An Intelligent Exercise Intervention for Enhancing Hot Executive Functions in Children With Attention-Deficit/Hyperactivity Disorder: A Randomized Clinical Trial

Background: Deficits in hot executive functions (EFs), including risky decision-making, delay discounting, and emotion regulation, represent important yet relatively understudied features of attention-deficit/hyperactivity disorder (ADHD). Although physical exercise has been shown to improve cool EFs, its effects on hot EFs remain uncertain. Furthermore, conventional intervention approaches are often limited by accessibility and implementation barriers, underscoring the need for intelligent, home-based alternatives. Methods: In this three-arm randomized controlled trial, 145 children aged 6-10 years with ADHD were randomly assigned to an intelligent exercise group (EG1; n = 53), a traditional offline exercise group (EG2; n = 45), or a wait-list control group (CG; n = 47). Both intervention groups participated in a 12-week program consisting of three sessions per week, each lasting 45-60 minutes and integrating physical and cognitive training. Participants in EG1 completed the intervention through a custom-developed WeChat mini-program ("LeDongYing"), which incorporates computer vision-based motor assessment, dynamically personalized exercise prescriptions, real-time feedback, an artificial intelligence (AI)-assisted guidance agent, and a tailored exercise library. Participants in EG2 received coach-led, face-to-face training sessions. Outcome measures included risky decision-making, delay discounting, and emotion regulation. Intervention effects were evaluated using generalized linear mixed models, with potential confounders included as covariates. Conclusions: The intelligent exercise intervention appears to be an effective, scalable, and accessible non-pharmacological approach for improving hot executive functions in children with ADHD. Its efficacy was comparable to that of traditional face-to-face exercise programs, suggesting that this delivery model may help overcome implementation barriers and expand access to rehabilitation services without implying superiority over conventional approaches. Clinical Trial Registration: The study has been registered on https://www.chictr.org.cn/ (registration number: ChiCTR2200065413; registration link: https://www.chictr.org.cn/showproj.html?proj=182412).