of 10 different types of physical activity on children with ADHD through a network meta-analysis. Methods PubMed, Embase, Web of Science, and Cochrane Library databases were searched for randomized controlled trials on the effects of physical activity interventions on children with ADHD. The search time frame was from database creation to October 2022. Two investigators independently performed literature screening, extraction, and quality assessment. Network meta-analysis was performed with Stata 15.1. Results A total of 31 studies were included, and the results indicated that perceptual-motor training was the most effective in terms of motor ability and working memory (SUCRA = 82.7 and 73.3%, respectively). For attention problems and cognitive flexibility, aquatic exercise was the most effective (SUCRA = 80.9 and 86.6%, respectively). For social problems, horsemanship was the most effective (SUCRA = 79.4%). For inhibition switching, cognitive-motor training was the most effective (SUCRA = 83.5%). Conclusion Our study revealed that aquatic exercise and perceptual-motor training had a superior overall performance. However, the effects of various physical activity interventions on different indicators in children with ADHD can vary depending on the individual and the intervention's validity. To ensure an appropriate physical activity intervention is selected, it is important to assess the severity of symptoms exhibited by children with ADHD beforehand.
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Affiliation(s)
- Dong Li
- School of Physical Education and Sports Science, Guangzhou Sport University, Guangzhou, China
| | - Deng Wang
- LFE Research Group, Department of Health and Human Performance, Universidad Politécnica de Madrid, Madrid, Spain
| | - Wenlai Cui
- School of Dance and Martial Arts, Capital University of Physical Education and Sports, Beijing, China
| | - Jin Yan
- Centre for Active Living and Learning, University of Newcastle, Callaghan, NSW, Australia
| | - Wanli Zang
- Postgraduate School, University of Harbin Sport, Harbin, China
| | - Chenmu Li
- School of Physical Education and Sports Science, Guangzhou Sport University, Guangzhou, China
- *Correspondence: Chenmu Li,
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Zhu F, Zhu X, Bi X, Kuang D, Liu B, Zhou J, Yang Y, Ren Y. Comparative effectiveness of various physical exercise interventions on executive functions and related symptoms in children and adolescents with attention deficit hyperactivity disorder: A systematic review and network meta-analysis. Front Public Health 2023; 11:1133727. [PMID: 37033046 PMCID: PMC10080114 DOI: 10.3389/fpubh.2023.1133727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/08/2023] [Indexed: 04/11/2023] Open
Abstract
Background Physical exercise has been recommended as an important nonpharmacological therapeutic strategy for managing attention deficit hyperactivity disorder (ADHD). We conducted a network meta-analysis (NMA) to assess the comparative impact of different physical exercise modalities on enhancing executive functions (EFs) and alleviating symptoms in children and adolescents with ADHD. Methods We searched Web of Science, PubMed, Embase, Cochrane Central Register of Controlled Trials, SPORTDiscus, PsycINFO, CNKI, and clinical trials databases from inception to October 20, 2022. Randomized controlled trials (RCTs) and quasi-experimental studies investigating physical exercise for ADHD-related symptoms of hyperactivity/impulsivity and inattention, and executive functions were included. The frequentist random-effect NMA method was applied to pool the results. Results A total of 59 studies (including 39 RCTs, 5 quasi-RCTs, and 15 self-controlled trials) published between 1983 and 2022 were incorporated into the systematic review, of which 44 studies with 1757 participants were eligible for meta-analysis. All types of physical exercise were effective in improving EFs (SMD = 1.15, 95% CI: 0.83 to 1.46), and open-skill activities which require participants to react in a dynamically changing and externally paced environment induced the most incredible benefits for executive functions (SUCRA = 98.0%, SMD = 1.96, and 95% CI: 1.15 to 2.77). Subgroup analyses for EFs revealed varied findings that open-skill activities were the most promising physical exercise type for improving inhibitory control (SUCRA = 99.1%, SMD = 1.94, and 95% CI: 1.24 to 2.64), and closed-skill activities dominated by aerobic exercises had a slightly higher probability of being the most promising physical exercise intervention for working memory (SUCRA = 75.9%, SMD = 1.21, and 95% CI: -0.22 to 2.65), and multicomponent physical exercise tended to be the most effective in cognitive flexibility (SUCRA = 70.3%, SMD = 1.44, and 95% CI: -0.19 to 3.07). Regarding ADHD-related symptoms, closed-skill activities dominated by aerobic exercises might be more advantageous for hyperactivity/impulsivity (SUCRA = 72.5%, SMD = -1.60, and 95% CI: -3.02 to -0.19) and inattention (SUCRA = 96.3%, SMD = -1.51, and 95% CI: -2.33 to -0.69) improvement. Conclusion Physical exercise can significantly help to alleviate the symptoms of ADHD and improve executive functions in children and adolescents with ADHD. Most of all, to promote adherence to treatment, they should be encouraged to perform the physical exercises that they enjoy most.
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Affiliation(s)
- Feilong Zhu
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Xiaotong Zhu
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Xiaoyu Bi
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Dongqing Kuang
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Boya Liu
- School of Social Ecology, University of California, Irvine, Irvine, CA, United States
| | - Jingyi Zhou
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Yiming Yang
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Yuanchun Ren
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
- *Correspondence: Yuanchun Ren,
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Aranas K, Leighton JP. Dimensions of physical activity as related to child attention-deficit/hyperactivity disorder symptoms and impairment. Clin Child Psychol Psychiatry 2022; 27:953-966. [PMID: 34875896 PMCID: PMC9574890 DOI: 10.1177/13591045211058338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In efforts to explore adjunct/alternative treatments for ADHD, this study investigated the associations between dimensions of physical activity (PA) and children's ADHD symptoms and impairment. Current evidence-based treatments include medication and behaviour management, but there is widespread consensus that more treatment options are desirable. Although there is increasing support for PA as an adjunct/alternative to existing treatment for ADHD, the interplay of specific dimensions of PA has not been studied. Fifty-one parents of children aged 6-12 years with ADHD filled out questionnaires. Hierarchical regression analysis indicated that only some dimensions of PA explained a statistically significant portion of the variance in ADHD symptoms, beyond that explained by typical demographic variables. PA dimensions did not account for a statistically significant portion of ADHD impairment. Refining the measurement of how long children have engaged in PA is a key step in generating evidence for PA as an adjunct or alternate treatment for ADHD, and developing guidelines to manage parental expectations for this treatment in the benefit of their children.
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Affiliation(s)
- Katrina Aranas
- Educational Psychology, 3158University of Alberta, Edmonton, Canada
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Vanderloo LM, Taylor L, Yates J, Bassett-Gunter R, Stanley M, Tucker P. Physical activity among young children with disabilities: a systematic review protocol. BMJ Open 2022; 12:e060140. [PMID: 35973701 PMCID: PMC9386215 DOI: 10.1136/bmjopen-2021-060140] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Physical activity in the early years is necessary for setting the foundation for healthy growth and development in later childhood and adolescence. While most published evidence to date focuses on typically developing children, prevalence rates of physical activity among children with disabilities have been less studied. This protocol paper documents the plan of a systematic review, which aims to synthesise the evidence regarding physical activity levels among young children with disabilities. METHODS AND ANALYSIS Searches are anticipated to commence in May 2022. Empirical quantitative studies will be considered for inclusion if they present intervention or observational data on non-therapeutic (ie, leisure time) physical activity among children <5.99 years with physical, mental, intellectual or sensory impairments. Data sources will be retrieved via electronic database searches (Cumulative Index to Nursing and Allied Health Literature (CINAHL), EBSCO Sports Medicine Database (SPORTDiscus), Medical Literature Analysis and Retrieval System Online (MEDLINE), Elsevier Bibliographic Database (Scopus), Psychological Abstracts (PsycINFO), Education Resources Information Centre (ERIC) and Excerpta Medica Database (EMBASE)). Additional strategies to identify relevant studies will include manual searching and citation tracking of included articles. Titles and abstracts of identified studies will be screened for inclusion, followed by full-text reviews. Three independent reviewers will conduct quality appraisal using the Downs and Black checklist. A summary of included studies will describe the study designs, participant and activity characteristics, and outcomes. ETHICS AND DISSEMINATION This systematic review involves a secondary analysis of previously published data; therefore, this review does not require ethical approval. The proposed paper will summarise the current evidence base on physical activity levels among young children with a diagnosed disability. The findings from this systematic review will identify gaps to be explored by future research studies and inform future investigations among the paediatric disability population. PROSPERO REGISTRATION NUMBER CRD42021266585.
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Affiliation(s)
- Leigh M Vanderloo
- School of Occupational Therapy, University of Western Ontario, London, Ontario, Canada
| | - Leah Taylor
- Department of Health and Rehabilitation Sciences, University of Western Ontario, London, Ontario, Canada
| | - Julia Yates
- Department of Health and Rehabilitation Sciences, University of Western Ontario, London, Ontario, Canada
| | | | - Meagan Stanley
- Department of Western Libraries, University of Western Ontario, London, Ontario, Canada
| | - Patricia Tucker
- School of Occupational Therapy, University of Western Ontario, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
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Tourjman V, Louis-Nascan G, Ahmed G, DuBow A, Côté H, Daly N, Daoud G, Espinet S, Flood J, Gagnier-Marandola E, Gignac M, Graziosi G, Mansuri Z, Sadek J. Psychosocial Interventions for Attention Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis by the CADDRA Guidelines Work GROUP. Brain Sci 2022; 12:brainsci12081023. [PMID: 36009086 PMCID: PMC9406006 DOI: 10.3390/brainsci12081023] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/25/2022] [Accepted: 07/29/2022] [Indexed: 12/10/2022] Open
Abstract
Multiple psychosocial interventions to treat ADHD symptoms have been developed and empirically tested. However, no clear recommendations exist regarding the utilization of these interventions for treating core ADHD symptoms across different populations. The objective of this systematic review and meta-analysis by the CADDRA Guidelines work Group was to generate such recommendations, using recent evidence. Randomized controlled trials (RCT) and meta-analyses (MA) from 2010 to 13 February 2020 were searched in PubMed, PsycINFO, EMBASE, EBM Reviews and CINAHL. Studies of populations with significant levels of comorbidities were excluded. Thirty-one studies were included in the qualitative synthesis (22 RCT, 9 MA) and 24 studies (19 RCT, 5 MA) were included in the quantitative synthesis. Using three-level meta-analyses to pool results of multiple observations from each RCT, as well as four-level meta-analyses to pool results from multiples outcomes and multiple studies of each MA, we generated recommendations using the GRADE approach for: Cognitive Behavioral Therapy; Physical Exercise and Mind–Body intervention; Caregiver intervention; School-based and Executive intervention; and other interventions for core ADHD symptoms across Preschooler, Child, Adolescent and Adult populations. The evidence supports a recommendation for Cognitive Behavioral Therapy for adults and Caregiver intervention for Children, but not for preschoolers. There were not enough data to provide recommendations for the other types of psychosocial interventions. Our results are in line with previous meta-analytic assessments; however, they provide a more in-depth assessment of the effect of psychosocial intervention on core ADHD symptoms.
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Affiliation(s)
- Valerie Tourjman
- Department of Psychiatry, Université de Montréal, Montreal, QC H3T 1J4, Canada; (V.T.); (G.L.-N.); (A.D.); (H.C.)
| | - Gill Louis-Nascan
- Department of Psychiatry, Université de Montréal, Montreal, QC H3T 1J4, Canada; (V.T.); (G.L.-N.); (A.D.); (H.C.)
- Department of Psychology, Université du Québec à Montréal, Montreal, QC H2X 3P2, Canada
| | - Ghalib Ahmed
- Departments of Family Medicine and Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada;
| | - Anaïs DuBow
- Department of Psychiatry, Université de Montréal, Montreal, QC H3T 1J4, Canada; (V.T.); (G.L.-N.); (A.D.); (H.C.)
| | - Hubert Côté
- Department of Psychiatry, Université de Montréal, Montreal, QC H3T 1J4, Canada; (V.T.); (G.L.-N.); (A.D.); (H.C.)
| | - Nadia Daly
- Department of Psychiatry, Harvard University, Boston, MA 02115, USA;
- Boston Children’s Hospital, Harvard University, Boston, MA 02115, USA;
| | - George Daoud
- Department of Psychiatry, Université de Sherbrooke, Sherbrooke, QC J1K 2R1, Canada;
| | - Stacey Espinet
- CADDRA—Canadian ADHD Resource Alliance, Toronto, ON M5A 3X9, Canada;
| | - Joan Flood
- Department of Psychiatry, The Shoniker Clinic, Scarborough, ON M1E 4B9, Canada;
| | | | - Martin Gignac
- Child and Adolescent Psychiatry Division, McGill University, Montreal, QC H3A 0G4, Canada;
| | - Gemma Graziosi
- Department of Psychology, York University, Toronto, ON M3J 1P3, Canada;
| | - Zeeshan Mansuri
- Boston Children’s Hospital, Harvard University, Boston, MA 02115, USA;
| | - Joseph Sadek
- Department of Psychiatry, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Correspondence:
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12
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Seiffer B, Hautzinger M, Ulrich R, Wolf S. The Efficacy of Physical Activity for Children with Attention Deficit Hyperactivity Disorder: A Meta-Analysis of Randomized Controlled Trials. J Atten Disord 2022; 26:656-673. [PMID: 34041952 PMCID: PMC8785285 DOI: 10.1177/10870547211017982] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND This systematic review and meta-analysis assesses the efficacy of regular, moderate to vigorous physical activity (MVPA) for attention deficit hyperactivity disorder (ADHD) in children and adolescents in randomized controlled trials (RCTs). METHODS RCTs including children and adolescents with clinically diagnosed ADHD, implementing regular MVPA, and assessing ADHD core-symptoms on a valid rating scale post-intervention (primary outcome) were included. Outcomes were pooled through random-effects meta-analysis. Prospero registration: CRD42019142166. RESULTS MVPA had a small effect on total ADHD core symptoms (n = 11; g = -0.33; 95% CI [-0.63; -0.02]; p = .037). CONCLUSIONS MVPA could serve as an alternative treatment for ADHD. New RCTs are necessary to increase the understanding of the effect regarding frequency, intensity, type of MVPA interventions, and differential effects on age groups.
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Affiliation(s)
- Britta Seiffer
- University of Tuebingen, Department of Clinical Psychology and Psychotherapy, Tuebingen, Germany
- University of Tuebingen, Department of Education & Health Research, Tuebingen, Germany
| | - Martin Hautzinger
- University of Tuebingen, Department of Clinical Psychology and Psychotherapy, Tuebingen, Germany
| | - Rolf Ulrich
- University of Tuebingen, Department of Cognition and Perception, Tuebingen, Germany
| | - Sebastian Wolf
- University of Tuebingen, Department of Clinical Psychology and Psychotherapy, Tuebingen, Germany
- University of Tuebingen, Department of Education & Health Research, Tuebingen, Germany
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13
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Barudin-Carreiro AM, Camhi SM, Lindsay AC, Wright JA. Physical Activity and Executive Function in Children with ADHD: A Systematic Review. TRANSLATIONAL JOURNAL OF THE AMERICAN COLLEGE OF SPORTS MEDICINE 2022. [DOI: 10.1249/tjx.0000000000000183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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14
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Ludyga S, Ishihara T. Brain structural changes and the development of interference control in children with ADHD: The predictive value of physical activity and body mass index. NEUROIMAGE: CLINICAL 2022; 35:103141. [PMID: 36002962 PMCID: PMC9421503 DOI: 10.1016/j.nicl.2022.103141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/15/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022] Open
Abstract
Children with ADHD show deficits in interference control during preadolescence. Abnormalities in gray-white matter ratio contributed contribute to these deficits. Higher physical activity and lower body mass index predict higher interference control. Gray-white matter ratio underlies the predictive value of body mass index. Brain structure does not explain the predictive value of physical activity.
Background Children with ADHD face deficits in interference control due to abnormalities in brain structure. A low body mass index and high physical activity are factors promoting brain health and may have the potential to reduce ADHD-related cognitive deficits. We aimed to investigate the predictive values of ADHD, body mass index and physical activity for interference control and the potential mediation of these associations by brain structure. Method At 9 and 11 years, 4576 children with ADHD and neurotypical peers from the ABCD-cohort completed a Flanker task, anthropometric assessments and reported physical activity. Additionally, T1- and T2-weighted magnet resonance images were collected at both measurement time points. Results ADHD, lower physical activity and higher body mass index at baseline predicted lower interference control. Gray matter volume, surface area and gray-white matter ratio contributed to interference control. The longitudinal association between body mass index and interference control was mediated by gray-white-matter ratio. This mediating effect was stronger for children with ADHD than neurotypical peers and mainly restricted to regions associated with cognitive control. Conclusion The maintenance of a lower body mass index contributes to interference control by a tendency to normalize regional alterations in grey-white-matter ratio. Being compliant with physical activity also promises higher interference control, but brain structure does not seem to underlie this association.
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15
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Zorrilla-Revilla G, Rodrigues D, Machado-Rodrigues AM, Mateos A, Rodríguez J, Padez C. Sex-specific differences in somatic investment and strategies of physical activity among Portuguese schoolchildren. Am J Hum Biol 2021; 34:e23626. [PMID: 34076323 DOI: 10.1002/ajhb.23626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/21/2021] [Accepted: 05/22/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Physical activity (PA) is required for healthy growth, development, and maturation and plays an important role in the prevention of overweight and obesity in childhood and adolescence. Sex-differences in PA levels are well documented, with boys spending more time in PA, especially in moderate-to-vigorous activities. Following the Life History Theory, our aim is to study if PA affects the fat tissues increases during childhood and juvenile phases in both sexes. METHODS Time spent in sedentary, light, and moderate-to-vigorous PA levels were measured in a sample of 415 Portuguese children and juveniles (207 females/208 males; aged 6-11 years), using an accelerometer for 7 days. Skinfolds related with body fat were objectively collected and socioeconomic status factors were reported using a parental questionnaire. RESULTS The outcomes show that girls' and boys' fat variables increased during the end of the childhood and the juvenile phase. However, these variables were differently affected by PA. Girls increased fat variables with the sedentary activity while boys decreased fat variables with moderate-to-vigorous PA. Alike, active boys but not girls reduced the fat increase tendency with age. CONCLUSIONS Although both sexes displayed a general fat increment with age, moderate-to-vigorous PA dampens the increase only in boys. In fact, active girls increased body fat in the same manner as non-active girls. From an evolutionary perspective, it could explain sex-specific somatic strategies related to future reproduction or, with future mating and intrasexual competition.
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Affiliation(s)
| | - Daniela Rodrigues
- CIAS - Research Centre for Anthropology and Health, University of Coimbra, Coimbra, Portugal.,Department of Life Sciences, University of Coimbra, Coimbra, Portugal
| | - Aristides M Machado-Rodrigues
- CIAS - Research Centre for Anthropology and Health, University of Coimbra, Coimbra, Portugal.,High School of Education, Polytechnic Institute of Viseu, Viseu, Portugal
| | - Ana Mateos
- National Research Center on Human Evolution, CENIEH, Burgos, Spain
| | - Jesús Rodríguez
- National Research Center on Human Evolution, CENIEH, Burgos, Spain
| | - Cristina Padez
- CIAS - Research Centre for Anthropology and Health, University of Coimbra, Coimbra, Portugal.,Department of Life Sciences, University of Coimbra, Coimbra, Portugal
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16
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Liang X, Li R, Wong SHS, Sum RKW, Sit CHP. The impact of exercise interventions concerning executive functions of children and adolescents with attention-deficit/hyperactive disorder: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2021; 18:68. [PMID: 34022908 PMCID: PMC8141166 DOI: 10.1186/s12966-021-01135-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/05/2021] [Indexed: 12/30/2022] Open
Abstract
Background Previous studies found that exercise interventions have positive effects on executive functions of the general population. However, studies seldom target executive functions of children and adolescents with attention-deficit hyperactivity disorder (ADHD). This study aimed to synthesise empirical studies regarding the effects of exercise interventions on executive functions of children and adolescents with ADHD. Methods A systematic search of the relevant literature was conducted in March 2020 through six electronic databases: CINAHL Complete, Eric, MEDLINE, PsychINFO, SPORTDiscus with Full Text, and Web of Science. Randomised controlled trials/quasi-experimental designs that applied exercise interventions and assessed executive functions through neurocognitive tasks among children and adolescents with ADHD were included. Altogether, 314 studies were identified, from which 31 full texts were independently assessed by two authors for eligibility. Finally, 21 studies underwent systematic reviews and 15 were selected for meta-analysis. Data extraction procedures and risk of bias analysis were conducted by two independent authors using the Physiotherapy Evidence Database (PEDro) scale. Results The findings indicated that exercise interventions improved overall executive functions of children and adolescents with ADHD (SMD = 0.611, 95% CI [0.386 to 0.836], p < 0.01). Exercise interventions had a moderate-to-large positive effect on inhibitory control (g = 0.761, 95% CI [0.376 to 1.146], p < 0.01) and cognitive flexibility (g = 0.780, 95% CI [0.331 to 1.228], p < 0.001). Likewise, during the subgroup analysis, intervention intensity and sessions of exercise (acute vs chronic) significantly moderated exercise intervention rather than intervention type. Conclusions Chronic sessions of exercise interventions with moderate intensity should be incorporated as treatment for children with ADHD to promote executive functions. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01135-6.
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Affiliation(s)
- Xiao Liang
- Department of Sports Science and Physical Education, The Chines University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Ru Li
- Faculty of Physical Education, Shenzhen University, Shenzhen, China
| | - Stephen H S Wong
- Department of Sports Science and Physical Education, The Chines University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Raymond K W Sum
- Department of Sports Science and Physical Education, The Chines University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Cindy H P Sit
- Department of Sports Science and Physical Education, The Chines University of Hong Kong, Shatin, New Territories, Hong Kong, China.
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Impacts of Participation in Community-Based Physical Activity Programs on Cognitive Functions of Children and Youth with Neurodevelopmental Disabilities: A Scoping Review. Brain Sci 2021; 11:brainsci11020195. [PMID: 33562519 PMCID: PMC7916019 DOI: 10.3390/brainsci11020195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 01/22/2023] Open
Abstract
This review paper aimed to undertake an extensive exploration of the extent, range, and nature of research activities regarding the effect and emerging evidence in the field of physical activity interventions on cognitive development among children and youth (0–17.99 years) with neurodevelopmental disorders (NDD), and to help identify key gaps in research and determine precise research questions for future investigations. To carry out this scoping review, five electronic databases were searched. A total of 12,097 articles were retrieved via search efforts with an additional 93 articles identified from the identified review papers. Sixty articles were eligible for inclusion. The results of this scoping review revealed many positive key cognitive outcomes related to physical activity including, but not limited to: focus, attention, self-control, cognitive process, and alertness. No studies reported a negative association between physical activity and cognitive outcomes. Based on the findings from this scoping review, physical activity appears to have a favorable impact on the cognitive outcomes of children and youth with NDD.
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18
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Xie Y, Gao X, Song Y, Zhu X, Chen M, Yang L, Ren Y. Effectiveness of Physical Activity Intervention on ADHD Symptoms: A Systematic Review and Meta-Analysis. Front Psychiatry 2021; 12:706625. [PMID: 34764893 PMCID: PMC8575983 DOI: 10.3389/fpsyt.2021.706625] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/13/2021] [Indexed: 01/27/2023] Open
Abstract
Objective: To assess the effectiveness of physical activity (PA) intervention on attention-deficit/hyperactivity disorder (ADHD)-related symptoms. Method: Studies that investigated PA intervention for ADHD-related symptoms were identified through searching PubMed, Web of Science, Cochrane Library, and Embase databases from inception through June 2021. Standardized mean difference (SMD) with 95% confidence interval (CI) was used to assess the effectiveness of PA intervention on improving ADHD-related symptoms. The meta-analyses were conducted using fixed-effect or random-effect models according to the heterogeneity of the studies. Results: Nine before-after studies (232 participants) and 14 two-group control studies (162 participants/141 controls) were included in this meta-analysis. Combined results for before-after studies indicated significant improvements on all studied ADHD-related symptoms (inattention: SMD = 0.604, 95% CI: 0.374-0.834, p < 0.001; hyperactivity/impulsivity: SMD = 0.676, 95% CI: 0.401-0.950, p < 0.001; emotional problems: SMD = 0.416, 95% CI: 0.283-0.549, p < 0.001; behavioral problems: SMD = 0.347, 95% CI: 0.202-0.492, p < 0.001). Meta-analyses for two-group control studies further confirmed that PA intervention significantly improved the inattentive symptom (SMD = 0.715, 95% CI: 0.105, 1.325, p = 0.022). Subgroup analyses suggested significant beneficial effect on inattention symptoms in children. Moreover, closed motor skills were beneficial for hyperactive/impulsive problems (SMD = 0.671, p < 0.001), while open motor skills were beneficial for attention problems (SMD = 0.455, p = 0.049). When excluding studies with combined medication, the studies in unmedicated participants in before-after studies still showed significant results in all studied ADHD-related symptoms as in the overall analysis. Given the limited sample size, the best frequency and intensity of PA intervention need further investigation. Conclusion: Our results suggested that PA intervention could possibly improve ADHD-related symptoms, especially inattention symptoms. Closed-skill and open-skill activities could be beneficial for hyperactivity/impulsivity and inattention symptoms, respectively. Further high-quality randomized clinical trials with large sample size are needed.
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Affiliation(s)
- Yongtao Xie
- College of Physical Education and Sports, Beijing Normal University, Beijing, China.,Department of Human Movement Science, Hebei Sports University, Shijiazhuang, China
| | - Xuping Gao
- Department of Child & Adolescent Psychiatry, National Clinical Research Center for Mental Disorders and NHC Key Laboratory of Mental Health (Peking University Sixth Hospital), Peking University Sixth Hospital (Institute of Mental Health), Beijing, China
| | - Yiling Song
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Xiaotong Zhu
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Mengge Chen
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Li Yang
- Department of Child & Adolescent Psychiatry, National Clinical Research Center for Mental Disorders and NHC Key Laboratory of Mental Health (Peking University Sixth Hospital), Peking University Sixth Hospital (Institute of Mental Health), Beijing, China
| | - Yuanchun Ren
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
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Cahill SM, Beisbier S. Occupational Therapy Practice Guidelines for Children and Youth Ages 5-21 Years. Am J Occup Ther 2020; 74:7404397010p1-7404397010p48. [PMID: 32602457 DOI: 10.5014/ajot.2020.744001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Demand is increasing for activity- and occupation-based interventions to address occupational performance and support maximal participation of children and youth. OBJECTIVE This Practice Guideline was developed to guide decision making and support best practices in service delivery for children and youth ages 5-21 yr at home, at school, and in the community. METHOD The results from three systematic reviews (SRs) of activity- and occupation-based interventions for children and youth ages 5-21 yr were reviewed, synthesized, and translated into recommendations for education, practice, and research. RESULTS One hundred eighty-five articles were included in the three SRs examining the evidence for interventions to promote activities of daily living, instrumental activities of daily living, play and leisure, and rest and sleep; to improve mental health, positive behavior, and social participation; and to enhance learning, academic achievement, and successful participation in school. The reviews provide evidence for interventions associated with typical concerns addressed by occupational therapy practitioners. CONCLUSIONS AND RECOMMENDATIONS On the basis of the evidence, this guideline recommends that occupational therapy practitioners consistently collaborate with families and caregivers and provide services in the natural context of the desired occupation. The evidence also supports group service models and models that include peer mediation; these models can promote participation across areas of occupation. Skills-based training and therapeutic practice in the context of valued occupations are recommended over isolated sensorimotor approaches. Technology, manualized programs, and sports activities can be effective but should be evaluated and matched to age, diagnosis, and outcomes as guided by the evidence. WHAT THIS ARTICLE ADDS When guided by evidence, activity- and occupation-based interventions are effective in promoting participation and enhancing performance in valued occupations of children and youth ages 5-21 yr.
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Affiliation(s)
- Susan M Cahill
- Susan M. Cahill, PhD, OTR/L, FAOTA, is Associate Professor and Occupational Therapy Department Chair, MSOT Program, Lewis University, Romeoville, IL
| | - Stephanie Beisbier
- Stephanie Beisbier, OTD, OTR/L, is Associate Professor, Occupational Therapy Department, Mount Mary University, Milwaukee, WI;
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Cahill SM, Egan BE, Seber J. Activity- and Occupation-Based Interventions to Support Mental Health, Positive Behavior, and Social Participation for Children and Youth: A Systematic Review. Am J Occup Ther 2020; 74:7402180020p1-7402180020p28. [PMID: 32204773 DOI: 10.5014/ajot.2020.038687] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Children and youth are often challenged to maintain well-being, positive behavior, and social participation. OBJECTIVE To identify evidence for occupational therapy interventions for children and youth with and at risk for mental health concerns. DATA SOURCES Articles published in English-language peer-reviewed journals between January 2010 and March 2017 identified through searches of MEDLINE, PsycINFO, CINAHL, ERIC, OTseeker, and Cochrane databases. Study Selection and Data Collectio : The methodology in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used to complete the review. Of 5,310 articles screened by title and abstract, 357 were retrieved for full-text review, and 62 met inclusion criteria. Articles describing interventions that were activity or occupation based were included. Conference proceedings, non-peer reviewed publications, dissertations, theses, and presentations were excluded. FINDINGS Of the 62 studies included in the review, 20 (32%) were Level I studies, 22 (36%) were Level II studies, and 20 (32%) were Level III studies. Articles were categorized by type: outdoor camps, video and computer games, productive occupations and life skills, meditation, animal-assisted interventions, creative arts, play, sports, and yoga. Moderate to strong evidence supports the use of yoga and sports. Moderate-strength evidence supports the use of play and creative arts. Evidence for the use of animal-assisted interventions, meditation, video and computer games, and productive occupations was of low strength. CONCLUSION AND RELEVANCE Substantial evidence exists to support the use of activity- and occupation-based interventions to address the mental health, behavioral, and social participation concerns of children and youth. Occupational therapy practitioners should match the desired outcome of therapy with the appropriate intervention to provide the best and most effective services to their clients. WHAT THIS ARTICLE ADDS This review provides additional support for the use of activity- and occupation-based interventions (i.e., those that involve active participation) to improve the behavior, social participation, and mental health of children and youth.
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Affiliation(s)
- Susan M Cahill
- Susan M. Cahill, PhD, OTR/L, FAOTA, is Associate Professor and Occupational Therapy Department Chair, MSOT Program, Lewis University, Romeoville, IL;
| | - Brad E Egan
- Brad E. Egan, OTD, PhD, CADC, OTR/L, is Associate Professor and Occupational Therapy Program Site Coordinator, Occupational Therapy Program, Lenoir-Rhyne University, Columbia, SC
| | - Joanna Seber
- Joanna Seber, OTD, OTR/L, is Adjunct Instructor, MSOT Program, Lewis University, Romeoville, IL. At the time of the study, she was a postprofessional OTD student (maiden name Swanton) at the University of Illinois at Chicago
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Klil-Drori S, Hechtman L. Potential Social and Neurocognitive Benefits of Aerobic Exercise as Adjunct Treatment for Patients With ADHD. J Atten Disord 2020; 24:795-809. [PMID: 27288905 DOI: 10.1177/1087054716652617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The aim of the article is to review the evidence that aerobic exercise may be a useful adjunct treatment for ADHD. Method: Studies on physical, cognitive, and psychosocial aspects of aerobic exercise that are relevant to ADHD are reviewed and evaluated. Results: Stimulant medication, the main pharmacotherapy for ADHD, and aerobic exercise both act on catecholamine pathways. Aerobic exercise has been shown to be beneficial in preclinical studies on spontaneous hypertensive rats, an animal model of ADHD, and in clinical trials of children with ADHD, as an adjunct treatment to medication. Social and neurocognitive function in children and adults seem to be positively affected by exercise as well. Nevertheless, no controlled clinical trials in adults with ADHD have been conducted. Conclusion: Aerobic exercise may be a useful non-medication adjunct therapy for ADHD. The clinical effectiveness of aerobic exercise for ADHD in children and adults warrants further clinical studies.
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Mehren A, Reichert M, Coghill D, Müller HHO, Braun N, Philipsen A. Physical exercise in attention deficit hyperactivity disorder - evidence and implications for the treatment of borderline personality disorder. Borderline Personal Disord Emot Dysregul 2020; 7:1. [PMID: 31921425 PMCID: PMC6945516 DOI: 10.1186/s40479-019-0115-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 10/23/2019] [Indexed: 12/13/2022] Open
Abstract
A growing body of literature indicates a potential role for physical exercise in the treatment of attention deficit hyperactivity disorder (ADHD). Suggested effects include the reduction of ADHD core symptoms as well as improvements in executive functions. In the current review, we provide a short overview on the neurophysiological mechanisms assumed to underlie the beneficial effects of exercise. Further, we review the current evidence from experimental studies regarding both acute exercise and long-term interventions in ADHD. While the positive effects observed after acute aerobic exercise are promising, very few well-designed long-term intervention studies have been conducted yet. Moreover, although exercise effects have not yet been studied in borderline personality disorder (BPD), in the end of this paper we derive hypotheses why exercise could also be beneficial for this patient population.
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Affiliation(s)
- Aylin Mehren
- 1Department of Psychology, Biological Psychology Lab, European Medical School, University of Oldenburg, Oldenburg, Germany
| | - Markus Reichert
- 2Department of Applied Psychology, Mental mHealth Lab, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany.,3Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - David Coghill
- 4Royal Children's Hospital, Melbourne, Victoria Australia
| | - Helge H O Müller
- 5Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Niclas Braun
- 5Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Alexandra Philipsen
- 5Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
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Zang Y. Impact of physical exercise on children with attention deficit hyperactivity disorders: Evidence through a meta-analysis. Medicine (Baltimore) 2019; 98:e17980. [PMID: 31725664 PMCID: PMC6867774 DOI: 10.1097/md.0000000000017980] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) which is characterized by developmentally inappropriate levels of attention, hyperactivity and impulsivity, is considered as the most common neurodevelopmental disorder in childhood. Physical exercise has shown to have several benefits in the improvement of children with ADHD. In this meta-analysis, we aimed to systematically show, with evidence, the impact of physical exercise on children with ADHD. METHODS Web of Science, MEDLINE, EMBASE, Google Scholar, Cochrane Central and http://www.ClinicalTrials.gov were the searched sources for studies which were based on the impact of physical exercise on children with ADHD. Relevant endpoints were assessed. This evidence based meta-analysis was carried out by the most relevant RevMan 5.3 software. Due to the involvement of continuous data (mean and standard deviation), weight mean difference (WMD) with 95% confidence intervals (CI) were used to represent the final analysis. A significant level of P ≤ .05 was set and a fixed statistical effect model was used throughout the analysis. RESULTS Fourteen studies with a total number of 574 participants with ADHD were included in this evidenced based meta-analysis. Two hundred and seventy six (276) participants were assigned to the physical activity group whereas 298 participants were assigned to the control group. Results of this analysis showed that anxiety and depression were significantly improved with physical activity in these children with ADHD (WMD: -1.84; 95% CI: [-2.65 - (-1.03)], P = .00001). Hyperactive/impulsive symptoms (WMD: -0.01; 95% CI: [-0.32 - 0.29], P = .93) and inattention symptoms (WMD: -0.22; 95% CI: [-0.51 - 0.08], P = .15) were also improved with physical exercise but the results were not statistically significant. This evidence based analysis showed thought problems (WMD: -3.49; 95% CI: [-5.51 - (-1.47)], P = .0007), social problems (WMD: -5.08; 95% CI: [-7.34 - (-2.82)], P = .0001), and aggressive behaviors (WMD: -3.90; 95% CI: [-7.10 - (-0.70)], P = .02) to have significantly been improved in participants with ADHD who were assigned to physical activity group. CONCLUSIONS This current meta-analysis showed with evidence, that physical exercise has a major contribution owing to significant improvement in anxiety and depression, aggressive behaviors, thought and social problems among children suffering from ADHD. Therefore, physical exercise should be incorporated in the daily life of children with ADHD. Further future research should be able to confirm this hypothesis.
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Effects of Exercise on Cognitive Performance in Children and Adolescents with ADHD: Potential Mechanisms and Evidence-based Recommendations. J Clin Med 2019; 8:jcm8060841. [PMID: 31212854 PMCID: PMC6617109 DOI: 10.3390/jcm8060841] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/04/2019] [Accepted: 06/06/2019] [Indexed: 12/14/2022] Open
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder with a complex symptomatology, and core symptoms as well as functional impairment often persist into adulthood. Recent investigations estimate the worldwide prevalence of ADHD in children and adolescents to be ~7%, which is a substantial increase compared to a decade ago. Conventional treatment most often includes pharmacotherapy with central nervous stimulants, but the number of non-responders and adverse effects call for treatment alternatives. Exercise has been suggested as a safe and low-cost adjunctive therapy for ADHD and is reported to be accompanied by positive effects on several aspects of cognitive functions in the general child population. Here we review existing evidence that exercise affects cognitive functions in children with and without ADHD and present likely neurophysiological mechanisms of action. We find well-described associations between physical activity and ADHD, as well as causal evidence in the form of small to moderate beneficial effects following acute aerobic exercise on executive functions in children with ADHD. Despite large heterogeneity, meta-analyses find small positive effects of exercise in population-based control (PBC) children, and our extracted effect sizes from long-term interventions suggest consistent positive effects in children and adolescents with ADHD. Paucity of studies probing the effect of different exercise parameters impedes finite conclusions in this regard. Large-scale clinical trials with appropriately timed exercise are needed. In summary, the existing preliminary evidence suggests that exercise can improve cognitive performance intimately linked to ADHD presentations in children with and without an ADHD diagnosis. Based on the findings from both PBC and ADHD children, we cautiously provide recommendations for parameters of exercise.
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Prat Q, Andueza J, Echávarri B, Camerino O, Fernandes T, Castañer M. A Mixed Methods Design to Detect Adolescent and Young Adults' Impulsiveness on Decision-Making and Motor Performance. Front Psychol 2019; 10:1072. [PMID: 31178778 PMCID: PMC6543009 DOI: 10.3389/fpsyg.2019.01072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/24/2019] [Indexed: 11/25/2022] Open
Abstract
Impulsiveness in adolescents and young adults is an important aspect of psychological research. However, there still is lack of research that relates impulsiveness and motor performance in those. Thus, we aim to detect the levels of impulsiveness related to motor skills, motor laterality, spatial orientation, and individual interaction on the decision-making of adolescents and young adults across three staggered workouts. The study had 71 participants (53 males and 18 females), ranging in age from 17 to 24 years old (Mage = 18.5 years; SD = 1.72) and classified as non-impulsiveness (n = 47), impulsiveness (n = 17), and attention deficit hyperactivity disorder (ADHD) (n = 7). A Mixed Methods research was conducted throughout four research tools (a) The Observational System of Motor Skills (OSMOS) was used to observe and detect the movement sequences patterns; (b) The Spanish version of Impulsive Behavior Scale (UPPS-P) was administered to obtain the impulsiveness profiles; (c) The Precision and Agility Tapping over Hoops (PATHoops) was carried out to observe the decision-making and temporal-spatial over movement effectiveness; (d) Motor Laterality Inventory (MOTORLAT) was applied to obtain the laterality profiles related to motor skills performance. This Mixed Methods approach has obtained useful results for impulsiveness in motor situations as the results from the different tools converge to established three clear profiles of impulsiveness. Participants with ADHD showed lack of interpersonal interaction, non-resolute decision-making, and lesser richness of motor skills patterns than non-impulsiveness and impulsiveness subjects. Additionally, impulsiveness participants also showed rich motor patterns, dyadic interactions, good decision making in spatial orientation tasks, and more versatile laterality in the lower limbs.
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Affiliation(s)
- Queralt Prat
- INEFC (National Institute of Physical Education of Catalonia), University of Lleida, Lleida, Spain
| | - Juan Andueza
- INEFC (National Institute of Physical Education of Catalonia), University of Lleida, Lleida, Spain
| | | | | | - Tiago Fernandes
- Faculty of Sport, Center for Research, Training, Innovation and Intervention in Sport, University of Porto, Porto, Portugal
| | - Marta Castañer
- INEFC (National Institute of Physical Education of Catalonia), University of Lleida, Lleida, Spain.,IRBLLEIDA (Lleida Institute for Biomedical Research Dr. Pifarré Foundation), University of Lleida, Lleida, Spain
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Neudecker C, Mewes N, Reimers AK, Woll A. Exercise Interventions in Children and Adolescents With ADHD: A Systematic Review. J Atten Disord 2019; 23:307-324. [PMID: 25964449 DOI: 10.1177/1087054715584053] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Exercise has attracted attention as a potential helpful intervention in children with ADHD. Effects are emphasized on cognition, social-emotional, and motor development. METHOD A systematic literature search was conducted using the electronic databases Web of Science, PubMed, Scopus, and ERIC to analyze the efficacy of different types of exercise interventions in children and adolescents with ADHD. Seven studies examining the acute and 14 studies examining the long-term effects were included. RESULTS The largest effects were reported for mixed exercise programs on ADHD symptomatology and fine motor precision. However, because of the large differences in the study designs, the comparability is limited. CONCLUSION At this time, no evidence-based recommendation can be formulated regarding frequency, intensity, or duration of exercise. Nevertheless, some first trends regarding the effects of certain types of exercise can be identified. When focusing on long-term health benefits in children and adolescents with ADHD, qualitative exercise characteristics might play an important role.
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Affiliation(s)
| | | | - Anne K Reimers
- 1 Karlsruhe Institute of Technology, Germany
- 2 University of Konstanz, Germany
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Physical Activity Interventions for Children with Social, Emotional, and Behavioral Disabilities-A Systematic Review. J Dev Behav Pediatr 2018; 38:431-445. [PMID: 28671892 DOI: 10.1097/dbp.0000000000000452] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Perform a systematic review of the available literature regarding the effectiveness of exercise interventions on children with any type of social, emotional, or behavioral disability (SEBD), with attention to a range of physiological, behavioral, and mood outcomes. METHODS Six databases were searched using a systematic methodology. References of included studies, as well as relevant reviews, were also examined. The review was limited to studies published since 2000 reporting a quantitative analysis of the effects of a physical activity (PA) intervention on at least 1 behavioral, psychological, or cognitive outcome in children aged 21 and under, diagnosed with a SEBD. Only studies with a control group were included. RESULTS We identified 24 eligible studies. Studies varied in design, participant characteristics, and intervention characteristics (single-bout vs repeated exposure, duration, intensity level, mode of exercise). Of the 20 behavioral outcome assessments, there was 1 negative finding, 12 null findings, 5 positive findings, and 2 mixed findings. For the 25 executive functioning outcome assessments, there were 5 null findings, 18 positive findings, and 2 mixed findings. For the remaining outcome domains, 1 of 2 studies looking at academic performance, 3 of 6 studies looking at objective neurological measures, and 1 of 3 studies looking at affect outcomes found positive results. All other results were null or mixed. CONCLUSION Although additional research is warranted to further understand the mechanisms by which PA affects behavioral and cognitive outcome measures in children with SEBDs, PA offers a safe and alternative form of treatment for this population.
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The influence of participation in target-shooting sport for children with inattentive, hyperactive and impulsive symptoms - A controlled study of best practice. BMC Psychiatry 2017; 17:115. [PMID: 28351351 PMCID: PMC5371218 DOI: 10.1186/s12888-017-1283-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/23/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Practising target-shooting sport requires focused attention and motoric steadiness. A previous non-controlled pilot study suggests that children with impairing symptoms of attention-deficit/hyperactivity disorder (ADHD) benefit from participating in target-shooting sport in local shooting associations, as rated by parents and teachers. This study aims at examining if, and to which extent, target-shooting sport reduces parent- and teacher-reported severity of inattentiveness, hyperactivity, and impulsivity in children with attention difficulties, and if, and to which extend, target-shooting sport improves the children's wellbeing and quality of life. METHODS A mixed method approach is applied. A non-blinded, waiting list controlled study is combined with a case study, consisting of interviews and observations. The intervention consists of children practising target-shooting sport, by attending a local shooting association, once a week for six months, during regular school hours. Data from questionnaires (ADHD-RS, SDQ, Kidscreen-27), as well as a computerized continued performance test (Qb test), measure the children's activity and attention. The study includes 50 children in an intervention group and 50 children in a waiting list control group. The Qb test collects data from at least 20 children from the intervention group and at least 20 children from the waiting list control group. Data from the questionnaires and Qb-test is collected at baseline, and six months post intervention. In addition, a case study is carried out, consisting of interviews of at least five children from the intervention group, their parents, teachers and shooting instructors. Observations are carried out, when children are in school and while they are attending the local shooting association. The case study adds to an in-depth understanding of children's participation in target-shooting sports. DISCUSSION At present, little is known about the effects and influence of practising target-shooting sport for children experiencing difficulties with inattentiveness, hyperactivity and impulsivity. This study is expected to contribute to an understanding of the influence of participating in target-shooting sports on inattentive, hyperactive and impulsive symptoms, and the effects on the children's psychological wellbeing and quality of life. TRIAL REGISTRATION Current Controlled Trials NCT02898532 . Retrospectively registered 14 September 2016.
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Den Heijer AE, Groen Y, Tucha L, Fuermaier ABM, Koerts J, Lange KW, Thome J, Tucha O. Sweat it out? The effects of physical exercise on cognition and behavior in children and adults with ADHD: a systematic literature review. J Neural Transm (Vienna) 2017; 124:3-26. [PMID: 27400928 PMCID: PMC5281644 DOI: 10.1007/s00702-016-1593-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 07/01/2016] [Indexed: 12/05/2022]
Abstract
As attention-deficit/hyperactivity disorder (ADHD) is one of the most frequently diagnosed developmental disorders in childhood, effective yet safe treatment options are highly important. Recent research introduced physical exercise as a potential treatment option, particularly for children with ADHD. The aim of this review was to systematically analyze potential acute and chronic effects of cardio and non-cardio exercise on a broad range of functions in children with ADHD and to explore this in adults as well. Literature on physical exercise in patients with ADHD was systematically reviewed based on categorizations for exercise type (cardio versus non-cardio), effect type (acute versus chronic), and outcome measure (cognitive, behavioral/socio-emotional, and physical/(neuro)physiological). Furthermore, the methodological quality of the reviewed papers was addressed. Cardio exercise seems acutely beneficial regarding various executive functions (e.g., impulsivity), response time and several physical measures. Beneficial chronic effects of cardio exercise were found on various functions as well, including executive functions, attention and behavior. The acute and chronic effects of non-cardio exercise remain more questionable but seem predominantly positive too. Research provides evidence that physical exercise represents a promising alternative or additional treatment option for patients with ADHD. Acute and chronic beneficial effects of especially cardio exercise were reported with regard to several cognitive, behavioral, and socio-emotional functions. Although physical exercise may therefore represent an effective treatment option that could be combined with other treatment approaches of ADHD, more well-controlled studies on this topic, in both children and adults, are needed.
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Affiliation(s)
- Anne E Den Heijer
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioural and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands.
| | - Yvonne Groen
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioural and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - Lara Tucha
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioural and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - Anselm B M Fuermaier
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioural and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - Janneke Koerts
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioural and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - Klaus W Lange
- Department of Experimental Psychology, University of Regensburg, Universitätssraße 31, 93053, Regensburg, Germany
| | - Johannes Thome
- Department of Psychiatry and Psychotherapy, University of Rostock, Gehlsheimer Straße 20, 18147, Rostock, Germany
| | - Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioural and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
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Strøm V, Fønhus MS, Ekeland E, Jamtvedt G. Physical exercise for oppositional defiant disorder and conduct disorder in children and adolescents. Hippokratia 2017. [DOI: 10.1002/14651858.cd010670.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Vegard Strøm
- Norwegian Knowledge Centre for the Health Services; Primary Health Care Unit; Pilestredet Park 7 Oslo Norway 0130
| | - Marita S Fønhus
- Norwegian Institute of Public Health; Department for Evidence Synthesis; Pilestredet Park 7 Oslo Norway N-0130
| | | | - Gro Jamtvedt
- Norwegian Knowledge Centre for the Health Services; Department for Evidence Synthesis; PO Box 7004, St. Olavs Plass Oslo Norway N-0130
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Benzing V, Schmidt M. Cognitively and physically demanding exergaming to improve executive functions of children with attention deficit hyperactivity disorder: a randomised clinical trial. BMC Pediatr 2017; 17:8. [PMID: 28068954 PMCID: PMC5223426 DOI: 10.1186/s12887-016-0757-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 12/09/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is one of the most common mental disorders observed in childhood and adolescence. Its key symptoms - reduced attention, poor control of impulses as well as increased motor activity - are associated with decreased executive functions performance, finally affecting academic achievement. Although drug treatments usually show some effect, alternative treatments are continually being sought, due to lack of commitment and possible side effects. Cognitive trainings are frequently used with the objectives of increasing executive function performance. However, since transfer effects are limited and novelty and diversity are frequently ignored, interventions combining physical and cognitive demands targeting a broader range of cognitive processes are demanded. METHODS The aim of the study is to examine the effects of a cognitively and physically demanding exergame on executive functions of children with ADHD. In a randomised clinical trial, 66 girls and boys diagnosed with ADHD (age 8-12) will be assigned either to an 8-week exergame intervention group (three training sessions per week à 30 min) or a waiting-list control group. Before and afterwards, the executive function performance (computer-based tests), the sport motor performance and ADHD symptoms will be assessed. DISCUSSION The current study will offer insights into the effectiveness of a combination of cognitive and physical training using exergaming. Positive effects on the executive functions, sport motor performance and ADHD symptoms are hypothesized. Beneficial effects would mean a large degree of scalability (simple and cost-effective) and high utility for patients with ADHD. TRIAL REGISTRATION KEK BE 393/15 (March 8, 2016); DRKS00010171 (March 14, 2016).
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Affiliation(s)
- Valentin Benzing
- Institute of Sport Science, University of Bern, Bremgartenstrasse 145, 3012, Bern, Switzerland
| | - Mirko Schmidt
- Institute of Sport Science, University of Bern, Bremgartenstrasse 145, 3012, Bern, Switzerland.
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Hoza B, Martin CP, Pirog A, Shoulberg EK. Using Physical Activity to Manage ADHD Symptoms:The State of the Evidence. Curr Psychiatry Rep 2016; 18:113. [PMID: 27807701 DOI: 10.1007/s11920-016-0749-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article summarizes the evidence for management of attention-deficit/hyperactivity disorder (ADHD) using chronic aerobic physical activity (PA). Known studies comparing chronic aerobic PA to at least one control group are listed; uncontrolled studies and studies of non-aerobic PA are not considered. Key challenges to conducting chronic PA studies with children and youth with ADHD are summarized. After condensing information from widely varying studies, measures, and research designs, conclusions are stated in broad brush stroke terms. Preliminary evidence supports PA as beneficial for ADHD symptoms, executive function, and motor abilities. Social, emotional, and behavioral outcomes also may benefit. The preliminary state of the evidence supports PA as an adjunctive treatment for ADHD at this time, but the body and sophistication of the research to date is insufficient at present to support PA as a stand-alone treatment. Critical directions for future research are discussed.
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Affiliation(s)
- Betsy Hoza
- Department of Psychological Science, University of Vermont, 2 Colchester Ave, Burlington, VT, 05405, USA.
| | - Caroline P Martin
- Department of Psychological Science, University of Vermont, 2 Colchester Ave, Burlington, VT, 05405, USA
| | - Anna Pirog
- Department of Psychological Science, University of Vermont, 2 Colchester Ave, Burlington, VT, 05405, USA
| | - Erin K Shoulberg
- Department of Psychological Science, University of Vermont, 2 Colchester Ave, Burlington, VT, 05405, USA
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Wolfe ES, Madden KJ. Evidence-Based Considerations and Recommendations for Athletic Trainers Caring for Patients With Attention-Deficit/Hyperactivity Disorder. J Athl Train 2016; 51:813-820. [PMID: 27834506 DOI: 10.4085/1062-6050-51.12.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Patients with attention-deficit/hyperactivity disorder (ADHD) can be noncompliant, impulsive, and disruptive in an athletic training or physical rehabilitation facility. Athletic trainers (ATs) are valuable and essential health care providers for active patients with ADHD. However, for a patient with ADHD to have a successful outcome in a busy athletic training environment, the AT or health care provider must tailor the treatment setting to the patient's needs. OBJECTIVE To educate and raise awareness among ATs about patients with ADHD and to provide ATs with strategies and tools that will allow them to treat patients with ADHD more effectively. DATA SOURCES We retrieved and reviewed articles from PubMed, PsychINFO, and Ovid without date restrictions. Search words were attention deficit hyperactivity disorder plus 1 of the following topics or search words: athletic training, athletics, coaching, sport, or sport psychology. STUDY SELECTION Any ADHD articles that were not applicable or translatable in good faith to athletic training, physical rehabilitation, or sport and exercise were excluded. DATA EXTRACTION Nonpharmacologic interventions were reviewed and amassed into categories from which the recommendations were created. No statistical analyses were conducted for this review. DATA SYNTHESIS We identified 1241 articles, and 86 met the inclusion criteria. Five groups of evidence were observed: (1) goal setting and coaching, (2) reinforcements and outcomes, (3) routines and treatment timing, (4) simplified feedback and instructions, and (5) environmental control. Reliable evidence suggests that these techniques can be translated and applied within an athletic training and physical rehabilitation setting. CONCLUSIONS Athletic trainers are a vital component in providing health care for patients with ADHD. Using goal contagion creates a structured environment and positive reinforcements that accommodate patients with ADHD. Furthermore, ATs may use the evidence-based recommendations in this review to create a treatment and physical rehabilitation program and space that are tailored to the needs of the ADHD patient to increase the chance of a successful outcome.
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Tan BWZ, Pooley JA, Speelman CP. A Meta-Analytic Review of the Efficacy of Physical Exercise Interventions on Cognition in Individuals with Autism Spectrum Disorder and ADHD. J Autism Dev Disord 2016; 46:3126-43. [DOI: 10.1007/s10803-016-2854-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bustamante EE, Davis CL, Frazier SL, Rusch D, Fogg LF, Atkins MS, Marquez DX. Randomized Controlled Trial of Exercise for ADHD and Disruptive Behavior Disorders. Med Sci Sports Exerc 2016; 48:1397-407. [PMID: 26829000 PMCID: PMC4911251 DOI: 10.1249/mss.0000000000000891] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The objective of this study is to test the feasibility and impact of a 10-wk after-school exercise program for children with attention deficit hyperactivity disorder and/or disruptive behavior disorders living in an urban poor community. METHODS Children were randomized to an exercise program (n = 19) or a comparable but sedentary attention control program (n = 16). Cognitive and behavioral outcomes were collected pre-/posttest. Intent-to-treat mixed models tested group-time and group-time-attendance interactions. Effect sizes were calculated within and between groups. RESULTS Feasibility was evidenced by 86% retention, 60% attendance, and average 75% maximum HR. Group-time results were null on the primary outcome, parent-reported executive function. Among secondary outcomes, between-group effect sizes favored exercise on hyperactive symptoms (d = 0.47) and verbal working memory (d = 0.26), and controls on visuospatial working memory (d = -0.21) and oppositional defiant symptoms (d = -0.37). In each group, within-group effect sizes were moderate to large on most outcomes (d = 0.67 to 1.60). A group-time-attendance interaction emerged on visuospatial working memory (F[1,33] = 7.42, P < 0.05), such that attendance to the control program was related to greater improvements (r = 0.72, P < 0.01), whereas attendance to the exercise program was not (r = 0.25, P = 0.34). CONCLUSIONS Although between-group findings on the primary outcome, parent-reported executive function, were null, between-group effect sizes on hyperactivity and visuospatial working memory may reflect adaptations to the specific challenges presented by distinct formats. Both groups demonstrated substantial within-group improvements on clinically relevant outcomes. Findings underscore the importance of programmatic features, such as routines, engaging activities, behavior management strategies, and adult attention, and highlight the potential for after-school programs to benefit children with attention deficit hyperactivity disorder and disruptive behavior disorder living in urban poverty where health needs are high and services resources few.
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Affiliation(s)
- Eduardo E. Bustamante
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL
- Georgia Prevention Institute, Medical College of Georgia, Georgia Regents University, Augusta, GA
| | - Catherine L. Davis
- Georgia Prevention Institute, Medical College of Georgia, Georgia Regents University, Augusta, GA
| | - Stacy L. Frazier
- Center for Children and Families, Department of Psychology, Florida International University, Modesto A. Maidique Campus, Miami, FL
| | - Dana Rusch
- Institute for Juvenile Research, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL
| | - Louis F. Fogg
- Department of Community Systems and Mental Health Nursing, College of Nursing, Rush University, Chicago, IL
| | - Marc S. Atkins
- Institute for Juvenile Research, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL
| | - David X. Marquez
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL
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Physical Activity Interventions for Neurocognitive and Academic Performance in Overweight and Obese Youth: A Systematic Review. Pediatr Clin North Am 2016; 63:459-80. [PMID: 27261545 DOI: 10.1016/j.pcl.2016.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This article examines cognitive, academic, and brain outcomes of physical activity in overweight or obese youth, with attention to minority youth who experience health disparities. Physically active academic lessons may have greater immediate cognitive and academic benefits among overweight and obese children than normal-weight children. Quasi-experimental studies testing physical activity programs in overweight and obese youth show promise; a few randomized controlled trials including African Americans show efficacy. Thus, making academic lessons physically active may improve inhibition and attentiveness, particularly in overweight youngsters. Regular physical activity may be efficacious for improving neurologic, cognitive, and achievement outcomes in overweight or obese youth.
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Song M, Lauseng D, Lee S, Nordstrom M, Katch V. Enhanced Physical Activity Improves Selected Outcomes in Children With ADHD: Systematic Review. West J Nurs Res 2016; 38:1155-84. [PMID: 27226208 DOI: 10.1177/0193945916649954] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This review examines associations between physical activity (PA) and cognitive, behavioral, and physiological outcomes in children with attention-deficit/hyperactivity disorder (ADHD). We reviewed studies on participants ≤18 years old, published in English between January 1998 and December 2014, in PubMed, CINAHL, PsycINFO, and Cochrane Reviews. Twenty-six studies were grouped into two categories: those that did and did not account for effects of ADHD medications. The first category showed lower levels of PA and improved cognitive and behavioral outcomes in youth whose ADHD was treated with medications. The second category showed a positive association between PA levels and cognitive and behavioral outcomes in youth whose ADHD was not treated with medications. For both categories of studies, results were inconclusive regarding physiological outcomes. Randomized controlled trials are needed to better clarify the relationship between PA and outcomes in youth with ADHD, and particularly to understand the impact of ADHD medications on that relationship.
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Affiliation(s)
- MinKyoung Song
- University of Michigan, Ann Arbor, USA Oregon Health & Science University, Portland, USA
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Choi JW, Han DH, Kang KD, Jung HY, Renshaw PF. Aerobic exercise and attention deficit hyperactivity disorder: brain research. Med Sci Sports Exerc 2016; 47:33-9. [PMID: 24824770 DOI: 10.1249/mss.0000000000000373] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE As adjuvant therapy for enhancing the effects of stimulants and thereby minimizing medication doses, we hypothesized that aerobic exercise might be an effective adjunctive therapy for enhancing the effects of methylphenidate on the clinical symptoms, cognitive function, and brain activity of adolescents with attention deficit hyperactivity disorder (ADHD). METHODS Thirty-five adolescents with ADHD were randomly assigned to one of two groups in a 1/1 ratio; methylphenidate treatment + 6-wk exercise (sports-ADHD) or methylphenidate treatment + 6-wk education (edu-ADHD). At baseline and after 6 wk of treatment, symptoms of ADHD, cognitive function, and brain activity were evaluated using the Dupaul attention deficit hyperactivity disorder rating scale--Korean version (K-ARS), the Wisconsin Card Sorting Test, and 3-T functional magnetic resonance imaging, respectively. RESULTS The K-ARS total score and perseverative errors in the sports-ADHD group decreased compared with those in the edu-ADHD group. After the 6-wk treatment period, the mean β value of the right frontal lobe in the sports-ADHD group increased compared with that in the edu-ADHD group. The mean β value of the right temporal lobe in the sports-ADHD group decreased. However, the mean β value of the right temporal lobe in the edu-ADHD group did not change. The change in activity within the right prefrontal cortex in all adolescents with ADHD was negatively correlated with the change in K-ARS scores and perseverative errors. CONCLUSIONS The current results indicate that aerobic exercise increased the effectiveness of methylphenidate on clinical symptoms, perseverative errors, and brain activity within the right frontal and temporal cortices in response to the Wisconsin card sorting test stimulation.
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Affiliation(s)
- Jae Won Choi
- 1Department of Sports, Chung-Ang University, Anseong, REPUBLIC OF KOREA; 2Department of Psychiatry, Chung-Ang University Hospital, Seoul, REPUBLIC OF KOREA; and 3Brain Institute, Department of Psychiatry, University of Utah, Salt Lake City, UT
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Cerrillo-Urbina AJ, García-Hermoso A, Sánchez-López M, Pardo-Guijarro MJ, Santos Gómez JL, Martínez-Vizcaíno V. The effects of physical exercise in children with attention deficit hyperactivity disorder: a systematic review and meta-analysis of randomized control trials. Child Care Health Dev 2015; 41:779-88. [PMID: 25988743 DOI: 10.1111/cch.12255] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2015] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis was to examine the evidence for the effectiveness of exercise interventions on attention deficit hyperactivity disorder (ADHD)-related symptoms such as inattention, hyperactivity/impulsivity, anxiety and cognitive functions in children and adolescents. METHOD Five databases covering the period up to November 2014 (PubMed, Scopus, EMBASE, EBSCO [E-journal, CINAHL, SportDiscus] and The Cochrane Library) were searched. Methodological quality was assessed using the Cochrane tool of bias. Standardized mean differences (SMD) and 95% confidence intervals were calculated, and the heterogeneity of the studies was estimated using Cochran's Q-statistic. RESULTS Eight randomized controlled trials (n = 249) satisfied the inclusion criteria. The studies were grouped according to the intervention programme: aerobic and yoga exercise. The meta-analysis suggests that aerobic exercise had a moderate to large effect on core symptoms such as attention (SMD = 0.84), hyperactivity (SMD = 0.56) and impulsivity (SMD = 0.56) and related symptoms such as anxiety (SMD = 0.66), executive function (SMD = 0.58) and social disorders (SMD = 0.59) in children with ADHD. Yoga exercise suggests an improvement in the core symptoms of ADHD. CONCLUSIONS The main cumulative evidence indicates that short-term aerobic exercise, based on several aerobic intervention formats, seems to be effective for mitigating symptoms such as attention, hyperactivity, impulsivity, anxiety, executive function and social disorders in children with ADHD.
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Affiliation(s)
- A J Cerrillo-Urbina
- Social and Health Care Research Center, University of Castilla-La Mancha, Cuenca, Spain
| | | | - M Sánchez-López
- Social and Health Care Research Center, University of Castilla-La Mancha, Cuenca, Spain.,Faculty of Education, University of Castilla-La Mancha, Ciudad Real, Spain
| | - M J Pardo-Guijarro
- Social and Health Care Research Center, University of Castilla-La Mancha, Cuenca, Spain.,Faculty of Education, University of Castilla-La Mancha, Ciudad Real, Spain
| | | | - V Martínez-Vizcaíno
- Social and Health Care Research Center, University of Castilla-La Mancha, Cuenca, Spain
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Jang B, Song J, Kim J, Kim S, Lee J, Shin HY, Kwon JY, Kim YH, Joung YS. Equine-Assisted Activities and Therapy for Treating Children with Attention-Deficit/Hyperactivity Disorder. J Altern Complement Med 2015; 21:546-53. [PMID: 26167851 DOI: 10.1089/acm.2015.0067] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate clinical effects of equine-assisted activities and therapy (EAA/T) for treating attention-deficit/hyperactivity disorder (ADHD) in children age 6-13 years. METHODS This 12-week, prospective, open-label trial included 24 sessions of EAA/T. Twenty participants (19 boys and 1 girl) completed 12 weeks of EAA/T. Various clinical tests were administered at baseline and after EAA/T. Assessments included the investigator-administered ADHD-Rating Scale (ARS-I), Clinical Global Impressions (CGI)-Severity Scale, Clinical Global Impressions-Improvement Scale (CGI-I), Gordon Diagnostic System, Korea-Child Behavior Checklist (K-CBCL), Self-Esteem Scale, second edition of the Bruininks-Oseretsky test of motor proficiency (BOT-2), and quantitative electroencephalography. The primary efficacy measure was the response rate. RESULTS The response rate was 90% based on a 30% or greater decline in the ARS-I score or 85% based on CGI-I scores of 1 or 2. The mean±standard deviation ARS-I score decreased from 33.65±6.42 at baseline to 16.80±6.86 after 12 weeks of EAA/T (p<0.001, paired t-test). EAA/T also resulted in significant improvement in the social problems subscale of the K-CBCL and in the manual dexterity, bilateral coordination, and total motor composite subscales of the BOT-2. The theta/beta ratio on electroencephalography was decreased significantly at the Pz electrode after 12 weeks of EAA/T. CONCLUSION This is the first study demonstrating that EAA/T is effective for improving core ADHD symptoms. On the basis of these results, EAA/T could be a viable treatment strategy as a part of a multimodal therapy for children with ADHD.
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Affiliation(s)
| | - Jihye Song
- 1 Hae-sol Psychiatric Clinic , Seoul, Korea
| | - Jiwon Kim
- 2 Samsung Biomedical Research Institute , Seoul, Korea
| | - Seonwoo Kim
- 2 Samsung Biomedical Research Institute , Seoul, Korea
| | - Jiyoung Lee
- 3 Samsung RD Center , Samsung Equestrian Team, Gunpo-si, Gyeonggi-do, Korea
| | - Hye-Yeon Shin
- 3 Samsung RD Center , Samsung Equestrian Team, Gunpo-si, Gyeonggi-do, Korea
| | - Jeong-Yi Kwon
- 4 Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Yun-Hee Kim
- 4 Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Yoo-Sook Joung
- 5 Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
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Rommel AS, Lichtenstein P, Rydell M, Kuja-Halkola R, Asherson P, Kuntsi J, Larsson H. Is Physical Activity Causally Associated With Symptoms of Attention-Deficit/Hyperactivity Disorder? J Am Acad Child Adolesc Psychiatry 2015; 54:565-70. [PMID: 26088661 PMCID: PMC4984951 DOI: 10.1016/j.jaac.2015.04.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 04/15/2015] [Accepted: 05/01/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Emerging evidence suggests that physical activity (PA) enhances cognition and may be a protective factor for attention-deficit/hyperactivity disorder (ADHD). Yet the impact of PA on ADHD symptoms has been investigated only in a few undersized, nonrandomized, and retrospective studies. We examined the effect of PA during late adolescence on ADHD symptoms in early adulthood while controlling for unmeasured genetic and shared environmental confounding. METHOD The effect of PA at age 16 to 17 years (baseline) on ADHD symptoms at age 19 to 20 years (follow-up) was examined using a within-monozygotic (MZ) twins fixed-effects model in 232 MZ twin pairs born in Sweden between May 1985 and December 1986. Parents rated their children's DSM ADHD symptoms at baseline and follow-up. Participants' weekly energy expenditure (in metabolic equivalent task minutes per week) was based on self-reports at baseline of PA frequency, intensity, and duration. RESULTS Greater weekly energy expenditure in adolescence was significantly associated with reduced ADHD symptom levels in early adulthood, even when controlling for unmeasured confounding (all genetic and environmental factors shared within MZ twin pairs) as well as ADHD symptoms and body mass index (BMI) at baseline, β = -0.21, p = .013 (95% CI = -0.38 to -0.05). Similar results were observed for the 2 ADHD subcomponents: hyperactivity/impulsivity, β = -0.21, p = .022 (95% CI = -0.39 to -0.03), and inattention, β = -0.19, p = .049 (95% CI = -0.36 to -0.0005). CONCLUSION In line with a causal hypothesis, PA was inversely associated with ADHD symptoms, even after adjusting for unmeasured confounding. These findings suggest that PA in adolescence might decrease ADHD symptoms in early adulthood. However, given the size of the effect, the clinical value of this intervention needs to be explored further.
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Affiliation(s)
- Anna-Sophie Rommel
- Medical Research Council Social, Genetic and Developmental Psychiatry Centre, at the Institute of Psychiatry, Psychology and Neuroscience, King's College London.
| | | | | | | | - Philip Asherson
- Medical Research Council Social, Genetic and Developmental Psychiatry Centre, at the Institute of Psychiatry, Psychology and Neuroscience, King's College London
| | - Jonna Kuntsi
- Medical Research Council Social, Genetic and Developmental Psychiatry Centre, at the Institute of Psychiatry, Psychology and Neuroscience, King's College London
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Halperin JM, Berwid OG, O'Neill S. Healthy body, healthy mind?: the effectiveness of physical activity to treat ADHD in children. Child Adolesc Psychiatr Clin N Am 2014; 23:899-936. [PMID: 25220093 DOI: 10.1016/j.chc.2014.05.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Data from animal studies provide convincing evidence that physical exercise enhances brain development and neurobehavioral functioning in areas believed to be impaired in children with attention-deficit/hyperactivity disorder (ADHD). To a lesser but still compelling extent, results from studies in typically developing children and adults indicate beneficial effects of exercise on many of the neurocognitive functions that have been shown to be impaired in children with ADHD. Together, these data provide a strong rationale for why a program of structured physical exercise might serve as an effective intervention for children with ADHD.
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Affiliation(s)
- Jeffrey M Halperin
- Psychology Department, Queens College, The City University of New York (CUNY), 65-30 Kissena Boulevard, Flushing, NY 11367, USA.
| | - Olga G Berwid
- York College, The City University of New York (CUNY), 94-20 Guy R. Brewer Boulevard, Jamaica, NY 11451, USA
| | - Sarah O'Neill
- Psychology Department, The City College, The City University of New York (CUNY), 160 Convent Avenue, New York, NY 10031, USA
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Berger NAA, Müller A, Brähler E, Philipsen A, de Zwaan M. Association of symptoms of attention-deficit/hyperactivity disorder with symptoms of excessive exercising in an adult general population sample. BMC Psychiatry 2014; 14:250. [PMID: 25214027 PMCID: PMC4172949 DOI: 10.1186/s12888-014-0250-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 08/26/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND An increasing number of studies suggest that physical activity can alleviate symptoms of ADHD in children. In adults there are currently insufficient data available on this subject. Interestingly, ADHD and forms of excessive exercising have both been shown to occur more frequently in adult athletes. The aim of the present study was to empirically investigate the association of ADHD and excessive exercising in the adult general population. METHODS For diagnosis of adult and childhood ADHD a large representative sample of the German general population (n = 1,615) completed a retrospective assessment of childhood ADHD and a self-report assessment of adult ADHD. Excessive exercising as well as putative mediating variables such as eating related psychopathology, depression, and anxiety were assessed using standardized self-rating instruments. RESULTS Individuals with childhood only ADHD had a significantly higher frequency of excessive exercising (9.0%) than individuals without ADHD (2.7%). Excessive exercising was significantly associated with childhood only ADHD compared to no ADHD with an odds ratio of 3.239 even after controlling for socio-demographic variables, BMI, eating related and general psychopathology. CONCLUSIONS Our data show that excessive exercising is significantly overrepresented in individuals in which ADHD symptoms in childhood have not persisted into adulthood. We thus hypothesize that a subgroup of individuals might suppress ADHD symptoms by excessive sporting activities. Although in healthy adults physical activity has been associated with immediate and long term improvements in cognitive functioning, studies empirically investigating associations between the effects of physical activity and adult ADHD are rare. Further studies are warranted to explore the potential role of physical activity in the treatment of ADHD in adults.
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Affiliation(s)
- Nikolas AA Berger
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Astrid Müller
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Elmar Brähler
- Department of Medical Psychology and Medical Sociology, University of Leipzig Medical Center, Leipzig, Germany ,Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
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Kamp CF, Sperlich B, Holmberg HC. Exercise reduces the symptoms of attention-deficit/hyperactivity disorder and improves social behaviour, motor skills, strength and neuropsychological parameters. Acta Paediatr 2014; 103:709-14. [PMID: 24612421 DOI: 10.1111/apa.12628] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 12/11/2013] [Accepted: 03/05/2014] [Indexed: 11/30/2022]
Abstract
UNLABELLED This review summarises research studies on the impact and beneficial effects of different types of exercise on childhood attention-deficit/hyperactivity disorder (ADHD) and provides recommendations for the scientific and therapeutic communities. CONCLUSION Although the design and the exercise interventions featured in these studies varied considerably, all showed that exercise reduced the symptoms of ADHD and led to improvements in social behaviour, motor skills, strength and neuropsychological parameters.
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Affiliation(s)
- Carolin Friederike Kamp
- Department of Child and Adolescent Psychiatry and Psychotherapy; University of Cologne; Cologne Germany
| | - Billy Sperlich
- Department of Sport Science; University of Würzburg; Würzburg Germany
| | - Hans-Christer Holmberg
- Department of Health Sciences; Swedish Winter Sports Research Centre; Mid Sweden University; Östersund Sweden
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Kim SH, Han DH, Lee YS, Kim BN, Cheong JH, Han SH. Baduk (the Game of Go) Improved Cognitive Function and Brain Activity in Children with Attention Deficit Hyperactivity Disorder. Psychiatry Investig 2014; 11:143-51. [PMID: 24843369 PMCID: PMC4023088 DOI: 10.4306/pi.2014.11.2.143] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 08/30/2013] [Accepted: 09/02/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Attention deficit hyperactivity disorder (ADHD) symptoms are associated with the deficit in executive functions. Playing Go involves many aspect of cognitive function and we hypothesized that it would be effective for children with ADHD. METHODS Seventeen drug naïve children with ADHD and seventeen age and sex matched comparison subjects were participated. Participants played Go under the instructor's education for 2 hours/day, 5 days/week. Before and at the end of Go period, clinical symptoms, cognitive functions, and brain EEG were assessed with Dupaul's ADHD scale (ARS), Child depression inventory (CDI), digit span, the Children's Color Trails Test (CCTT), and 8-channel QEEG system (LXE3208, Laxtha Inc., Daejeon, Korea). RESULTS There were significant improvements of ARS total score (z=2.93, p<0.01) and inattentive score (z=2.94, p<0.01) in children with ADHD. However, there was no significant change in hyperactivity score (z=1.33, p=0.18). There were improvement of digit total score (z=2.60, p<0.01; z=2.06, p=0.03), digit forward score (z=2.21, p=0.02; z=2.02, p=0.04) in both ADHD and healthy comparisons. In addition, ADHD children showed decreased time of CCTT-2 (z=2.21, p=0.03). The change of theta/beta right of prefrontal cortex during 16 weeks was greater in children with ADHD than in healthy comparisons (F=4.45, p=0.04). The change of right theta/beta in prefrontal cortex has a positive correlation with ARS-inattention score in children with ADHD (r=0.44, p=0.03). CONCLUSION We suggest that playing Go would be effective for children with ADHD by activating hypoarousal prefrontal function and enhancing executive function.
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Affiliation(s)
- Se Hee Kim
- Department of Psychiatry, YongSang Andong Hospital, Andong, Republic of Korea
| | - Doug Hyun Han
- Department of Psychiatry, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Young Sik Lee
- Department of Psychiatry, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Bung-Nyun Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Hoon Cheong
- Uimyung Research Institute for Neuroscience, Samyook University, Seoul, Republic of Korea
| | - Sang Ho Han
- Laxtha Incorporated, Daejeon, Republic of Korea
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Lehnert K. Der Einfluss von Sport auf kognitive Funktionen bei Kindern mit ADHS. ZEITSCHRIFT FUR SPORTPSYCHOLOGIE 2014. [DOI: 10.1026/1612-5010/a000124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Der positive Einfluss sportlicher Aktivitäten auf kognitive und exekutive Funktionen (EF) wurde mittlerweile vielfach aufgezeigt. EF stellen zugleich ein zentrales Defizit bei ADHS dar, weshalb betroffene Kinder und Jugendliche im Besonderen von sportlichen Aktivitäten profitieren könnten. Dieser Überblicksbeitrag verfolgt das Ziel, den aktuellen Forschungsstand zum Einfluss von sportlichen Aktivitäten auf Kognitionen allgemein und im Besonderen auf EF für Kinder und Jugendliche mit ADHS aufzuzeigen sowie auf einer theoretisch-konzeptionellen Ebene Erklärungsansätze zu liefern. Es wird deutlich, dass eine heterogene Befundlage vorliegt, die unter anderem mit einer zu geringen Differenzierung der sportlichen Aktivitäten begründet wird. Interessante sportspezifische Erklärungen stammen aus der aktuellen Kognitionsforschung an gesunden Kindern und Jugendlichen, wo eine physiologische und/oder kognitive Aktivierung durch sportliche Aktivitäten diskutiert wird. Die gewonnenen Erkenntnisse fließen in ein Rahmenmodell von Tomporowski, Lambourne und Okumura (2011) ein, welches für den Anwendungsbereich von ADHS adaptiert wurde, und wo bereits identifizierte Mediatoren und Moderatoren im Sport-Kognitions-Zusammenhang beinhaltet sind.
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Rommel AS, Halperin JM, Mill J, Asherson P, Kuntsi J. Protection from genetic diathesis in attention-deficit/hyperactivity disorder: possible complementary roles of exercise. J Am Acad Child Adolesc Psychiatry 2013; 52:900-10. [PMID: 23972692 PMCID: PMC4257065 DOI: 10.1016/j.jaac.2013.05.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 04/23/2013] [Accepted: 06/07/2013] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The degree of functional impairment and adverse developmental outcomes in individuals with attention-deficit/hyperactivity disorder (ADHD) likely reflect interplay between genes and environment. To establish whether physical exercise might reduce the level of ADHD symptoms or ADHD-related impairments, we conducted a comprehensive review of the effect of exercise in children with ADHD. Findings on the impact of exercise in animals and typically developing human beings, and an overview of putative mechanisms involved, are also presented to provide the context in which to understand this review. METHOD The electronic databases PubMed, OVID, and Web of Knowledge were searched for all studies investigating the effect of exercise in children and adolescents with ADHD, as well as animal models of ADHD behaviors (available in January 2013). Of 2,150 initially identified records, 16 were included. RESULTS Animal studies indicate that exercise, especially early in development, may be beneficial for ADHD symptom reduction. The limited research investigating the effect of exercise in children and adolescents with ADHD suggests that exercise may improve executive functioning and behavioral symptoms associated with ADHD. Although animal research suggests that brain-derived neurotrophic factor (BDNF) and catecholamines (CAs) play a role in mediating these effects, the association between BDNF and ADHD remains unclear in human beings. CONCLUSIONS The potential protective qualities of exercise with regard to reducing symptoms and impairments commonly associated with ADHD may hold promise for the future. Further research is needed to firmly establish whether there are clinically significant effects of exercise on the severity of ADHD symptoms, impairments, and associated developmental outcomes.
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Affiliation(s)
- Anna-Sophie Rommel
- Medical Research Council Social, Genetic and Developmental Psychiatry Centre, the Institute of Psychiatry, King's College London.
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Yazdani S, Yee CT, Chung PJ. Factors predicting physical activity among children with special needs. Prev Chronic Dis 2013; 10:E119. [PMID: 23866163 PMCID: PMC3716337 DOI: 10.5888/pcd10.120283] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Introduction Obesity is especially prevalent among children with special needs. Both lack of physical activity and unhealthful eating are major contributing factors. The objective of our study was to investigate barriers to physical activity among these children. Methods We surveyed parents of the 171 children attending Vista Del Mar School in Los Angeles, a nonprofit school serving a socioeconomically diverse group of children with special needs from kindergarten through 12th grade. Parents were asked about their child’s and their own physical activity habits, barriers to their child’s exercise, and demographics. The response rate was 67%. Multivariate logistic regression was used to examine predictors of children being physically active at least 3 hours per week. Results Parents reported that 45% of the children were diagnosed with attention deficit hyperactivity disorder, 38% with autism, and 34% with learning disabilities; 47% of children and 56% of parents were physically active less than 3 hours per week. The top barriers to physical activity were reported as child’s lack of interest (43%), lack of developmentally appropriate programs (33%), too many behavioral problems (32%), and parents’ lack of time (29%). However, child’s lack of interest was the only parent-reported barrier independently associated with children’s physical activity. Meanwhile, children whose parents were physically active at least 3 hours per week were 4.2 times as likely to be physically active as children whose parents were less physically active (P = .01). Conclusion In this group of students with special needs, children’s physical activity was strongly associated with parental physical activity; parent-reported barriers may have had less direct effect. Further studies should examine the importance of parental physical activity among children with special needs.
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Affiliation(s)
- Shahram Yazdani
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095-1752, USA.
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