Inattentiveness, procrastination, fidgetiness, and disorganized work habits are just a few of the symptoms of ADHD. For a child with ADHD, such behaviors impair functioning at school, home, and their ability to maintain relationships with peers. The cause of ADHD is largely unknown and likely to be a multi-factorial interplay between genetic and environmental influences. Current strategies for management include medications and intensive behavioral therapy which are not optimal for long term management of the disorder.
Can physical activity help symptoms of ADHD? There is burgeoning research in this area that suggests this may be the case. A recent review paper published by Jeffery M. Halperin and colleagues from Queens College of the City University of New York, in Neuroscience and Behavioral Reviews, January 2011, suggests ADHD in children should be viewed within the context of a “developmental trajectory” rather than a fixed medical condition. As such, ADHD can be modified by environmental influences, including exercise. Individuals with ADHD are never cured, but they can compensate. Environmental influences, including exercise, may affect the degree of later brain development and hence determine the extent to which an individual can compensate.
Functional magnetic resonance imaging (fMRI) scans of the brains of children show that exercise increases activity in the frontal lobes, which are responsible for executive function (see USA Today article). The executive functions consist of processes responsible for planning, rule acquisition, initiating appropriate actions/inhibiting inappropriate actions, and selecting relevant sensory information. ADHD is a disorder of executive function. In an NIH funded study performed by Catherine Davis and colleagues at the Medical College of Georgia, on 94 sedentary children randomized to a high dose exercise intervention group, found improvement in planning scores (i.e., executive function) in the high dose group compared to controls.
Studies are underway to determine the optimal frequency and amount of physical activity appropriate for children with ADHD. There is some consensus however, that certain types of physical activities may be more beneficial in children with ADHD (see article). Activities that require memorization and sequencing of behaviors help focus attention and repeat learned movement patterns, e.g., yoga, martial arts, dance/ballet, gymnastics, swimming and team sports. One study of the brains of judo players (adults) by Jacini and colleagues found significantly higher volume of gray matter in the frontal, parietal, occipital, temporal, and cerebellar regions of the brains of judo players versus controls. Interestingly, neuroimaging studies have shown reduced volume of the frontal, posterior, and cerebellar areas of brains of children with ADHD.
There is also evidence that physical activity outdoors may be more beneficial for children with ADHD. Dr. Frances Kuo from the University of Illinois found that green outdoor settings (green backyard, park, or neighborhood space) appeared to reduce the symptoms of ADHD in children compared to the same activities performed in indoor settings AND built outdoor settings (concrete areas, not much green). Lastly, in July 2010, Yale Researcher, Dr. David Katz published preliminary results of the ABC Fitness Program (Activity Bursts in the Classroom) which focuses on physical activity during the school day. The study compared an intervention group (schools that incorporated bursts of physical activity throughout the day) versus a control group. Preliminary results indicated that medication use for ADHD decreased in the intervention group. Green settings for playgrounds at schools, physical activity in the morning before class (tai chi on the lawn anyone?), and incorporating physical activity during the day in the classroom, may be just the prescription needed to help children overcome the hurdles of ADHD.
Thanks to Farzana L. Walcott, MD, MPH, for submission of this post.