Exercise-based interventions for anxiety and emotional-behavioral outcomes in youth with ADHD: an umbrella review and evidence gap map

Exercise is proposed as an adjunct for emotional and behavioral difficulties in youth with attention-deficit/hyperactivity disorder (ADHD), but overlapping reviews may overstate the evidence. Seven databases were searched through 1 June 2026 and updated on 20 August 2026. Eligible reviews addressed exercise and emotional-behavioral outcomes in participants aged under 18 years with ADHD. Screening and extraction were independently duplicated, with third-reviewer adjudication. Methodological confidence was assessed using AMSTAR 2; planned ROBIS assessment was not undertaken. Overlap was quantified using corrected covered area (CCA). Only verifiable, outcome-specific source certainty ratings were retained. A post hoc hierarchy selected one review for highly overlapping constructs and was examined in sensitivity analyses. Estimates were not re-pooled. Fourteen reviews covered 132 unique primary studies, including 109 in the ADHD-specific core evidence base; the update added no eligible review. AMSTAR 2 confidence was moderate in one review, low in five, and critically low in eight. CCA was 7.46% overall (8.79% for the core evidence base) and 23.44%, 26.67%, and 12.64% for anxiety, depression, and social functioning, respectively. Across overlapping reviews, standardized estimates ranged from − 0.66 to − 0.22 for anxiety, − 1.67 to − 0.42 for depression, and − 0.59 to − 0.27 for social functioning. The selected reviews—Zhou et al. (low methodological confidence) for anxiety/depression and Seiffer et al. (moderate) for social functioning—reported − 0.43 (95% confidence interval − 0.84 to − 0.01), − 0.42 (− 0.71 to − 0.13), and − 0.46 (− 0.85 to − 0.08), respectively. Certainty was not assessable for anxiety or depression and was low for social functioning. A bias-adjusted social-functioning analysis gave a posterior mean of 0.146 (95% credible interval − 0.509 to 0.820), slightly favoring the comparator but not establishing a direction of effect. No dedicated adverse-event synthesis was reported. Review-level estimates generally favored exercise, but the evidence is insufficient to establish reliable benefits for anxiety, depression, or social functioning in youth with ADHD. These findings do not support outcome-, modality-, or dose-specific clinical recommendations. General physical-activity guidance is distinct from the outcome-specific evidence synthesized here. PROSPERO CRD420261394424; registered 15 May 2026. Not applicable.