Why make it easy when you can make it complicated?
Children with Attention Deficit Hyperactivity Disorder (ADHD) not only display the well-known symptoms of hyperactivity and impulsivity, but also show significant deficits in executive functions such as working memory and inhibitory control. These deficits impact their academic performance, behavior, and social relationships. I recommend reading the chapter on ADHD in the book Neurodevelopmental Disorders, published by Elsevier this year.
In this context, physical exercise has emerged as a promising non-pharmacological alternative. Groundbreaking, right?
A recent study titled “Effect of vigorous-intensity exercise on the working memory and inhibitory control among children with attention deficit hyperactivity disorder: a systematic review and meta-analysis” (Zhang & Li, 2025), published in the Italian Journal of Pediatrics, presents a systematic review and meta-analysis that reinforces the value of vigorous exercise as a therapeutic tool for this population.
Think about it — so many complex techniques, when simply moving like a child, intensely, could actually help.
🔍 What does the study offer?
The meta-analysis reviewed 10 randomized clinical trials, involving more than 500 children with ADHD, and evaluated the effects of vigorous-intensity exercise on working memory, inhibitory control, overall cognition, body mass index (BMI), and motor capacity.
✔️ Key findings:
- 🧠 Significant improvement in working memory with vigorous-intensity exercise (p < 0.05).
- 🚫 Inhibitory control did not improve with maximal-intensity exercise, but it did improve with submaximal-intensity exercise (p < 0.05).
- 🏃♂️ Overall motor capacity also improved.
- 📉 No significant improvements were observed in attention or BMI.
- 🧩 Moderate improvement in overall cognition.
⚙️ What types of exercises were used?
Interventions included:
- Active chasing-type games
- Jump rope
- Aerobic training or high-intensity interval training (HIIT)
- Frequency: 2 to 5 times per week, lasting 6 to 12 weeks
Submaximal exercise (60–90% of maximum heart rate) was more effective than maximal intensity for improving inhibitory control, a key function in self-regulation.
🧬 What’s the neurophysiological basis?
The authors suggest that vigorous exercise:
- Increases neurotransmitter release (catecholamines).
- Enhances neuroplasticity, improving the functioning of brain areas like the frontal lobe and hippocampus.
- Improves cerebral blood flow, frontal oxygenation, and interhemispheric communication.
- Neuroimaging studies conducted post-exercise showed increased activation in areas related to memory and control (such as the middle frontal gyrus and posterior cingulate).
👩⚕️ Clinical applications for physiotherapists
As movement professionals, physiotherapists are in a strategic position to:
- Implement structured therapeutic exercise programs for children with ADHD.
- Design individualized, accessible, and playful submaximal routines that promote engagement and reduce frustration.
- Collaborate with interdisciplinary teams (neuropsychologists, occupational therapists, pediatricians) to integrate exercise into holistic treatment plans.
- Perform functional follow-up on motor, cognitive, and behavioral improvements.
🧩 Practical recommendations
- Start with moderate to high-intensity exercises that are engaging and sustainable.
- Monitor the child’s response using perceived exertion scales or heart rate (64–90% max HR).
- Include elements of play, coordination, and decision-making in the routine.
- Prioritize consistency (at least 2–3 times per week).
- Assess using standardized executive function tests, such as working memory or inhibitory control tasks (e.g., Stop-Signal Task)
🧠 Conclusion
Intense physical exercise, especially submaximal intensity, stands out as an effective, safe, and accessible therapeutic tool to improve executive functions in children with ADHD. Integrating it into physiotherapy practice can make a significant difference in the lives of these children and their families.
Other studies have also shown that contact with nature improves working memory in children with ADHD. Now imagine combining exercise and nature — how powerful could that be?
This study offers a solid foundation for pediatric physiotherapists to integrate movement not just as a tool for motor improvement, but as a neurocognitive intervention.
Maybe we need to think not only about the clinic, but also about going outside and doing something intense.
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