Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jan 7:12:1479615.
doi: 10.3389/fped.2024.1479615. eCollection 2024.

Effects of physical exercise on anxiety depression and emotion regulation in children with attention deficit hyperactivity disorder: a systematic review and meta-analysis

Yagang Song #  1 , Shuqi Jia #  2 , Xing Wang  2 , Aiwei Wang  3 , Tao Ma  4 , Shufan Li  2 , Jiwei Chen  2 , Zhaohui Guo  2 , Feng Ding  2 , Yuxi Ren  2 , Man Qin  5
Affiliations

Effects of physical exercise on anxiety depression and emotion regulation in children with attention deficit hyperactivity disorder: a systematic review and meta-analysis

Yagang Song et al. Front Pediatr. .

Abstract

Objective: This systematic review and meta-analysis aimed to comprehensively evaluate the impact of physical exercise interventions on anxiety, depression, and emotional regulation in children diagnosed with attention deficit hyperactivity disorder (ADHD).

Methods: A comprehensive search was conducted across multiple databases, including Embase, Web of Science (WOS), PubMed, The Cochrane Library, Wanfang Data, VIP Information, and China National Knowledge Infrastructure (CNKI), from their inception up to July 2024. The search aimed to identify randomized controlled trials (RCTs) investigating the impact of physical exercise on anxiety, depression, and emotional regulation in children diagnosed with ADHD. The Physiotherapy Evidence Database (PEDro) scale was employed to assess the quality of the literature, while the revised Cochrane risk-of-bias tool (ROB-2) was used to evaluate the overall risk of bias. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) profiler method was utilized to further assess the quality of evidence. Meta-analysis, sensitivity analysis, and publication bias testing were performed using Stata 18.0 software. Effect sizes were calculated using the standardized mean difference (SMD) and 95% confidence intervals (CI).

Results: The analysis included 18 RCTs, encompassing 830 participants. Physical exercise exhibited a significant positive effect on anxiety (SMD = -0.58, p < 0.05), depression (SMD = -0.57, p < 0.05), and emotional regulation (SMD = 1.03, p < 0.05) in children diagnosed with ADHD. Subgroup analysis revealed that exercise programs with monotypic and mixed modalities, short duration, high frequencies, medium duration, and moderate intensities were the most efficacious in ameliorating anxiety symptoms. The mixed exercise program, when conducted for short duration, with low frequencies, medium duration, and moderate intensity was the most effective in alleviating depression symptoms. Exercise programs featuring mixed modalities, longer duration, moderate to high frequencies, shorter duration, and low intensity yielded the most significant improvements in emotional regulation.

Conclusions: Research demonstrates that physical exercise mitigates anxiety and depression and improves emotional regulation in children with ADHD. A dose-response relationship is evident, correlating with the type, duration, intensity, frequency, and overall exercise duration.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, PROSPERO identifier (CRD42024571577).

Keywords: anxiety; attention deficit hyperactivity disorder; depression; emotional regulation; meta-analysis; physical exercise.

PubMed Disclaimer

Conflict of interest statement

The authors declare that this research was conducted without any commercial or financial relationships that could be interpreted as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of literature selection and inclusion.
Figure 2
Figure 2
Assessment of methodological quality included in the study.
Figure 3
Figure 3
Forest diagram of the effect of physical activity on anxiety, depression and emotion in children with ADHD [(a) anxiety, (b) depression; (c) emotion].
Figure 4
Figure 4
Sensitivity analysis [(a) anxiety; (b) depression; (c) emotion].
Figure 5
Figure 5
Egger's test results [(a) anxiety; (b) depression; (c) emotion].
Figure 6
Figure 6
Evidence quality assessment.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. de la Peña IC, Pan MC, Thai CG, Alisso T. Attention-Deficit/Hyperactivity disorder predominantly inattentive subtype/presentation: research progress and translational studies. Brain Sci. (2020) 10(5):292. 10.3390/brainsci10050292 - DOI - PMC - PubMed
    1. Mechler K, Banaschewski T, Hohmann S, Häge A. Evidence-based pharmacological treatment options for ADHD in children and adolescents. Pharmacol Ther. (2022) 230:107940. 10.1016/j.pharmthera.2021.107940 - DOI - PubMed
    1. Sibley MH, Arnold LE, Swanson JM, Hechtman LT, Kennedy TM, Owens E, et al. Variable patterns of remission from ADHD in the multimodal treatment study of ADHD. Am J Psychiatry. (2022) 179(2):142–51. 10.1176/appi.ajp.2021.21010032 - DOI - PMC - PubMed
    1. Caldwell DM, Welton NJ. Approaches for synthesising complex mental health interventions in meta-analysis. Evid Based Ment Health. (2016) 19(1):16–21. 10.1136/eb-2015-102275 - DOI - PMC - PubMed
    1. Martz E, Weiner L, Weibel S. Identifying different patterns of emotion dysregulation in adult ADHD. Borderline Personal Disord Emot Dysregul. (2023) 10(1):28. 10.1186/s40479-023-00235-y - DOI - PMC - PubMed

Publication types

LinkOut - more resources