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Physical activity for persons with ADHD or autism

Exercise has attracted attention as a potential helpful intervention in persons with ADHD or autism. Effects are often emphasized on cognition, social-emotional, and motor development. The purpose of this report was to systematically review published systematic reviews on examining the effects of all types of exercise interventions in persons with ADHD or Autism.

Reading time approx. 8 minutes Published: October 24, 2019 Publication type:

SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

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Published: October 24, 2019 Report no: ut201929 Registration no: SBU 2019/403

Question

What systematic reviews are there on exercise interventions for persons with hyperactivity and inattention (for example in ADHD or autism)?

Identified literature

**Table 1. Systematic reviews with low/medium risk of bias.**
ADHD = Attention deficit hyperactivity disorder; PA = Physical activity * ;intensity of their maximum heart rate
Included studies	Population/Intervention	Outcome
Bremer et al (2016) [1]
13 studies	Population: Individuals with autism spectrum disorder aged ⩽16 years. Intervention: Exercise interventions	Effect: Numerous behavioural outcomes including stereotypic behaviours, social-emotional functioning, cognition and attention Adverse effect: Not reported
Authors' conclusion: Results demonstrated that exercise interventions consisting individually of jogging, horseback riding, martial arts, swimming or yoga/dance can result in improvements to numerous behavioural outcomes including stereotypic behaviours, social-emotional functioning, cognition and attention. Horseback riding and martial arts interventions may produce the greatest results with moderate to large effect sizes, respectively. Future research with well-controlled designs, standardized assessments, larger sample sizes and longitudinal follow-ups is necessary, in addition to a greater focus on early childhood (aged 0–5 years) and adolescence (aged 12–16 years), to better understand the extent of the behavioural benefits that exercise may provide these populations.”
Suarez-Manzano et al (2018) [2]
16 studies	Population: Young people with ADHD Intervention: Physical activity (PA)	Effect: The acute and chronic effect on the cognition and behaviour of children and adolescents with ADHD Adverse effect: Not reported
Authors' conclusion: PA practice of 20–30 min (intensity 40–75%)* produces a positive acute effect on processing speed, working memory, planning and problem solving in young people with ADHD. However, these effects on behaviour are contradictory and vary depending on age. Chronic PA practice (≥30 min per day, ≥40% intensity*, ≥three days per week, ≥five weeks) further improves attention, inhibition, emotional control, behaviour and motor control. The results must be treated with caution, because only 25% of the studies used confounders. More research is needed to justify the causes of these effects. It is necessary to establish programs with regard to the duration, intensity, kind of exercise, and time of PA to improve cognition and behaviour in young people with ADHD taking into account potential confounders.

References

Bremer E, Crozier M, Lloyd M. A systematic review of the behavioural outcomes following exercise interventions for children and youth with autism spectrum disorder. Autism 2016;20: 899-915.
Suarez-Manzano S, Ruiz-Ariza A, De La Torre-Cruz M, Martinez-Lopez EJ. Acute and chronic effect of physical activity on cognition and behaviour in young people with ADHD: A systematic review of intervention studies. Res Dev Disabil 2018;77,12-23.

Literature search

**MEDLINE via OVID 2019 09 04**
**Hyperactivity and exercise**
The search result, usually found at the end of the documentation, forms the list of abstracts. [MeSH] = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; [MeSH:NoExp] = Does not include terms found below this term in the MeSH hierarchy; [MAJR] = MeSH Major Topic; [TIAB] = Title or abstract; [TI] = Title; [AU] = Author; [TW] = Text Word; Systematic[SB] = Filter for retrieving systematic reviews; * = Truncation
	Search terms	Items found
Population:
1.	“Attention Deficit and Disruptive Behavior Disorders”/	2747
2.	Attention Deficit Disorder with Hyperactivity/	27226
3.	"Attention deficit* ".ab,kw,ti.	27852
4.	("Attention deficit" adj6 hyper).ab,kw,ti.	24598
5.	("ADHD" or "ADDH").ab,kw,ti.	23672
6.	1 OR 2 OR 3 OR 4 OR 5	40896
7.	"Autistic Disorder"/ or "Autism Spectrum Disorder"/	26189
8.	(Autism or Autistic* or "ASD" or "Autism spectrum disorder*").ti,ab,kw.	50587
9.	7 OR 8	53333
10.	6 OR 9	90701
Intervention:
11.	Exercise/	101551
12.	("Physical" adj6 ("Activit" or "therap" or "exercise" or “training”)).ti,ab,kw.	155219
13.	(exercise* or physiotherapy or sport*).ti,ab.	345492
14.	11 OR 12 OR 13	466786
Limits:
15.	(((comprehensive* or integrative or systematic) adj3 (bibliographic or review* or literature)) or (meta-analy* or metaanaly* or "research synthesis" or ((information or data) adj3 synthesis) or (data adj2 extract))).ti,ab. or (cinahl or (cochrane adj3 trial) or embase or medline or psyclit or (psycinfo not "psycinfo database") or pubmed or scopus or "sociological abstracts" or "web of science").ab. or ("cochrane database of systematic reviews" or evidence report technology assessment or evidence report technology assessment summary).jn. or Evidence Report: Technology Assessment*.jn. or ((review adj5 (rationale or evidence)).ti,ab. and review.pt.) or meta-analysis as topic/ or Meta-Analysis.pt.
16.	Filtered by: Publication date: 2009-2019
Combined Searches:
17.	10 AND 14	1109
18.	10 AND 14 AND 15	78
Final	18 AND 16	71

**Cochrane Library 2019 09 04**
**Hyperactivity and exercise**
The search result, usually found at the end of the documentation, forms the list of abstracts; au = Author; MeSH = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; this term only = Does not include terms found below this term in the MeSH hierarchy; :ti = Title; :ab = Abstract; :kw = Keyword; * = Truncation; “ “ = Citation Marks; searches for an exact phrase; CDSR = Cochrane Database of Systematic Review; CENTRAL = Cochrane Central Register of Controlled Trials, “trials”; CRM = Method Studies; DARE = Database Abstracts of Reviews of Effects, “other reviews”; EED = Economic Evaluations; HTA = Health Technology Assessments
	Search terms	Items found
Population:
1.	[mh “Attention Deficit and Disruptive Behavior Disorders”]	2809
2.	[mh “Attention Deficit Disorder with Hyperactivity”]	2482
3.	(“Attention Deficit Disorder*”:ab,ti)	3751
4.	("Attention deficit":ab,ti NEAR hyper:ab,ti)	3529
5.	(“adhd”:ti,ab,kw OR “addh”:ti,ab)	4168
6.	1 OR 2 OR 3 OR 4 OR 5	5506
7.	[mh "Autistic Disorder"]	867
8.	[mh "Autism Spectrum Disorder"]	1211
9.	("Autism" or Autist* or "ASD" OR "Autism spectrum*"):ti,ab	3467
10.	7 OR 8 OR 9	3523
11.	6 OR 10	8787
Intervention
12.	[mh “Exercise”]	22364
13.	(Physical:ti,ab NEAR (Activit* OR therap* OR exercise):ti,ab)	37078
14.	(exercise* or physiotherap* or sport*):ti,ab.	87292
15.	12 OR 13 OR 14	110896
Limits:
16.	Filtered by: Cochrane Reviews.
17.	Filtered by: Publication date: 2009-2019
Combined Searches:
18.	11 AND 15	303
19.	11 AND 15 AND 16	2
Final	19 AND 17	2

**PsycINFO via EBSCO 2019 09 04**
**Hyperactivity and exercise**
The search result, usually found at the end of the documentation, forms the list of abstracts.; AB = Abstract; AU = Author; DE = Term from the thesaurus; MM = Major Concept; TI = Title; TX = All Text. Performs a keyword search of all the database's searchable fields; ZC = Methodology Index; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
	Search terms	Items found
Population:
1.	(DE "Attention Deficit Disorder")	2020
2.	(DE "Attention Deficit Disorder with Hyperactivity")	28479
3.	(AB “Attention Deficit” OR TI “Attention Deficit”)	21124
4.	("Attention deficit” N6 hyper)	32822
5.	(AB “adhd” OR AB “addh” OR TI "adhd" OR TI "ADDH")	26227
6.	1 OR 2 OR 3 OR 4 OR 5	37788
7.	(DE "Autism Spectrum Disorders")	41117
8.	(AB Autism OR TI Autism) OR (AB Autistic* OR TI Autistic*)	48405
9.	(AB "Autism spectrum disorder" OR TI "Autism spectrum disorder")	22137
10.	(AB “ASD” OR TI “ASD”)	16617
11.	7 OR 8 OR 9 OR 10	51629
12.	6 OR 11	86164
Intervention:
13.	DE "Exercise"	27909
14.	("Physical" N6 ("Activit" or "therap" or "exercise" or “training”))	62585
15.	(AB “exercise” OR TI “exercise”)	46773
16.	(AB “physiotherapy” OR TI “physiotherapy”)	1851
17.	(AB “sport” OR TI “sport”)	32066
18.	13 OR 14 OR 15 OR 16 OR 17 OR 18	124968
Limits:
19.	(TI (systematic* n3 review)) or (AB (systematic n3 review)) or (TI (systematic n3 bibliographic)) or (AB (systematic n3 bibliographic)) or (TI (systematic n3 literature)) or (AB (systematic* n3 literature)) or (TI (comprehensive* n3 literature)) or (AB (comprehensive* n3 literature)) or (TI (comprehensive* n3 bibliographic)) or (AB (comprehensive n3 bibliographic)) or (TI (integrative n3 review)) or (AB (integrative n3 review)) or (JN “Cochrane Database of Systematic Reviews”) or (TI (information n2 synthesis)) or (TI (data n2 synthesis)) or (AB (information n2 synthesis)) or (AB (data n2 synthesis)) or (TI (data n2 extract)) or (AB (data n2 extract)) or (TI (medline or pubmed or psyclit or cinahl or (psycinfo not “psycinfo database”) or “web of science” or scopus or embase)) or (AB (medline or pubmed or psyclit or cinahl or (psycinfo not “psycinfo database”) or “web of science” or scopus or embase)) or (MH “Systematic Review”) or (MH “Meta Analysis”) or (TI (meta-analy or metaanaly)) or (AB (meta-analy or metaanaly*))
20.	Filtered by: Publication date: 2009-2019
Combined Searches:
21.	12 AND 19	1103
22.	12 AND 18 AND 19	44
Final	22 AND 20	44

Page published October 24, 2019

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