Physical Activity as an Adjunctive Intervention for Adults with ADHD: A Narrative Review
DOI:
https://doi.org/10.12775/JEHS.2026.94.72851Keywords
Attention Deficit Disorder with Hyperactivity, Adult, Exercise, Exercise Therapy, Executive Function, Inhibitory ControlAbstract
Background: Attention-deficit/hyperactivity disorder (ADHD) often persists into adulthood and is associated with executive dysfunction, emotional dysregulation, and reduced quality of life. As pharmacological treatment may not be sufficient for all patients, adjunctive non-pharmacological strategies are needed.
Aim: This narrative review summarises evidence on the effects of physical activity on ADHD symptoms and cognition in adults.
Material and Methods: PubMed and Scopus were searched, with manual reference screening. English-language studies published up to May 2026 were included, prioritising randomised trials, experimental studies, systematic reviews, and meta-analyses on physical activity in adults with ADHD.
Results: Physical activity may improve selected outcomes in adults with ADHD, especially inhibitory control, the most consistently supported cognitive domain. Benefits have also been reported for attention, symptom severity, sleep, and quality of life, although findings remain heterogeneous. Adult-specific evidence remains limited compared with paediatric and mixed-age ADHD literature. Acute and longer-term interventions appear promising, but the evidence is limited by small samples, diverse protocols, and variable outcome measures.
Conclusions: Physical activity is a biologically plausible and promising adjunctive strategy for adult ADHD, but it should not replace established pharmacological or psychosocial treatments. Further high-quality trials are needed to define optimal exercise protocols, long-term clinical relevance, and its role in multimodal ADHD care.
Keywords: Attention Deficit Disorder with Hyperactivity; Adult; Exercise; Exercise Therapy; Executive Function; Inhibitory Control
References
1. Williams OC, Prasad S, McCrary A, Jordan E, Sachdeva V, Deva S, et al. Adult attention deficit hyperactivity disorder: a comprehensive review. Ann Med Surg. 2023;85(5):1802–10. https://doi.org/10.1097/MS9.0000000000000631
2. Song P, Zha M, Yang Q, Zhang Y, Li X, Rudan I. The prevalence of adult attention-deficit hyperactivity disorder: a global systematic review and meta-analysis. J Glob Health. 2021;11:04009. https://doi.org/10.7189/jogh.11.04009
3. Kosheleff AR, Mason O, Jain R, Koch J, Rubin J. Functional impairments associated with ADHD in adulthood and the impact of pharmacological treatment. J Atten Disord. 2023;27(7):669–97. https://doi.org/10.1177/10870547231158572
4. Fuermaier ABM, Tucha L, Koerts J, Aschenbrenner S, Kaunzinger I, Hauser J, et al. Cognitive impairment in adult ADHD—perspective matters! Neuropsychology. 2015;29(1):45–58. https://doi.org/10.1037/neu0000108
5. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5-TR. Washington (DC): American Psychiatric Association Publishing; 2022.
6. Shier AC, Reichenbacher T, Ghuman HS, Ghuman JK. Pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: clinical strategies. J Cent Nerv Syst Dis. 2013;5:1–17. https://doi.org/10.4137/JCNSD.S6691
7. Faraone SV, Banaschewski T, Coghill D, Zheng Y, Biederman J, Bellgrove MA, et al. The World Federation of ADHD International Consensus Statement: 208 evidence-based conclusions about the disorder. Neurosci Biobehav Rev. 2021;128:789–818. https://doi.org/10.1016/j.neubiorev.2021.01.022
8. Nanda A, Janga LSN, Sambe HG, Yasir M, Man RK, Gogikar A, et al. Adverse effects of stimulant interventions for attention deficit hyperactivity disorder (ADHD): a comprehensive systematic review. Cureus. 2023;15(9):e45995. https://doi.org/10.7759/cureus.45995
9. National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: diagnosis and management. NICE guideline NG87. London: NICE; 2018 [updated 2019 Sep 13; cited 2026 May 27]. Available from: https://www.nice.org.uk/guidance/ng87
10. Katzman MA, Bilkey TS, Chokka PR, Fallu A, Klassen LJ. Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC Psychiatry. 2017;17(1):302. https://doi.org/10.1186/s12888-017-1463-3
11. Szuhany KL, Bugatti M, Otto MW. A meta-analytic review of the effects of exercise on brain-derived neurotrophic factor. J Psychiatr Res. 2015;60:56–64. https://doi.org/10.1016/j.jpsychires.2014.10.003
12. Hillman CH, Erickson KI, Kramer AF. Be smart, exercise your heart: exercise effects on brain and cognition. Nat Rev Neurosci. 2008;9(1):58–65. https://doi.org/10.1038/nrn2298
13. Gomez-Pinilla F, Hillman C. The influence of exercise on cognitive abilities. Compr Physiol. 2013;3(1):403–28. https://doi.org/10.1002/cphy.c110063
14. Wachowska M, Rycąbel PM, Romaniuk M, Molenda MJ, Paniak M, Sowiński WJ, Woszczyńska OB, Szymura M, Wojciechowska AE, Krawczyk MB. Physical Activity in Mental Health Disorders – Therapeutic Potential and Mechnisms. Quality in Sport. 2025;41:60020. https://doi.org/10.12775/QS.2025.41.60020
15. Siemko J, Rulewska NM, Grabowski F, Neska D, Prystacka-Szar D, Stadler-Szajda J, Czyżnikiewicz A, Stołowski W, Bujak M, Waśniowska M. The role of physical activity in the treatment of depression. Journal of Education, Health and Sport. 2025;80:57828. https://doi.org/10.12775/JEHS.2025.80.57828
16. Vancampfort D, Firth J, Stubbs B, Schuch F, Rosenbaum S, Hallgren M, et al. The efficacy, mechanisms and implementation of physical activity as an adjunctive treatment in mental disorders: a meta-review of outcomes, neurobiology and key determinants. World Psychiatry. 2025;24(2):227–239. https://doi.org/10.1002/wps.21314
17. Cerrillo-Urbina AJ, García-Hermoso A, Sánchez-López M, Pardo-Guijarro MJ, Santos Gómez JL, Martínez-Vizcaíno V. The effects of physical exercise in children with attention deficit hyperactivity disorder: a systematic review and meta-analysis of randomized control trials. Child Care Health Dev. 2015;41(6):779–88. https://doi.org/10.1111/cch.12255
18. Svedell LA, Lindvall MA, Holmqvist KL, Cao Y, Msghina M. Physical exercise as add-on treatment in adults with ADHD – the START study: a randomized controlled trial. Front Psychiatry. 2025;16:1690216. https://doi.org/10.3389/fpsyt.2025.1690216
19. Yang Y, Wu CH, Sun L, Zhang TR, Luo J. The impact of physical activity on inhibitory control of adult ADHD: a systematic review and meta-analysis. J Glob Health. 2025;15:04025. https://doi.org/10.7189/jogh.15.04025
20. Das D, Cherbuin N, Butterworth P, Anstey KJ, Easteal S. A population-based study of attention deficit/hyperactivity disorder symptoms and associated impairment in middle-aged adults. PLoS One. 2012;7(2):e31500. https://doi.org/10.1371/journal.pone.0031500
21. Shaw P, Eckstrand K, Sharp W, Blumenthal J, Lerch JP, Greenstein D, et al. Attention-deficit/hyperactivity disorder is characterized by a delay in cortical maturation. Proc Natl Acad Sci U S A. 2007;104(49):19649–54. https://doi.org/10.1073/pnas.0707741104
22. Spencer TJ, Biederman J, Wilens TE, Faraone SV. Overview and neurobiology of attention-deficit/hyperactivity disorder. J Clin Psychiatry. 2002;63 Suppl 12:3–9. PMID: 12562055.
23. Kuntsi J, McLoughlin G, Asherson P. Attention deficit hyperactivity disorder. Neuromolecular Med. 2006;8(4):461–84. https://doi.org/10.1385/NMM:8:4:461
24. Arnsten AFT. The emerging neurobiology of attention deficit hyperactivity disorder: the key role of the prefrontal association cortex. J Pediatr. 2009;154(5 Suppl):I-S43. https://doi.org/10.1016/j.jpeds.2009.01.018
25. Cotman CW, Berchtold NC, Christie LA. Exercise builds brain health: key roles of growth factor cascades and inflammation. Trends Neurosci. 2007;30(9):464–72. https://doi.org/10.1016/j.tins.2007.06.011
26. Gomes-Osman J, Cabral DF, Hinchman C, Jannati A, Morris TP, Pascual-Leone A. The effects of exercise on cognitive function and brain plasticity – a feasibility trial. Restor Neurol Neurosci. 2017;35(5):547–56. https://doi.org/10.3233/RNN-170758
27. Kline CE, Hillman CH, Bloodgood Sheppard B, Tennant B, Conroy DE, Macko RF, et al. Physical activity and sleep: an updated umbrella review of the 2018 Physical Activity Guidelines Advisory Committee report. Sleep Med Rev. 2021;58:101489. https://doi.org/10.1016/j.smrv.2021.101489
28. Mehren A, Özyurt J, Thiel CM, Brandes M, Lam AP, Philipsen A. Effects of acute aerobic exercise on response inhibition in adult patients with ADHD. Sci Rep. 2019;9(1):19884. https://doi.org/10.1038/s41598-019-56332-y
29. Wang YH, Gau SF, Yang LK, Chang JC, Cheong PL, Kuo HI. Acute aerobic exercise at different intensities modulates inhibitory control and cortical excitability in adults with attention-deficit hyperactivity disorder (ADHD). Asian J Psychiatr. 2024;95:103993. https://doi.org/10.1016/j.ajp.2024.103993
30. Svedell LA, Holmqvist KL, Lindvall MA, Cao Y, Msghina M. Feasibility and tolerability of moderate intensity regular physical exercise as treatment for core symptoms of attention deficit hyperactivity disorder: a randomized pilot study. Front Sports Act Living. 2023;5:1133256. https://doi.org/10.3389/fspor.2023.1133256
31. LaCount PA, Hartung CM, Vasko JM, Serrano JW, Wright HA, Smith DT. Acute effects of physical exercise on cognitive and psychological functioning in college students with attention-deficit/hyperactivity disorder. Ment Health Phys Act. 2022;22:100443. https://doi.org/10.1016/j.mhpa.2022.100443
32. Chen JW, Du WQ, Zhu K. Optimal exercise intensity for improving executive function in patients with attention deficit hyperactivity disorder: systematic review and network meta-analysis. Eur Child Adolesc Psychiatry. 2025;34(2):497–518. https://doi.org/10.1007/s00787-024-02507-6
33. Converse AK, Barrett BP, Chewning BA, Wayne PM. Tai Chi training for attention deficit hyperactivity disorder: a feasibility trial in college students. Complement Ther Med. 2020;53:102538. https://doi.org/10.1016/j.ctim.2020.102538
34. Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451–62. https://doi.org/10.1136/bjsports-2020-102955
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Aleksandra Zybert, Igor Nowiński, Dawid Ocicki, Michał Bojarski, Michał Kwiatkowski, Michał Musielak, Iga Kobryń, Pola Kobryń, Aleksandra Borowska, Jakub Grabowski
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Stats
Number of views and downloads: 48
Number of citations: 0
