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How is Exercise Beneficial for Adults with ADHD?



One of the authors of the famous ADHD guide Driven to Distraction, Dr. John Ratey, is a big advocate of exercise for ADHD. The prominent psychiatrist, an ADHDer himself, wrote a whole book on the topic and started a school exercise program for children with ADHD. Indeed, research and anecdotal evidence alike show that exercise improves school performance and reduces restlessness in kids. However, many adults may not see these considerations as relevant, especially those who tend to present with inattentive rather than hyperactive symptoms. 


The principal question of this blog post is – is exercise helpful for symptoms of ADHD in adults? 


The TL;DR is that exercise has the potential to benefit all ADHDers, no matter their age. Practicing any type of exercise has a positive effect on one’s physical health and specific ADHD symptoms too. If exercise fits into your lifestyle, it’s definitely worth considering. And for those interested in learning more about the topic, the following post contains a rundown of scientific evidence about exercise for ADHD.

How exercise can be helpful for ADHDers

Physical activity is generally good for you – whether one has ADHD or not. The CDC lists significant effects like longevity, cardiovascular health, and even cancer prevention among such benefits. That said, most of these positive effects are not immediate, so people may not find them particularly motivating. Fortunately, physical activity also comes with instant physical and mental rewards, particularly for folks with ADHD.


Researchers have long pointed out that exercise does similar things to the brain to ADHD medications, albeit to a lesser degree. When a person exercises, the levels of many neurotransmitters in the brain, including dopamine and norepinephrine, increase. “With regular physical activity, we can raise the baseline levels of dopamine and norepinephrine by spurring the growth of new receptors in certain brain areas,” says John Ratey to Additide Magazine. “Exercise also helps balance norepinephrine in the brain stem’s arousal center.” 


In practice, children with ADHD who engage in exercise report measurable improvements in core symptoms. There’s also some evidence that executive functions improve with regular exercise – a finding consistent for both adults and kids with ADHD. A 2015 paper by Gapin et al. found 40 minutes of moderate-intensity exercise promotes inhibition in young adults with ADHD. Another experiment in adult men with ADHD observed increased motivation and reduced fatigue following 20 minutes of cycling. Consistent with other studies in adults, this experiment also observed a drop in depression symptoms, emotional regulation, and a better mood after exercise. However, the study didn’t observe improvements in restless leg syndrome or vigilance. 


As for attention and vigilance in adults post-exercise, research needs to be more consistent. A study from 2019 indicated improvements in concentration after 30 minutes of exercise in adults, but others did not observe any beneficial effect.


Probably the most exciting development is the finding that aerobic exercise – from hiking and cycling to martial arts and CrossFit – could level out brain-derived neurotrophic factor (BDNF) levels. BDNF is crucial for maintaining cognitive health, as it plays a vital role in the development of the dopamine and serotonin systems of the brain in kids. It also helps in the survival and production of brain cells and neuronal signaling throughout one’s lifetime. BDNF changes have been observed in children and adults with ADHD, and exercise is theorized to boost brain functioning by equalizing BDNF levels.

Combining exercise and ADHD medications

Managing ADHD with medication, psychotherapy, coaching, and lifestyle interventions like exercise is a standard recommendation. This holistic, multi-pronged approach is intuitive. After all, combining several proven strategies should result in a positive cumulative effect. And there’s some evidence to support these claims, too, but with a caveat: the only two trials that investigated the effects of exercise with medications were conducted in children and adolescents, not adults. 


In 2011, Kang and colleagues published the results of a randomized controlled trial involving 28 boys with ADHD. Thirteen boys received methylphenidate and a 90-minute biweekly workout, and the remaining group got methylphenidate and biweekly sessions of education on behavior control. After six weeks and 12 sessions of exercise or therapy, both groups had reduced core ADHD symptoms (inattention, impulsivity, and hyperactivity), enhanced executive functions, and improved social skills. 


The second study is from 2015, and it involved a nearly identical six-week exercise or behavioral education trial along with methylphenidate, but in adolescents with ADHD. The experiment used functional magnetic resonance imaging (fMRI) to measure brain activity in the frontal lobe – the brain area associated with executive functions. Like the 2011 paper, this research found a positive effect of exercise on ADHD symptoms and executive functioning. Moreover, fMRI recorded greater activity in the frontal lobe compared to participants who took methylphenidate in conjunction with educational sessions.


The two trials suggest that kids and adolescents who exercise also tend to experience a more significant positive effect of ADHD medication than their peers who rely on medication alone. Similar results are predicted in adults too.

Is any type of exercise better than others?

This citation from a CHADD bulletin provides a detailed yet brief answer: “While most clinical studies researching the effects of exercise on ADHD have utilized running on treadmills, you don’t have to be a marathoner, or even a jogger, to benefit from exercise.” For a bit more context, the reason why many early ADHD studies investigated aerobic training is that they were conducted on animal models, and running is the most accessible type of exercise to measure in lab animals like mice and rats.


More recent research, such as a 2015 randomized controlled trial by Ziereis and Jansen, suggests that both specific skills like balance or ball handling and more general exercise like running, swimming, or climbing have similar benefits for kids with ADHD. Compared to controls, kids who practiced any type of exercise had improved motor skills and working memory. Hence, all activity appears to be beneficial, at least for children.


How often should I exercise? 

In most studies, participants exercised 3-5 times a week.


How long should an exercise session last? 

Studies report workouts lasting 20-60 minutes.


The bottom line is, do any exercise you enjoy or can sustain. Remember, ADHDers are motivated by curiosity, so utilize this asset and let curiosity lead the way in keeping your life more physically active.



References:



  • Choi, J. W., Han, D. H., Kang, K. D., Jung, H. Y., & Renshaw, P. F. (2015). Aerobic exercise and attention deficit hyperactivity disorder: brain research. Medicine and science in sports and exercise, 47(1), 33–39. https://doi.org/10.1249/MSS.0000000000000373


  • Corominas-Roso, M., Ramos-Quiroga, J. A., Ribases, M., Sanchez-Mora, C., Palomar, G., Valero, S., Bosch, R., & Casas, M. Decreased serum levels of brain-derived neurotrophic factor in adults with attention-deficit hyperactivity disorder, International Journal of Neuropsychopharmacology, Volume 16, Issue 6, July 2013, Pages 1267–1275, https://doi.org/10.1017/S1461145712001629


  • Dinu, L. M., Singh, S. N., Baker, N. S., Georgescu, A. L., Singer, B. F., Overton, P. G., & Dommett, E. J. (2023). The Effects of Different Exercise Approaches on Attention Deficit Hyperactivity Disorder in Adults: A Randomised Controlled Trial. Behavioral Sciences, 13(2), 129. https://doi.org/10.3390/bs13020129



  • Fritz, K. M. & O’Connor, P. J.. Acute Exercise Improves Mood and Motivation in Young Men with ADHD Symptoms. Medicine & Science in Sports & Exercise 48(6):p 1153-1160, June 2016., DOI: 10.1249/MSS.0000000000000864


  • Gapin, J. I., Labban, J. D., Bohall, S. C., Wooten, J. S., & Chang, Y. Acute exercise is associated with specific executive functions in college students with ADHD: A preliminary study, Journal of Sport and Health Science, Volume 4, Issue 1, 2015, Pages 89-96, ISSN 2095-2546, https://doi.org/10.1016/j.jshs.2014.11.003.



  • Kang, K. D., Choi, J. W., Kang, S. G., & Han, D. H. (2011). Sports therapy for attention, cognition, and sociality. International journal of sports medicine, 32(12), 953–959. https://doi.org/10.1055/s-0031-1283175


  • LaCount, P. A., Hartung, C. M., John M. Vasko, Judah W. Serrano, Halle A. Wright, Derek T. Smith, Acute effects of physical exercise on cognitive and psychological functioning in college students with attention-deficit/hyperactivity disorder, Mental Health, and Physical Activity, Volume 22, 2022, 100443, ISSN 1755-2966, https://doi.org/10.1016/j.mhpa.2022.100443.



  • Mehren, A., Özyurt, J., Lam, A. P., Brandes, M., Müller, H. H. O., Thiel, C. M., & Philipsen, A. (2019). Acute Effects of Aerobic Exercise on Executive Function and Attention in Adult Patients With ADHD. Frontiers in psychiatry, 10, 132. https://doi.org/10.3389/fpsyt.2019.00132

  • Wang, L.-J., Wu, C.-C., Lee, M.-J., Chou, M.-C., Lee, S.-Y., & Chou, W.-J. (2019). Peripheral brain-derived neurotrophic factor and contactin-1 levels in patients with attention-deficit/hyperactivity disorder. Journal of Clinical Medicine, 8(9), 1366. https://doi.org/10.3390/jcm8091366


  • Wenxin Sun, Mingxuan Yu, Xiaojing Zhou, Effects of physical exercise on attention deficit and other major symptoms in children with ADHD: A meta-analysis, Psychiatry Research, Volume 311, 2022, 114509, ISSN 0165-1781, https://doi.org/10.1016/j.psychres.2022.114509.

  • Xie, Y., Gao, X., Song, Y., Zhu, X., Chen, M., Yang, L., & Ren, Y. (2021). Effectiveness of physical activity intervention on ADHD symptoms: A systematic review and meta-analysis. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.706625


  • Ziereis, S., & Jansen, P. (2015). Effects of physical activity on executive function and motor performance in children with ADHD. Research in developmental disabilities, 38, 181–191. https://doi.org/10.1016/j.ridd.2014.12.005


  • Zouhal H, Jacob C, Delamarche P, Gratas-Delamarche A. Catecholamines and the effects of exercise, training and gender. Sports Med. 2008;38(5):401–423. doi: 10.2165/00007256-200838050-00004.

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