Background

Attention-deficit hyperactivity disorder (ADHD) is a commonly diagnosed behavioral disorder in school-aged children. A core symptom of ADHD is difficulties with executive functions (EF). Physical activity (PA) interventions are proposed to be a valuable addition to traditional treatment approaches for ADHD. This systematic review examined the evidence for the effect of chronic PA on EF, specifically, inhibition, shifting, working memory, and attention in children with ADHD compared to no treatment. The moderating impact of PA cognitive demand and methylphenidate (MPH) treatment on the effect of PA interventions on EF was also examined.

Methods

A systematic review and meta-analyses were conducted following the Cochrane Guidelines for Systematic Reviews. A protocol was published with PROSPERO (CRD42018099617); seven databases were searched, and 3690 results screened by two independent researchers. Based on inclusion and exclusion criteria, 12 eligible studies were included, and separate meta-analyses were conducted for each EF domain, each including subgroups of high vs low cognitive demand, and MPH-intake vs. MPH-free.

Results

Results showed beneficial effects of PA for all EF, with 95%-CI compatible with positive effects for shifting (SMD = −1.58; 95%-CI [−3.12; −0.04]) and working memory (SMD = −0.99; 95%-CI [−1.80; −0.18])only. Cognitive demand of PA differed in its impact depending on the domain of EF. Benefits of PA were lesser in those taking MPH, though subgroup differences were statistically non-significant.

Conclusion

Children with ADHD benefit from PA leading to enhanced executive functioning performance. However, the cognitive demands of the PA need to be considered when contemplating PA as an adjunctive treatment option.

中文翻译：

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体育锻炼干预对多动症儿童执行功能的影响：系统评价和荟萃分析

背景

注意缺陷多动障碍（ADHD）是学龄儿童中一种常见的行为障碍。ADHD的核心症状是执行功能（EF）的困难。身体活动（PA）干预被提议为ADHD的传统治疗方法的宝贵补充。这项系统的审查检查了慢性PA对EF的影响的证据，特别是与未治疗的ADHD儿童相比，抑制，转移，工作记忆和注意力的影响。还检查了PA认知需求和哌醋甲酯（MPH）治疗对PA干预对EF的影响的调节作用。

方法

遵循《 Cochrane系统评价指南》进行了系统评价和荟萃分析。与PROSPERO（CRD42018099617）发布了协议; 搜索了七个数据库，两名独立研究人员筛选了3690个结果。根据纳入和排除标准，纳入12项合格研究，并对每个EF域进行单独的荟萃分析，每个亚组包括高认知需求和低认知需求以及MPH摄入量与无MPH的亚组。

结果

结果显示PA对所有EF均具有有益的作用，其中95％-CI与转移（SMD = -1.58; 95％-CI [-3.12; -0.04]）和工作记忆（SMD = -0.99; 95％）的积极作用相容-CI [−1.80; −0.18]）。对PA的认知需求，其影响取决于EF的范围。尽管亚组差异在统计学上无统计学意义，但服用MPH的患者PA的获益较少。

结论

多动症儿童可以受益于PA，从而增强执行功能。但是，在考虑将PA作为辅助治疗方案时，需要考虑PA的认知需求。