Integrated cognitive-motor exercise for core symptoms and executive functions in children with attention deficit hyperactivity disorder: a randomized clinical trial.

Abstract

Background: Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder. While physical exercise is a promising non-pharmacological intervention, the efficacy of integrating cognitive demands with physical activity remains underexplored. This trial compared the effects of integrated cognitive-motor exercise, aerobic exercise, and a minimal intervention on core symptoms and executive functions (EFs) in children with ADHD.

Methods: In this randomized, controlled, multicenter trial, 107 children with ADHD (aged 6-10 years) were allocated to one of three groups for 12 weeks: (1) integrated cognitive-motor exercise (EG1, n = 36); (2) aerobic exercise (EG2, n = 35); or (3) wait-list control (CG, n = 36). Both EG1 and EG2 performed their respective interventions three times per week in 45-minute sessions. The primary outcomes were inattention and hyperactivity-impulsivity symptoms and EFs (inhibitory control, working memory, and cognitive flexibility). The analysis followed the intention-to-treat principle with linear mixed models.

Results: Compared with the CG, both exercise groups presented significant, comparable reductions in inattention and hyperactivity-impulsivity symptoms (all P ≤ 0.01). However, EG1 demonstrated superior improvements in specific EFs. For inhibitory control (Stroop color-word interference), EG1 resulted in a significantly greater reduction in color-word interference time than both EG2 [β = - 6.24, 95% confidence interval (CI) = - 12.28 to - 0.20, P = 0.045] and CG (β = - 13.97, 95% CI = - 19.97 to - 7.97, P < 0.001). For immediate working memory, the improvement in EG1 was greater than that in both EG2 (β = 2.09, 95% CI = 0.33-3.85, P = 0.032) and CG (β = 3.57, 95% CI = 1.83-5.31, P < 0.001). Both exercise groups improved similarly in cognitive flexibility compared with the CG. Parental satisfaction was significantly greater in EG1 than in EG2 (P < 0.001). No adverse events were reported.

Conclusions: A structured integrated cognitive-motor exercise intervention is an effective and safe non-pharmacological treatment for children with ADHD. Compared with aerobic exercise alone, it not only alleviates core symptoms but also yields superior benefits for key EFs, specifically inhibitory control and immediate working memory.