Beyond binary comparisons: a Bayesian dose-response meta-analysis of exercise on executive function in children and adolescents with ADHD

Abstract

Objective: This study aimed to systematically evaluate the acute and long-term effects of exercise interventions on executive function in children and adolescents with attention-deficit/hyperactivity disorder (ADHD), using Bayesian dose-response modelling to identify optimal dose ranges and modality-specific effects.

Methods: A systematic search of five major databases (PubMed, Web of Science, Embase, Cochrane Library, and APA PsycInfo) was conducted up to March 2025. Thirty-three eligible studies were included, comprising 10 acute and 23 long-term exercise intervention trials. Bayesian non-linear dose-response models were applied to determine optimal doses for three executive function domains: cognitive flexibility, working memory, and inhibitory control.

Results: Exercise interventions significantly improved executive function in youth with ADHD and showed clear dose-dependent patterns. In acute interventions, optimal doses were 270 METs for cognitive flexibility, 170 METs for working memory, and 130 METs for inhibitory control. In long-term interventions, optimal weekly doses were 1100, 1300, and 2500 METs, respectively. Different exercise modalities yielded varying effects across executive domains.

Conclusion: Exercise benefits executive function in children and adolescents with ADHD, with effects influenced by both dose and modality. This study proposes a "dose-domain-modality" framework, offering empirical support for individualized, precision-based exercise prescriptions.

Impact: This is the first systematic review and dose-response meta-analysis quantifying acute and long-term effects of exercise on executive function in ADHD youth, identifying domain-specific optimal doses for cognitive flexibility, working memory, and inhibitory control across 33 studies. By integrating Bayesian modeling and network meta-analytic methods, the study introduces a "dose-domain-modality" framework, offering novel empirical support for individualized, function-targeted exercise prescriptions. It moves beyond merely showing effectiveness or a single "optimal" dose, emphasizing precise prescriptions tailored to executive function domains for targeted cognitive enhancement.