Effects of Exercise Intervention on Physical and Mental Health of Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-analysis Based on ICF-CY

Background Attention deficit/hyperactivity disorder (ADHD) affects the physical and mental health in children and adolescents. Evidence suggests that participation in exercise may benefit children and adolescents with ADHD and enhance current and future physical and mental health. This systematic review and meta-analysis investigated the effects of exercise interventions on the physical and mental health of children and adolescents with ADHD, based on the International Classification of Functioning, Disability and Health-Children and Youth Version (ICF-CY) framework. Method This review systematically searched for studies published up to August 1, 2023, through PubMed, Web of Science, PsycINFO, and Scopus. A meta-analysis was performed on studies that reported physical and mental health outcomes more than 10 times. A semiquantitative analysis was performed on studies that reported those indicators less than 10 times. In addition, all physical and mental health outcome indicators were linked to ICF-CY codes. Results A total of 43 studies were included in the systematic review, 13 of which were eligible for meta-analysis. Our meta-analysis results showed that levels of anxiety and depression significantly decreased after exercise intervention, with medium (Hedges'g = - 0.63, 95% CI [1.17, - 0.09], P < 0.05) and large effect sizes (Hedges'g = - 1.03, 95% CI [- 1.94, - 0.12], P < 0.05), respectively. The level of attention problem significantly decreased after exercise intervention, with a large effect size (Hedges'g = - 1.28, 95% CI [- 2.59, 0.04], P = 0.06), but no statistical difference was observed. The level of motor skills significantly improved after exercise intervention with a large effect size (Hedges'g = 0.97, 95% CI [0.42, 1.51], P < 0.01). The level of muscle strength significantly improved after exercise intervention, with a small effect size (Hedges'g = 0.37, 95% CI [0.05, 0.68], P < 0.05). The included studies covered a total of 31 outcome indicators, which could be divided into 4 one-level classifications and 27 two-level classifications according to the ICF-CY framework. Among the outcome indicators, 21 (67.74%) were related to "physical functions", 9 (29.03%) were related to "activities and participation", and 1 (3.23%) was related to "body structures". Conclusion This study confirmed that exercise could improve the physical and mental health in children and adolescents with ADHD. Regarding exercise intervention to improve the health of children and adolescents with ADHD, existing research has focused on verifying the immediate effect of intervention from the perspective of "physical functions". However, there is a lack of in-depth exploration into changes in the dimensions of "body structures" and "activities and participation", as well as the long-term intervention effects. Future studies should focus more on a holistic view of health that considers "body structures and functions" and "activities and participation", which could ultimately favor comprehensive and long-term improvements in the health status of children and adolescents with ADHD.