Paola Teresa Penagos Gómez*

paola.penagos@anahuac.mx

Cyndi Yacira Meneses Castaño**

cyndi.meneses@ecr.edu.co

Karen Montserrat León Laredo+

karen.leon@anahuac.mx

Ana Paula Bernal Salazar+

paula.bernal@anahuac.mx

Tali Bianca Soltak Goldberg+

tali.soltakgo@anahuac.mx

*Fisioterapeuta, Especialista en Docencia Universitaria

Mg. Desarrollo Infantil

Mg. en Actividad Física, Entrenamiento y Gestión Deportiva

Doctoranda en Bioética aplicada

Docente Licenciaturas de fisioterapia y medicina

Universidad Anáhuac Norte

Docente licenciatura de fisioterapia

Universidad Nacional Autónoma de México (UNAM)

**Fisioterapeuta, Especialista y Magister en Neurorrehabilitación

Doctora en Educación y Sociedad

Docente y Directora del Grupo de Investigación Capacidades Humanas, Salud

e Inclusión de la Escuela Colombiana de Rehabilitación.

+Estudiante de fisioterapia. Universidad Anáhuac Norte, CDMX

(México)

Reception: 07/15/2024 - Acceptance: 04/03/2025

1st Review: 03/17/2025 - 2nd Review: 03/31/2025

Accessible document. Law N° 26.653. WCAG 2.0

Suggested reference: Penagos Gómez, P.T., Meneses Castaño, C.Y., León Laredo, K.M., Bernal Salazar, A.P., & Soltak Goldberg, T.B. (2025). Effect of Physical Activity on Cognitive Functions in Children with Attention Deficit Hyperactivity Disorder. A Systematic Review. Lecturas: Educación Física y Deportes, 30(325), 218-242. https://doi.org/10.46642/efd.v30i325.7780

 

Abstract

    Children and adolescents with attention deficit hyperactivity disorder (ADHD) often experience difficulties in the development of executive functions, which may persist into adulthood. The purpose of this study is to analyze and synthesize scientific literature on the effect of physical activity on children and adolescents with ADHD. A systematic review followed PRISMA guidelines, searching PubMed and Scopus from 2015 to 2024 without gender or language restrictions. A total of 231 studies were identified, of which 18 met the selection criteria. Data analysis was performed using descriptive statistics. Results showed that 55.5% of studies were conducted in Europe, and the highest % of publications occurred in 2022 at 33.3%. Evidence supported aerobic physical activity, specific sports, and physical activity mediated by apps and electronic devices. Studies indicated that an average of 15 to 20 minutes of daily intervention over 12 weeks could improve working memory, visuospatial memory, self-regulation, planning, and anticipation. In conclusion, physical activity contributes to the development and maintenance of executive functions.

    Keywords: Physical activity. Child. Adolescent. Attention deficit hyperactivity disorder.

 

Abstract

    Los niños y adolescentes con trastorno por déficit de atención e hiperactividad (TDAH) suelen presentar dificultades en el desarrollo de funciones ejecutivas, que pueden persistir en la edad adulta. El objetivo de este análisis sistemático es analizar y sintetizar la literatura científica sobre el efecto de la actividad física en niños y adolescentes con TDAH. Se propuso una revisión sistemática de acuerdo con consideraciones PRISMA, la búsqueda se realizó en Pubmed y Scopus, en una ventana de observación entre el 2015 y 2024 sin restricciones de género ni idioma. Se encontraron 231 estudios y 18 cumplieron con criterios de selección. El análisis de información se efectuó con estadística descriptiva. Los resultados demostraron que el 55,5% de los estudios se reportaron en Europa y que el mayor número de publicaciones se registró en el año 2022 con un 33,3%. Se encontró evidencia para actividad física aeróbica, deportes específicos y actividad física mediada por aplicaciones y dispositivos electrónicos. Los estudios señalan, que un promedio de intervenciones entre 15 y 20 minutos diarios por 12 semanas, pueden tener generar una mejora en la memoria de trabajo, memoria visoespacial, autorregulación, planeación y anticipación. En conclusión, la actividad física contribuye al desarrollo y mantenimiento de las funciones ejecutivas.

    Palabras clave: Actividad física. Niño. Adolescente. Trastorno de déficit de atención con hiperactividad.

 

Resumo

    As crianças e adolescentes com transtorno de défice de atenção com hiperatividade (TDAH) apresentam frequentemente dificuldades no desenvolvimento das funções executivas, que podem persistir na idade adulta. O objetivo desta revisão sistemática foi analisar e sintetizar a literatura científica sobre os efeitos da atividade física em crianças e adolescentes com TDAH. Foi proposta uma revisão sistemática de acordo com as considerações PRISMA. A pesquisa foi realizada no PubMed e Scopus, com janela de observação entre 2015 e 2024, sem restrições de género ou idioma. Foram encontrados um total de 231 estudos, e 18 cumpriram os critérios de seleção. A análise dos dados foi realizada através de estatística descritiva. Os resultados mostraram que 55,5% dos estudos foram reportados na Europa e que o maior número de publicações ocorreu em 2022, com 33,3%. Foram encontradas evidências para a atividade física aeróbica, desportos específicos e atividade física mediada por aplicações e dispositivos eletrônicos. Estudos indicam que uma média de 15 a 20 minutos de intervenção por dia, durante 12 semanas, pode levar a melhorias na memória de trabalho, memória visoespacial, autorregulação, planeamento e antecipação. Em conclusão, a atividade física contribui para o desenvolvimento e manutenção das funções executivas.

    Unitermos: Atividade física. Criança. Adolescente. Transtorno de déficit de atenção com hiperatividade.

 

Lecturas: Educación Física y Deportes, Vol. 30, Núm. 325, Jun. (2025)

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Introduction 

 

    ADHD, also known as attention deficit hyperactivity disorder, has been described in the literature for 250 years, appearing in medical textbooks by authors such as Weikard in 1775 and later by Crichton in 1798, who were the first to describe it. It is currently recognized as a neurodevelopmental disorder characterized by complex symptoms, including core symptoms and functional impairment. Its diagnosis is common in children, yet these symptoms often persist into adulthood. (Christiansen et al., 2019)

 

    Approximately 129 million children and adolescents worldwide aged 5 to 19 years are affected by ADHD. In the United States, males are more likely to receive an ADHD diagnosis than females (Wirth, 2023). Global prevalence among children and adolescents ranges from 5% to 10%. Recent findings indicate that 57% of diagnosed cases persist into adulthood. (Antshel, & Barkley, 2020)

 

    Attention Deficit Hyperactivity Disorder (ADHD) is a neurobiological condition affecting a significant number of children, characterized by difficulties in attention, impulse control, and motor activity regulation. ADHD is subdivided into three levels of severity: mild, moderate, and severe, which allows for the adaptation of interventions and treatment strategies based on the intensity of the symptoms presented (American Psychiatric Association, 2013). Additionally, ADHD is classified into three types, according to the predominance of symptoms: the inattentive type, the hyperactive-impulsive type, or the combined type, in which both attentional and behavioral difficulties are present (American Psychiatric Association, 2013). These differences in the clinical presentation of ADHD are crucial for proper evaluation and the design of personalized therapeutic strategies that support the development and well-being of affected children.

 

    The etiology of ADHD has been extensively studied and is attributed to a combination of genetic and environmental factors, influencing behaviors such as violent and impulsive behaviors (Raman, & Man, 2020). There is significant heterogeneity in the etiological factors of ADHD; children with this condition often exhibit genetic variants interacting with prenatal and postnatal risk factors, resulting in neurological imbalances (Luo et al., 2020). Additionally, ADHD is associated with various medical and psychiatric conditions. For instance, a significant relationship has been documented between ADHD, overweight, and obesity, impacting post-meal sleep disturbances and reward pathways related to attention and impulsivity. (Sanchez et al., 2015)

 

    Symptoms are typically characterized by anomalies in concentration, stability, and selectivity of attention. Hyperactivity/impulsivity is another critical symptom, manifesting as significantly higher activity levels compared to typically developing children, often resulting in difficulties maintaining prolonged seated positions or orderly behaviors.

 

    Children with ADHD often exhibit deficits in executive functions, including planning, organization, problem-solving, management, inhibitory control, working memory, and cognitive flexibility; motor skill impairments may also accompany these deficits.

 

    Comorbidity, or the presence of additional psychiatric disorders, is common among children and adolescents with ADHD, with studies showing comorbidity rates between 70% and 80%. The most frequent comorbidities include disruptive disorders such as oppositional defiant disorder (ODD) or conduct disorder (CD). In ADHD, common additional conditions include depression, low self-esteem, or periods of decreased mood. Less common are motor tics, Tourette syndrome, sleep disturbances, or obsessive-compulsive disorder.

 

    These comorbidities may persist into adulthood, underscoring the need for intervention strategies that mitigate core symptoms, reduce comorbidities, facilitate effective participation in daily activities, and support successful transition to adulthood by fostering necessary executive functioning skills. (Martínez et al., 2024)

 

    Physical activity, as described in the literature, refers to any bodily movement produced by skeletal muscles that increases energy expenditure (Caspersen, Powell, & Christenson, 1985). It is important to distinguish it from "physical exercise," which refers to structured and planned activities undertaken with the purpose of improving physical fitness (Caspersen et al., 1985). Additionally, "sports training" is considered a specific process aimed at developing skills and physical abilities directed towards enhancing performance in a particular sport. (Bompa, & Haff, 2009)

 

    Physical activity has been shown to be beneficial in improving executive functions in children and adolescents who have attention deficit hyperactivity disorder (ADHD) (Zhu et al., 2023). Studies indicate that physical exercise sessions lasting between 20 to 30 minutes can positively impact processing speed, working memory, planning, and problem-solving. Despite this, more research is needed to fully understand how physical activity can be effectively applied as an intervention. Although the results obtained so far are encouraging, particularly in terms of improving attention and inhibitory control, it is crucial to develop studies that provide clear guides, and evidence-based guidelines that can be used by families, therapists, and physical educators.

 

    In this context, the purpose of this systematic review, is to analyze and summarize the available scientific literature on the effect of physical activity on the cognitive function of children with attention deficit hyperactivity disorder (ADHD). The results are expected to guide the use and applicability of physical activity in clinical, educational, sports, and recreational settings, supported by solid data and reliable practices.

 

Method 

 

    A systematic literature review was conducted following the parameters of the PRISMA 2020 declaration (The Preferred Reporting Items for Systematic Reviews and Meta-Analyses). (Page et al., 2021)

 

Research strategy 

 

    The review was conducted using interdisciplinary databases such as Pubmed and Scopus within an observation window between 2015 and 2024, without restriction on gender or language. The PICO question was formulated, and the search terms were established through DeCS (Health Sciences Descriptors) and MeSH (Medical Subject Headings), establishing the following keywords: “Physical activity”, “cognitive function”, “Attention Deficit Hyperactivity Disorder”, forming combinations in English with boolean connectors AND and OR.

 

    The process was carried out in three phases. The initial search yielded a total of 231 articles. In the first phase of analysis, 181 were eliminated based on title and abstract, and 5 were removed due to duplication. In the second phase, 45 articles were selected for full-text review. The final phase involved evaluating the methodological quality, level of evidence, and degree of recommendation. After this rigorous screening process, 18 manuscripts were included in the final analysis (Figure 1).

 

Selection criteria 

 

    Types of studies and methodological assessment 

 

    Randomized controlled trials (RCTs) and observational studies were included. Methodological quality was assessed using the PEDro scale (https://www.pedro.org.au), with a minimum score of 6, and evidence level "I" with a recommendation grade of "A" using the classification proposed by the Centre for Evidence-Based Medicine at Oxford (CEBM, 2016), without language restrictions (Table 1).

 

    Characteristics of participants and interventions 

 

    Participants needed to be within the age ranges of childhood and adolescence, with a diagnosis of attention deficit hyperactivity disorder, without gender restrictions.

 

    Analysis and data extraction 

 

    From the included manuscripts, the following were analyzed

1. Year of publication, country of origin, participants, and study type (Table 2).

2. Study objectives, variables, assessment instruments, and main results (Table 3).

    Descriptive statistics were used for data analysis, describing the total number of patients, the total number of studies by country and year, and the results of each study.

 

Source: Own development

 

Results 

 

    Of the analyzed studies, 18 met the inclusion criteria. The characteristics of the included studies are as follows: regarding the geographical origin, 55.51% of the studies were conducted in Europe (Switzerland, Spain, Germany), 27.7% in Asia (Iraq, Iran, Japan, China and Taiwan), and 16.67% in North America (USA). In terms of the years the studies were conducted, 33.3% were conducted in 2022, 22.2% in 2015, 11.11% in 2016, 11.11% in 2017, 11.11% in 2018, 5.5% in 2020, and 5.5% in 2021. (Table 2).

 

Authors	Years	Country	Participants	Study type
Benzing et al. (2017)	2017	Switzerland	66 children with ADHD. Age range: 8 to 12 years Using the XBOX Kinect. 3 times a week for at least 30 minutes for 8 weeks.	Randomized clinical trial
Bustamante et al. (2017)	2017	EE.UU.	35 children with ADHD Age range: 6 to 12 years. 2 groups: 1 with exercise and the other one with a control program for 10 weeks.	Randomized controlled trial
Ludyga et al. (2023)	2023	Switzerland	120 children with ADHD Age range: 8 to 14 years. Sessions for 60 min judo, twice a week over 12 weeks.	Randomized controlled trials
Ludyga et al. (2022)	2022	Switzerland	57 children with ADHD. Age range: 8 to 12 years in judo training. Sessions of 120 minutes per week over 3 months.	Randomized controlled trial
Memar Moghaddam et al. (2016)	2016	Irán	40 male students are suspected of having ADHD. Age range: 7 to 11 years. Experimental group: exercise program for 24 Sessions, 90 minutes per. Control group: did not receive any intervention.	Randomized controlled trial
Pan et al. (2016)	2016	Taiwan	32 boys with ADHD. Age range: 6 to 12 years. In the first 12-week phase, 16 boys received the intervention and 16 boys didn't. The second 12-week phase followed the treatments reversed.	Randomized controlled trial
Wronska et al. (2015)	2015	Spain	2 boys and 4 girls, aged between 8 and 12 years old. Consists of 9 serious games that include 3 stages.	Randomized controlled trial
Ziereis et al. (2015)	2015	Germany	43 children (32 boys and 11 girls) Age range: 7 to 12 years. 3 groups for a 12-week training program. Group 1: abilities ball handling, balance, and manual dexterity. Group 2: sports and Group 3: no intervention.	Randomized controlled trial
Benzing et al. (2018)	2018	Taiwan, Switzerland	51 participants between the ages of 8 and 12 years with ADHD. Two groups: exergaming (“Shape up “- XBOX Kinect) and control group (Watch a documentary about mountain running). 15 minutes with a short break of 1 minute.	Randomized controlled trial
Hattabi et al. (2022)	2022	Switzerland	40 children aged from 9 to 12 years. The swimming sessions duration was 12 weeks with 3 sessions per week. Each session lasted 90 minutes and was divided into 3 stages (warm-up, aquatic exercises, and cool-down)	Randomized controlled trial
Huang et al. (2015)	2015	Taiwan	28 children including 23 boys and 5 girls with an ADHD diagnosis. Age range: 8 to 10 years. The fitness assessment includes flexibility, muscular endurance, power, and agility.	Exploratory study
Liang et al. (2022)	2022	China	56 Children aged 6-12 years old diagnosed with ADHD. Participants were instructed to complete three computer-based EF tasks and self-reported questionnaires.	Randomized controlled trial
Ludyga et al. (2018)	2018	Switzerland, Iran	18 children with ADHD and 18 children with healthy peers. Age range: 11 to 16 years. 20 minutes of aerobic exercise (20 minutes cycling, moderate intensity) and a physically inactive control condition (seated, 20 minutes watching a documentary of exercise behavior).	Randomized controlled trial
Ludyga et al. (2022)	2022	Switzerland, Japan	4576 children aged 9-10 years with ADHD and neurotypical peers. Completed flanker tasks, anthropometric assessments, and reported physical activity.	Observational study
Munz et al. (2022)	2022	Germany	12 male children diagnosed with ADHD and 12 typically developing boys. Age range: 9 to 11 years. Participated in an exercise and rest condition before a night in the sleep laboratory.	Randomized controlled trial
Nejati et al. (2021)	2021	Iran	30 children. Age range: 9 to 11 years. The experimental group (received EXCEL) and the active control group (received an aerobic exercise program without cognitive load, running). 10-12 sessions and were assessed in 3 sessions, 1 month followed up.	Randomized controlled trial
Pepmeier et al. (2015)	2015	EE.UU.	32 adolescents: 14 with ADHD and 18 non-ADHD. First day: 30 min aerobic exercise (cycling). Second day: watched a 30-minute nature documentary.	Randomized controlled trial
Sun et al. (2022)	2022	China	42 children with ADHD from local schools. Age range: 6-13 years. 8-week training programs on the executive function. 3 groups: Game HIIT group, Game SAE group, and con treatment control group.	Randomized controlled trial

Source: Research data

 

Characteristics of the population and interventions 

 

    The total number of participants was n=5257 children and adolescents (both females and males) diagnosed with ADHD, age range: 6-16 years. One article did not specify the age range (Pepmeier et al., 2015) (Table 2).

 

    Regarding the characteristics of the interventions, these were grouped into 4 categories according to the way the studies presented their results: evidence was found on physical exercise/activity, aerobic exercise, physical activity mediated by electronic devices such as iPad and Xbox games, and specific sports modalities such as Judo, swimming, and racket sports.

 

    Seven articles highlight that a 12-week intervention with low intensity will have positive effects on executive function performance, working memory, and cognitive flexibility.

 

    Only one article discusses the short- and long-term benefits of physical activity combined with sports, specifically Judo in children with ADHD. The benefits are similar to the previous ones, with the difference being that they are sustained over a longer period and aid in other areas of cognitive, motor, and social development of neurodivergent children and adolescents. (Bustamante et al., 2017; Ziers, & Jansen 2015; Huang et al., 2015; Ludyga et al., 2022; Munz et al., 2022; Nejati, & Derakhshan., 2021; Premier et al., 2015; Liang et al., 2022)

 

    According to studies that had an intervention with aerobic exercise, two studies specifically addressed aerobic exercise interventions, demonstrating benefits in executive functions for children and adolescents.

 

    One article mentions that executive functions are sensitive to aerobic exercise in childhood and that benefits in behavior, cognitive flexibility, and executive functions were observed 10-15 minutes after moderate-intensity aerobic exercise intervention. High-Intensity Interval Training (HIIT) was also used, showing physiological adaptations equivalent to those provided by longer exercise sessions. Another benefit found is that children find the duration enjoyable, resulting in low dropout rates from the intervention. (Ludyga et al., 2018; Sun et al., 2022)

 

    According to studies using electronic devices like iPad and Xbox games, three utilized electronic devices and technology (Exergames and iPad) as intervention methods. Positive effects were observed on executive functions such as attention, coordination, working memory, and planning. Additionally, results were seen in motor skills such as endurance, inhibition, speed, strength, and mobility. Being a more innovative intervention model, participants were more motivated compared to traditional methods. (Wronska et al., 2015; Benzing, & Schmidt, 2017, Benzing et al., 2018)

 

    Finally, other studies focused on specific sports modalities such as judo, swimming, and racket sports. Two studies addressed judo as an intervention for children and adolescents with ADHD. They mentioned that practicing judo for 10 to 15 minutes with moderate to intense intensity could positively influence executive functions. However, if the intensity is low, the effect on executive and cognitive functions would be much less. Benefits were obtained in cognitive functions like memory and motor skills, although these do not include fine and gross motor control, which would be improved by combining Judo with other exercise or physical activity interventions. Long-term observations showed positive impacts on motor skills such as strength and agility, particularly when combined with other physical activities. There was also an impact on social relationships among children and adolescents with this neurodivergence, for example, in teamwork, attention, and aggression issues. (Ludyga et al., 2022; Memarmoghaddam et al., 2016; Pan et al., 2016; Hattabi et al., 2022; Ludyga et al., 2023)

 

Outcome measures 

 

    Table 3 presents the evaluated variables and the outcome measures found within the studies, including cognitive impairment at 55.55%, motor function at 27.7%, and cognitive functions at 16.6%.

 

    For the assessment of executive functions, various instruments were used both collectively and individually. The selected studies list a total of 52 tests, with the most frequently used tests being Body Mass Index (BMI) at 27.7%, Statistical Package for Social Science (SPSS) at 22.2%, weight measure one (T1) at 16.6%, weight measure two (T2) at 16.6%, devices used for monitoring physical activity and sleep quality (Actigraph) at 11.11%, and psychological assessment tool in children with ADHD (Go-No-Go Test) at 11.11%.

 

    Tests used less frequently, at 5.5% utilization, included cognitive memory test (N-back task), Forced exercise test (DECIR), Open-source physics engine for game and interactive application development (CHIPMUNK), Color-word test (Stroop test), among others.

 

Authors	Objectives	Variables	Instruments	Results
Benzing et al. (2017)	Evaluate the influence of an exergame intervention. Watch if this has a positive impact on executive functions.	Executive functions.	T1, Actigraph GT9X, T2.	Physical activity can have a positive effect on cognitive performance, physical activity, and symptoms of ADHD.
Bustamante et al. (2017)	To test the feasibility and impact of a 10-week-after-school exercise program for children with ADHD.	Disruptive behavior disorders, aerobic exercise/activity, sedentary play	PACER, Health o meter, BMI, CDC.	The after-school physical activity programs are influential and positive in children with behavioral disorders. Also influenced a reduction of mood and anxiety disorders, for all children with ADHD.
Ludyga et al. (2023)	Investigated the behavioral and neurocognitive effects of judo training on response inhibition in children with ADHD.	Behavioral and neurocognitive indexes.	SPSS, BMI, Armonk, IDS-2, FAS, SDQ, CON, INT, CHIPMUNK, JETPAC.	Positive effects of exercise on inhibitory control. Response inhibition is also sensitive to structured exercise and judo in particular has a normalizing effect on this cognitive function, at least in children born very premature.
Ludyga et al. (2022)	Investigated the effect of judo training program targeting motor skills on behavioral and neurocognitive indices of working memory capacity.	Executive functions, behavioral and neurocognitive indexes, visuospatial working memory capacity, coordinative demands.	JTG, CON, MABC- 2, BMI, IQ screening items, K-score, CDA.	The prescription of a 12-week judo promises improvements in working memory capacity. These beneficial effects can be observed on both behavioral and neurocognitive levels.
Memarmoghaddam et al. (2016)	Examine the effectiveness of a selected exercise program on the executive function of children with ADHD	Executive functions, cognitive function, behavior.	Stroop test, Go-No-Go test, HRR.	Differences in the attention and inhibition of responses using a walk/not walk task after 30 sessions of physical activity on children with ADHD. The effect of the designed exercises program on behavioral and cognitive inhibition in children with ADHD.
Pan et al. (2016)	Assessed the effect of a 12-week table tennis exercise. The racket-sport intervention would improve motor skills, social behavior, and executive functions in children with ADHD.	Motor skills, social behavior, executive functions.	RCT, BOT-2.	The racket-sport intervention was helpful in promoting motor skills, social behaviors, and executive functions.
Wronska et al. (2015)	Improve attention skills in patients with ADHD by using a game created for children with learning difficulties and special needs.	Comprehension, performing.	SQLite, SUS questionnaire.	iPad devices, used as therapy not only improve comprehension but also hold the attention and reading comprehension of children with ADHD.
Ziereis et al. (2015)	Determinate whether PA improves cognitive performance in children with ADHD.	Executive function.	EG1, EG2.	Potential of long-term PA demonstrates to improve motor abilities and have a positive effect on cognition of ADHD children.
Benzing et al. (2018)	This study investigated the effects of physical activity selectively affects the three core EFs (inhibition, stitching, and visual working memory).	Inhibition, switching, working memory, exergaming.	SPSS.	Physical activity might have specific effects on EFs in children with ADHD. The cognitive skills might be considered as well, modification to positive effects of the application of PA.
Hattabi et al. (2022)	Investigate the impact of a recreational swimming program, such as cognitive functions, academic performance, and disruptive behavior on the symptomatology of children with ADHD (9-12 years).	Cognitive functions, academic performance, disruptive behavior.	CBCL, Conner´s scale (K-SADS-PL, v. 1.0, 1996), Junior Hayling test.	Exercise programs improved the cognition and behavior of ADHD children and improved academic performance in reading comprehension and math. Organized recreational swimming activities could be considered an effective approach to improving the performance of ADHD children.
Huang et al. (2015)	Investigate the relationship between physician fitness and resting-state electroencephalographic oscillation in children with ADHD.	Physical fitness, cognitive performance, brain oscillations, flexibility, muscular endurance, power, agility.	BMI, LSD.	Physical fitness subset was associated with resting EEG which may underlie particular ADHD symptomatology. The findings support a positive relationship between increased power fitness and less deviant baseline cortical activity in children with ADHD.
Liang et al. (2022)	This study examined the mediating role of sleep in the relationship between physical activity and executive function in children with ADHD.	Executive functions, physical activity, cognition, sleep quality, cognitive tasks.	GT3X model; ActiGraph, Pensacola, FL.	PA intensity should be considered in designing exercise intervention studies to improve sleep quality in children with ADHD.
Ludyga et al. (2018)	Investigate cognitive flexibility and task-related heart rate variability following moderately intense aerobic exercise and after watching a video on both children with ADHD and healthy controls.	Cognitive flexibility, cognitive performance.	BMI, SPSS.	Cognitive flexibility was in line with meta-analytical findings showing general benefits for executive functions 10 to 15 min following moderate aerobic exercise. Single aerobic exercise sessions also enhance cognitive flexibility in both children with ADHD.
Ludyga et al. (2022)	Investigate the predictive values of ADHD. Body mass index, physical activity for associations by brain structure.	Body mass index, brain structure.	FreeSurfer, BMI, T1, T2.	The effect of GWMR may extend to other cognitive functions, given that the ACC has been proposed to optimize the allocation of cognitive control based on an assessment of the overall expected value of control.
Munz et al. (2022)	It investigated the impact of daytime physical exercise on declarative memory.	Declarative memory evolution, sleep-dependent consolidation.	ASEBA (Achenbach System of Empirically Based Assessment), CSHQ (Children Sleep Habit Questionnaire), and PDS (pubertal development scale).	Physical exercise induces plasticity and declarative memory consolidation during wake and sleep. For typically developing children, this inferior immediate retrieval after physical exercise does not necessarily mean that they performed worse than after rest.
Nejati et al. (2021)	Compare the effect of physical activity with and without cognitive demand on executive functions and behavioral symptoms in children with ADHD.	Cognitive involvement and cognitive training.	One-Back Task, Wisconsin Card Sorting Task, GO-No-Go Task, Conners Rating Scales (CRS), Exercise for Cognitive Improvement and Rehabilitation (EXCIR).	Improvement in inhibitory control, working memory, and cognitive flexibility in children with ADHD through EXCEL. Also, EXIR alleviates the symptoms of ADHD in children.
Pep Meier et al. (2015)	Examine the effect of acute exercise on cognitive performance by children with and without ADHD.	Executive function, cognitive tasks, cognitive performance.	OMNI scale, TMT.	Acute exercise would benefit executive function performance. Benefits of acute exercise were not observed for all of the executive function tasks administered in this study, it is impossible to identify an incontrovertible reason.
Sun et al. (2022)	Examine whether a high-intensity interval training (HIIT) program can improve the executive function of children with ADHD.	Executive function.	T0, T1, T2, CWST, TLT.	Long-term exercise may have medium to large effects on inhibition and attention in children with ADHD. Exercise programs with low- to moderate and high intensity benefits extend to children with ADHD in the executive functions.

Source: Research data

 

Assessment of methodological quality 

 

    The PEDRo scale was used for the methodological quality assessments, as shown in Table 4. Most studies scored between 7 and 8. The study with the highest score was Bustamante et al. (2017), who scored 9.

 

Author/Year	PEDro												CEBM
	1	2	3	4	5	6	7	8	9	1	1	Total	Level of evidence	Grade of recommendation
Benzing et al., 2017	SI	1	0	1	0	1	1	1	1	1	1	8	1b	A
Bustamante et al., 2017	SI	1	0	1	1	1	1	1	1	1	1	9	1b	A
Ludyga et al., 2023	SI	1	1	0	0	0	0	1	1	1	1	7	1b	A
Ludyga et al., 2022	SI	1	1	0	0	0	0	1	1	1	1	7	1b	A
Memarmoghaddam et al., 2016	SI	0	0	1	0	0	0	1	1	1	1	6	1b	A
Pan et al., 2016	SI	0	1	1	1	0	0	1	1	1	1	8	1b	A
Wronska et al., 2015	SI	1	1	1	1	0	0	1	1	1	1	8	1b	A
Ziereis et al., 2015	SI	1	0	1	0	0	0	1	1	1	1	7	1b	A
Benzing et al., 2018	SI	1	0	1	0	0	0	1	1	1	1	7	1b	A
Hattabi et al., 2022	SI	1	1	1	0	0	0	1	1	0	1	7	1b	A
Huang et al., 2015	SI	1	0	1	0	0	0	1	1	1	1	6	1a	A
Liang et al., 2022	SI	1	1	1	0	0	0	1	1	1	1	8	1b	A
Ludyga et al., 2018	SI	1	1	1	0	0	0	1	1	1	1	8	1b	A
Ludyga et al., 2022	SI	1	1	1	0	0	0	1	1	1	1	8	2b	B
Munz et al., 2022	SI	1	0	1	0	0	0	1	1	1	1	7	1b	A
Nejati et al., 2021	SI	1	1	1	0	0	0	1	1	1	1	8	1b	A
Pepmeier et al., 2015	SI	1	0	1	0	0	0	1	1	1	1	7	1b	A
Sun et al., 2022	SI	1	0	1	0	0	0	1	1	1	1	7	1b	A

    The selection criteria were specified. 2. Subjects were randomly assigned to groups (in a crossover study, subjects were randomized as they received treatments). 3. Allocation was concealed. 4. The groups were similar at the beginning in relation to the indicators of the most important forecast. 5 All subjects were blinded. 6. All therapists who administered the therapy were blinded. 7. All raters who measured at least one key outcome were blinded. 8. Measures of at least one of the key outcomes were obtained from more than 85% of the subjects initially assigned to the groups. 9. Results were presented for all subjects who received treatment or were allocated to the control group, or where this could not be, data for at least one key outcome were analyzed by “intention to treat” 10. Results of statistical comparisons between groups were reported for at least one key outcome. 11. The study provides point and variability measures for at least one key outcome. Source: Research data

 

Discussion 

 

    Through the systematic review, we were able to analyze and synthesize the literature on the effects of physical activity on the cognitive function of children with attention deficit disorder.

 

    Regarding the prescription of physical activity, the intervention programs exhibited heterogeneous characteristics. However, according to some authors like Zieris (2015), 12 weeks of low-intensity intervention showed positive effects on executive function performance. Conversely, Nejati, & Derakhshan (2021) found positive effects on working memory and cognitive flexibility following a 12-week intervention. These findings contrast with studies by Ludyga et al. (2018) and Ludyga et al. (2022), who established a directly proportional relationship between the intensity of physical activity and its effects on cognitive functions. According to their findings, practicing judo for at least 10 to 15 minutes could positively influence executive functions such as memory, particularly with moderate to intense application; whereas with low intensity, the results are significantly less pronounced.

 

    This situation highlights the need to continue conducting studies that establish intervention protocols that can be tested and applied with representative samples using multicenter methodologies, allowing results to be generalized and adapted to the needs of children and adolescents with this diagnosis.

 

    It is important to note that although there was no consensus on criteria such as intensity, duration, and frequency of interventions, all studies reported positive effects. Authors like Pan et al. (2016) and Memarmohaddam et al. (2016) reported a positive impact underlined specific conditions such as problem-solving, consensus in decision-making with peers, improvements in attention, and reduction in aggressive reactions. Highlighting an additional benefit, the maintenance of results over the long term. Liang et al. (2022) mentions that exercise interventions with higher intensity level a improve sleep quality, reduce anxiety, and enhance executive functions. Liang et al. (2022) also demonstrates that exercise leads to increased prolonged sleep, thereby increasing brain plasticity in this population.

 

    As a result of this review, the use of Exergames (exercise video games) also stands out as an innovative and motivating method for children and adolescents with ADHD. Benzing, & Schmidt (2017) conducted a study examining whether the use of exergames elicited cognitive and physical demands that influenced executive functions in children with ADHD. In this sense, it was identified that through the use of XBOX Kinect, the individual’s movements were projected on the screen, addressing endurance, strength, and mobility, as well as coordination, working memory, inhibition, speed, and motor function planning.

 

    In 2018, Benzing conducted the same study but now compared it with a control group. This study investigated the effects of physical activity across various aspects, considering executive functions (inhibition, shifting, and visual working memory) in children with ADHD. The results of this study revealed that participants who underwent the intervention through exergaming showed significant and faster improvements than the control group in tasks related to visual memory.

 

    There was also reported the use of other devices such as an IOS application for iPad, utilizing an interactive game as an intervention (Wronska et al., 2015). This study noted improvements in focused attention. This method proved to be effective, as well as highly engaging and interesting due to the cognitive challenge involved. It also incorporated point-based reward systems that provided positive feedback, encouraging sustained engagement in the activity. This aspect could be considered a pivotal element in selecting intervention activities for children and adolescents, which should not only meet their needs but also align with their interests. This contributes to enhancing treatment adherence through the use of innovative yet equally effective methods.

 

Conclusions 

 

    Within the results analysis, it was recognized that more than half of the research was reported in Europe, followed by Asia, and at a lower percentage in North America. This review did not find studies in Latin America or Central America, and 2022 was noted as the year with the highest number of publications on this topic. In this regard, expanding studies in underrepresented regions could be considered a measure to provide a more comprehensive and global understanding of the subject.

 

    Regarding the characteristics of the interventions, various modalities of physical activity were reported in the studies, including aerobic exercise and specific sports activities such as racket games, swimming, and martial arts. These activities contribute to the improvement of focused attention, self-regulation, anticipation, and planning. Depending on the participant´s age, these benefits could be linked to other advantages, such as brain plasticity. The use of electronic devices to mediate physical activity was also noted, as they can generate additional positive outcomes such as increased motivation and cognitive challenge, which could help improve treatment adherence and maintain long-term goals.

 

    The weakness of this review, methodological aspects of the included studies are highlighted, such as small sample sizes and difficulty in blinding, possibly related to the ages of the participants, as well as heterogeneity in the programs or protocols of physical activity implementation. These aspects do not allow us to obtain results that can be considered conclusive and these can make it difficult to adapt to certain groups with similar conditions.

 

    However, it is pertinent to mention that this type of study constitutes a necessary path for consolidating scientific evidence to generate solid and rigorous experimental studies.

 

    Finally, this review emphasizes that physical activity could be considered an intervention strategy that positively impacts executive functions in children and adolescents, such as working memory, focused attention, self-regulation, planning, and anticipation. It can be applied in various contexts such as clinical, sports, recreational, and educational settings, and with appropriate prescription, it can be motivating, safe, and effective.

 

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Lecturas: Educación Física y Deportes, Vol. 30, Núm. 325, Jun. (2025)