A network meta-analysis on the comparative effectiveness and acceptability of physical exercise interventions in children and adolescents with attention-deficit hyperactivity disorder

Physical exercise may have positive effects on ADHD-related
problems. We conducted a network meta-analysis (NMA) to
examine the comparative effectiveness of different types of
physical exercise interventions on reducing ADHD symptoms and
improving executive functions in children and adolescents with
ADHD as compared with any type of control intervention, as well
as with established rival ADHD treatments. Randomised
controlled trials were identified in EMBASE, Medline, Web of
Science, Cochrane, PsycINFO, CINAHL, and previous reviews. Two
independent reviewers performed screening, data extraction and
risk-of-bias (RoB) assessments. We conducted random-effects
NMAs based on a frequentist framework. Our primary outcome
was parent-rated ADHD symptoms, secondary outcomes were
teacher-rated ADHD symptoms, executive functions and
treatment acceptability. We included 35 trials. The analyses
showed that several types of physical exercise interventions were
effective in either reducing ADHD core symptoms or improving
executive functions in children and adolescents with ADHD as
compared with no treatment. However, the magnitude of the
comparative effectiveness remains unclear because the included
trials had high RoB and the analyses showed large heterogeneity,
complicating definite conclusions. Treatment acceptability did not
differ significantly between the comparators. Our main conclusion
is that more high-quality trials with larger sample sizes are
needed to allow definite conclusions regarding the comparative
effectiveness of physical exercise interventions in reducing ADHD-
related problems.