Recent years have seen an expansion of interest in non-pharmacological interventions for attention-deficit/hyperactivity disorder (ADHD). Although considerable treatment development has focused on cognitive training programs, compelling evidence indicates that intense aerobic exercise enhances brain structure and function, and as such, might be beneficial to children with ADHD. This paper reviews evidence for a direct impact of exercise on neural functioning and preliminary evidence that exercise may have positive effects on children with ADHD. At present, data are promising and support the need for further study, but are insufficient to recommend widespread use of such interventions for children with ADHD.
This is a preview of subscription content, log in to check access.
Buy single article
Instant unlimited access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Papers of particular interest, published recently, have been highlighted as: • Of importance•• Of major importance
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington DC: American Psychiatric Press 1994.
Mannuzza S, Klein RG. Long-term prognosis in attention-deficit/hyperactivity disorder. Child Adolesc Psychiatr Clin N Am. 2000;9:711–26.
Barkley RA. Global issues related to the impact of untreated attention-deficit/hyperactivity disorder from childhood to young adulthood. Postgrad Med. 2008;120:48–59.
Conners CK. Forty years of methylphenidate treatment in attention-deficit/ hyperactivity disorder. J Atten Disord. 2002;6:S17–30.
Greenhill LL, Halperin JM, Abikoff H. Stimulant medications. J Am Acad Child Adolesc Psychiatry. 1999;38:503–12.
Spencer T, Biederman J, Wilens T, et al. Pharmacotherapy of attention-deficit hyperactivity disorder across the life cycle. J Am Acad Child Adolesc Psychiatry. 1996;35:409–32.
Pelham Jr WE, Fabiano GA. Behavior modification. Child Adolesc Psychiatr Clin N Am. 2000;9:671–88. ix.
Pelham Jr WE, Fabiano GA. Evidence-based psychosocial treatments for attention-deficit/hyperactivity disorder. J Clin Child Adolesc Psychol. 2008;37:184–214.
Sanchez RJ, Crismon ML, Barner JC, et al. Assessment of adherence measures with different stimulants among children and adolescents. Pharmacotherapy. 2005;25:909–17.
Perwien A, Hall J, Swensen A, et al. Stimulant treatment patterns and compliance in children and adults with newly treated attention-deficit/hyperactivity disorder. J Manag Care Pharm. 2004;10:122–9.
Molina BS, Hinshaw SP, Swanson JM, et al. The MTA at 8years: prospective follow-up of children treated for combined-type ADHD in a multisite study. J Am Acad Child Adolesc Psychiatry. 2009;48:484–500.
Shaw P, Eckstrand K, Sharp W, et al. Attention-deficit/hyperactivity disorder is characterized by a delay in cortical maturation. Proc Natl Acad Sci U S A. 2007;104:19649–54.
Giedd JN, Rapoport JL. Structural MRI of pediatric brain development: what have we learned and where are we going? Neuron. 2010;67:728–34.
Halperin JM, Schulz KP. Revisiting the role of the prefrontal cortex in the pathophysiology of attention-deficit/hyperactivity disorder. Psychol Bull. 2006;132:560–81.
Bedard AC, Trampush JW, Newcorn JH, et al. Perceptual and motor inhibition in adolescents/young adults with childhood-diagnosed ADHD. Neuropsychology. 2010;24:424–34.
Halperin JM, Trampush JW, Miller CJ, et al. Neuropsychological outcome in adolescents/young adults with childhood ADHD: profiles of persisters, remitters and controls. J Child Psychol Psychiatry. 2008;49:958–66.
Shaw P, Lerch J, Greenstein D, et al. Longitudinal mapping of cortical thickness and clinical outcome in children and adolescents with attention-deficit/hyperactivity disorder. Arch Gen Psychiatry. 2006;63:540–9.
Schulz KP, Newcorn JH, Fan J, et al. Brain activation gradients in ventrolateral prefrontal cortex related to persistence of ADHD in adolescence. J Am Acad Child Adolesc Psychiatry. 2005;44:47–54.
•• Halperin JM, Healey DM. The influences of environmental enrichment, cognitive enhancement, and physical exercise on brain development: can we alter the developmental trajectory of ADHD? Neurosci Biobehav Rev. 2011;35:621–34. This review examines the emerging literature on the underlying neural determinants of ADHD, along with research demonstrating powerful influences of environmental factors on brain development and functioning. Based on these largely distinct scientific literatures, the authors propose an approach that employs directed play and physical exercise to promote brain growth, which, in turn, could lead to the development of potentially more enduring treatments for the disorder.
Sonuga-Barke EJ, Halperin JM. Developmental phenotypes and causal pathways in attention deficit/hyperactivity disorder: potential targets for early intervention? J Child Psychol Psychiatry. 2010;51:368–89.
Halperin JM, Bedard AC, Curchack-Lichtin JT. Preventive interventions for ADHD: a neurodevelopmental perspective. Neurotherapeutics. 2012. doi:10.1007/s13311-012-0123-z.
Klingberg T, Forssberg H, Westerberg H. Training of working memory in children with adhd. J Clin Exp Neuropsychol. 2002;24:781–91.
Klingberg T, Fernell E, Olesen PJ, et al. Computerized training of working memory in children with adhd–a randomized, controlled trial. J Am Acad Child Adolesc Psychiatry. 2005;44:177–86.
Halperin JM, Marks DJ, Bedard AC, et al. Training executive, attention, and motor skills: a proof-of-concept study in preschool children with ADHD. J Atten Disord. 2012. doi:10.1177/1087054711435681.
Tamm L, McCandless BD, Liang A, et al. Can attention itself be trained? attention training for children at-risk for adhd. In: McBurnett K, Pfiffner L, editors. Attention deficit hyperactivity disorder: concepts, controversies and new directions. New York: Informa Healthcare; 2008. p. 397–407.
Toplak ME, Connors L, Shuster J, et al. Review of cognitive, cognitive-behavioral, and neural-based interventions for attention-deficit/hyperactivity disorder (ADHD). Clin Psychol Rev. 2008;28:801–23.
Dishman RK, Berthoud HR, Booth FW, et al. Neurobiology of exercise. Obesity. 2006;14:345–56.
Audiffren M. Acute exercise and psychological functions: a cognitive-energetic approach. In: McMorris T, Tomporowski PD, Audiffren M, editors. Exercise and cognitive function. Chichester: John Wiley & Sons; 2009. p. 3–39.
Vaynman S, Gomez-Pinilla F. Revenge of the "sit": how lifestyle impacts neuronal and cognitive health through molecular systems that interface energy metabolism with neuronal plasticity. J Neurosci Res. 2006;84:699–715.
van Praag H, Kempermann G, Gage FH. Running increases cell proliferation and neurogenesis in the adult mouse dentate gyrus. Nat Neurosci. 1999;2:266–70.
Bobinski F, Martins DF, Bratti T, et al. Neuroprotective and neuroregenerative effects of low-intensity aerobic exercise on sciatic nerve crush injury in mice. Neuroscience. 2011;194:337–48.
Ding YH, Li J, Zhou Y, et al. Cerebral angiogenesis and expression of angiogenic factors in aging rats after exercise. Curr Neurovasc Res. 2006;3:15–23.
Swain RA, Harris AB, Wiener EC, et al. Prolonged exercise induces angiogenesis and increases cerebral blood volume in primary motor cortex of the rat. Neuroscience. 2003;117:1037–46.
Cotman CW, Berchtold NC, Christie LA. Exercise builds brain health: key roles of growth factor cascades and inflammation. Trends Neurosci. 2007;30:464–72.
van Praag H. Exercise and the brain: something to chew on. Trends Neurosci. 2009;32:283–90.
Ding Q, Vaynman S, Souda P, et al. Exercise affects energy metabolism and neural plasticity-related proteins in the hippocampus as revealed by proteomic analysis. Eur J Neurosci. 2006;24:1265–76.
Tong L, Shen H, Perreau VM, et al. Effects of exercise on gene-expression profile in the rat hippocampus. Neurobiol Dis. 2001;8:1046–56.
Vaynman SS, Ying Z, Yin D, et al. Exercise differentially regulates synaptic proteins associated to the function of BDNF. Brain Res. 2006;1070:124–30.
Farmer J, Zhao X, van Praag H, et al. Effects of voluntary exercise on synaptic plasticity and gene expression in the dentate gyrus of adult male Sprague-Dawley rats in vivo. Neuroscience. 2004;124:71–9.
Berchtold NC, Chinn G, Chou M, et al. Exercise primes a molecular memory for brain-derived neurotrophic factor protein induction in the rat hippocampus. Neuroscience. 2005;133:853–61.
Trejo JL, Carro E, Torres-Aleman I. Circulating insulin-like growth factor I mediates exercise-induced increases in the number of new neurons in the adult hippocampus. J Neurosci. 2001;21:1628–34.
Bailey SP, Davis JM, Ahlborn EN. Neuroendocrine and substrate responses to altered brain 5-HT activity during prolonged exercise to fatigue. J Appl Physiol. 1993;74:3006–12.
Elam M, Svensson TH, Thoren P. Brain monoamine metabolism is altered in rats following spontaneous, long-distance running. Acta Physiol Scand. 1987;130:313–6.
Fordyce DE, Farrar RP. Physical activity effects on hippocampal and parietal cortical cholinergic function and spatial learning in F344 rats. Behav Brain Res. 1991;43:115–23.
Fordyce DE, Wehner JM. Effects of aging on spatial learning and hippocampal protein kinase C in mice. Neurobiol Aging. 1993;14:309–17.
Samorajski T, Delaney C, Durham L, et al. Effect of exercise on longevity, body weight, locomotor performance, and passive-avoidance memory of C57BL/6J mice. Neurobiol Aging. 1985;6:17–24.
Colcombe SJ, Kramer AF, Erickson KI, et al. Cardiovascular fitness, cortical plasticity, and aging. Proc Natl Acad Sci U S A. 2004;101:3316–21.
Kramer AF, Erickson KI, Colcombe SJ. Exercise, cognition, and the aging brain. J Appl Physiol. 2006;101:1237–42.
Colcombe SJ, Erickson KI, Scalf PE, et al. Aerobic exercise training increases brain volume in aging humans. J Gerontol (A Biol Sci Med Sci). 2006;61:1166–70.
Peyrin L, Pequignot JM, Lacour JR, et al. Relationships between catecholamine or 3-methoxy 4-hydroxy phenylglycol changes and the mental performance under submaximal exercise in man. Psychopharmacology. 1987;93:188–92.
Querido JS, Sheel AW. Regulation of cerebral blood flow during exercise. Sports Med. 2007;37:765–82.
Ferris LT, Williams JS, Shen CL. The effect of acute exercise on serum brain-derived neurotrophic factor levels and cognitive function. Med Sci Sports Exerc. 2007;39:728–34.
Gold SM, Schulz KH, Hartmann S, et al. Basal serum levels and reactivity of nerve growth factor and brain-derived neurotrophic factor to standardized acute exercise in multiple sclerosis and controls. J Neuroimmunol. 2003;138:99–105.
Rasmussen P, Brassard P, Adser H, et al. Evidence for a release of brain-derived neurotrophic factor from the brain during exercise. Exp Physiol. 2009;94:1062–9.
Seifert T, Brassard P, Wissenberg M, et al. Endurance training enhances BDNF release from the human brain. Am J Physiol Regul Integr Comp Physiol. 2010;298:R372–7.
Strohle A, Stoy M, Graetz B, et al. Acute exercise ameliorates reduced brain-derived neurotrophic factor in patients with panic disorder. Psychoneuroendocrinology. 2010;35:364–8.
Tang SW, Chu E, Hui T, et al. Influence of exercise on serum brain-derived neurotrophic factor concentrations in healthy human subjects. Neurosci Lett. 2008;431:62–5.
Zoladz JA, Pilc A, Majerczak J, et al. Endurance training increases plasma brain-derived neurotrophic factor concentration in young healthy men. J Physiol Pharmacol. 2008;59:119–32.
Baker LD, Frank LL, Foster-Schubert K, et al. Effects of aerobic exercise on mild cognitive impairment: a controlled trial. Arch Neurol. 2010;67:71–9.
Laurin D, Verreault R, Lindsay J, et al. Physical activity and risk of cognitive impairment and dementia in elderly persons. Arch Neurol. 2001;58:498–504.
Colcombe SJ, Erickson KI, Raz N, et al. Aerobic fitness reduces brain tissue loss in aging humans. J Gerontol (A Biol Sci Med Sci). 2003;58:176–80.
Hyman C, Hofer M, Barde YA, et al. BDNF is a neurotrophic factor for dopaminergic neurons of the substantia nigra. Nature. 1991;350:230–2.
Knusel B, Winslow JW, Rosenthal A, et al. Promotion of central cholinergic and dopaminergic neuron differentiation by brain-derived neurotrophic factor but not neurotrophin 3. Proc Natl Acad Sci U S A. 1991;88:961–5.
del Campo N, Chamberlain SR, Sahakian BJ, et al. The roles of dopamine and noradrenaline in the pathophysiology and treatment of attention-deficit/hyperactivity disorder. Biol Psychiatry. 2011;69:e145–57.
Volkow ND, Wang GJ, Newcorn JH, et al. Motivation deficit in ADHD is associated with dysfunction of the dopamine reward pathway. Mol Psychiatry. 2011;16:1147–54.
Arnsten AF. Fundamentals of attention-deficit/hyperactivity disorder: circuits and pathways. J Clin Psychiatry. 2006;67 Suppl 8:7–12.
Shim SH, Hwangbo Y, Kwon YJ, et al. Increased levels of plasma brain-derived neurotrophic factor (BDNF) in children with attention deficit-hyperactivity disorder (ADHD). Prog Neuropsychopharmacol Biol Psych. 2008;32:1824–8.
Meredith G, Callen S, Scheuer DA. Brain-derived neurotrophic factor expression is increased in the rat amygdala, piriform cortex and hypothalamus following repeated amphetamine administration. Brain Res. 2002;949:218–27.
Fumagalli F, Cattaneo A, Caffino L, et al. Sub-chronic exposure to atomoxetine up-regulates BDNF expression and signalling in the brain of adolescent spontaneously hypertensive rats: comparison with methylphenidate. Pharmacol Res. 2010;62:523–9.
Tsai SJ. Attention-deficit hyperactivity disorder may be associated with decreased central brain-derived neurotrophic factor activity: clinical and therapeutic implications. Med Hypotheses. 2007;68:896–9.
Chaddock L, Erickson KI, Prakash RS, et al. A functional MRI investigation of the association between childhood aerobic fitness and neurocognitive control. Biol Psychol. 2012;89:260–8.
Voss MW, Chaddock L, Kim JS, et al. Aerobic fitness is associated with greater efficiency of the network underlying cognitive control in preadolescent children. Neuroscience. 2011;199:166–76.
Wu CT, Pontifex MB, Raine LB, et al. Aerobic fitness and response variability in preadolescent children performing a cognitive control task. Neuropsychology. 2011;25:333–41.
Hillman CH, Kamijo K, Scudder M. A review of chronic and acute physical activity participation on neuroelectric measures of brain health and cognition during childhood. Prev Med. 2011;52 Suppl 1:S21–8.
Kamijo K, Pontifex MB, O'Leary KC, et al. The effects of an afterschool physical activity program on working memory in preadolescent children. Dev Sci. 2011;14:1046–58.
Hillman CH, Buck SM, Themanson JR, et al. Aerobic fitness and cognitive development: Event-related brain potential and task performance indices of executive control in preadolescent children. Dev Psychol. 2009;45:114–29.
Centers for Disease Control and Prevention. The association between school-based physical activity, including physical education, and academic performance, (Atlanta, GA). 2010.
Best JR. Effects of physical activity on children's executive function: contributions of experimental research on aerobic exercise. Dev Rev. 2010;30:331–551.
Barenberg J, Berse T, Dutke S. Executive functions in learning processes: do they benefit from physical activity? Educ Res Rev. 2011;6:208–22.
Tomporowski PD, Davis CL, Miller PH, et al. Exercise and children's intelligence, cognition, and academic achievement. Educ Psychol Rev. 2008;20:111–31.
• Best JR. Exergaming immediately enhances children's executive function. Dev Psychol. 2011. This study is notable for its well-contrived experimental design to determine whether cognitive engagement during exercise (using video-games as a medium) interacts or adds to the cognitive benefits of acute exercise in typically developing school-age children.
• Davis CL, Tomporowski PD, McDowell JE, et al. Exercise improves executive function and achievement and alters brain activation in overweight children: a randomized, controlled trial. Health Psychol. 2011;30:91–8. This is the first study to examine the impact of physical exercise on the brain activation of children using fMRI
Ellemberg D, St-Louis-Deschenes M. The effect of acute physical exercise on cognitive function during development. Psychol Sport Exerc. 2010;11:122–6.
Fisher A, Boyle JM, Paton JY, et al. Effects of a physical education intervention on cognitive function in young children: randomized controlled pilot study. BMC Pediatr. 2011;11:97.
Hill LJ, Williams JH, Aucott L, et al. How does exercise benefit performance on cognitive tests in primary-school pupils? Dev Med Child Neurol. 2011;53:630–5.
Sternberg S. High-speed scanning in human memory. Science. 1966;153:652–4.
Castelli DM, Hillman CH, Hirsch J, et al. FIT Kids: time in target heart zone and cognitive performance. Prev Med. 2011;52 Suppl 1:S55–9.
Trudeau F, Shephard RJ. Relationships of physical activity to brain health and the academic performance of schoolchildren. Am J Lifestyle Med. 2010;4:138–50.
Kibbe DL, Hackett J, Hurley M, et al. Ten years of TAKE 10!((R)): integrating physical activity with academic concepts in elementary school classrooms. Prev Med. 2011;52 Suppl 1:S43–50.
Mahar MT. Impact of short bouts of physical activity on attention-to-task in elementary school children. Prev Med. 2011;52 Suppl 1:S60–4.
Mahar MT, Murphy SK, Rowe DA, et al. Effects of a classroom-based program on physical activity and on-task behavior. Med Sci Sports Exerc. 2006;38:2086–94.
Allison DB, Faith MS, Franklin RD. Antecedent exercise in the treatment of disruptive behavior: a meta-analytic review. Clin Psychol Sci Pract. 1995;2:279–304.
Wilens TE, Biederman J, Spencer TJ. Attention deficit/hyperactivity disorder across the lifespan. Annu Rev Med. 2002;53:113–31.
Tomporowski PD. Effects of acute bouts of exercise on cognition. Acta Psychol, (Amst). 2003;112:297–324.
Gapin JI, Labban JD, Etnier JL. The effects of physical activity on attention deficit hyperactivity disorder symptoms: the evidence. Prev Med. 2011;52 Suppl 1:S70–4.
Verret C, Guay MC, Berthiaume C, et al. A physical activity program improves behavior and cognitive functions in children with ADHD: an exploratory study. J Atten Disord. 2012;16:71–80.
Smith AL, Hoza B, Linnea K, et al. Pilot physical activity intervention reduces severity of ADHD symptoms in young children. J Atten Disord. 2011. doi:10.1177/1087054711417395.
Medina JA, Netto TL, Muszkat M, et al. Exercise impact on sustained attention of ADHD children, methylphenidate effects. Atten Defic Hyperact Disord. 2010;2:49–58.
Gapin J, Etnier JL. The relationship between physical activity and executive function performance in children with attention-deficit hyperactivity disorder. J Sport Exerc Psychol. 2010;32:753–63.
Chang YK, Liu S, Yu HH, et al. Effect of acute exercise on executive function in children with attention deficit hyperactivity disorder. Arch Clin Neuropsychol. 2012;27:225–37.
This work was supported by grant numbers R21/R33 MH085898 and R01 MH68286 from the National Institute of Mental Health (NIMH) to Jeffrey M. Halperin. The content is solely the responsibility of the authors and does not necessarily represent the official views of NIMH.
O. G. Berwid: none; J. M. Halperin: grant from NIMH, payment for lectures from Cereb, and travel/accommodations/meeting expenses reimbursed by Eunethydis.
About this article
Cite this article
Berwid, O.G., Halperin, J.M. Emerging Support for a Role of Exercise in Attention-Deficit/Hyperactivity Disorder Intervention Planning. Curr Psychiatry Rep 14, 543–551 (2012) doi:10.1007/s11920-012-0297-4
- Attention-deficit/hyperactivity disorder
- Cortical development
- Neurocognitive functioning
- Aerobic exercise
- Cognitive remediation strategies
- Nonpharmacological intervention
- Neural growth
- Cognitive development
- Executive functioning