Effects of physical exercise on anxiety depression and emotion regulation in children with attention deficit hyperactivity disorder: a systematic review and meta-analysis

Objective: This systematic review and meta-analysis aimed to comprehensively evaluate the impact of physical exercise interventions on anxiety, depression, and emotional regulation in children diagnosed with attention deficit hyperactivity disorder (ADHD).

Methods: A comprehensive search was conducted across multiple databases, including Embase, Web of Science (WOS), PubMed, The Cochrane Library, Wanfang Data, VIP Information, and China National Knowledge Infrastructure (CNKI), from their inception up to July 2024. The search aimed to identify randomized controlled trials (RCTs) investigating the impact of physical exercise on anxiety, depression, and emotional regulation in children diagnosed with ADHD. The Physiotherapy Evidence Database (PEDro) scale was employed to assess the quality of the literature, while the revised Cochrane risk-of-bias tool (ROB-2) was used to evaluate the overall risk of bias. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) profiler method was utilized to further assess the quality of evidence. Meta-analysis, sensitivity analysis, and publication bias testing were performed using Stata 18.0 software. Effect sizes were calculated using the standardized mean difference (SMD) and 95% confidence intervals (CI).

Results: The analysis included 18 RCTs, encompassing 830 participants. Physical exercise exhibited a significant positive effect on anxiety (SMD = -0.58, p < 0.05), depression (SMD = -0.57, p < 0.05), and emotional regulation (SMD = 1.03, p < 0.05) in children diagnosed with ADHD. Subgroup analysis revealed that exercise programs with monotypic and mixed modalities, short duration, high frequencies, medium duration, and moderate intensities were the most efficacious in ameliorating anxiety symptoms. The mixed exercise program, when conducted for short duration, with low frequencies, medium duration, and moderate intensity was the most effective in alleviating depression symptoms. Exercise programs featuring mixed modalities, longer duration, moderate to high frequencies, shorter duration, and low intensity yielded the most significant improvements in emotional regulation.

Conclusions: Research demonstrates that physical exercise mitigates anxiety and depression and improves emotional regulation in children with ADHD. A dose-response relationship is evident, correlating with the type, duration, intensity, frequency, and overall exercise duration.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, PROSPERO identifier (CRD42024571577).