Effects of exercise interventions on executive function in school-aged children with ADHD: a systematic review and meta-analysis

Executive function deficits are a core deficit among school-aged children with ADHD. Although exercise interventions have received increasing attention in recent years, many existing studies have overlooked potential biases introduced by differences in measurement paradigms and scoring methods, which may compromise the validity and consistency of the findings. This meta-analysis aimed to evaluate the effects of exercise interventions on executive function in school-aged children with ADHD and to explore the moderating effects of measurement paradigms under different scoring methods. A systematic search was conducted in PubMed, Embase, Web of Science, Cochrane Library, Scopus, CNKI, and Wanfang, covering publications from database inception to December 28, 2024. A total of 16 randomized controlled trials were included. Meta-analysis was performed using Stata 17.0. The meta-analysis revealed that exercise interventions had significant overall effects on improving inhibitory control(positive scoring: g = 0.60, 95% CI 0.34, 0.87, P < 0.001; reverse scoring: g=-0.69, 95% CI -0.91, -0.46, P < 0.001) and working memory (positive scoring: g = 0.51, 95% CI 0.30, 0.70, P < 0.001; reverse scoring: g=-0.55, 95% CI -0.74, -0.36, P < 0.001) in school-aged children with ADHD under both positive and reverse scoring conditions. However, the overall effect on cognitive flexibility was significant only under the reverse scoring condition (g=-0.54, 95% CI -0.75, -0.33, P < 0.001), and not under the positive scoring condition (g = 0.28, 95% CI -0.01, 0.56, P = 0.10). Subgroup analyses further indicated that the effects of exercise interventions on inhibitory control, working memory, and cognitive flexibility varied depending on the measurement paradigms and scoring methods used. Exercise interventions can significantly improve inhibitory control and working memory in school-aged children with ADHD. However, their effect on cognitive flexibility appears to be limited. Moreover, the observed intervention effects are influenced by the measurement paradigms and scoring. .