Effects of Six Types of Exercise Interventions on Inhibitory Control, Executive Function, and Gross Motor Skills in Children With ADHD: A Network Meta-Analysis of 26 Randomized Controlled Trials.

backgroundAttention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity, which adversely affect academic performance and social functioning in children. Current treatment approaches, including medication and behavioral therapy, present certain limitations. In recent years, exercise therapy has attracted increasing attention as a non-pharmacological intervention without adverse side effects. However, the efficacy of conventional exercise regimens remains limited. Consequently, to address this limitation, researchers have developed a range of innovative exercise-based interventions-such as mind-dody movement (MBM), ball games (BG), artificial intelligence training (AI), aerobic training (AT), circuit training (CIR), and neurofeedback training (NFT)-which have demonstrated significant benefits in improving inhibitory control, executive function, and gross motor skills among children with ADHD. This study aims to analyze the effects of these innovative exercise interventions and to provide a foundation for optimizing exercise therapy for this population.

methodsWe systematically searched six databases, including PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), Embase, Scopus, and SPORT Discus (EBSCOhost), to screen 26 randomized controlled trials (RCTs) covering 1,276 children with ADHD. The results of the study focused on the key metrics of inhibitory control, executive function, and gross motor skills. We used the Review Manager 5.3 software to assess the methodological quality of the studies. Based on the results criteria, we provided an overall rating and level of evidence for each attribute. We performed network meta-analysis (NMA) using Stata 15.0 software with the aim of assessing the relative effectiveness of different interventions and verifying the consistency of direct and indirect evidence.

resultsThe NMA revealed distinct patterns of domain-specific effectiveness across interventions. For gross motor skills, BG (SMD = -2.08, 95% CI [-3.70, -0.47]) and MBM (SMD = -1.59, 95% CI [-2.20, -0.98]) demonstrated the largest effect sizes, with CIR, NFT, and AI also showing statistically significant benefits. In the domain of inhibitory control, MBM again showed the strongest effect (SMD = -2.26, 95% CI [-2.97, -1.55]), followed by AT and NFT. For executive function, only MBM and NFT achieved statistically significant improvements compared to the control. Notably, MBM emerged as the only intervention with consistent trans-domain efficacy, showing significant benefits in inhibitory control, executive function, and gross motor skills.

conclusionThis NMA indicates that while six exercise interventions generally benefit children with ADHD, their effects exhibit distinct domain specificity. A key finding is that mind-body exercise emerged as the most universal and effective intervention across all measures, demonstrating the strongest effects on inhibitory control and significant benefits in both executive function and gross motor skills. NFT also demonstrated broad utility, significantly improving executive function and inhibitory control. Other interventions, such as ball sports and AT, showed effects more confined to specific domains like gross motor skills or inhibitory control.NMA comparing six exercise therapies for improving inhibitory function, executive function, and gross motor development in children with ADHD.