Beyond binary comparisons: a Bayesian dose-response meta-analysis of exercise on executive function in children and adolescents with ADHD.

OBJECTIVE

This study aimed to systematically evaluate the acute and long-term effects of exercise interventions on executive function in children and adolescents with attention-deficit/hyperactivity disorder (ADHD), using Bayesian dose-response modelling to identify optimal dose ranges and modality-specific effects.

METHODS

A systematic search of five major databases (PubMed, Web of Science, Embase, Cochrane Library, and APA PsycInfo) was conducted up to March 2025. Thirty-three eligible studies were included, comprising 10 acute and 23 long-term exercise intervention trials. Bayesian non-linear dose-response models were applied to determine optimal doses for three executive function domains: cognitive flexibility, working memory, and inhibitory control.

RESULTS

Exercise interventions significantly improved executive function in youth with ADHD and showed clear dose-dependent patterns. In acute interventions, optimal doses were 270 METs for cognitive flexibility, 170 METs for working memory, and 130 METs for inhibitory control. In long-term interventions, optimal weekly doses were 1100, 1300, and 2500 METs, respectively. Different exercise modalities yielded varying effects across executive domains.

CONCLUSION

Exercise benefits executive function in children and adolescents with ADHD, with effects influenced by both dose and modality. This study proposes a "dose-domain-modality" framework, offering empirical support for individualized, precision-based exercise prescriptions.

IMPACT

This is the first systematic review and dose-response meta-analysis quantifying acute and long-term effects of exercise on executive function in ADHD youth, identifying domain-specific optimal doses for cognitive flexibility, working memory, and inhibitory control across 33 studies. By integrating Bayesian modeling and network meta-analytic methods, the study introduces a "dose-domain-modality" framework, offering novel empirical support for individualized, function-targeted exercise prescriptions. It moves beyond merely showing effectiveness or a single "optimal" dose, emphasizing precise prescriptions tailored to executive function domains for targeted cognitive enhancement.