BACKGROUND:Physical exercise is a promising adjunctive intervention for attention deficit hyperactivity disorder (ADHD), but conclusions from previous meta-analyses remain inconsistent.
OBJECTIVES:This umbrella review synthesized meta-analytic evidence on the effects of physical exercise interventions on ADHD-related and broader functional outcomes in children and adolescents with ADHD.
METHODS:Six databases were searched from inception to March 5, 2026. Eligible meta-analyses evaluating structured physical exercise interventions in children and adolescents with ADHD were included. Random-effects models were used to calculate standardized mean differences (SMDs) with 95% confidence intervals (CIs). Methodological quality and certainty of evidence were assessed using AMSTAR-2 and GRADE, respectively.
RESULTS:Forty-five meta-analyses were included. Physical exercise showed significant beneficial effects on ADHD core symptoms (SMD = 0.50, 95% CI: 0.39 to 0.61) and executive functions (SMD = 0.77, 95% CI: 0.62 to 0.93). Benefits were also observed for mental health, motor skills, and social problems, whereas no significant effects were found for sleep quality, body mass index, or academic achievement. Cognitively engaging exercise and interventions delivered at least three times per week showed significantly larger effects in executive functions. Certainty of evidence was low for ADHD core symptoms, executive functions, mental health, motor skills, and social problems, and very low for other outcomes.
CONCLUSIONS:Structured physical exercise may be a useful adjunctive component of multimodal ADHD management, but should not replace established treatments. Given the low to very low certainty of evidence across outcomes, these findings should be interpreted cautiously and require confirmation in further high-quality studies.