Physical activity, a key element for improving attention and hyperactivity

Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in childhood. Although pharmacological treatments and cognitive-behavioral interventions have long been the mainstay of its management, recent scientific research has highlighted the potential of a powerful, accessible, and low-cost complementary intervention: physical activity (Sun, Yu & Zhou, 2022). To understand how physical activity can have an impact on the symptomatology of these disorders, it is first necessary to understand how physical activity is defined in a therapeutic context and how ADHD works at a neurobiological level.

Defining movement: physical activity, exercise and sport

To analyze the impact of movement on ADHD, it is crucial to differentiate between some terms that are often used interchangeably. Not all types of physical activity generate the same cognitive benefits, and understanding these distinctions is key to designing programs that maximize the impact of physical activity on ADHD symptomatology. Thus, movement is classified into three levels:

• Physical activity: This is the broadest concept. According to the World Health Organization (WHO), it is defined as "any bodily movement produced by skeletal muscles that requires energy expenditure." It includes everything from walking to school to playing in the playground or helping with household chores.
• Exercise: It is a subcategory of physical activity that is characterized by being planned, structured and repetitive, with the aim of improving or maintaining physical fitness. In this context, two main types of exercise are distinguished:
  - Aerobic exercise: These are activities that involve relatively steady, repetitive movements that require low cognitive demand. Common examples include running on a treadmill, swimming, or jumping rope.
  - Cognitively demanding exercise: This type of exercise requires a high degree of cognitive engagement, as it involves making decisions, planning strategies, using memory and solving problems in real time. Some clear examples include racket sports such as table tennis, team sports such as football or basketball, martial arts, water sports or even exergaming (video games that require physical movement).
• Sport: Considered a structured form of exercise, often competitive and governed by rules. Most sports fall into the category of cognitively demanding exercise due to the tactical and rapid response demands they impose.
  This distinction, especially between aerobic exercise and cognitively demanding exercise, is essential. As we will see, research shows that the cognitive component of physical activity is a determining factor in improving executive functions in people with ADHD (Li et al., 2025).

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Understanding ADHD: Beyond Attention and Hyperactivity

It is essential to define ADHD not just as a simple behavioral problem, but as what it really is: a neurodevelopmental disorder with defined neurological bases . This perspective allows us to understand that the difficulties experienced by children and adolescents with ADHD are the result of differences in brain structure and function that directly affect their cognitive abilities.

At a neurobiological level, ADHD is linked to dysfunctions in neurotransmitter systems, particularly dopamine and noradrenaline . These neurotransmitters are crucial for motivation, attention, and behavioral regulation, which establishes a direct link to the mechanisms through which physical activity exerts its benefits. Understanding this complex interplay between the core symptoms of the disorder, executive functions, and neurobiology is the first step in designing effective physical activity interventions.

The science behind physical activity and the brain

The benefits of physical activity in ADHD are not a coincidence; they are based on measurable and well-documented neurobiological changes. Understanding these mechanisms helps us understand why physical activity is such a powerful therapeutic tool:

• Physical activity increases levels of dopamine and norepinephrine in the prefrontal cortex , the area of ​​the brain responsible for planning and control. This mechanism is strikingly similar to that of many stimulant medications used for ADHD, which act on these same neurotransmitters to improve attention and impulse control.
• The brain is not a static structure ; it has the capacity to change and adapt (neuroplasticity). Exercise, especially cognitively demanding exercise, acts as a powerful stimulator of this plasticity. It promotes the strengthening of synapses (the connections between neurons) and improves neuronal connectivity in the prefrontal cortex, thus strengthening the brain circuits that support executive functions.
• Physical activity increases the expression of brain-derived neurotrophic factor (BDNF), a protein that is crucial for the survival, growth, and differentiation of neurons. In the context of ADHD, it is particularly relevant because it helps protect and maintain dopaminergic neurons, which are directly involved in the etiology of the disorder.

In short, physical activity not only "burns energy", but actively remodels the brain, making it more efficient in the areas where people with ADHD have the most difficulty. These biological mechanisms are the basis for practical applications that we can implement in our daily lives.

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Benefits of physical activity in ADHD

The idea that physical activity is beneficial for ADHD has moved from being a hypothesis to a conclusion supported by solid scientific evidence. Numerous meta-analyses and systematic reviews have evaluated the effectiveness of physical activity interventions , confirming that they are an effective complementary strategy for improving key areas affected by the disorder.

Research shows that physical activity interventions have a positive effect on the executive functions of children and adolescents with ADHD (Li, Wang & Li, 2025). Specifically, improvements are observed in:

• Inhibitory control (ability to stop impulses).
• Working memory (ability to maintain, manipulate and organize information mentally).
• Cognitive flexibility (ability to adapt to changes).

Cognitively demanding exercise has been shown to have greater effects on executive functions than aerobic exercise. The reason is that this type of exercise not only activates the body, but also requires higher cognitive engagement. Activities such as team sports or martial arts require constant response to an unpredictable environment, which directly stimulates the prefrontal cortex, a brain region closely linked to executive function. This combined challenge strengthens neural connections and promotes neuroplasticity, leading to more robust and lasting improvements.

Physical activity actively remodels the brain, making it more efficient in the areas where people with ADHD have the most difficulty.

In addition to improving underlying executive functions, physical activity also has a direct impact on core symptoms of ADHD . Meta-analyses consistently show that physical activity effectively improves attention. Regarding hyperactivity and impulsivity, the results are generally positive, although some analyses do not always find statistically significant effects, suggesting that the impact may vary depending on the type of intervention and individual characteristics.

The positive impact of physical activity goes beyond cognition and the main symptoms of the disorders. Several studies have also shown significant improvements in other areas important for comprehensive development:

• Motor competence: improvement of coordination, balance and general motor skills (Fang et al., 2024).
• Social skills: especially in team sports, cooperation and interaction with others are encouraged (Zheng et al., 2025).
• Associated mental health: Some research suggests a reduction in symptoms such as anxiety, which often coexists with ADHD (Cerrillo-Urbina et al., 2015).

These results raise a key question for families, teachers and health professionals: if exercise is so beneficial, what type, amount and frequency are most effective?

The exercise "recipe": what does science say about the dosage?

As a starting point, WHO recommendations advise an average of 60 minutes of moderate-to-vigorous intensity physical activity per day for children and adolescents, a goal that serves as an excellent global reference. However, beyond the amount, the type of activity and frequency are fundamental.

In this sense, the concept of " Exercise is Medicine ", promoted by institutions such as the American College of Sports Medicine, emphasizes that the relationship between the amount of exercise and its benefits is not necessarily linear. Therefore, more is not always better; the essential point is to find the optimal combination of type, duration, frequency and period of activity . A meta-analysis carried out by Li et al. (2025) offers clear guidelines for determining these factors:

• The most compelling conclusion is that cognitively demanding exercise is the most favorable option for improving executive functions compared to simple aerobic exercise. Activities that require thinking, planning, and reacting to a changing environment are more effective in stimulating the neural networks involved in ADHD.
• There is no direct correlation in which more minutes per session, more days per week, or a longer intervention period always guarantee greater benefits . Science points to the existence of an optimal range. Beyond this point, the positive effects may diminish or stagnate. The goal is not the maximum amount, but the most effective dose.
• The ideal dose varies depending on the cognitive goal. For example, research suggests that to optimally improve inhibitory control, the ideal dose may consist of sessions of less than 60 minutes, three or more times per week; while to improve working memory, the optimal dose is sessions of 60 minutes or more, but less than three times per week. Each executive function shows a slightly different response to different exercise “recipes.”
• There is no one-size-fits-all formula. The selection of activity type, frequency, and duration should be based on the individual differences of the person with ADHD. Factors such as the presentation of the disorder (predominantly inattentive, hyperactive/impulsive, or combined), gender, and the presence of comorbidities (such as anxiety) are crucial in designing a program that achieves optimal results.

In summary, while there is no universal "exercise pill," science provides a solid framework for personalizing interventions, knowledge that can be translated into practical recommendations for different contexts.

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Practical recommendations for families, teachers and health professionals

Translating scientific findings into concrete actions is the final step in harnessing the power of physical activity. Here are some practical, evidence-based tips designed to be implemented in school, family, and health settings:

Schools are an ideal environment to integrate physical activity in a structured way. It is recommended to implement sports activities with high cognitive involvement during physical education classes or as extracurricular activities. Sports such as football and badminton are excellent options, as they combine aerobic exercise with the need to make quick decisions, coordinate with peers and plan strategies.

Cognitively demanding exercise is the most favorable option for improving executive functions compared to simple aerobic exercise. Sports such as soccer and badminton are excellent options.

Organizing family sports activities not only improves your child's executive functions, but also strengthens family bonds and interactions. Opt for activities that are cooperative and cognitively demanding. Some ideas include creating family obstacle courses at the park, playing basketball, or organizing soccer games. These activities promote planning, teamwork, and adapting to changing rules and situations.

Mental health professionals working with children and adolescents with ADHD can significantly improve the effectiveness of their interventions by incorporating physical activity. Practices such as juggling, which requires great concentration and coordination, or mini-basketball, which adapts a complex sport to the scale of children, are excellent tools for working on executive functions in a playful and effective way.

Integrating physical activity into ADHD treatment

Physical activity is a first-rate therapeutic tool for ADHD (Fang et al., 2024). Far from being a simple way to “burn energy,” physical activity, and in particular cognitively demanding exercise, has been shown to be an effective non-pharmacological intervention to improve core executive functions such as attention, inhibitory control, and working memory , while reducing the core symptoms of the disorder.

It is time to consider physical activity not as an optional add-on, but as an integral and fundamental part of any holistic treatment plan for people with ADHD. Its additional benefits, such as improved physical fitness, acquisition of motor skills, and promotion of social skills, make it a promising strategy from all points of view.

Integrating physical activity in an intelligent and personalized way into the daily lives of children and adolescents with ADHD is a direct investment in their cognitive, emotional and physical development, providing them with tools to thrive in school and beyond.