The Impact of Exercise Interventions on Sustained Attention for Children and Adolescents With ADHD: A Systematic Review and Meta-Analysis

Purpose: Studies have consistently shown that exercise interventions are beneficial for improving attention in children and adolescents. Nevertheless, the evidence regarding its impact on the sustained attention (SA) of children and adolescents with attention-deficit hyperactivity disorder (ADHD) is unclear. This study synthesises empirical studies on the effects of exercise interventions on the SA of children and adolescents with ADHD. Methods: Following PRISMA guidelines, a systematic search of the literature was conducted in April 2024, and the updated search was conducted until September 2025 in six electronic databases: CINAHL Complete, Embase, Medline, PsychINFO, SPORTDiscus, and Web of Science. Randomised controlled trials and non-randomised comparison studies that applied exercise interventions and assessed SA using neurocognitive tasks among children and adolescents with ADHD were included. Meta-analyses were performed using a random-effects model, and Hedges’ g was used to express the effect size index. The quality assessment was conducted using the Physiotherapy Evidence Database (PEDro) scale. Results: 11 studies with adequate to high methodological quality were included, originating from four regions and published between 2012 and 2023. In total, 540 children and adolescents with ADHD aged 5–18 years were included. The meta-analytic findings indicated that exercise interventions improved their sustained SA (g = 0.877). Subgroup analysis revealed that cognitively engaging exercises (g = 0.980) produced significant training effects than aerobic exercise on SA. Meta-regression indicated that older children (5–18 years) interventions with more total sessions (12–144 sessions), generated greater benefits. Conclusion: Exercise interventions positively affect the SA of children and adolescents with ADHD.