What Does the Research Say about ADHD and Exercise?

Many parents of ADHD children are waiting for the day they can use non-medical methods to treat symptoms of this neurologic disorder. One such method is physical exercise, which some research suggests may reduce ADHD symptoms that prevent children from succeeding at school and in social settings. What does the research say about the relationship between exercise and ADHD and what does it mean for parents?

The Need for Non-Medical Treatment

According to the Centers for Disease Control (CDC), 6.4 million children in the United States have been diagnosed with attention deficit hyperactivity disorder (ADHD), a neurobehavioral condition that appears in childhood and compromises a child's ability to pay attention, listen, follow instructions, avoid distractions, and perform certain mental activities. The accepted treatment for ADHD has been part medication and part behavior therapy.

However, both forms of therapy have disadvantages. For medication therapy, the disadvantage is that the most commonly prescribed drugs–stimulants such as Ritalin and Adderall–can cause serious side effects, such as psychosis, heart disturbances, reduced growth, and increased aggression. And since ADHD is a chronic condition that can affect individuals from age 4 through their late thirties, parents worry about the potential damage that decades of stimulant use might cause.

While behavior therapy doesn't involve nearly as many risks as drugs, it requires formal training. Parents must be taught how to create good behavior charts and implement rewards systems that will help their ADHD children control the tendencies to fight, throw tantrums, and oppose authority. Once learned, these methods must be applied consistently at home. No doubt, a tall order.

And parents aren't the only ones fearful that potentially harmful medications are becoming the default treatment for ADHD. So is the CDC, which expressed concern over findings in 2011 that prescriptions to treat ADHD children had risen dramatically. Between 2007 and 2011, the percentage of children taking ADHD drugs had increased by 28 percent, roughly 7 percent each year. Alarmed by these statistics, the CDC urged that doctors and parents try non-medical interventions before opting for drugs.

Why Exercise?

At about the same time that parents and the CDC were calling for non-medical therapies to treat ADHD, researchers began to notice mounting evidence that environmental factors could change how the brain functions. Though not specifically targeting ADHD children, these early findings were promising.

In 2007, researchers at the Medical College of Georgia concluded that children who engaged in aerobic exercise improved their 'executive functions,' the ability to organize tasks, maintain steady focus, manage frustration, and recall information needed to perform everyday tasks. These are the same functions considered to be impaired in ADHD children.

By 2011, a more direct link between physical activity and ADHD was forming. Professor of Psychology at the City University of New York Jeffrey Halperin reported data showing that play-time activities and physical exercise helped children learn how to control their behavior and take turns with their peers. When combined with laboratory evidence that 'play' could increase 'BDNF,' a protein necessary to control brain functions, Halperin concluded that 'directed play' in the form of structured exercise could help improve mental processes and behavior, allowing ADHD children to develop mental and social skills.

Once 'play' was found to improve development in ADHD children, it was only a matter of time before researchers wondered if exercise could do the same. That hypothesis was fueled by findings from brain MRIs done on children that showed exercise could increase activity in parts of the brain needed for 'executive functions.'

By 2012, the link between physical activity and ADHD symptoms was established. Olga Berwid, a professor of behavior sciences at the City University of New York, wrote about studies that showed daily aerobic exercise had improved children's attention, concentration and social functioning in the classroom.

An Exercise Pill

But exactly how can activities as simple as running and tossing a ball improve symptoms of a cognitive disorder such as ADHD?

The answer, says Dr. John Ratey of Harvard Medical School, lies in how exercise affects the brain. In his book Spark: The Revolutionary New Science of Exercise and the Brain, Dr. Ratey said: ''Exercise turns on the attention system, the so-called executive functions…'' Exercise, explains Dr. Ratey, stimulates chemicals in the brain-dopamine, norepinephrine, and serotonin–that control how humans focus and pay attention, the exact functions ADHD kids struggle with. This stimulating action, he says, makes ''for a nice recipe for an exercise pill.''

The Mounting Evidence

FITKids After-School Program

In 2014, researcher Charles H. Hillman at the University of Illinois reported on a study of 221 children, aged 7 to 9, who were randomly assigned to a FITKids after-school program in East Central Illinois. After nine months, the children who took part in physical activity were compared to a group who did not. The FITKids group showed marked improvement in the ability to control their emotions and perform mental work.

A Before-School Program

In 2014, Dr. Betsy Hoza, professor of psychology at the University of Vermont, created a stir in the scientific community when she published the results of a study more targeted to ADHD children. In Hoza's study, 202 children, both ADHD and non-ADHD, between the ages of 4 and 8 were separated into two groups. One group participated in aerobic activities that required deep breathing before school while the other participated in sedentary activities, such as art projects. After 12 weeks, the parents of children in the physical activity group had noted their children were less moody and were more attentive. For Hoza, these results laid a solid foundation to believe that aerobic exercise could effectively manage ADHD symptoms in children.

A Healthy Lifestyle

The evidence that exercise could effectively treat ADHD symptoms continued to rise. In 2016, professor Kathleen Holton in the Department of Health Studies at American University led a study that compared lifestyle habits of ADHD children with non-ADHD children. Holton's findings were based on parent responses to questions on how much water as opposed to sweetened beverages their children drank, how often they read and watched TV, what kind of physical activity they engaged in and how much, and how many hours they slept at night. Holton found that ADHD children were almost two times as likely to follow healthy habits when compared to their non-ADHD counterparts. The findings led Holton to recommend that ADHD children get at least one hour of exercise every day.

Not a Treatment Substitute

Although the research findings to date are catching the eye of prominent researchers throughout the United States, not everyone is convinced. Among the skeptics is clinical psychologist Thomas E. Brown, Ph.D., Director of the Brown Clinic for Attention & Related Disorders in Hamden, Connecticut. In a blog post written in 2016, Dr. Brown agreed that exercise is important for ADHD children–just as it is for children who did not exhibit ADHD symptoms. In Dr. Brown's opinion, exercise helps but does not provide lasting benefits. In particular, he said, exercise didn't improve the ability of ADHD children to perform executive functions such as organizing, beginning tasks, retaining information, and maintaining focus.

Dr. Brown is not alone in suggesting that parents and doctors remain cautiously optimistic about the research findings. Even Dr. Hoza, in her landmark study, admitted that ''the exact mechanism by which exercise might ameliorate symptoms of ADHD is not definitively known.''