ࡱ> DFC)` ;bjbj . {{;    4 u/LLLLLLLL.......$c0h2/LLLLL/LL//LLL.L.^ "L@ p5 L*!.E/0u/D!u3Lju34"" u3L.LLLLLLL//LLLu/LLLL Does Exercise Improve ADHD Symptoms? Shannon Lancaster, MD Cognitive deficits in Attention Deficit Hyperacitivity Disorder (ADHD) are common, due to problems with executive function tasks such as organization, prioritizing, focusing, sustaining effort, and working memory. Although typically treated with stimulants, these drugs are not without risk and side effects. Exercise has been shown to improve cognitive abilities, and recently there has been increasing interest in the role of exercise in ADHD treatment. A PubMed search was performed to answer the PICO question in pediatric patients with ADHD, does exercise compared to no exercise lead to an improvement in attention and/or cognition. Search terms were physical activity or exercise, attention deficit hyperactivity disorder, and children. Chang et al (2012) conducted a randomized prospective trial with the intervention consisting of 30 minutes running on a treadmill. Changes in cognition were evaluated with the Stroop Test and Wisconsin Card Sorting Test (WCST). There was a significant difference in degree of improvement in the exercise group (p <0.0001) as measured by Stroop Test, while the control group improved but not significantly (p = 0.08), but no significant effect of exercise as measured by the WCST. Hill et al (2011) conducted a 2-week crossover study to evaluate the effect of exercise on cognitive performance. Participants with no ADHD symptoms outperformed those with clinical ADHD symptoms as reported by Vanderbilt. There was no relationship between participants' scores on ADHD questionnaire and the magnitude of cognitive benefit that they received from exercise. This study did not evaluate whether those with clinical ADHD had clinically significant changes in their symptom report after exercise. Kang et al (2011) conducted a 6-week prospective trial comparing exercise to ADHD and behavior education. Changes in attention, executive function, and social skills were analyzed. There was significant improvement in attention (p = 0.04) in the exercise group compared to the education group. There was also improvement in executive function testing when compared to the education group (digit symbol test p=0.02, TMT-B test p= 0.04). Results may be difficult to interpret as all participants were started on methylphenidate at the outset of the study. Although these small prospective studies demonstrated improvement on measures of attention and cognition after exercise, the degree of benefit in the clinical setting remains unclear. In addition, there is not enough data to recommend exercise as a replacement for medication, or clear indication of whether it will alleviate the need to start medication. Further studies are needed to evaluate whether there is a clinically significant cognitive effect of exercise on children with ADHD. References Chang, Y., Liu, S., Yu, H., & Lee, Y. (2012). Effect of Acute Exercise on Executive Function in Children with Attention Deficit Hyperactivity Disorder.Archives of Clinical Neuropsychology,27(2), 225-237. Hill, L. J., Williams, J. H., Aucott, L., Thomson, J., & Mon-Williams, M. (2011). How does exercise benefit performance on cognitive tests in primary-school pupils?Developmental Medicine & Child Neurology,53(7), 630-635. Himelstein, J., J. H. Newcorn, and J. M. Halperin. 2000. The Neurobiology of Attention-Deficit Hyperactivity Disorder. Frontiers in Bioscience: A Journal and Virtual Library 5 (April): D46178 Kaplan, Gabriel, and Jeffrey H. Newcorn. 2011. Pharmacotherapy for Child and Adolescent Attention-Deficit Hyperactivity Disorder. Pediatric Clinics of North America 58 (1): 99120, xi. doi:10.1016/j.pcl.2010.10.009. Kang, K., Choi, J., Kang, S., & Han, D. (2011). 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