# A multilevel meta-analysis of the effects of exercise interventions on inhibitory control in children with ADHD

## TL;DR

Exercise interventions may significantly improve inhibitory control in children with ADHD, but more high-quality studies are needed.

## Contribution

A multilevel meta-analysis showing exercise's potential to improve inhibitory control in children with ADHD.

## Key findings

- Exercise interventions showed a medium-to-large improvement in inhibitory control (SMD = 0.71).
- Intervention groups improved significantly, but control groups did not.
- No significant moderators of the effect were identified.

## Abstract

Inhibitory control deficits are core cognitive dysfunctions in children with attention-deficit/hyperactivity disorder (ADHD). Exercise interventions, as a non-pharmacological approach, show promise for improving executive functions, yet quantitative evidence regarding their effectiveness and moderating factors remains limited.

We systematically searched PubMed, Web of Science, Embase, and the Cochrane Library from inception to October 2025. Randomized controlled trials examining exercise effects on inhibitory control in children with ADHD were included. Risk of bias was assessed using the RoB 2 tool. A three-level random-effects model was employed to pool effect sizes while accounting for within-study dependencies. Meta-regression analyses examined moderating effects of gender ratio, training frequency, session duration, and intervention duration. Evidence quality was evaluated using GRADE.

Eleven trials (512 participants; 268 intervention, 244 control) yielded 15 effect sizes. The three-level meta-analysis revealed a medium-to-large beneficial effect of exercise on inhibitory control (SMD = 0.71, 95% CI [0.52, 0.91], p < 0.001) with negligible heterogeneity (I² = 0%). Within-group analyses showed significant improvements in intervention groups (SMD = 0.98, 95% CI [0.68, 1.28], p < 0.001), but not in controls (SMD = 0.13, 95% CI [−0.06, 0.31], p = 0.158). Meta-regression found no significant moderators (all p > 0.05). Sensitivity analyses confirmed robust results. Egger’s test indicated no publication bias (p = 0.606). GRADE assessment indicated low-quality evidence due to lack of blinding and trial preregistration.

Exercise interventions may produce medium-to-large improvements in inhibitory control among children with ADHD. Although robust across intervention parameters, overall evidence certainty remains low due to methodological limitations. High-quality studies are needed to confirm these findings.

https://www.crd.york.ac.uk/prospero/, identifier CRD420251178371.