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Effects of Exercise on Hyperactivity/Impulsivity and Inhibitory Control at Behavioral and Electrophysiological Levels in ADHD: A Systematic Review and Meta-Analysis

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Title: Effects of Exercise on Hyperactivity/Impulsivity and Inhibitory Control at Behavioral and Electrophysiological Levels in ADHD: A Systematic Review and Meta-Analysis
Language: English
Authors: Zeping Zhang (ORCID 0000-0002-4675-3169), Xuanyu Bo (ORCID 0009-0001-4793-1692), Kun Liu (ORCID 0009-0005-3656-5956), Jiangdi Su (ORCID 0009-0004-9129-2893), Yongfei Zhu (ORCID 0009-0001-7324-6373), Suyong Yang (ORCID 0000-0001-9881-347X)
Source: Journal of Attention Disorders. 2026 30(5):677-693.
Availability: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
Peer Reviewed: Y
Page Count: 17
Publication Date: 2026
Document Type: Journal Articles
Information Analyses
Descriptors: Attention Deficit Hyperactivity Disorder, Exercise, Hyperactivity, Conceptual Tempo, Inhibition, Self Control, Age Differences, Children, Adolescents, Intervention, Incidence, Research Methodology, Program Effectiveness, Behavior Problems, Adults
DOI: 10.1177/10870547251404197
ISSN: 1087-0547
1557-1246
Abstract: Objective: This study aimed to assess the impact of exercise on hyperactivity/impulsivity, inhibitory control, and inhibition-related event-related potential (ERP) components in individuals with ADHD. Method: A systematic search identified relevant studies, and methodological quality was assessed using the Revised Cochrane Risk-of-Bias tool for randomized trials (RoB 2) and the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I), with data analysis conducted using Stata software. Results: A total of 36 studies (38 comparisons) were included, comprising 10 acute and 26 chronic exercise interventions. Exercise yielded a small-to-moderate improvement in inhibitory control but showed no significant effects on hyperactivity/impulsivity or inhibition-related N2 and P3 components. Subgroup analyses of inhibitory control revealed significant moderating effects of age (children/adolescents), intervention type (chronic interventions), frequency (three sessions per week), control condition (sedentary or no-intervention groups), and study quality (studies with moderate or high risk of bias). Conclusion: Exercise enhances inhibitory control in individuals with ADHD, with the effect being especially pronounced in children and adolescents. Chronic interventions and a frequency of three sessions per week appear to be most beneficial. However, it shows no significant effect on hyperactivity/impulsivity or inhibition-related N2 and P3 components. The impact of exercising should not be overestimated.
Abstractor: As Provided
Entry Date: 2026
Accession Number: EJ1501666
Database: ERIC
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  Value: <anid>AN0192584786;gs001may.26;2026Mar31.02:51;v2.2.500</anid> <title id="AN0192584786-1">Effects of Exercise on Hyperactivity/Impulsivity and Inhibitory Control at Behavioral and Electrophysiological Levels in ADHD: A Systematic Review and Meta-Analysis </title> <p>Objective: This study aimed to assess the impact of exercise on hyperactivity/impulsivity, inhibitory control, and inhibition-related event-related potential (ERP) components in individuals with ADHD. Method: A systematic search identified relevant studies, and methodological quality was assessed using the Revised Cochrane Risk-of-Bias tool for randomized trials (RoB 2) and the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I), with data analysis conducted using Stata software. Results: A total of 36 studies (38 comparisons) were included, comprising 10 acute and 26 chronic exercise interventions. Exercise yielded a small-to-moderate improvement in inhibitory control but showed no significant effects on hyperactivity/impulsivity or inhibition-related N2 and P3 components. Subgroup analyses of inhibitory control revealed significant moderating effects of age (children/adolescents), intervention type (chronic interventions), frequency (three sessions per week), control condition (sedentary or no-intervention groups), and study quality (studies with moderate or high risk of bias). Conclusion: Exercise enhances inhibitory control in individuals with ADHD, with the effect being especially pronounced in children and adolescents. Chronic interventions and a frequency of three sessions per week appear to be most beneficial. However, it shows no significant effect on hyperactivity/impulsivity or inhibition-related N2 and P3 components. The impact of exercising should not be overestimated.</p> <p>Keywords: attention deficit hyperactivity disorder; exercise; inhibitory control; behavioral performance</p> <hd id="AN0192584786-2">Introduction</hd> <p>Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder marked by inattention, hyperactivity, and impulsivity, typically emerging in childhood and often persisting into adulthood ([<reflink idref="bib1" id="ref1">1</reflink>]). Its global prevalence is about 8% in children/adolescents ([<reflink idref="bib2" id="ref2">2</reflink>]) and 2.58% among adults ([<reflink idref="bib70" id="ref3">70</reflink>]). ADHD negatively impacts academic performance ([<reflink idref="bib34" id="ref4">34</reflink>]), social functioning ([<reflink idref="bib59" id="ref5">59</reflink>]), and emotional regulation ([<reflink idref="bib72" id="ref6">72</reflink>]). Additionally, research has linked ADHD to an increased risk of suicidal behavior ([<reflink idref="bib33" id="ref7">33</reflink>]) and substance use disorders ([<reflink idref="bib44" id="ref8">44</reflink>]).</p> <p>Inhibitory control deficits are a core cognitive mechanism underlying impulsivity and executive dysfunction in ADHD ([<reflink idref="bib4" id="ref9">4</reflink>]). It refers to regulating attention, behavior, thoughts, and emotions to suppress internal tendencies or external distractions, with two subtypes: response inhibition (suppressing automatic motor responses) and interference control (avoiding distractions from irrelevant stimuli) ([<reflink idref="bib21" id="ref10">21</reflink>]). Impaired inhibitory control is closely linked to hyperactive and impulsive behaviors, such as restlessness, excessive talking, and frequent interruptions ([<reflink idref="bib38" id="ref11">38</reflink>]). Behavioral studies show that individuals with ADHD have higher error rates in tasks like Go/No-Go ([<reflink idref="bib78" id="ref12">78</reflink>]), Flanker ([<reflink idref="bib52" id="ref13">52</reflink>]), and Continuous Performance Test ([<reflink idref="bib23" id="ref14">23</reflink>]), indicating difficulty suppressing impulsive responses and filtering out irrelevant information. At the electroencephalographic (EEG) level, the event-related potentials (ERPs) closely associated with inhibitory control are N2 and P3. The N2 component refers to a negative deflection in the fronto-central region occurring within the 250 to 400 ms time window after stimulus presentation under No-Go or incongruent conditions, with its primary neural source located in the anterior cingulate cortex ([<reflink idref="bib26" id="ref15">26</reflink>]). It reflects the process of conflict monitoring ([<reflink idref="bib29" id="ref16">29</reflink>]; [<reflink idref="bib64" id="ref17">64</reflink>]). The P3 component related to inhibition appears as a positive deflection in the central region within the 300 to 600 ms time window after stimulus presentation, with its primary neural sources located in the inferior frontal gyrus, precentral gyrus, and supplementary motor area ([<reflink idref="bib66" id="ref18">66</reflink>]). It is considered a marker of both cognitive and response inhibition ([<reflink idref="bib67" id="ref19">67</reflink>]). Neurophysiological evidence supports these findings, with reduced N2 and P3 amplitudes in No-Go trials among individuals with ADHD, suggesting impaired conflict monitoring ([<reflink idref="bib11" id="ref20">11</reflink>]; [<reflink idref="bib37" id="ref21">37</reflink>]) and inhibitory processing ([<reflink idref="bib17" id="ref22">17</reflink>]; [<reflink idref="bib82" id="ref23">82</reflink>]). A neuroimaging meta-analysis revealed reduced volume and function in the ventrolateral prefrontal cortex/insular-striatal regions in ADHD ([<reflink idref="bib60" id="ref24">60</reflink>]), which may contribute to the core neurocognitive deficits commonly observed in children with the disorder.</p> <p>Exercise has gained attention as an ADHD intervention due to its cost-effectiveness, accessibility, and non-invasive nature. Regarding hyperactivity/impulsivity, some studies suggest yoga alleviates ADHD symptoms in children ([<reflink idref="bib51" id="ref25">51</reflink>]), while others do not confirm this effect ([<reflink idref="bib7" id="ref26">7</reflink>]; [<reflink idref="bib12" id="ref27">12</reflink>]; [<reflink idref="bib75" id="ref28">75</reflink>]), highlighting inconsistencies. Inhibitory control improvements have been observed in children with ADHD following aquatic exercise ([<reflink idref="bib14" id="ref29">14</reflink>]), ball games, and aerobic exercise ([<reflink idref="bib55" id="ref30">55</reflink>]), with further benefits from aerobic exercise combined with cognitive tasks ([<reflink idref="bib47" id="ref31">47</reflink>]), exergaming ([<reflink idref="bib6" id="ref32">6</reflink>]), and table tennis ([<reflink idref="bib61" id="ref33">61</reflink>]). These effects may be mediated by brain changes, increased serotonin, dopamine, brain-derived neurotrophic factor (BDNF), and enhanced neuroplasticity ([<reflink idref="bib8" id="ref34">8</reflink>]; [<reflink idref="bib13" id="ref35">13</reflink>]). However, some studies report no significant effects on inhibitory control in children with ADHD ([<reflink idref="bib27" id="ref36">27</reflink>]; [<reflink idref="bib50" id="ref37">50</reflink>]; [<reflink idref="bib75" id="ref38">75</reflink>]). Similarly, findings in adults with ADHD have also been mixed, with some studies failing to demonstrate consistent benefits ([<reflink idref="bib25" id="ref39">25</reflink>]; [<reflink idref="bib41" id="ref40">41</reflink>]). These inconsistencies call for systematic reviews and meta-analyses to better evaluate exercise interventions and identify moderating factors.</p> <p>Although previous meta-analyses have examined the effects of exercise on ADHD symptoms and executive function in children ([<reflink idref="bib32" id="ref41">32</reflink>]; [<reflink idref="bib46" id="ref42">46</reflink>]; [<reflink idref="bib65" id="ref43">65</reflink>]; [<reflink idref="bib76" id="ref44">76</reflink>]), several limitations remain. These studies often treat executive function as a unitary construct, with moderator analyses focusing on overall executive function and not isolating specific subdomains like inhibitory control. Inhibitory control, a core component of executive function linked to impulsivity ([<reflink idref="bib3" id="ref45">3</reflink>]), has been insufficiently addressed. Additionally, most studies focus on children, neglecting adults with ADHD. Most research also relies on behavioral data, with limited electrophysiological evidence, restricting understanding of the neural mechanisms of exercise interventions. Finally, the dose-response relationship between exercise and inhibitory control is unclear, hindering optimal intervention development. This study aims to assess the effects of exercise on hyperactivity/impulsivity symptoms and inhibitory control at behavioral and electrophysiological levels in ADHD, explore the dose-response relationship, and identify potential moderators, providing a foundation for optimizing exercise-based interventions.</p> <hd id="AN0192584786-3">Methods</hd> <p>This study adhered to the PRISMA guidelines ([<reflink idref="bib48" id="ref46">48</reflink>]) and was registered with PROSPERO (CRD42025637758).</p> <hd id="AN0192584786-4">Eligibility Criteria</hd> <p>Inclusion criteria were: (a) ADHD diagnosis based on the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases (ICD), with no age restrictions; (b) interventions involving exercise or physical activity, with no restrictions on type, either alone or in combination with usual treatment; (c) control conditions included medication, neurofeedback therapy, psychoeducation, sedentary activities, waitlist control, and regular physical activity; (d) outcomes including hyperactivity/impulsivity symptom questionnaires, behavioral tasks on inhibitory control, and corresponding event-related potentials (ERP); and (e) study design including randomized controlled trials (RCTs), non-randomized controlled trials (Non-RCTs), and crossover designs (CRD). Exclusion criteria were: (a) cross-sectional studies, (b) non-peer-reviewed articles (e.g., theses), (c) studies in languages other than Chinese or English, (d) conference abstracts, and (e) studies with unextractable or unconvertible outcome data.</p> <hd id="AN0192584786-5">Literature Search</hd> <p>This study conducted a literature search in PubMed, Web of Science, EBSCOhost, Embase, Cochrane Library, PsycINFO, and China National Knowledge Infrastructure (CNKI), covering all records from each database's inception to January 12, 2025. We used a combination of keywords and Medical Subject Headings (MeSH) terms, including "Attention-Deficit/Hyperactivity Disorder," "Exercise," "Physical Activity," "Inhibitory Control," "Response Inhibition," and "Interference Control." Search strategies were tailored to each database's requirements. In addition, the reference lists of all included studies and relevant reviews were manually screened by two researchers to identify additional eligible studies. Any disagreements regarding the inclusion of additional studies were resolved through discussion with the first author. The full search strategy, including Boolean operators and database-specific adaptations, is provided in Supplemental Material 1.</p> <hd id="AN0192584786-6">Screening and Data Extraction</hd> <p>The first author imported the relevant literature into EndNote 20 and created a reference library. Duplicate articles were removed, and two researchers independently conducted an initial screening by reviewing titles and abstracts. Full texts of the articles that passed the initial screening were then downloaded, and the final inclusion of studies was determined, along with the extraction of relevant data. Data extracted included study characteristics (i.e., author, publication time, country, and study design), participant details (i.e., age, sample size, diagnostic criteria, ADHD type, and medication usage), interventions (i.e., program, exercise session, frequency, duration, and exercise intensity), outcome measures (i.e., types of questionnaires, behavioral tasks, and ERP components, and key quality assessment elements. Literature screening and data extraction were independently conducted by two researchers. Any discrepancies were resolved through discussion with the first author.</p> <hd id="AN0192584786-7">Risk of Bias Assessment</hd> <p>The risk of bias in included studies was assessed using the Revised Cochrane Risk-of-Bias tool for randomized trials (RoB 2), the RoB 2 tool for crossover trials, and the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I). Two independent researchers conducted the assessments, with disagreements resolved by discussion or consultation with the first author. For randomized controlled trials, RoB 2 was used to evaluate bias across five domains: randomization, deviations from intended interventions, missing outcome data, outcome measurement, and selection of reported results, with studies classified as having low risk, some concerns, or high risk ([<reflink idref="bib74" id="ref47">74</reflink>]). For crossover trials, the adapted RoB 2 tool incorporated additional considerations such as carryover effects ([<reflink idref="bib18" id="ref48">18</reflink>]). For non-randomized studies, ROBINS-I evaluated bias across seven domains: confounding, participant selection, classification of interventions, deviations from intended interventions, missing data, outcome measurement, and selection of reported results, with studies categorized as low, moderate, serious, or critical risk ([<reflink idref="bib73" id="ref49">73</reflink>]).</p> <hd id="AN0192584786-8">Statistical Analysis</hd> <p>The meta-analysis was performed using Stata SE 14.0 with the following treatments: (<reflink idref="bib1" id="ref50">1</reflink>) Inhibitory control at the behavioral level was assessed using key measures like No-Go error rates in the Go/No-Go task, converting accuracy to error rate when necessary; (<reflink idref="bib2" id="ref51">2</reflink>) In ERPs, inhibitory control is assessed through inhibition-related components, including the amplitudes of N2 and P3 in the fronto-central region under No-Go or incongruent conditions; (<reflink idref="bib3" id="ref52">3</reflink>) For RCTs with three study arms, the sample size of the control group was split equally (1:1) following Cochrane recommendations to minimize unit-of-analysis bias; (<reflink idref="bib4" id="ref53">4</reflink>) If symptom questionnaires were completed by both parents and teachers, all outcomes were included; (<reflink idref="bib5" id="ref54">5</reflink>) If both response inhibition and interference control were assessed, all relevant outcomes were included. The pre-to-post change in mean and standard deviation (SD) was calculated using the formulas: meanchange = meanpost − meanpre; SDchange = square root [SDpre2 + SDpos2 – (2<emph>r</emph> × SDpre × SDpos) ], where the correlation coefficient (<emph>r</emph>) was fixed at 0.5 ([<reflink idref="bib32" id="ref55">32</reflink>]).</p> <p>A random-effects model was used for the pooled analysis. Heterogeneity was assessed using the <emph>Q</emph> statistic and <emph>I</emph>² statistic. The standardized mean difference (SMD) was estimated using Hedges' <emph>g</emph>, with effect sizes interpreted as large (≥0.8), moderate (0.5), and small (≤0.2), as defined by [<reflink idref="bib31" id="ref56">31</reflink>]. Subgroup analyses were conducted based on the following moderators: subject age (children/adolescents, adults), domains of inhibitory control (response inhibition, interference control), study design (RCT, CRD, non-RCT), exercise intervention type (acute: a one-time, short-duration exercise session; chronic: repeated and regular exercise training over an extended period of time), exercise duration (<12 weeks, ≥12 weeks), exercise frequency (2 times/week, 3 times/week, 5 times/week), exercise session length (≤50 min, >50 min), exercise intensity (moderate, moderate-to-vigorous, vigorous), motor skill type (closed-skill, open-skill), control group type (sedentary activity/no treatment, traditional aerobic exercise, neurofeedback training), and study quality (low, moderate, high risk). Sensitivity analysis was conducted by sequentially excluding individual studies to assess the robustness of the meta-analysis results. Funnel plots and Egger's test were used to examine publication bias, with Egger's test applied only when more than 10 studies were available. When publication bias was detected, trim-and-fill methodology was applied for correction.</p> <hd id="AN0192584786-9">Results</hd> <p></p> <hd id="AN0192584786-10">Screening Results</hd> <p>The study selection process is shown in Figure 1. A total of 4,218 records were identified through electronic databases and manual searches. After removing 1,499 duplicates, 2,595 records were excluded based on title and abstract screening, leaving 124 studies. Of these, 88 were excluded for reasons such as unavailability of full text, non-Chinese/English publications, conference abstracts, reviews, non-exercise interventions, non-ADHD populations, missing data, or inability to convert data. Finally, 36 studies were included in the meta-analysis ([<reflink idref="bib5" id="ref57">5</reflink>]; [<reflink idref="bib6" id="ref58">6</reflink>]; [<reflink idref="bib7" id="ref59">7</reflink>]; [<reflink idref="bib9" id="ref60">9</reflink>]; [<reflink idref="bib12" id="ref61">12</reflink>]; [<reflink idref="bib15" id="ref62">15</reflink>], [<reflink idref="bib14" id="ref63">14</reflink>]; [<reflink idref="bib16" id="ref64">16</reflink>]; [<reflink idref="bib19" id="ref65">19</reflink>]; [<reflink idref="bib22" id="ref66">22</reflink>]; [<reflink idref="bib24" id="ref67">24</reflink>]; [<reflink idref="bib25" id="ref68">25</reflink>]; [<reflink idref="bib27" id="ref69">27</reflink>]; [<reflink idref="bib28" id="ref70">28</reflink>]; [<reflink idref="bib30" id="ref71">30</reflink>]; [<reflink idref="bib35" id="ref72">35</reflink>]; [<reflink idref="bib36" id="ref73">36</reflink>]; [<reflink idref="bib40" id="ref74">40</reflink>]; [<reflink idref="bib41" id="ref75">41</reflink>]; [<reflink idref="bib42" id="ref76">42</reflink>]; [<reflink idref="bib43" id="ref77">43</reflink>]; [<reflink idref="bib45" id="ref78">45</reflink>]; [<reflink idref="bib47" id="ref79">47</reflink>]; [<reflink idref="bib49" id="ref80">49</reflink>], [<reflink idref="bib50" id="ref81">50</reflink>]; [<reflink idref="bib51" id="ref82">51</reflink>]; [<reflink idref="bib55" id="ref83">55</reflink>]; [<reflink idref="bib57" id="ref84">57</reflink>]; [<reflink idref="bib58" id="ref85">58</reflink>]; [<reflink idref="bib61" id="ref86">61</reflink>], [<reflink idref="bib62" id="ref87">62</reflink>]; [<reflink idref="bib68" id="ref88">68</reflink>], [<reflink idref="bib69" id="ref89">69</reflink>]; [<reflink idref="bib71" id="ref90">71</reflink>]; [<reflink idref="bib75" id="ref91">75</reflink>]; [<reflink idref="bib79" id="ref92">79</reflink>]).</p> <p>Graph: Figure 1. Flowchart of study identification, screening, and inclusion.</p> <hd id="AN0192584786-11">Study Characteristic</hd> <p>Table 1 summarizes the characteristics of the included studies. Of the 36 studies, 27 were RCTs (including two three-arm RCTs), 6 were crossover studies, and 3 were non-RCTs. Regarding age groups, 6 studies focused on adults ([<reflink idref="bib19" id="ref93">19</reflink>]; [<reflink idref="bib22" id="ref94">22</reflink>]; [<reflink idref="bib24" id="ref95">24</reflink>]; [<reflink idref="bib25" id="ref96">25</reflink>]; [<reflink idref="bib41" id="ref97">41</reflink>]; [<reflink idref="bib42" id="ref98">42</reflink>]), while the remaining studies examined children or adolescents. In terms of language, 3 studies were published in Chinese ([<reflink idref="bib16" id="ref99">16</reflink>]; [<reflink idref="bib45" id="ref100">45</reflink>]; [<reflink idref="bib71" id="ref101">71</reflink>]), while the rest were in English. Regarding exercise intervention types, 10 studies investigated acute exercise interventions ([<reflink idref="bib5" id="ref102">5</reflink>]; [<reflink idref="bib6" id="ref103">6</reflink>]; [<reflink idref="bib9" id="ref104">9</reflink>]; [<reflink idref="bib15" id="ref105">15</reflink>]; [<reflink idref="bib22" id="ref106">22</reflink>]; [<reflink idref="bib24" id="ref107">24</reflink>]; [<reflink idref="bib42" id="ref108">42</reflink>]; [<reflink idref="bib43" id="ref109">43</reflink>]; [<reflink idref="bib49" id="ref110">49</reflink>]; [<reflink idref="bib79" id="ref111">79</reflink>]), while the remaining studies focused on chronic exercise interventions. For outcome measures, 7 studies assessed hyperactivity/impulsivity symptom ([<reflink idref="bib7" id="ref112">7</reflink>]; [<reflink idref="bib12" id="ref113">12</reflink>]; [<reflink idref="bib16" id="ref114">16</reflink>]; [<reflink idref="bib19" id="ref115">19</reflink>]; [<reflink idref="bib35" id="ref116">35</reflink>]; [<reflink idref="bib51" id="ref117">51</reflink>]; [<reflink idref="bib75" id="ref118">75</reflink>]). Behavioral measures of Inhibitory control were reported in 34 studies ([<reflink idref="bib5" id="ref119">5</reflink>]; [<reflink idref="bib6" id="ref120">6</reflink>]; [<reflink idref="bib7" id="ref121">7</reflink>]; [<reflink idref="bib9" id="ref122">9</reflink>]; [<reflink idref="bib12" id="ref123">12</reflink>]; [<reflink idref="bib15" id="ref124">15</reflink>], [<reflink idref="bib14" id="ref125">14</reflink>]; [<reflink idref="bib16" id="ref126">16</reflink>]; [<reflink idref="bib19" id="ref127">19</reflink>]; [<reflink idref="bib22" id="ref128">22</reflink>]; [<reflink idref="bib24" id="ref129">24</reflink>]; [<reflink idref="bib25" id="ref130">25</reflink>]; [<reflink idref="bib27" id="ref131">27</reflink>]; [<reflink idref="bib28" id="ref132">28</reflink>]; [<reflink idref="bib30" id="ref133">30</reflink>]; [<reflink idref="bib36" id="ref134">36</reflink>]; [<reflink idref="bib40" id="ref135">40</reflink>]; [<reflink idref="bib41" id="ref136">41</reflink>]; [<reflink idref="bib42" id="ref137">42</reflink>]; [<reflink idref="bib43" id="ref138">43</reflink>]; [<reflink idref="bib45" id="ref139">45</reflink>]; [<reflink idref="bib47" id="ref140">47</reflink>]; [<reflink idref="bib49" id="ref141">49</reflink>], [<reflink idref="bib50" id="ref142">50</reflink>]; [<reflink idref="bib55" id="ref143">55</reflink>]; [<reflink idref="bib57" id="ref144">57</reflink>]; [<reflink idref="bib58" id="ref145">58</reflink>]; [<reflink idref="bib61" id="ref146">61</reflink>], [<reflink idref="bib62" id="ref147">62</reflink>]; [<reflink idref="bib68" id="ref148">68</reflink>], [<reflink idref="bib69" id="ref149">69</reflink>]; [<reflink idref="bib71" id="ref150">71</reflink>]; [<reflink idref="bib75" id="ref151">75</reflink>]; [<reflink idref="bib79" id="ref152">79</reflink>]). Regarding ERP measures, three studies examined N2 components ([<reflink idref="bib36" id="ref153">36</reflink>]; [<reflink idref="bib50" id="ref154">50</reflink>]; [<reflink idref="bib68" id="ref155">68</reflink>]), and another three studies focused on P3 components ([<reflink idref="bib49" id="ref156">49</reflink>], [<reflink idref="bib50" id="ref157">50</reflink>]; [<reflink idref="bib68" id="ref158">68</reflink>]).</p> <p>Table 1. Characteristics of Included Studies.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left" colspan="3">Study</th><th align="center" colspan="5">Participants (IG vs. CG)</th><th align="center" colspan="4">Intervention</th><th align="center" rowspan="2">Outcome measures</th></tr><tr><th align="left">Author and year</th><th align="center">Country</th><th align="center">Design</th><th align="center">Sample size (<italic>n</italic>)</th><th align="center">Mean age or age range</th><th align="center">Diagnostic methods</th><th align="center">ADHD type (I/HI/C, unknown)</th><th align="center">Medication user (%)</th><th align="center">Program (IG vs. CG)</th><th align="center">Type</th><th align="center">Session (min/), frequency (times/week), duration (weeks)</th><th align="center">Exercise intensity</th></tr></thead><tbody><tr><td><xref ref-type="bibr" rid="bibr5">Barudin-Carreiro et al. (2024)</xref></td><td>USA</td><td>RCT</td><td>7 vs. 8</td><td>9.69 ± 1.75 vs. 9.65 ± 1.19</td><td>NR</td><td>2/2/2,1 vs. 2/0/6</td><td>71.42 vs. 75</td><td>Walking vs. sitting</td><td>Acute</td><td>20</td><td>NR</td><td>①</td></tr><tr><td><xref ref-type="bibr" rid="bibr6">Benzing et al. (2018)</xref></td><td>Switzerland</td><td>RCT</td><td>24 vs. 22</td><td>10.46 ± 1.35 vs. 10.50 ± 1.41</td><td>ICD-10</td><td>NR</td><td>79.2 vs. 77.3</td><td>Exergaming vs. watching a movie</td><td>Acute</td><td>15</td><td>55%–90%HRmax</td><td>②</td></tr><tr><td><xref ref-type="bibr" rid="bibr7">Benzing and Schmidt (2019)</xref></td><td>Switzerland</td><td>RCT</td><td>28 vs. 23</td><td>10.46 ± 1.30 vs. 10.39 ± 1.44</td><td>ICD-10</td><td>NR</td><td>71.4 % vs. 73.9</td><td>Exergaming vs. non-intervention</td><td>Chronic</td><td>30/3/8</td><td>NR</td><td>③⑧</td></tr><tr><td><xref ref-type="bibr" rid="bibr9">Bigelow et al. (2021)</xref></td><td>Canada</td><td>CRD</td><td>16</td><td>11.38 ± 1.50</td><td>DSM-V</td><td>3/1/3,9</td><td>56.25</td><td>Cycling vs. reading</td><td>Acute</td><td>10</td><td>65%–85% HRmax</td><td>①</td></tr><tr><td><xref ref-type="bibr" rid="bibr12">Bustamante et al. (2016)</xref></td><td>USA</td><td>RCT</td><td>19 vs. 16</td><td>9.4 ± 2.2 vs. 8.7 ± 2.0</td><td>DSM-IV</td><td>NR</td><td>NR</td><td>Structured play vs. sedentary activity</td><td>Chronic</td><td>90/5/10</td><td>75% HRmax</td><td>④⑨</td></tr><tr><td><xref ref-type="bibr" rid="bibr15">Chang et al. (2012)</xref></td><td>Taiwan</td><td>RCT</td><td>20 vs. 20</td><td>10.45 ± 0.95 vs. 10.42 ± 0.87</td><td>DSM-IV</td><td>10/2/8 vs. 4/3/13</td><td>50 vs. 50</td><td>Running vs. watching a video</td><td>Acute</td><td>30</td><td>50%–70%HRR</td><td>①</td></tr><tr><td><xref ref-type="bibr" rid="bibr14">Chang et al. (2014)</xref></td><td>Taiwan</td><td>Non-RCT</td><td>14 vs. 13</td><td>8.19 ± 7.65 vs. 8.78 ± 8.33</td><td>DSM-IV</td><td>4/2/8 vs. 3/0/10</td><td>46.15 vs. 50</td><td>Aquatic exercise vs. non-intervention</td><td>Chronic</td><td>90/2/8</td><td>Moderate intensity</td><td>⑤</td></tr><tr><td><xref ref-type="bibr" rid="bibr16">Chen et al. (2022)</xref></td><td>China (in China)</td><td>RCT</td><td>32 vs. 32</td><td>8.37 ± 1.68 vs. 7.89 ± 2.13</td><td>DSM-V</td><td>5/10/17 vs. 6/8/18</td><td>NR</td><td>Cycling vs. sitting</td><td>Chronic</td><td>25/3/12</td><td>60%–80%HRmax</td><td>①⑩</td></tr><tr><td><xref ref-type="bibr" rid="bibr19">Converse et al. (2020)</xref></td><td>USA</td><td>RCT</td><td>9 vs. 5 vs. 7</td><td>20.70 ± 1.50</td><td>NR</td><td>12/1/7</td><td>76.19</td><td>Taichi vs. kickboxing vs. non-intervention</td><td>Chronic</td><td>60/2/7</td><td>NR</td><td>②⑪</td></tr><tr><td><xref ref-type="bibr" rid="bibr22">Dinu et al. (2023)</xref></td><td>UK</td><td>RCT</td><td>40 vs. 42</td><td>26.62 ± 5.26</td><td>NR</td><td>NR</td><td>NR</td><td>Yoga vs. cycling</td><td>Acute</td><td>10</td><td>/</td><td>⑦</td></tr><tr><td><xref ref-type="bibr" rid="bibr24">K. M. Fritz and O'Connor (2016)</xref></td><td>USA</td><td>CRD</td><td>32</td><td>18–33</td><td>NR</td><td>NR</td><td>NR</td><td>Cycling vs. resting</td><td>Acute</td><td>20</td><td>65% VO2peak</td><td>⑥</td></tr><tr><td><xref ref-type="bibr" rid="bibr25">K. Fritz and O'Connor (2022)</xref></td><td>USA</td><td>RCT</td><td>16 vs. 16</td><td>20.16 ± 1.46</td><td>DSM-V</td><td>NR</td><td>NR</td><td>Yoga vs. non-intervention</td><td>Chronic</td><td>90/2/6</td><td>NR</td><td>②</td></tr><tr><td><xref ref-type="bibr" rid="bibr27">Geladé et al. (2017)</xref></td><td>Netherlands</td><td>RCT</td><td>37 vs. 39</td><td>9.80 ± 1.96 vs. 9.96 ± 1.88</td><td>DSM-IV</td><td>NR</td><td>No</td><td>HIIT vs. NFB</td><td>Chronic</td><td>45/3/12</td><td>70%–80%HRmax</td><td>④</td></tr><tr><td><xref ref-type="bibr" rid="bibr28">Ghadamgahi Sani et al. (2022)</xref></td><td>Iran</td><td>RCT</td><td>20 vs. 20</td><td>7.50 ± 1.34 vs. 8.41 ± 0.85</td><td>DSM-V</td><td>NR</td><td>NR</td><td>Perceptual-motor exercise vs. NFB</td><td>Chronic</td><td>45/3/7</td><td>NR</td><td>⑥</td></tr><tr><td><xref ref-type="bibr" rid="bibr30">Hattabi et al. (2019)</xref></td><td>Tunisia</td><td>RCT</td><td>20 vs. 20</td><td>9.95 ± 1.31 vs. 9.75 ± 1.33</td><td>DSM-IV</td><td>4/6/10 vs. 5/4/11</td><td>NR</td><td>Swimming vs. non-intervention</td><td>Chronic</td><td>90/3/12</td><td>Moderate intensity</td><td>①</td></tr><tr><td><xref ref-type="bibr" rid="bibr35">Jensen and Kenny (2004)</xref></td><td>Australia</td><td>RCT</td><td>11 vs. 8</td><td>10.63 ± 1.78 vs. 9.35 ± 1.70</td><td>DSM-IV</td><td>2/0/9 vs. 1/0/7</td><td>9.09 vs. 12.5</td><td>Yoga vs. cooperative activity</td><td>Chronic</td><td>60/20</td><td>NR</td><td>⑫⑬</td></tr><tr><td><xref ref-type="bibr" rid="bibr36">Ji et al. (2023)</xref></td><td>Korea</td><td>RCT</td><td>16 vs. 14</td><td>9.00 ± 1.46 vs. 8.85 ± 1.63</td><td>NR</td><td>NR</td><td>NR</td><td>Exergaming vs. cycling</td><td>Chronic</td><td>50/3/12</td><td>60%–80% HRR</td><td>⑤⑯</td></tr><tr><td><xref ref-type="bibr" rid="bibr40">Kadri et al. (2019)</xref></td><td>Tunisia</td><td>RCT</td><td>20 vs. 20</td><td>14.5 ± 3.5 vs. 14.2 ± 3</td><td>NR</td><td>NR</td><td>NR</td><td>Taekwondo vs. non-intervention</td><td>Chronic</td><td>50/2/52</td><td>NR</td><td>①</td></tr><tr><td><xref ref-type="bibr" rid="bibr41">Kouhbanani et al. (2023)</xref></td><td>Iran</td><td>RCT</td><td>25 vs. 27</td><td>35.24 ± 11.49 vs. 35.40 ± 11.01</td><td>DSM-V</td><td>16/0/9 vs. 18/0/9</td><td>NR</td><td>Pilates training vs. non-intervention</td><td>Chronic</td><td>45/3/24</td><td>NR</td><td>⑥</td></tr><tr><td><xref ref-type="bibr" rid="bibr42">Kuo, Nitsche, et al. (2024)</xref></td><td>Taiwan</td><td>CRD</td><td>26</td><td>23.5 ± 3.2</td><td>DSM-IV</td><td>NR</td><td>NR</td><td>Cycling vs. watching a video</td><td>Acute</td><td>30</td><td>50%–70%HRR</td><td>④</td></tr><tr><td><xref ref-type="bibr" rid="bibr43">Kuo, Sun, et al. (2024)</xref></td><td>Taiwan</td><td>CRD</td><td>24</td><td>17.2 ± 2.2</td><td>DSM-V</td><td>1/2/21</td><td>NR</td><td>Cycling vs. watching a video</td><td>Acute</td><td>30</td><td>50%–70%HRR</td><td>④</td></tr><tr><td><xref ref-type="bibr" rid="bibr45">Li et al. (2024)</xref></td><td>China (in China)</td><td>Non-RCT</td><td>16 vs. 12</td><td>7.93 ± 1.61</td><td>DSM-V</td><td>NR</td><td>NR</td><td>Ball activity vs. non-intervention</td><td>Chronic</td><td>60/2/8</td><td>64%–95%HRmax</td><td>①</td></tr><tr><td><xref ref-type="bibr" rid="bibr47">Liang et al. (2022)</xref></td><td>China</td><td>RCT</td><td>40 vs. 40</td><td>8.37 ± 1.42 vs. 8.29 ± 1.27</td><td>DSM-V</td><td>22/7/11 vs. 19/6/15</td><td>No</td><td>Combined aerobic and neurocognitive exercise vs. non-intervention</td><td>Chronic</td><td>60/3/12</td><td>60%–80%HRmax</td><td>②</td></tr><tr><td><xref ref-type="bibr" rid="bibr49">Ludyga et al. (2017)</xref></td><td>Switzerland</td><td>CRD</td><td>16</td><td>12.8 ± 1.8</td><td>DSM-IV</td><td>NR</td><td>NR</td><td>Cycling vs. coordinative exercise vs. watching a video</td><td>Acute</td><td>20</td><td>65%–70%HRmax</td><td>②⑰</td></tr><tr><td><xref ref-type="bibr" rid="bibr50">Ludyga et al. (2023)</xref></td><td>Switzerland</td><td>RCT</td><td>29 vs. 27</td><td>10.0 ± 1.2 vs. 10.8 ± 1.2</td><td>DSM-V</td><td>NR</td><td>NR</td><td>Judo vs. non-intervention</td><td>Chronic</td><td>60/2/12</td><td>NR</td><td>⑤⑯⑰</td></tr><tr><td><xref ref-type="bibr" rid="bibr51">Luo et al. (2023)</xref></td><td>China</td><td>RCT</td><td>15 vs. 15</td><td>4.94 ± 0.70 vs. 5.07 ± 0.88</td><td>NR</td><td>NR</td><td>NR</td><td>Yoga vs. non-intervention</td><td>Chronic</td><td>10/2/16</td><td>NR</td><td>⑭</td></tr><tr><td><xref ref-type="bibr" rid="bibr55">Memarmoghaddam et al. (2016)</xref></td><td>Iran</td><td>RCT</td><td>19 vs. 17</td><td>8.31 ± 1.29 vs. 8.29 ± 1.31</td><td>NR</td><td>6/5/8 vs. 5/3/9</td><td>NR</td><td>Ball activity vs. non-intervention</td><td>Chronic</td><td>90/3/8</td><td>65%–80%HRR</td><td>①⑤</td></tr><tr><td><xref ref-type="bibr" rid="bibr57">Nejati (2021)</xref></td><td>Iran</td><td>RCT</td><td>15 vs. 14</td><td>9.73 ± 1.94 vs. 9.21 ± 1.25</td><td>NR</td><td>NR</td><td>NR</td><td>Combined balanced and cognitive training vs. running</td><td>Chronic</td><td>40-50/3/4-5</td><td>NR</td><td>⑤</td></tr><tr><td><xref ref-type="bibr" rid="bibr58">Nejati and Derakhshan (2021)</xref></td><td>Iran</td><td>RCT</td><td>15 vs. 15</td><td>9.43 ± 1.43</td><td>DSM-V</td><td>5/2/8 vs. 6/1/8</td><td>NR</td><td>Exercise combining cognitive and virtual technology vs. running</td><td>Chronic</td><td>40-50/3/4-5</td><td>NR</td><td>⑤</td></tr><tr><td><xref ref-type="bibr" rid="bibr61">Pan et al. (2016)</xref></td><td>Taiwan</td><td>RCT</td><td>16 vs. 16</td><td>8.93 ± 1.49 vs. 8.87 ± 1.56</td><td>DSM-IV</td><td>NR</td><td>56.25 vs. 56.25</td><td>Table tennis vs. non-intervention</td><td>Chronic</td><td>70/2/12</td><td>NR</td><td>①</td></tr><tr><td><xref ref-type="bibr" rid="bibr62">Pan et al. (2019)</xref></td><td>Taiwan</td><td>Non-RCT</td><td>15 vs. 15</td><td>9.08 ± 1.43 vs. 8.90 ± 1.66</td><td>DSM-IV</td><td>NR</td><td>60 vs. 60</td><td>Table tennis vs. non-intervention</td><td>Chronic</td><td>70/2/12</td><td>NR</td><td>①</td></tr><tr><td><xref ref-type="bibr" rid="bibr68">S. D. Smith et al. (2019)</xref></td><td>USA</td><td>RCT</td><td>13 vs. 16</td><td>7.23 ± 1.42 vs. 7.06 ± 1.06</td><td>DSM-IV</td><td>5/2/4, 2 vs. 5/2/7, 2</td><td>15.4 vs. 18.8</td><td>Integrated brain, body, and social intervention vs. standard care</td><td>Chronic</td><td>120/3/15</td><td>NR</td><td>⑤⑯⑰</td></tr><tr><td><xref ref-type="bibr" rid="bibr69">S. D. Smith et al. (2020)</xref></td><td>USA</td><td>RCT</td><td>42 vs. 38</td><td>7.6 ± 0.9 vs. 7.2 ± 1.2</td><td>DSM-IV</td><td>12/7/15, 8 vs. 8/5/16, 9</td><td>19.05 vs. 18.42</td><td>Integrated brain, body, and social intervention vs. standard care</td><td>Chronic</td><td>90/3/15</td><td>NR</td><td>②</td></tr><tr><td><xref ref-type="bibr" rid="bibr71">Song et al. (2022)</xref></td><td>China (in China)</td><td>RCT</td><td>8 vs. 8</td><td>7.68 ± 0.56 vs. 7.53 ± 0.79</td><td>DSM-IV</td><td>6/0/2 vs. 5/1/2</td><td>NR</td><td>Football vs. non-intervention</td><td>Chronic</td><td>30/5/6</td><td>NR</td><td>①</td></tr><tr><td><xref ref-type="bibr" rid="bibr75">Sun et al. (2024)</xref></td><td>China</td><td>RCT</td><td>16 vs. 15 vs. 18</td><td>10.10 ± 1.83</td><td>NR</td><td>NR</td><td>NR</td><td>Game HIIT vs. Structured aerobic exercise vs. non-intervention</td><td>Chronic</td><td>30/2/8 for HIIT; 60/2/8 for aerobic exercise</td><td>Moderate-to-vigorous intensity</td><td>①⑮</td></tr><tr><td><xref ref-type="bibr" rid="bibr79">Walters et al. (2024)</xref></td><td>UK</td><td>CRD</td><td>34</td><td>9.9 ± 1.0</td><td>NR</td><td>NR</td><td>58.82</td><td>Coordinative exercise and game vs. resting</td><td>Acute</td><td>30</td><td>NR</td><td>①</td></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note.</emph> NR = not reported; IG = intervention group; CG = control group; RCT = Randomized Controlled Trial; CRD = Cross-over Randomized Design; Non-RCT = Non-Randomized Controlled Trial. ① Stroop Task (Stroop Color and Word Test), ② Flanker Task (Eriksen Flanker Task), ③ Simon Task (Simon Effect Task), ④ Stop-Signal Task, ⑤ Go/No-Go Task, ⑥ Continuous Performance Test (CPT), ⑦ Test of Variables of Attention (TOVA), ⑧ The German version of the Conners-3 scales, ⑨ The Disruptive Behavior Disorders Rating Scale, ⑩ The Conners' Parent Symptom Questionnaire, ⑪ The Conners' Adult ADHD Rating Scales – Self-Report: Long Version, ⑫ The Conners' Teacher Rating Scale–Revised: Long (CTRSR: L), ⑬ The Conners' Parent Rating Scale–Revised: Long (CPRS–R:L), ⑭ SNAP-IV Rating Scale, ⑮ The Attention-Deficit/Hyperactivity-symptoms and Normal behaviors (SWAN) rating scale, ⑯ ERP (N2), ⑰ ERP (P3).</p> <hd id="AN0192584786-12">Risk of Bias Assessment</hd> <p>Figure 2 shows the risk of bias for RCTs, Figure 3 for crossover studies, and Table 2 for non-RCT studies. Among RCTs, 2 studies had a low risk of bias ([<reflink idref="bib7" id="ref159">7</reflink>]; [<reflink idref="bib69" id="ref160">69</reflink>]), 9 had some concerns ([<reflink idref="bib5" id="ref161">5</reflink>]; [<reflink idref="bib6" id="ref162">6</reflink>]; [<reflink idref="bib12" id="ref163">12</reflink>]; [<reflink idref="bib15" id="ref164">15</reflink>]; [<reflink idref="bib19" id="ref165">19</reflink>]; [<reflink idref="bib22" id="ref166">22</reflink>]; [<reflink idref="bib27" id="ref167">27</reflink>]; [<reflink idref="bib50" id="ref168">50</reflink>]; [<reflink idref="bib61" id="ref169">61</reflink>]), and 16 had a high risk of bias ([<reflink idref="bib16" id="ref170">16</reflink>]; [<reflink idref="bib25" id="ref171">25</reflink>]; [<reflink idref="bib28" id="ref172">28</reflink>]; [<reflink idref="bib30" id="ref173">30</reflink>]; [<reflink idref="bib35" id="ref174">35</reflink>]; [<reflink idref="bib36" id="ref175">36</reflink>]; [<reflink idref="bib40" id="ref176">40</reflink>]; [<reflink idref="bib41" id="ref177">41</reflink>]; [<reflink idref="bib47" id="ref178">47</reflink>]; [<reflink idref="bib51" id="ref179">51</reflink>]; [<reflink idref="bib55" id="ref180">55</reflink>]; [<reflink idref="bib57" id="ref181">57</reflink>]; [<reflink idref="bib58" id="ref182">58</reflink>]; [<reflink idref="bib68" id="ref183">68</reflink>]; [<reflink idref="bib71" id="ref184">71</reflink>]; [<reflink idref="bib75" id="ref185">75</reflink>]). In crossover studies, four had some concerns ([<reflink idref="bib9" id="ref186">9</reflink>]; [<reflink idref="bib42" id="ref187">42</reflink>]; [<reflink idref="bib49" id="ref188">49</reflink>]; [<reflink idref="bib79" id="ref189">79</reflink>]), while two had a high risk of bias ([<reflink idref="bib24" id="ref190">24</reflink>]; [<reflink idref="bib43" id="ref191">43</reflink>]). Among non-RCTs, two had a moderate risk of bias ([<reflink idref="bib14" id="ref192">14</reflink>]; [<reflink idref="bib62" id="ref193">62</reflink>]), and one had a serious risk ([<reflink idref="bib45" id="ref194">45</reflink>]).</p> <p>Graph: Figure 2. Methodological quality of included RCTs.</p> <p>Graph: Figure 3. Methodological quality of included CRDs.</p> <p>Table 2. ROBINS-I Assessment for the Methodological Quality of the Included non-RCT Studies.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left">Study</th><th align="center">Confounding</th><th align="center">Recruitment of participants</th><th align="center">Classification of intervention</th><th align="center">Deviation from intended intervention</th><th align="center">Missing data</th><th align="center">Measurement of outcomes</th><th align="center">Selection of the reported result</th><th align="center">Total</th></tr></thead><tbody><tr><td><xref ref-type="bibr" rid="bibr14">Chang et al. (2014)</xref></td><td>Moderate risk</td><td>Low risk</td><td>Low risk</td><td>Low risk</td><td>Low risk</td><td>Moderate risk</td><td>Low risk</td><td>Moderate risk</td></tr><tr><td><xref ref-type="bibr" rid="bibr45">Li et al. (2024)</xref></td><td>Serious risk</td><td>Low risk</td><td>Low risk</td><td>Low risk</td><td>Low risk</td><td>Moderate risk</td><td>Low risk</td><td>Serious risk</td></tr><tr><td><xref ref-type="bibr" rid="bibr62">Pan et al. (2019)</xref></td><td>Moderate risk</td><td>Low risk</td><td>Low risk</td><td>Low risk</td><td>Low risk</td><td>Moderate risk</td><td>Low risk</td><td>Moderate risk</td></tr></tbody></table> </ephtml> </p> <hd id="AN0192584786-13">Meta-Analysis of the Effects of Exercise on Hyperactivity/Impulsivity</hd> <p>A total of 7 studies, including 10 comparisons, evaluated hyperactivity/impulsivity symptoms as an outcome ([<reflink idref="bib7" id="ref195">7</reflink>]; [<reflink idref="bib12" id="ref196">12</reflink>]; [<reflink idref="bib16" id="ref197">16</reflink>]; [<reflink idref="bib19" id="ref198">19</reflink>]; [<reflink idref="bib35" id="ref199">35</reflink>]; [<reflink idref="bib51" id="ref200">51</reflink>]; [<reflink idref="bib75" id="ref201">75</reflink>]). The results indicated that exercise interventions had no significant effect on hyperactivity/impulsivity symptoms in individuals with ADHD compared to control conditions (<emph>g</emph> = −0.61, 95% CI [−1.27, 0.06], <emph>p</emph> = 0.222), with high heterogeneity (<emph>I²</emph> = 83.8%, <emph>p</emph> <.001), as shown in Figure 4.</p> <p>Graph: Figure 4. Forest plot of the meta-analysis of hyperactivity/impulsivity.</p> <hd id="AN0192584786-14">Meta-Analysis of the Effects of Exercise on Behavioral Performance of Inhibitory Control</hd> <p>A total of 34 studies, comprising 38 comparisons, evaluated the effect of exercise interventions on inhibitory control ([<reflink idref="bib5" id="ref202">5</reflink>]; [<reflink idref="bib6" id="ref203">6</reflink>]; [<reflink idref="bib7" id="ref204">7</reflink>]; [<reflink idref="bib9" id="ref205">9</reflink>]; [<reflink idref="bib12" id="ref206">12</reflink>]; [<reflink idref="bib15" id="ref207">15</reflink>], [<reflink idref="bib14" id="ref208">14</reflink>]; [<reflink idref="bib16" id="ref209">16</reflink>]; [<reflink idref="bib19" id="ref210">19</reflink>]; [<reflink idref="bib22" id="ref211">22</reflink>]; [<reflink idref="bib24" id="ref212">24</reflink>]; [<reflink idref="bib25" id="ref213">25</reflink>]; [<reflink idref="bib27" id="ref214">27</reflink>]; [<reflink idref="bib28" id="ref215">28</reflink>]; [<reflink idref="bib30" id="ref216">30</reflink>]; [<reflink idref="bib36" id="ref217">36</reflink>]; [<reflink idref="bib40" id="ref218">40</reflink>]; [<reflink idref="bib41" id="ref219">41</reflink>]; [<reflink idref="bib42" id="ref220">42</reflink>]; [<reflink idref="bib43" id="ref221">43</reflink>]; [<reflink idref="bib45" id="ref222">45</reflink>]; [<reflink idref="bib47" id="ref223">47</reflink>]; [<reflink idref="bib49" id="ref224">49</reflink>], [<reflink idref="bib50" id="ref225">50</reflink>]; [<reflink idref="bib55" id="ref226">55</reflink>]; [<reflink idref="bib57" id="ref227">57</reflink>]; [<reflink idref="bib58" id="ref228">58</reflink>]; [<reflink idref="bib61" id="ref229">61</reflink>], [<reflink idref="bib62" id="ref230">62</reflink>]; [<reflink idref="bib68" id="ref231">68</reflink>], [<reflink idref="bib69" id="ref232">69</reflink>]; [<reflink idref="bib71" id="ref233">71</reflink>]; [<reflink idref="bib75" id="ref234">75</reflink>]; [<reflink idref="bib79" id="ref235">79</reflink>]). The results showed that, compared to the control condition, exercise interventions had a significant but small-to-moderate effect on inhibitory control (<emph>g</emph> = −0.47, 95% CI [−0.71, −0.23], <emph>p</emph> <.001), with high heterogeneity (<emph>I²</emph> = 79.3%, <emph>p</emph> <.001), as shown in Figure 5.</p> <p>Graph: Figure 5. Forest plot of the meta-analysis of behavioral performance of inhibitory control.</p> <hd id="AN0192584786-15">Meta-Analysis of the Effects of Exercise on ERPs of Inhibitory Control</hd> <p>Three studies evaluated the N2 component as an outcome measure ([<reflink idref="bib36" id="ref236">36</reflink>]; [<reflink idref="bib50" id="ref237">50</reflink>]; [<reflink idref="bib68" id="ref238">68</reflink>]). The results indicated that, compared to the control condition, exercise interventions had no significant effect on the N2 component in individuals with ADHD (<emph>g</emph> = −0.19, 95% CI [−0.92, 0.54], <emph>p</emph> = 0.610), with high heterogeneity (<emph>I²</emph> = 72.1%, <emph>p</emph> = 0.028), as shown in Figure 6. Additionally, four comparisons from three studies evaluated the P3 component as an outcome measure ([<reflink idref="bib49" id="ref239">49</reflink>], [<reflink idref="bib50" id="ref240">50</reflink>]; [<reflink idref="bib68" id="ref241">68</reflink>]). The results indicated that, compared to the control condition, exercise interventions had no significant effect on the P3 component in individuals with ADHD (g = 0.06, 95% CI [−0.35, 0.47], <emph>p</emph> = 0.789), with better homogeneity (<emph>I²</emph> = 22.8%, <emph>p</emph> = 0.274), as shown in Figure 7.</p> <p>Graph: Figure 6. Forest plot of the meta-analysis of the N2.</p> <p>Graph: Figure 7. Forest plot of the meta-analysis of the P3.</p> <hd id="AN0192584786-16">Subgroup Analysis</hd> <p>Due to the limited number of studies on hyperactivity/impulsivity symptoms and EEG studies on inhibitory control, subgroup analyses were not conducted. Instead, moderator variable analysis focused on behavioral performance of inhibitory control, considering subject age, inhibitory control domains, study design, exercise intervention type, exercise time, frequency, duration, intensity, motor skills, control group type, and study quality. In age subgroup analysis, exercise intervention showed a small-to-moderate effect in children and adolescents with ADHD (<emph>g</emph> = −0.46, 95% CI [−0.70, −0.21], p <.001) but no significant effect in adults (<emph>g</emph> = −0.52, 95% CI [−1.31, 0.27], <emph>p</emph> = 0.196). Chronic interventions had a moderate-to-large effect (<emph>g</emph> = −0.57, 95% CI [−0.89, −0.24], p =.001), while acute interventions had no significant effect (<emph>g</emph> = −0.26, 95% CI [−0.52, 0.00], <emph>p</emph> =.051). Exercise frequency of three times per week showed a significant moderate-to-large effect (<emph>g</emph> = −0.76, 95% CI [−1.17, −0.35], <emph>p</emph> <.001), while twice (<emph>g</emph> = −0.30, 95% CI [−0.93, 0.33], <emph>p</emph> = 0.351) and five times per week (<emph>g</emph> = −0.43, 95% CI [−1.27, 0.41], <emph>p</emph> = 0.317) showed no significant effects. Exercise interventions had a moderate-to-large effect compared to sedentary/no-intervention groups (<emph>g</emph> = −0.52, 95% CI [−0.79, −0.24], <emph>p</emph> <.001) but did not differ from regular physical activity (<emph>g</emph> = −0.13, 95% CI [−0.52, 0.27], <emph>p</emph> = 0.537) or neurofeedback training (<emph>g</emph> = −0.36, 95% CI [−1.35, 0.63], p = 0.473). Subgroup analysis by study quality revealed a significant effect for moderate (<emph>g</emph> = −0.34, 95% CI [−0.64, −0.05], <emph>p</emph> =.023) and high-risk bias studies (<emph>g</emph> = −0.61, 95% CI [−1.01, −0.21], <emph>p</emph> =.003), but not for low-risk studies (<emph>g</emph> = −0.13, 95% CI [−0.48, 0.21], <emph>p</emph> = 0.445). However, no moderating effects were observed for inhibitory control domains, study design, exercise time (min/session), exercise duration (weeks), exercise intensity, or motor skills. Detailed results are presented in Figure 8.</p> <p>Graph: Figure 8. Subgroup analysis of behavioral performance of inhibitory control.</p> <hd id="AN0192584786-17">Sensitivity Analysis</hd> <p>Sensitivity analysis using the leave-one-out method revealed that the 95% confidence intervals of the pooled effect sizes for hyperactivity/impulsivity symptoms, behavioral performance of inhibitory control, and the N2 and P3 components of ERP remained largely unchanged, indicating that no single study substantially influenced the overall results.</p> <hd id="AN0192584786-18">Publication Bias</hd> <p>A visual inspection of the funnel plots (Figure 9(A) for hyperactivity/impulsivity, 9(B) for behavioral performance of inhibitory control, 9(C) for the N2 component, and 9(D) for the P3 component) suggested potential asymmetry. However, Egger's linear regression analysis revealed no statistical evidence of publication bias for behavioral performance of inhibitory control (<emph>p</emph> = 0.167). Egger's tests were not conducted for hyperactivity/impulsivity, N2, and P3 due to the inclusion of fewer than 10 studies in each case.</p> <p>Graph: Figure 9. Funnel plot for hyperactivity/impulsivity (A), behavioral performance of inhibitory control (B), the N2 (C), and the P3 (D).</p> <hd id="AN0192584786-19">Discussion</hd> <p>To our knowledge, this is the first systematic review and meta-analysis evaluating the effects of exercise interventions on inhibitory control in ADHD across three levels: questionnaire assessments, behavior, and electrophysiology. Synthesizing 36 studies (38 comparisons), we found a small to moderate significant effect of exercise on behavior performance of inhibitory control, supporting its efficacy in ADHD management. No significant effects were found on hyperactivity/impulsivity or inhibitory control-related ERP components.</p> <hd id="AN0192584786-20">Hyperactivity/Impulsivity Symptoms</hd> <p>Since lower symptom scores indicate improvement, negative effect sizes reflect benefits. Our meta-analysis found no significant effects of exercise on hyperactivity/impulsivity, consistent with findings from studies focusing on children with ADHD (2022), but contrasting with [<reflink idref="bib81" id="ref242">81</reflink>], who included both children and adults, highlighting the need for further investigation. The forest plot shows some effect sizes on the right of the null line, potentially contributing to the non-significant result. Possible reasons include small sample sizes ([<reflink idref="bib19" id="ref243">19</reflink>]; [<reflink idref="bib35" id="ref244">35</reflink>]), reducing statistical power and increasing variability. [<reflink idref="bib75" id="ref245">75</reflink>] noted that studies conducted during the COVID-19 pandemic faced intervention period restrictions due to public health policies, potentially reducing intervention efficacy. Although our overall analysis did not detect significant effects, individual studies observed positive impacts of exercise on hyperactivity/impulsivity symptoms, necessitating further research to clarify these findings.</p> <hd id="AN0192584786-21">Behavioral Outcomes of Inhibitory Control</hd> <p>Our findings align with previous studies ([<reflink idref="bib32" id="ref246">32</reflink>]; [<reflink idref="bib46" id="ref247">46</reflink>]; [<reflink idref="bib80" id="ref248">80</reflink>]), suggesting that exercise enhances inhibitory control in individuals with ADHD. In addition, a recent umbrella review also reported that exercise significantly improves inhibitory control in children with ADHD, with this conclusion supported by a high level of evidence ([<reflink idref="bib20" id="ref249">20</reflink>]). Previous research mainly examined the effects through moderator analyses, whereas our study focused on inhibitory control as a single dimension and included more studies. Sensitivity analysis confirmed the robustness of our results, with no evidence of publication bias. Several moderators were identified, including participant age, exercise type, exercise frequency, control group type, and study quality.</p> <p>Subgroup analysis showed exercise interventions were not significantly effective in adults, likely due to more stable inhibitory control from neurodevelopmental maturation. In contrast to children and adolescents, adults demonstrate lower impulsivity scores in tasks like CPT-AX, reflecting superior inhibitory control. Additionally, No-Go N2 amplitude declines with age ([<reflink idref="bib39" id="ref250">39</reflink>]), suggesting that adults may have already attained mature inhibitory control, influencing exercise intervention effectiveness. Nevertheless, this finding should be interpreted with caution, as it may be partly attributable to the small number of studies included in the adult subgroup. Acute exercise interventions did not show significant effects, possibly due to their transient impact on neural processes rather than sustained behavioral performance ([<reflink idref="bib53" id="ref251">53</reflink>]). While acute exercise can enhance cerebral blood flow ([<reflink idref="bib56" id="ref252">56</reflink>]) and brain-derived neurotrophic factor ([<reflink idref="bib10" id="ref253">10</reflink>]), these short-term changes may not yield lasting behavioral improvements. Chronic exercise, on the other hand, also increases gray matter volume ([<reflink idref="bib77" id="ref254">77</reflink>]), optimizes neurophysiological functioning ([<reflink idref="bib54" id="ref255">54</reflink>]), and modulates neurotransmitter systems ([<reflink idref="bib13" id="ref256">13</reflink>]), leading to more substantial and sustained improvements in inhibitory control. Three sessions per week produced significant effects, supporting the inverted-U hypothesis, which suggests moderate intervention frequency optimizes outcomes. Both insufficient and excessive frequencies may hinder efficacy. Exercise interventions did not outperform regular physical activity and neurofeedback training, both of which have been shown to enhance inhibitory control. However, exercise interventions showed more significant benefits when compared to passive control groups (e.g., sedentary conditions or no-treatment controls). Studies with a low risk of bias did not demonstrate significant improvements. Notably, the low-bias-risk category included two RCTs that implemented rigorous randomization and blinding procedures, minimizing expectation effects from both researchers and participants. Consequently, effect size estimates in these studies were likely more objective and conservative. In contrast, studies with moderate or high risk of bias, which exhibited methodological limitations such as inadequate control conditions or randomization procedures, tended to report larger effect sizes. No moderating effects were found for inhibitory control domains, study design, exercise duration per session, total intervention duration, exercise intensity, or motor skill level.</p> <hd id="AN0192584786-22">Electrophysiological Measures of Inhibitory Control</hd> <p>The N2 component, a negative deflection linked to conflict monitoring, reflects response inhibition in the Go/No-Go task ([<reflink idref="bib29" id="ref257">29</reflink>]; [<reflink idref="bib64" id="ref258">64</reflink>]). A more negative value indicates greater improvement. Among the three studies, one ([<reflink idref="bib36" id="ref259">36</reflink>]) showed an effect size on the right side of the null line, comparing exergaming and cycling. While no significant pre-post changes in No-Go N2 amplitude were found, the exergaming group showed a significant increase in Go N2 amplitude, suggesting that exergaming may enhance response execution rather than directly improving response inhibition. The P3 component, a positive deflection associated with inhibitory control ([<reflink idref="bib26" id="ref260">26</reflink>]; [<reflink idref="bib29" id="ref261">29</reflink>]), attentional resource allocation, and context updating ([<reflink idref="bib63" id="ref262">63</reflink>]), serves as an index where greater positive values indicate improved performance. Three studies (four comparisons) used Go/No-Go and Flanker tasks. Two studies ([<reflink idref="bib50" id="ref263">50</reflink>]; [<reflink idref="bib68" id="ref264">68</reflink>]) reported effect sizes to the left of the null line. In the study by [<reflink idref="bib50" id="ref265">50</reflink>], the judo intervention did not yield significant improvements, which may be attributed to the participants' relatively low motor skill levels. Motor proficiency is foundational for mastering complex movement techniques, and children with ADHD who exhibit lower motor skills may experience heightened cognitive demands when learning judo, potentially diminishing intervention benefits. Similarly, [<reflink idref="bib68" id="ref266">68</reflink>] observed no significant effect of exercise on P3, possibly due to the study's small sample size and limited intervention dosage. Although no significant effects of exercise interventions on N2 and P3 components were observed, these findings do not rule out their potential benefits for inhibitory control. Future research should use neuroimaging to explore the neural mechanisms underlying exercise-induced improvements.</p> <hd id="AN0192584786-23">Limitations</hd> <p>This study has several limitations: (<reflink idref="bib1" id="ref267">1</reflink>) Many studies reported only total symptom scores, limiting subgroup analyses on hyperactivity/impulsivity; (<reflink idref="bib2" id="ref268">2</reflink>) The small number of EEG studies may have reduced our ability to detect significant effects, and future research should integrate neuroimaging techniques for more comprehensive evidence; (<reflink idref="bib3" id="ref269">3</reflink>) Few studies were classified as low-risk, and future RCTs should follow CONSORT guidelines for greater transparency in study design, randomization, and blinding; (<reflink idref="bib4" id="ref270">4</reflink>) Some studies lacked detailed diagnostic criteria and intervention parameters, limiting subgroup analyses. Future studies should provide comprehensive methodological details for better reproducibility and comparability.</p> <hd id="AN0192584786-24">Conclusions</hd> <p>This meta-analysis shows a small-to-moderate beneficial effect of exercise on inhibitory control in ADHD, significantly moderated by age, intervention type, frequency, control group type, and study quality. However, exercise did not show significant effects on hyperactivity, impulsivity, or inhibition-related N2 and P3 components, suggesting that its impact should not be overestimated. These findings underscore the necessity of implementing chronic exercise interventions and maintaining a moderate exercise frequency from childhood to promote the development of inhibitory control. Future RCTs employing neuroimaging techniques and following CONSORT guidelines are needed to clarify the mechanisms of exercise and verify its effectiveness in ADHD management.</p> <hd id="AN0192584786-25">Supplemental Material</hd> <p>Graph: Supplemental material, sj-docx-1-jad-10.1177_10870547251404197 for Effects of Exercise on Hyperactivity/Impulsivity and Inhibitory Control at Behavioral and Electrophysiological Levels in ADHD: A Systematic Review and Meta-Analysis by Zeping Zhang, Xuanyu Bo, Kun Liu, Jiangdi Su, Yongfei Zhu and Suyong Yang in Journal of Attention Disorders</p> <ref id="AN0192584786-26"> <title> References </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (DSM-5 TR) (5th ed., text revision ed.).</bibtext> </blist> <blist> <bibl id="bib2" idref="ref2" type="bt">2</bibl> <bibtext> Ayano G., Demelash S., Gizachew Y., Tsegay L., Alati R. (2023). 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European Journal of Neuroscience, 53(10), 3447–3462. https://doi.org/10.1111/ejn.15198</bibtext> </blist> </ref> <ref id="AN0192584786-27"> <title> Footnotes </title> <blist> <bibtext> Zeping Zhang</bibtext> </blist> <blist> <bibtext>Graph</bibtext> </blist> <blist> <bibtext>https://orcid.org/0000-0002-4675-3169 Xuanyu Bo</bibtext> </blist> <blist> <bibtext>Graph</bibtext> </blist> <blist> <bibtext>https://orcid.org/0009-0001-4793-1692 Kun Liu</bibtext> </blist> <blist> <bibtext>Graph</bibtext> </blist> <blist> <bibtext>https://orcid.org/0009-0005-3656-5956 Jiangdi Su</bibtext> </blist> <blist> <bibtext>Graph</bibtext> </blist> <blist> <bibtext>https://orcid.org/0009-0004-9129-2893 Yongfei Zhu</bibtext> </blist> <blist> <bibtext>Graph</bibtext> </blist> <blist> <bibl id="bib10" idref="ref253" type="bt"></bibl> <bibtext>https://orcid.org/0009-0001-7324-6373 Suyong Yang</bibtext> </blist> <blist> <bibl id="bib11" idref="ref20" type="bt"></bibl> <bibtext>Graph https://orcid.org/0000-0001-9881-347X</bibtext> </blist> <blist> <bibtext> The protocol for this study was registered with PROSPERO (CRD42025637758).</bibtext> </blist> <blist> <bibtext> Zeping Zhang, Yongfei Zhu, and Suyong Yang developed the idea of systematic review and meta-analysis. Literature search was conducted by Xuanyu Bo and Kun Liu. Literature screening and data extraction were performed by Xuanyu Bo and Kun Liu. Data analysis was conducted by Zeping Zhang and Jiangdi Su. The first draft of the manuscript was written by Zeping Zhang, and all the authors made critical modifications to the manuscript. All authors read and approved the final manuscript.</bibtext> </blist> <blist> <bibtext> The authors received no financial support for the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibtext> The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibtext> Supplemental material for this article is available online.</bibtext> </blist> </ref> <aug> <p>By Zeping Zhang; Xuanyu Bo; Kun Liu; Jiangdi Su; Yongfei Zhu and Suyong Yang</p> <p>Reported by Author; Author; Author; Author; Author; Author</p> <p></p> <p>Zeping Zhang is a doctoral student at Shanghai University of Sport. His research interests focus on exercise and health promotion, particularly the development of intervention approaches for children and adolescents with attention-deficit/hyperactivity disorder, depressive disorders, and anxiety disorders.</p> <p>Xuanyu Bo is a doctoral student at the University of Newcastle. Her research primarily involves physical activity, exercise, and health promotion in children and adolescents, with attention to behavioral patterns and their associated health outcomes.</p> <p>Kun Liu is a lecturer at Ma'anshan University. His research focuses on exercise and health promotion across diverse populations. He is particularly interested in how regular physical activity promotes physical and mental well-being and supports healthy lifestyle behaviors.</p> <p>Jiangdi Su is a master's student at Shanghai University of Sport. Her research interests focus on exercise and health promotion, particularly the development of intervention approaches for children and adolescents with attention-deficit/hyperactivity disorder, depressive disorders, and anxiety disorders.</p> <p>Yongfei Zhu is an associate professor at Chizhou University. His research primarily examines the role of physical activity in health promotion, including its effects on middle-aged and older adults, individuals with chronic conditions, and children with special needs.</p> <p>Suyong Yang is an assistant professor of psychology and neuroscience at Shanghai University of Sport. His research interests focus on the relationships among physical exercise, emotion, and neurocognitive functioning in both adults and children.</p> </aug> <nolink nlid="nl1" bibid="bib70" firstref="ref3"></nolink> <nolink nlid="nl2" bibid="bib34" firstref="ref4"></nolink> <nolink nlid="nl3" bibid="bib59" firstref="ref5"></nolink> <nolink nlid="nl4" bibid="bib72" firstref="ref6"></nolink> <nolink nlid="nl5" bibid="bib33" firstref="ref7"></nolink> <nolink nlid="nl6" bibid="bib44" firstref="ref8"></nolink> <nolink nlid="nl7" bibid="bib21" firstref="ref10"></nolink> <nolink nlid="nl8" bibid="bib38" firstref="ref11"></nolink> <nolink nlid="nl9" bibid="bib78" firstref="ref12"></nolink> <nolink nlid="nl10" bibid="bib52" firstref="ref13"></nolink> <nolink nlid="nl11" bibid="bib23" firstref="ref14"></nolink> <nolink nlid="nl12" bibid="bib26" firstref="ref15"></nolink> <nolink nlid="nl13" bibid="bib29" firstref="ref16"></nolink> <nolink nlid="nl14" bibid="bib64" firstref="ref17"></nolink> <nolink nlid="nl15" bibid="bib66" firstref="ref18"></nolink> <nolink nlid="nl16" bibid="bib67" firstref="ref19"></nolink> <nolink nlid="nl17" bibid="bib37" firstref="ref21"></nolink> <nolink nlid="nl18" bibid="bib17" firstref="ref22"></nolink> <nolink nlid="nl19" bibid="bib82" firstref="ref23"></nolink> <nolink nlid="nl20" bibid="bib60" firstref="ref24"></nolink> <nolink nlid="nl21" bibid="bib51" firstref="ref25"></nolink> <nolink nlid="nl22" bibid="bib12" firstref="ref27"></nolink> <nolink nlid="nl23" bibid="bib75" firstref="ref28"></nolink> <nolink nlid="nl24" bibid="bib14" firstref="ref29"></nolink> <nolink nlid="nl25" bibid="bib55" firstref="ref30"></nolink> <nolink nlid="nl26" bibid="bib47" firstref="ref31"></nolink> <nolink nlid="nl27" bibid="bib61" firstref="ref33"></nolink> <nolink nlid="nl28" bibid="bib13" firstref="ref35"></nolink> <nolink nlid="nl29" bibid="bib27" firstref="ref36"></nolink> <nolink nlid="nl30" bibid="bib50" firstref="ref37"></nolink> <nolink nlid="nl31" bibid="bib25" firstref="ref39"></nolink> <nolink nlid="nl32" bibid="bib41" firstref="ref40"></nolink> <nolink nlid="nl33" bibid="bib32" firstref="ref41"></nolink> <nolink nlid="nl34" bibid="bib46" firstref="ref42"></nolink> <nolink nlid="nl35" bibid="bib65" firstref="ref43"></nolink> <nolink nlid="nl36" bibid="bib76" firstref="ref44"></nolink> <nolink nlid="nl37" bibid="bib48" firstref="ref46"></nolink> <nolink nlid="nl38" bibid="bib74" firstref="ref47"></nolink> <nolink nlid="nl39" bibid="bib18" firstref="ref48"></nolink> <nolink nlid="nl40" bibid="bib73" firstref="ref49"></nolink> <nolink nlid="nl41" bibid="bib31" firstref="ref56"></nolink> <nolink nlid="nl42" bibid="bib15" firstref="ref62"></nolink> <nolink nlid="nl43" bibid="bib16" firstref="ref64"></nolink> <nolink nlid="nl44" bibid="bib19" firstref="ref65"></nolink> <nolink nlid="nl45" bibid="bib22" firstref="ref66"></nolink> <nolink nlid="nl46" bibid="bib24" firstref="ref67"></nolink> <nolink nlid="nl47" bibid="bib28" firstref="ref70"></nolink> <nolink nlid="nl48" bibid="bib30" firstref="ref71"></nolink> <nolink nlid="nl49" bibid="bib35" firstref="ref72"></nolink> <nolink nlid="nl50" bibid="bib36" firstref="ref73"></nolink> <nolink nlid="nl51" bibid="bib40" firstref="ref74"></nolink> <nolink nlid="nl52" bibid="bib42" firstref="ref76"></nolink> <nolink nlid="nl53" bibid="bib43" firstref="ref77"></nolink> <nolink nlid="nl54" bibid="bib45" firstref="ref78"></nolink> <nolink nlid="nl55" bibid="bib49" firstref="ref80"></nolink> <nolink nlid="nl56" bibid="bib57" firstref="ref84"></nolink> <nolink nlid="nl57" bibid="bib58" firstref="ref85"></nolink> <nolink nlid="nl58" bibid="bib62" firstref="ref87"></nolink> <nolink nlid="nl59" bibid="bib68" firstref="ref88"></nolink> <nolink nlid="nl60" bibid="bib69" firstref="ref89"></nolink> <nolink nlid="nl61" bibid="bib71" firstref="ref90"></nolink> <nolink nlid="nl62" bibid="bib79" firstref="ref92"></nolink> <nolink nlid="nl63" bibid="bib81" firstref="ref242"></nolink> <nolink nlid="nl64" bibid="bib80" firstref="ref248"></nolink> <nolink nlid="nl65" bibid="bib20" firstref="ref249"></nolink> <nolink nlid="nl66" bibid="bib39" firstref="ref250"></nolink> <nolink nlid="nl67" bibid="bib53" firstref="ref251"></nolink> <nolink nlid="nl68" bibid="bib56" firstref="ref252"></nolink> <nolink nlid="nl69" bibid="bib77" firstref="ref254"></nolink> <nolink nlid="nl70" bibid="bib54" firstref="ref255"></nolink> <nolink nlid="nl71" bibid="bib63" firstref="ref262"></nolink>
Header DbId: eric
DbLabel: ERIC
An: EJ1501666
AccessLevel: 3
PubType: Academic Journal
PubTypeId: academicJournal
PreciseRelevancyScore: 0
IllustrationInfo
Items – Name: Title
  Label: Title
  Group: Ti
  Data: Effects of Exercise on Hyperactivity/Impulsivity and Inhibitory Control at Behavioral and Electrophysiological Levels in ADHD: A Systematic Review and Meta-Analysis
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Zeping+Zhang%22">Zeping Zhang</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-4675-3169">0000-0002-4675-3169</externalLink>)<br /><searchLink fieldCode="AR" term="%22Xuanyu+Bo%22">Xuanyu Bo</searchLink> (ORCID <externalLink term="https://orcid.org/0009-0001-4793-1692">0009-0001-4793-1692</externalLink>)<br /><searchLink fieldCode="AR" term="%22Kun+Liu%22">Kun Liu</searchLink> (ORCID <externalLink term="https://orcid.org/0009-0005-3656-5956">0009-0005-3656-5956</externalLink>)<br /><searchLink fieldCode="AR" term="%22Jiangdi+Su%22">Jiangdi Su</searchLink> (ORCID <externalLink term="https://orcid.org/0009-0004-9129-2893">0009-0004-9129-2893</externalLink>)<br /><searchLink fieldCode="AR" term="%22Yongfei+Zhu%22">Yongfei Zhu</searchLink> (ORCID <externalLink term="https://orcid.org/0009-0001-7324-6373">0009-0001-7324-6373</externalLink>)<br /><searchLink fieldCode="AR" term="%22Suyong+Yang%22">Suyong Yang</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-9881-347X">0000-0001-9881-347X</externalLink>)
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Attention+Disorders%22"><i>Journal of Attention Disorders</i></searchLink>. 2026 30(5):677-693.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 17
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2026
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Information Analyses
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Attention+Deficit+Hyperactivity+Disorder%22">Attention Deficit Hyperactivity Disorder</searchLink><br /><searchLink fieldCode="DE" term="%22Exercise%22">Exercise</searchLink><br /><searchLink fieldCode="DE" term="%22Hyperactivity%22">Hyperactivity</searchLink><br /><searchLink fieldCode="DE" term="%22Conceptual+Tempo%22">Conceptual Tempo</searchLink><br /><searchLink fieldCode="DE" term="%22Inhibition%22">Inhibition</searchLink><br /><searchLink fieldCode="DE" term="%22Self+Control%22">Self Control</searchLink><br /><searchLink fieldCode="DE" term="%22Age+Differences%22">Age Differences</searchLink><br /><searchLink fieldCode="DE" term="%22Children%22">Children</searchLink><br /><searchLink fieldCode="DE" term="%22Adolescents%22">Adolescents</searchLink><br /><searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Incidence%22">Incidence</searchLink><br /><searchLink fieldCode="DE" term="%22Research+Methodology%22">Research Methodology</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Effectiveness%22">Program Effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Problems%22">Behavior Problems</searchLink><br /><searchLink fieldCode="DE" term="%22Adults%22">Adults</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1177/10870547251404197
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1087-0547<br />1557-1246
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective: This study aimed to assess the impact of exercise on hyperactivity/impulsivity, inhibitory control, and inhibition-related event-related potential (ERP) components in individuals with ADHD. Method: A systematic search identified relevant studies, and methodological quality was assessed using the Revised Cochrane Risk-of-Bias tool for randomized trials (RoB 2) and the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I), with data analysis conducted using Stata software. Results: A total of 36 studies (38 comparisons) were included, comprising 10 acute and 26 chronic exercise interventions. Exercise yielded a small-to-moderate improvement in inhibitory control but showed no significant effects on hyperactivity/impulsivity or inhibition-related N2 and P3 components. Subgroup analyses of inhibitory control revealed significant moderating effects of age (children/adolescents), intervention type (chronic interventions), frequency (three sessions per week), control condition (sedentary or no-intervention groups), and study quality (studies with moderate or high risk of bias). Conclusion: Exercise enhances inhibitory control in individuals with ADHD, with the effect being especially pronounced in children and adolescents. Chronic interventions and a frequency of three sessions per week appear to be most beneficial. However, it shows no significant effect on hyperactivity/impulsivity or inhibition-related N2 and P3 components. The impact of exercising should not be overestimated.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2026
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1501666
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1501666
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1177/10870547251404197
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 17
        StartPage: 677
    Subjects:
      – SubjectFull: Attention Deficit Hyperactivity Disorder
        Type: general
      – SubjectFull: Exercise
        Type: general
      – SubjectFull: Hyperactivity
        Type: general
      – SubjectFull: Conceptual Tempo
        Type: general
      – SubjectFull: Inhibition
        Type: general
      – SubjectFull: Self Control
        Type: general
      – SubjectFull: Age Differences
        Type: general
      – SubjectFull: Children
        Type: general
      – SubjectFull: Adolescents
        Type: general
      – SubjectFull: Intervention
        Type: general
      – SubjectFull: Incidence
        Type: general
      – SubjectFull: Research Methodology
        Type: general
      – SubjectFull: Program Effectiveness
        Type: general
      – SubjectFull: Behavior Problems
        Type: general
      – SubjectFull: Adults
        Type: general
    Titles:
      – TitleFull: Effects of Exercise on Hyperactivity/Impulsivity and Inhibitory Control at Behavioral and Electrophysiological Levels in ADHD: A Systematic Review and Meta-Analysis
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Zeping Zhang
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          Name:
            NameFull: Xuanyu Bo
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            NameFull: Kun Liu
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            NameFull: Jiangdi Su
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            NameFull: Yongfei Zhu
      – PersonEntity:
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            NameFull: Suyong Yang
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          Dates:
            – D: 01
              M: 05
              Type: published
              Y: 2026
          Identifiers:
            – Type: issn-print
              Value: 1087-0547
            – Type: issn-electronic
              Value: 1557-1246
          Numbering:
            – Type: volume
              Value: 30
            – Type: issue
              Value: 5
          Titles:
            – TitleFull: Journal of Attention Disorders
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