Is Aerobic Physical Activity a Viable Management Strategy for ADHD

Abstract

For the past couple decades, the recommended evidence-based treatments for attention-deficit/hyperactivity disorder (ADHD) have remained largely consistent: medication, behavior therapy, and their combination (American Academy of Pediatrics’ Subcommittee on ADHD, Steering Committee on Quality Improvement and Management, 2011; MTA Cooperative Group, 1999). Although important new pharmaceutical preparations have emerged, as well as variations on behavioral intervention strategies, the basic approach to treating the disorder has remained largely the same. Yet, medication is considered unpalatable or unworkable (e.g., due to side effects) for some families (Halperin & Healey, 2011) and behavior therapy is considered cumbersome to others (Benner-Davis & Heaton, 2007). Further, with both treatments, as well as their combination, symptoms generally return upon treatment cessation (Jensen et al., 2007). In the past decade, our understanding of the life course of the disorder has advanced, making clear that in a majority of cases, impairment associated with ADHD persists into adulthood (Barkley, Fischer, Smallish, & Fletcher, 2002; Biederman, Petty, Clarke, Lomedico, & Faraone, 2011; Hinshaw et al., 2012). Given the chronic nature of ADHD, sustainable lifestyle changes should be explored that enable a proactive, chronic approach to its treatment, much like the approach taken to manage chronic medical disorders (Hoza et al., 2014) such as heart disease. One relatively unexplored approach to managing ADHD symptoms over the long term is the use of chronic aerobic physical activity (PA). To our knowledge, only one large-scale randomized clinical trial has applied aerobic PA to management of ADHD symptoms and impairments in young children (Hoza, et al., 2014), and we are unaware of any well-controlled randomized trials applying aerobic PA to older children or adolescents with ADHD. A handful of smaller sample studies, however, are present in the literature. Although forms of PA and methods of measuring outcomes vary widely across these extant studies, the emerging message from this small body of work is that PA may be a promising strategy for managing ADHD symptoms and impairments both in the short and long term (see Berwid & Halperin, 2012, and Halperin, Berwid, & O’Neill, 2014, for reviews).