Effects of Aerobic Exercise on Executive Function in Children and Adolescents with Attention Deficit Hyperactivity Disorder: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Effects of Aerobic Exercise on Executive Function in Children and Adolescents with Attention Deficit Hyperactivity Disorder: A Systematic Review and Meta-Analysis of Randomized Controlled Trials | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effects of Aerobic Exercise on Executive Function in Children and Adolescents with Attention Deficit Hyperactivity Disorder: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Pengfei Wang, Fengshuo Rao, Zikang Xu, Kailin Xing, Yuhang Gao, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6437789/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 30 Aug, 2025 Read the published version in BMC Sports Science, Medicine and Rehabilitation → Version 1 posted 10 You are reading this latest preprint version Abstract Background The benefits of aerobic exercise interventions on the executive function of children and adolescents have been fully confirmed. However, the effects of such interventions on the executive function of children and adolescents with attention deficit hyperactivity disorder (ADHD) require further exploration. This study is a systematic review of randomized controlled trials (RCTs) of aerobic exercise interventions for children and adolescents with ADHD, aiming to provide valuable intervention suggestions to enhance the executive function of children and adolescents with ADHD. Method A comprehensive search was conducted across multiple databases, including PubMed, Web of Science, EMbase, Cochrane Library, ProQuest, Scopus, CNKI, Wanfang, and VIP databases, to identify relevant RCTs. Study screening, data extraction, quality assessment, and data analysis were independently performed by two researchers. Meta-analysis was performed using Reviewer Manager 5.4 software, and network meta-analysis was performed using Stata 17.0 software. A total of 12 studies involving 504 participants diagnosed with ADHD were included. Results The meta-analysis showed that aerobic exercise interventions positively affect the executive function of children and adolescents with ADHD. A large effect size was observed for inhibitory control (SMD= -0.91, 95% CI: -1.31, -0.51, p<0.05), moderate effect size for working memory (SMD= -0.50, 95% CI -0.86, 0.15, p<0.05) and cognitive flexibility (SMD= -0.65, 95% CI -0.87, 0.42, p<0.05). The network meta-analysis results showed that compared to the group without exercise intervention, combat aerobic exercise (SMD= -1.81, 95% CI -3.41, -0.20) and ball aerobic exercise (SMD= -1.26, 95% CI: -2.41, -0.12) significantly improved the inhibitory control of children and adolescents with ADHD. Combat aerobic exercise ranked the highest SUCRA (82.3%), followed by cycling (SUCRA = 72.8%) and ball aerobic exercise (SUCRA = 69.2%). Conclusion The research shows that aerobic exercise interventions can effectively enhance the executive function of children and adolescents with ADHD. However, the effect of the intervention is affected by factors like duration period, frequency, duration time, and intensity. In addition, combat aerobic exercise and ball aerobic exercise may provide the most optimal effects for improving inhibitory control. The specific choice of intervention should be flexibly adjusted based on individual needs. aerobic exercise executive function ADHD children adolescents Meta-Analysis Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 1 Introduction Attention deficit hyperactivity disorder (ADHD), commonly referred to as hyperactivity disorder, is a neurodevelopmental disorder frequently diagnosed in childhood 1 . The global prevalence of ADHD is about 5.29% 2 , and the prevalence among children and adolescents up to 7.2% 3 . Individuals with ADHD typically exhibit age-inappropriate inattention, hyperactivity, and impulsive behavior 4 , with comorbidities such as learning disabilities, conduct disorders, and emotional disorders 5 . If no effective interventions are implemented during childhood, ADHD symptoms may persist into adolescence and adulthood 6 . The adverse consequences of such conditions include antisocial behavior, substance abuse, criminal activity, psychiatric hospitalization, and accidental death 7 . A meta-analysis of prison inmates with ADHD shows that the prevalence of ADHD in juvenile inmates is 30.1% and in adult inmates 26.2% 8 . Furthermore, individuals with ADHD have higher risks of suicide, unemployment, and divorce compared to the general population, leading to significant economic, psychological, and social effects on families and society 9 , 10 . Executive function impairment is a core symptom of ADHD, and the degree of impairment in executive function is positively correlated with the severity of ADHD 11 , 12 . Executive function refers to an advanced cognitive process in which individuals can flexibly and efficiently regulate multiple cognitive processes when given complex cognitive tasks. Its ultimate goal is to achieve purposeful and orderly behaviors 13 . Executive function includes three core sub-functions: inhibitory control, working memory, and cognitive flexibility 14 . Inhibitory control, also known as inhibition, refers to the ability to consciously control one’s attention, thoughts, behaviors, emotions, and other factors during cognitive activities, blocking out strong internal tendencies, external temptations, and other irrelevant information to focus on relevant information 14 , 15 . Working memory, also known as refreshing, refers to the ability to temporarily process and store newly presented information, allowing individuals to continuously revise existing information 16 . Cognitive flexibility, also known as shifting, refers to the ability to switch between different operations or mental sets according to the requirements of the current task 14 . Studies have shown that among children with ADHD, the likelihood of impairment in at least one of the three core dimensions of executive function is as high as 89% 17 , and they usually exhibit varying degrees of deficits across all three core dimensions 18 , 19 .Inhibitory control impairment in children with ADHD is closely related to poor emotional self-regulation, defects in self-directed language, and reduced allocation of attention resources 20 – 22 . Working memory impairment often indicates a lack of sustained visual attention 23 . Children with this condition may remain focused during specific tasks, such as playing video games and watching TV. However, they find it extremely difficult to maintain attention when it comes to learning or academic activities. Besides, they usually cannot effectively grasp and process information and may also have social disorders 24 . Abnormal cognitive flexibility in children with ADHD shows poor academic performance and inefficient problem-solving ability 25 . Executive function impairment is only one aspect of the cognitive and behavioral problems of children with ADHD, but it has a significant negative effect. Improving executive function can treat the symptoms of ADHD effectively 26 . In recent years, research has reported that exercise intervention, as a new therapeutic approach, can improve the executive function of individuals with ADHD 27 – 29 . Traditional pharmacological treatments are not only expensive but may also lead to adverse reactions such as headaches, nausea, anorexia, and even stunted growth and development 30 . In contrast, exercise intervention can be well integrated into the daily lives of children and adolescents without adverse reactions. Among various forms of exercise, aerobic exercise has the advantages of strong operability and high compliance. It is currently widely applied to improve the executive function of normal children and adolescents 31 – 33 . Recently, a large number of studies have found that aerobic exercise can also improve the executive function of children with ADHD 34 – 36 . However, Diamond and Ling argue that aerobic exercise and resistance exercise are the least effective forms of exercise interventions 37 , 38 . Additionally, some studies conclude that aerobic exercise cannot achieve a significant improvement in executive function 39 . Previous systematic reviews and meta-analyses on the effects of aerobic exercise interventions on executive function have mostly focused on individuals without ADHD 40 – 43 . There are few studies on aerobic exercise intervention reviews involving people with ADHD. Only Yang et al.’s study explored the effect of aerobic exercise intervention on the executive function of children with ADHD 44 . However, their study did not identify which type of aerobic exercise yields the greatest benefits for the executive function of children and adolescents with ADHD. Moreover, it did not investigate the effect of aerobic exercise frequency on their executive function. Therefore, there is currently a lack of a comprehensive systematic review on the effect of aerobic exercise interventions on the executive function of children and adolescents with ADHD, making further exploration necessary. This study starts from the core dimensions of executive function (inhibitory control, working memory, and cognitive flexibility) and conducts meta-analysis and network meta-analysis based on RCTs of aerobic exercise interventions. The goal is to provide valuable insights into the treatment of children and adolescents with ADHD through aerobic exercise interventions. 2 Methods 2.1Protocol and registration This systematic review and meta-analysis were conducted under the Cochrane Handbook for Systematic Reviews of Interventions. The results are reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement 45 . The research protocol has been registered in the international prospective systematic review registry PROSPERO (CRD42024595660). 2.2 Retrieval Strategy We retrieved the following databases: PubMed, Web of Science, EMbase, Cochrane Library, ProQuest, Scopus, CNKI, Wanfang, and VIP, with the search period ranging from the database inception to September 10, 2024. We retrieved the following four groups of subject words and free words. For example: (1) Population: “children” OR “adolescents”; (2) Disease type: “attention deficit hyperactivity disorder” OR “hyperactivity disorder”; (3) Intervention: “exercise” OR “aerobic exercise”; (4) Outcome measures: “executive function” OR “inhibitory control” OR “inhibition,” “working memory” OR “refreshing” OR “cognitive flexibility” OR “shifting.” The Boolean logical operator “AND” was used to connect the search results between each group. The database retrieval was completed independently by two researchers, and the retrieval results were cross-checked. Any discrepancies were resolved through group discussions among team members until a consensus was reached. Table 1 shows the comprehensive search strategy for PubMed. The search strategies for other databases are shown in Appendix B. Table 1 Search strategy on PubMed #1 "Exercise"[Mesh] #2 "Exercise"[Title/Abstract] OR "Physical Exercise"[Title/Abstract] OR "Physical Activity"[Title/Abstract] OR "Aerobic Exercise"[Title/Abstract] OR "Isometric Exercise"[Title/Abstract] OR "Acute Exercise"[Title/Abstract] OR "Exercise Training"[Title/Abstract] OR "Running"[Title/Abstract] OR "Jogging"[Title/Abstract] OR "Marathon Running"[Title/Abstract] OR "Swimming"[Title/Abstract] OR "Walking"[Title/Abstract] OR "Nordic Walking"[Title/Abstract] OR "Stair Climbing"[Title/Abstract] OR "Exergaming"[Title/Abstract] OR "Aerobic Training"[Title/Abstract] OR "Dancing"[Title/Abstract] OR "Cycling"[Title/Abstract] OR "Endurance Training"[Title/Abstract] OR "Qigong"[Title/Abstract] OR "Taichi"[Title/Abstract] OR "Baduanjin"[Title/Abstract] OR "Wuqinxi"[Title/Abstract] OR "Yijinjing"[Title/Abstract] OR "Yoga"[Title/Abstract] OR "Ball"[Title/Abstract] OR "soccer ball"[Title/Abstract] OR "Soccer"[Title/Abstract] OR "Football"[Title/Abstract] OR "Basketball"[Title/Abstract] OR "ping pong"[Title/Abstract] OR "Badminton"[Title/Abstract] OR "Tennis"[Title/Abstract] OR "Baseball"[Title/Abstract] OR "Volleyball"[Title/Abstract] OR "Softball"[Title/Abstract] OR "Softball" OR "racket sport"[Title/Abstract] OR "Lacrosse"[Title/Abstract] OR "Racquetball”[Title/Abstract] #3 #1 OR #2 #4 "Executive Function"[Mesh] #5 "Executive Function"[Title/Abstract] OR "Executive Control"[Title/Abstract] OR "Cognitive Function"[Title/Abstract] OR "Cognitive Performance"[Title/Abstract] OR "Inhibitory Control"[Title/Abstract] OR "Shifting"[Title/Abstract] OR "Working Memory"[Title/Abstract] OR (("refresh"[All Fields] OR "refreshable"[All Fields] OR "refreshed"[All Fields] OR "refresher"[All Fields] OR "refreshers"[All Fields] OR "refreshes"[All Fields] OR "refreshing"[All Fields] OR "refreshment"[All Fields] OR "refreshments"[All Fields]) AND "function"[Title/Abstract]) OR "cognitive flexibility"[Title/Abstract] OR "Updating"[Title/Abstract] OR "Inhibition"[Title/Abstract] #6 #4 OR #5 #7 "Attention Deficit Disorder with Hyperactivity"[Mesh] #8 "Attention Deficit Hyperactivity Disorder"[Title/Abstract] OR "Attention Deficit Disorder with Hyperactivity"[Title/Abstract] OR "ADHD"[Title/Abstract] OR "ADDH"[Title/Abstract] OR "Attention Deficit Disorder"[Title/Abstract] OR "Hyperkinetic Syndrome"[Title/Abstract] #9 #7 OR #8 #10 "Child"[Mesh] #11 "Adolescent"[Mesh] #12 "Children"[Title/Abstract] OR "Adolescent"[Title/Abstract] OR "Child"[Title/Abstract] OR "Teenager"[Title/Abstract] OR "Adolescence"[Title/Abstract] #13 #10 OR #11 OR #12 #14 #3 AND #6 AND #9 AND #13 2.3 Inclusion and Exclusion Criteria 2.3.1 Inclusion Criteria The inclusion criteria for this study were as follows: (1) Research subjects: Individuals diagnosed with ADHD based on parental reports, physician diagnoses, or criteria from the International Classification of Diseases (ICD) or the Diagnostic and Statistical Manual of Mental Disorders (DSM) [32], with an age of <18 years. (2) Intervention type: Any form of aerobic exercise intervention. (3) Control type: No-exercise intervention or daily activities. (4) Trial design: All included studies are RCTs. (5) Outcome measures: At least one outcome measure with data that could be used to calculate the effect size for executive function (inhibitory control, working memory, cognitive flexibility). 2.3.2. Exclusion Criteria The exclusion criteria of this study include: (1) non-Chinese and non-English study; (2) non-randomized controlled trials; (3) no original data provided; (4) the provided original data cannot be used to calculate the effect size of executive function; (5) significant baseline differences between the experimental and control groups; (6) full text not available. 2.4 Study selection After removing duplicate studies, two independent researchers screened the studies using EndNote X9 software. Initial screening was conducted based on titles and abstracts. A study that preliminarily met the criteria was further evaluated through detailed full-text reading. Finally, the study that fully meets the criteria will be included in this study. If there are differences in the process of selecting and excluding studies by the two independent researchers, a consensus will be reached through group discussions among team members. 2.5 Data Extraction Two independent researchers extracted and recorded the following data from the final selected study: (1) basic information: author, year of study publication, and country where data was collected; (2) characteristics of trial participants: age, gender ratio, ADHD diagnostic criteria, and sample size; (3) components of the intervention: intervention content, intervention duration period, intervention frequency, intervention duration time, intervention intensity, and intervention type; (4) outcome measures and evaluation tools. 2.6 Quality Assessment Two independent researchers assessed the risk of bias in the included study using Reviewer Manager 5.4 software based on the Cochrane Risk of Bias Tool [33]. Seven items were included: random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective reporting, and other bias. The risk of bias in the study is categorized as “low,” “high,” or “unclear.” If the evaluation results of two independent researchers fail to reach an agreement, a consensus is reached through group discussions among team members. 2.7 Statistical Analysis Meta-analysis was conducted using Reviewer Manager 5.4 software. The data in the included studies are all continuous variables. However, due to the differences in the assessment tools used across studies, we use the standardized mean difference (SMD) as the effect size and calculate its 95% confidence interval (95% CI). Effect size < 0.2 is a small effect, 0.20–0.49 is a small to moderate effect, 0.50–0.79 is a moderate effect, and effect size ≥ 0.8 is a large effect 46 . If the directions of the effect sizes are inconsistent, we multiplied the results by -1 to ensure consistency 47 . Heterogeneity among studies was assessed using the I² test and the Q test. If p 50%, it indicated that there is heterogeneity among the studies, and a random-effects model was used to combine the effect sizes; otherwise, a fixed-effects model is used for effect size combination. In addition, The level of heterogeneity was quantified using I² statistics and classified as low (I²≤25%)), moderate (25%<I²≤50%), significant (50%75%) 48 . When heterogeneity was present, subgroup analyses were conducted to explore its sources. A network meta-analysis was conducted using a frequentist framework with Stata 17.0 software. A network relationship graph was plotted, followed by statistical analysis. The Surface Under the Cumulative Ranking Curve (SUCRA) was used to predict and rank the intervention effects of different types of aerobic exercise. The SUCRA values were expressed as percentages, with higher percentages indicating better effectiveness. Publication bias was assessed using both visual funnel plots and quantitative methods, including Egger’s test and Begg’s test. A P-value of 0.05 was used as the threshold: p > 0.05 indicated no publication bias; p < 0.05 indicated the presence of publication bias. In addition, sensitivity analysis was performed by sequentially excluding individual studies to examine the degree of influence of each study result on the combined effect size. 3 Results 3.1 Study selection To ensure the accuracy of the study retrieval and screening process, two researchers with expertise in attention deficit hyperactivity disorder and exercise science independently screened the titles, abstracts, and full-text literature after the completion of study retrieval and duplicate removal. The reliability of the two screening stages was calculated using Cohen’s kappa for both the title and abstract screening stage and the full-text screening stage. The agreement levels are categorized as follows: fair agreement (0.40–0.59), good agreement (0.60–0.74), and excellent agreement (> 0.75) 49 . We conducted a comprehensive search of nine Chinese and English databases from their inception to September 10, 2024, identifying a total of 1,875 papers. After removing duplicates, 1,538 relevant studies remained. Subsequently, two independent researchers conducted initial screening through titles and abstracts. Among them, 1474 studies were excluded, and 64 studies met the criteria for full-text review. At this stage, the reliability between the two reviewers was rated as “good” (Cohen’s kappa = 0.71). After full-text review, 52 studies were excluded: 7 studies were non-randomized controlled trials, 7 studies used interventions that did not meet the inclusion criteria, 4 studies lacked access to the full text, 10 studies did not meet the outcome measure criteria, 8 studies had participants who did not meet the inclusion criteria, 16 studies had incomplete data. Therefore, in the final meta-analysis, we included 12 eligible studies 50 – 61 for qualitative synthesis (Fig. 1 ). At this stage, the reliability between the two reviewers was rated as “excellent” (Cohen’s kappa = 0.75). 3.2 Study characteristics Table 2 lists the characteristics of the 12 included studies. All studies were randomized controlled trials. The publication years of the study range from 2012 to 2022. The research sample included 504 participants diagnosed with ADHD. Among them, 257 participants were assigned to the experimental group, and another 247 participants were assigned to the control group. 5 studies simultaneously focused on inhibitory control, working memory, and cognitive flexibility 54 , 55 , 58 , 59 , 61 ; 2 studies simultaneously focused on inhibitory control and cognitive flexibility 50 , 57 ; 4 studies only focused on inhibitory control 51 – 53 , 56 ; 1 study only focused on working memory 60 . Among the 12 studies, 2 had acute aerobic exercise as the intervention 50 , 54 , and the others were all chronic aerobic exercises. The duration time of a single chronic aerobic exercise intervention ranged from 25 to 90 minutes; the intervention frequency ranged from 2 to 5 times per week, and the most common intervention frequency was 3 times per week; the intervention duration period ranged from 6 to 78 weeks. The specific aerobic exercise interventions included ball aerobic exercise 51 , 52 , 57 , 61 , combat aerobic exercise 56 , 60 , acute aerobic exercise 50 , 54 , combined aerobic and neurocognitive-exercise 55 , 59 , cycling 58 , and combined aerobic exercise 53 . Table 2 Summary table of included reviews study Country Participant Characteristics Intervention Outcome Age Range; Sex-M (%) Diagnostic Methods Sample Size (EG/CG) Age (Control) EG CG Outcome Measures Intervention content Intervention time, frequency, period Intensity Type Intervention content Intervention time, frequency, period Type Liang et al.,2022 China 6–12;M-78%; DSM-5 78 (39/39) 8.37 ± 1.42 (8.29 ± 1.27) Combined aerobic and neurocognitive-exercise 60 mins/ 3 sessions/ 12 weeks MVI Combined aerobic and neurocognitive-exercise No intervention No intervention No-exercise intervention IC:Flanker Task WM:Tower of London Test CF:Trail Making Test Ludyga et al.,2022 Switzerland 8–12;M-70%; DSM-5 57 (29/28) 10.0 ± 1.2 (10.8 ± 1.2) Judo 60 mins/ 2 sessions/ 12 weeks MI Combat aerobic exercise No intervention No intervention No-exercise intervention WM:Change Detection Paradigm Test Chen et al.,2022 China 6–10;M-83%; DSM-5 64 (32/32) 8.37 ± 1.68 (7.89 ± 2.13) Cycling 25 mins/ 3 sessions/ 12 weeks MVI Cycling Watching cartoons 20 mins/ 3 sessions/ 12 weeks No-exercise intervention IC:Stroop Test CF:odd Even Size Test WM:N-back Test Chang et al.,2022 China NR;M-81%; DSM-5 32 (16/16) 8.31 ± 1.30 (8.38 ± 1.31) Actual table tennis training 60 mins/ 3 sessions/ 12 weeks NR Ball aerobic exercise Simulated table tennis training 60 mins/ 3 sessions/ 12 weeks Cognitive training IC:Stroop Test CF:Wisconsin Card Sorting Test Kadri et al.,2019 Kadri NR;M-90%; psychiatric physician 40 (20/20) 14.5 ± 3.5 (14.2 ± 3.0) Taekwondo 50 mins/ 2 sessions/ 78 weeks NR Combat aerobic exercise No intervention No intervention No-exercise intervention IC:Stroop Color-Word Test Benzing et al.,2019 Switzerland 8–12;M-84%; ICD-10 51 (28/23) 10.46 ± 1.30 (10.39 ± 1.44) Exergaming 30 mins/ 3 sessions/ 8 weeks NR Combined aerobic and neurocognitive-exercise No intervention No intervention No-exercise intervention IC:Simon Task CF:Flanker Task WM:Color Span Backwards Task Benzing et al.,2018 Switzerland 8–12; M-83%; ICD-10 46 (24/22) 10.46 ± 1.35 (10.50 ± 1.41) Exergaming 15 mins/ 1 session MVI Acute aerobic exercise Watching video 15 mins/ 1 session No-exercise intervention IC:Flanker Task CF:Flanker Task WM:Color Span Backwards Task Pan et al.,2016 China 6–12;M-100%; DSM-IV 32 (16/16) 8.93 ± 1.49 (8.87 ± 1.56) Table tennis 70 mins/ 2 sessions/ 12 weeks NR Ball aerobic exercise No intervention No intervention No-exercise intervention IC: Stroop Color-Word Test Chang et al.,2012 China 8–13;M-93%; DSM-IV 40 (20/20) 10.45 ± 0.95 (10.42 ± 0.87) Treadmill running 30 mins/ 1 session MI Acute aerobic exercise Watching videos 30 mins/ 1 session No-exercise intervention IC: Stroop Test CF༚Wisconsin Card Sorting Test Memarmoghaddam et al.,2016 Iran 7–11;M-100%; SNAP-IV 36 (19/17) 8.31 ± 1.29 (8.29 ± 1.31) Ball exercise (table tennis, bowling, football, basketball, etc.) 90 mins/ 3 sessions/ 8 weeks MVI Ball aerobic exercise No intervention No intervention No-exercise intervention IC: Go-No-Go Test Lee et al.,2017 Korea 6–10;M-100%; DSM-4 12(6/6) 8.83 ± 0.98 (8.83 ± 0.98) Rope skipping and ball exercise 60 mins/ 3 sessions/ 12 weeks MVI Combined aerobic exercise No intervention No intervention No-exercise intervention IC: Stroop Color-Word Test Song et al.,2022 China 6.75–8.58;M-100;DMS-IV 16(8/8) 7.68 ± 0.56 (7.53 ± 0.79) Football 60 mins/ 5 sessions/ 6 weeks MI Ball aerobic exercise Physical education class 40 mins/ 4 sessions/ 6 weeks Physical education class IC: Stroop Color-Word Test WM༚Complex Figure Test CF༚Trail Making Test EG: experimental group; CG: control group; NR: no report; M: male; DSM-5: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; ICD-10: International Classification of Diseases, 10th Revision; DSM-4/IV: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; MI: moderate intensity; MVI: moderate to vigorous intensity; IC: inhibitory control; WM: working memory; CF: cognitive flexibility. 3.3 Quality Assessment Twelve studies had no selective reporting or other bias. 5 studies 53 , 57 – 60 had a low risk of bias in the Random Sequence Generation section, and the others were all unclear. 2 studies 55 , 60 implemented Allocation Concealment and had a low risk of bias, and the others were all unclear. Since all the studies included in this meta-analysis are exercise intervention studies, all studies had a high risk of bias in the Blinding of Participants and Personnel section. 2 studies 54 , 60 had a low risk of bias in the Blinding of Outcome Assessment section, and the others were all unclear. In the Incomplete Outcome Data section, 2 studies were rated as having a high risk of bias 53 , 55 , 62 , 1 study was unclear 57 , and the other studies all had a low risk of bias. Detailed information on the risk of bias assessment is shown in Fig. 2 . 3.4 Meta-Analysis 3.4.1 Effect of Aerobic Exercise on Inhibitory Control A total of 11 studies investigated the effect of aerobic exercise interventions on inhibitory control in children and adolescents with ADHD, involving 447 participants diagnosed with ADHD. As shown in Fig. 3 A, aerobic exercise interventions had a large overall effect size compared to the control group (SMD=-0.91, 95% CI: -1.31, -0.51, p<0.05). This effect shows significant heterogeneity (I²=73%, p<0.05). Subgroup analysis was performed, and the results are shown in Table 3 . Table 3 Result of subgroup analysis Categories Subcategory Outcome N Effect Effet Size The Result Heterogeneity Test Variables Model SMD 95%CI Z P I 2 P Duration period IC 6 Random -1.06 -1.69, -0.43 3.28 0.001** 80% 0.0001 2 -0.58 -1.09, -0.06 2.19 0.03* 34% 0.22 ≥ 12weeks WM 3 Fixed -0.67 -0.95, -0.38 4.54 0.000*** 55% 0.11 6-8weeks 2 -0.39 -0.88, 0.10 1.55 0.12 62% 0.11 CF 3 Fixed -0.74 -1.05, -0.43 4.69 0.000*** 0% 0.56 2 -0.56 -1.06, -0.07 2.23 0.03* 48% 0.16 Frequency IC 2 Random -1.95 -2.52, -1.37 6.66 0.000*** 0% 0.57 7 -0.65 -1.05, -0.25 3.17 0.002** 59% 0.02 2 weekly WM 1 Fixed -0.2 -0.72, 0.32 0.75 0.45 N/A N/A 3–5 weekly 4 -0.71 -1.00, -0.43 4.95 0.000*** 41% 0.17 CF - - - - - - - - - - - - - - - Duration Time IC 3 Random -0.67 -1.35, 0.01 1.92 0.05 73% 0.02 7 -0.9 -1.42, -0.38 3.37 0.000*** 73% 0.001 15-30min WM 3 Random -0.36 -0.87, 0.16 1.36 0.17 63% 0.07 50-90min 3 -0.68 -1.25, -0.11 2.33 0.02* 59% 0.09 CF 4 Fixed -0.54 -0.82, -0.26 3.75 0.000*** 0% 0.73 3 -0.83 -1.19, -0.46 4.41 0.000*** 0% 0.42 intensity IC 2 Random -1.45 -2.05, -0.85 4.75 0.000*** 0% 0.99 5 -0.67 -1.12, -0.22 2.9 0.004** 61% 0.04 MI WM 2 Random -0.57 -1.52, 0.37 1.2 0.23 61% 0.11 MVI 3 -0.6 -1.14, -0.06 2.19 0.03* 69% 0.04 CF 2 Fixed -1.16 -1.78, -0.54 3.66 0.000*** 0% 0.82 3 -0.59 -0.88, -0.30 3.94 0.000*** 0% 0.69 *: P<0.05; **: P<0.01; ***: P<0.001; N/A: not applicable; IC: inhibitory control; WM: working memory; CF: cognitive flexibility. 3.4.2 Effect of Aerobic Exercise on Working Memory A total of 6 studies examined the effect of aerobic exercise intervention on the working memory of children and adolescents with ADHD, involving 312 participants diagnosed with ADHD. As shown in Fig. 3 B, compared with the control group, aerobic exercise intervention has a moderate effect size (SMD=-0.50, 95%CI: -0.86, -0.15, p<0.05). This effect shows significant heterogeneity (I²=56%, p<0.05). A subgroup analysis was conducted, and the results are shown in Table 3 . 3.4.3 Effect of Aerobic Exercise on Cognitive Flexibility A total of 7 studies examined the effect of aerobic exercise interventions on cognitive flexibility in children and adolescents with ADHD, involving 327 participants diagnosed with ADHD. As shown in Fig. 3 C, compared with the control group, aerobic exercise interventions have a moderate effect size (SMD=-0.65, 95%CI:-0.87, -0.42, p0.05). A subgroup analysis was conducted, and the results are shown in Table 3 . 3.5 Network Meta-Analysis Figure 4 illustrates the network meta-analysis graph of inhibitory control. Due to the limited number of studies included in working memory and cognitive flexibility, only network meta-analysis of inhibitory control is conducted. Interventions with a large sample size include no-exercise intervention, ball aerobic exercise, and combined aerobic and neurocognitive-exercise. The most common comparisons are ball aerobic exercise and no-exercise intervention, acute aerobic exercise and no-exercise intervention, and combined aerobic and neurocognitive-exercise and no-exercise intervention. The frequency of comparison is indicated by the thickness of the connecting line. Other interventions, such as combined aerobic exercise and cycling, have a small sample size and only one comparison, as shown by the smaller nodes and thinner connecting lines in the figure. This study shows the changes in inhibitory control in children and adolescents with ADHD after various aerobic exercise interventions. Due to the use of different measurement tools, standardized mean difference (SMD) and 95% confidence interval (CI) are used to show the effect on inhibitory control. As shown in Fig. 5 , pairwise comparisons show that compared with the no-exercise intervention group, combat aerobic exercises [SMD= -1.81, 95%CI= (-3.41, -0.20)] and ball aerobic exercises [SMD=-1.26, 95%CI= (-2.41, -0.12)] both show significant improvements. Cycling [SMD= -1.47, 95%CI= (-2.99, 0.06)] shows improvement but has not reached statistical significance. Based on the SUCRA ranking of aerobic exercise interventions. Combat aerobic exercise has the highest ranking (SUCRA = 82.3%). Cycling and ball aerobic exercises rank second and third with 72.8% and 69.2% (see Table 4 and Appendix C). Although cycling has a relatively high SUCRA value, its intervention effect does not show statistical significance. Therefore, combined with statistical significance analysis, we believe that combat aerobic exercise and ball aerobic exercise are more empirically supported interventions and may have more reliable effects in improving inhibitory control in children and adolescents with ADHD. Table 4 Ranking of SUCRA probabilities Intervention Sucra Rank Combat aerobic exercise 82.3 1 cycling 72.8 2 Ball aerobic exercise 69.2 3 Cognitive training 63.1 4 Acute aerobic exercise 54.7 5 Combined aerobic and neurocognitive-exercise 38.5 6 Combined aerobic exercise 30.1 7 physical education class 21.7 8 No-exercise intervention 17.6 9 3.6 Publication bias As shown in Fig. 6 , publication bias tests were conducted on the meta-analysis results of inhibitory control, working memory, and cognitive flexibility, respectively. Visual inspection of the funnel plots showed that the study distributions of the three indicators did not show any asymmetry. Publication bias tests were also conducted on the network meta-analysis results of inhibitory control, and visual inspection did not show any asymmetry. In addition, the results of Egger’s and Begg’s tests showed no statistically significant bias for inhibitory control (P = 0.493 and P = 0.697), working memory (P = 0.800 and P = 0.260), and cognitive flexibility (P = 0.108 and P = 0.230) (see Appendices D1, D2, and D3). This proves that there is no publication bias in each indicator of this study. The results of sensitivity analysis showed that there was no significant difference between the combined effect size after excluding each study one by one and the original combined effect size from the included study, indicating that the results of this study are relatively stable (see Appendix E). 4 Discussion 4.1 Main results In this study, we conducted traditional meta-analysis and network meta-analysis, including a total of 12 studies to evaluate the effect of aerobic exercise intervention on the executive function of children and adolescents with ADHD. The results of traditional meta-analysis show that aerobic exercise intervention generally has a moderate to large positive effect on inhibitory control, working memory, and cognitive flexibility of children and adolescents with ADHD. Specifically, aerobic exercise interventions that achieve the best intervention effect are shown in Table 5 . It can be observed that for the three outcome measures involved, the optimal single intervention duration time is 50–90 minutes. The optimal intervention frequency is twice a week for inhibitory control, and working memory requires three to five times a week. Regarding the intervention duration period, all three outcome measures required a minimum of 12 weeks or longer to achieve the optimal intervention effect. In terms of exercise intensity, the optimal intervention intensity for inhibitory control and cognitive flexibility is moderate intensity, while the optimal intervention intensity for working memory is medium-high intensity. The research results of network meta-analysis show that different types of aerobic exercise have different effects in improving the inhibitory control of this population, indicating that not all aerobic exercise interventions have the same effect. Specifically, combat aerobic exercise and ball aerobic exercise show significant benefits in improving the inhibitory control of this population. This result is supported by the SUCRA ranking (see Table 4 and Fig. 7 ). Table 5 The optimal form of aerobic exercise intervention for the best outcomes in each measure Indicator Time (min) Frequency (weekly) Period (weeks) intensity Inhibitory control 50–90 2 ≥ 12 MI Working memory 50–90 3–5 ≥ 12 MVI Cognitive flexibility 50–90 - ≥ 12 MI Time: single intervention duration time; Frequency: number of interventions per week; Period: total intervention duration period; intensity: exercise intensity; MI: moderate intensity; MVI: moderate to vigorous intensity 4.2 Comparison with existing study We further explored the executive function of children and adolescents with ADHD, expanding the scope of previous studies on aerobic exercise interventions for the ADHD population. Our study is consistent with earlier findings, and the results support the positive effects of aerobic exercise interventions 44 , 63 . That is, in general, aerobic exercise interventions can have a positive effect on the executive function of children and adolescents with ADHD. In the subgroup analysis of aerobic exercise intervention, aerobic exercise with a single duration of 50–90 minutes and at a moderate intensity has a better effect on improving executive functions of children and adolescents with ADHD. This finding is almost consistent with the conclusions of scholars such as Yang 44 . Their meta-analysis examined the effect of aerobic exercise intervention on the executive functions of children with ADHD and confirmed that aerobic exercise intervention is an effective way to improve the executive functions of children with ADHD. However, when conducting the subgroup analysis, they only explored inhibitory control and cognitive flexibility and did not involve working memory. Secondly, their subgroup analysis did not examine the effect of aerobic exercise at different frequencies on the executive functions of children with ADHD. Finally, they divided aerobic exercise into only two categories: single aerobic exercise and combined aerobic exercise, and no specific differentiation were made for different forms of aerobic exercise interventions.This study extends the age range to under 18 years old, aiming to explore the effect of aerobic exercise on the executive function of children and adolescents with ADHD and to determine the most effective aerobic exercise intervention to help improve their executive function. The effects of aerobic exercise were mainly analyzed in three core dimensions of executive function, namely, inhibitory control, working memory, and cognitive flexibility. 4.3 Mechanism of Aerobic Exercise on Executive Function in Children and Adolescents with ADHD Aerobic exercise intervention affects the executive function of children and adolescents with ADHD mainly based on the following aspects. First, individuals with ADHD have abnormalities in brain structure and function, such as in the dorsolateral prefrontal cortex, ventromedial prefrontal cortex, parietal cortex, and other regions 64 . The prefrontal cortex is the main brain region related to executive function 65 . Abnormalities in this area will lead to a decline in executive function 5 . However, due to the theory of brain plasticity, the structure and function of the brain will be continuously modified and reorganized as a result of external environmental changes and experiences 66 . This provides the possibility to improve the executive function of children and adolescents with ADHD. When performing aerobic exercise, brain regions related to executive function are activated, such as increased activity in the bilateral prefrontal cortex, remodeling of white matter integrity, and enhanced efficiency of overall neural circuits in the brain 67 , 68 . This has a positive effect on improving the executive function of children and adolescents with ADHD. Secondly, performing aerobic exercise will also have an effect on cardiovascular function. Aerobic exercise can enhance the heart’s ability to supply oxygen to various working muscles, increase the blood supply to cortical capillaries and the number of synaptic connections, and promote the development of new neurons 69 . This process leads to a more efficient and more plastic brain. Finally, some scholars believe that dysregulation of catecholamine function and insufficient secretion of neurotransmitters such as norepinephrine and dopamine may also be the pathogenesis of ADHD 70 , 71 . However, studies have found that physical activity can cause changes in cerebral blood flow, serotonin, and brain-derived neurotrophic factors 72 and enhance the release of catecholamine neurotransmitters such as norepinephrine and dopamine 73 . These neurotransmitters facilitate communication across different signal transmission pathways in the brain, enhancing overall brain arousal levels, which in turn improves executive function in children and adolescents with ADHD 74 . In addition, animal-based experiments have also confirmed that aerobic exercise promotes the proliferation and differentiation of hippocampal neurons by regulating the brain-derived neurotrophic factor pathway 75 . These mechanisms contribute to the improvement of executive function in children and adolescents with ADHD. 4.4 Discussion of subgroup analysis results Our subgroup analysis shows that to improve the overall executive function of children and adolescents with ADHD, the most suitable intervention duration time is 50–90 minutes per period with an intervention duration period of 12 weeks or more. In terms of intervention frequency, the improvement in inhibitory control can be achieved twice per week, while working memory requires 3 to 5 times per week. This may be because compared to inhibitory control, working memory involves a more complex and extensive brain area network (such as the dorsolateral prefrontal cortex, parietal cortex, cerebellum, and other areas) and requires more frequent training to achieve significant results 37 , 76 . The subgroup analysis of different exercise intensities shows that moderate-intensity aerobic exercise seems to have more advantages in improving inhibitory control and cognitive flexibility in children and adolescents with ADHD. This is consistent with previous studies 62 . According to the arousal theory, there is an inverted U-shaped relationship between brain arousal level and exercise intensity 77 . When the exercise intensity is at a moderate load, the arousal level reaches the optimum, which is most conducive to the development of cognitive function. Specifically, moderate-load exercise can optimize the release of catecholamines (such as dopamine, norepinephrine, etc.) and, at the same time, increase the general biological arousal effect of the central nervous system, thus better allocating cognitive resources 78 , 79 . However, our study shows that moderate-intensity aerobic exercise does not have a significant effect on working memory. Instead, moderate-to-high-intensity aerobic exercise has a significant effect on working memory. This may be because, compared to moderate-intensity exercise programs, moderate-high-intensity exercise leads to a greater increase in brain-derived neurotrophic factor levels, which leads to better regulating the neural structure and functional plasticity, thereby promoting the improvement of working memory 80 . As for why moderate-intensity aerobic exercise does not have a significant effect on working memory, it may be due to the small number of studies included, resulting in a certain deviation in the results. Therefore, further research is needed in the future once sufficient studies are available. In short, aerobic exercise has a positive effect on improving the executive function of children and adolescents with ADHD. However, the effect of aerobic exercise intervention varies depending on the intervention duration period, frequency, duration time, and intensity. 4.5 Discussion of network meta-analysis results In this study, a network meta-analysis was conducted to evaluate the effects of different types of aerobic exercise on inhibitory control in children and adolescents with ADHD. The results show that combat aerobic exercise and ball aerobic exercise have shown significant benefits in improving inhibitory control in this population. These two types of aerobic exercise have a common characteristic: they are open-skill activities. The characteristics of open-skill activities are variability and unpredictability 81 . Before performing skill movements, participants cannot decide in advance what the next movement should be. They need to respond according to the stimulation of the external environment, which requires the body to carry out overall organization, coordination, and control of various information processing processes 81 . Training in this dynamic environment can promote the development of neurocognitive function, enhance neuroplasticity, and improve various functions of the brain, including increasing the number of dendritic branches and spines, synaptogenesis, angiogenesis, and the growth of glial cells 82 . In addition, the patterns of these two aerobic exercises are relatively complex. According to Picard and Strick, the complexity of exercise changes together with the brain activation pattern and the speed of information processing 83 . The more complex the exercise is, the higher the degree of brain activation will be, and the more activity there will be in the prefrontal cortex 84 , 85 . As a result, the ability of inhibitory control will be enhanced. Finally, combat aerobic exercise and ball aerobic exercise show significant effects, which may also be because they can activate the pleasure processing network in the brain. Studies have shown that the movement of scoring a goal in football can trigger a strong sense of pleasure and activate the pleasure-processing network in the brain 86 , and the brain regions involved in the pleasure-processing network are closely related to inhibitory control 87 . 4.6 Heterogeneity In the inhibitory control and working memory sections of this meta-analysis, the study included showed a very high heterogeneity, which remained significant even after subgroup analysis, with reductions observed only in certain subgroups. After a detailed reading of the original study and discussions among the research team, we identified several potential reasons for the high heterogeneity. First, in different studies, different scholars use different measurement tools when measuring inhibitory control and working memory, which may be the most important reason for the high heterogeneity. Second, there are certain differences in aerobic exercise types, such as ball aerobic exercise, combat aerobic exercise, acute aerobic exercise, etc. Therefore, the specific effects of aerobic exercise intervention on the executive function of children and adolescents with ADHD can be explored in more detail in subsequent studies. 4.7 Strengths and limitations This study has the following strengths. Firstly, the studies included only contain randomized controlled trials and exclude non-randomized controlled trials. Secondly, the objects of studies included are limited to children and adolescents under 18 years old, which allowed for more targeted and relevant findings. Thirdly, this study separately examined the effects of the duration period, frequency, duration time, and intensity of aerobic exercise on the executive function of children and adolescents with ADHD. Finally, the network meta-analysis of this study shows that combat aerobic exercise and ball aerobic exercise can significantly affect the development of inhibitory control in children and adolescents with ADHD. This study still has certain limitations. Firstly, the sample size of studies included is relatively small, and there are differences in the assessment methods of executive function, which may affect the statistical power of meta-analysis. Secondly, only published studies in Chinese and English are included, and studies in other languages are excluded, which may introduce a selection bias. Thirdly, the number of available studies is relatively small, and the number of studies included in some subgroup analyses is insufficient, resulting in a lack of expected results in certain subgroups. Fourthly, although this study includes two groups of children and adolescents with ADHD, due to the scarcity of studies on adolescents, subgroup analysis between children and adolescents is not conducted. Considering that being in different age stages may have a certain effect on the results. Therefore, the specific effects of aerobic exercise intervention remain to be explored further in the future. Fifthly, due to the limited number of literature, when conducting a network meta-analysis of aerobic exercise interventions, only inhibitory control was analyzed. In the future, analyses of working memory and cognitive flexibility need to be conducted when sufficient studies are available. 5 Conclusion Our research shows that aerobic exercise intervention can effectively improve the development of executive function in children and adolescents with ADHD. However, the intervention effect is affected by the intervention duration period, frequency, duration time, and intensity. In addition, in terms of the development of inhibitory control function, combat aerobic exercise and ball games aerobic exercise may bring the optimal intervention effect. The specific intervention to be selected should be adjusted flexibly according to the individual’s condition. Abbreviations ADHD (attention deficit hyperactivity disorder) RCTs (randomized controlled trials) PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) SMD (Standardized Mean Difference) CI (confidence interval) Declarations Conflict of interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Funding None. Author Contribution All authors contributed to the study conception and design; P.W. and D.L. conceived and designed the study; P.W. and D.L. collected the data; P.W., F.R., K.X., Y.G. and Z.X. analyzed and interpreted the data; P.W., F.R. and D.L. drafted the manuscript; P.W., F.R. and D.L. revised the manuscript; All authors have read and agreed to the published version of the manuscript. Acknowledgement We would like to thank Tiance Jiang for his contributions to the preliminary preparations of this study. 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Supplementary Files SupplementaryMaterial.docx Cite Share Download PDF Status: Published Journal Publication published 30 Aug, 2025 Read the published version in BMC Sports Science, Medicine and Rehabilitation → Version 1 posted Editorial decision: Revision requested 12 Jun, 2025 Reviews received at journal 31 May, 2025 Reviews received at journal 16 May, 2025 Reviewers agreed at journal 16 May, 2025 Reviewers agreed at journal 16 May, 2025 Reviewers invited by journal 14 May, 2025 Editor invited by journal 21 Apr, 2025 Editor assigned by journal 15 Apr, 2025 Submission checks completed at journal 15 Apr, 2025 First submitted to journal 13 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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B The Distribution of the Methodological Quality of Included Studies.\u003c/p\u003e","description":"","filename":"Fig.2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6437789/v1/947c79013cdb0805a634f399.jpg"},{"id":83028497,"identity":"7df4f191-ef07-4f45-9edf-0b07d44edab8","added_by":"auto","created_at":"2025-05-19 08:46:30","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":7278157,"visible":true,"origin":"","legend":"\u003cp\u003eMeta-analysis results for executive function.\u003c/p\u003e","description":"","filename":"Fig.3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6437789/v1/cf7e06cd8e696917ff3ca0c3.jpg"},{"id":83028490,"identity":"67abeb77-d4ec-42c2-a690-41fa33c92446","added_by":"auto","created_at":"2025-05-19 08:46:30","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":533326,"visible":true,"origin":"","legend":"\u003cp\u003eNetwork diagram of inhibitory control.\u003c/p\u003e","description":"","filename":"Fig.4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6437789/v1/14cd7fb3a83ec766f997bbe8.jpg"},{"id":83029986,"identity":"3f6dc186-425b-46ff-ac09-92ecdc486ba4","added_by":"auto","created_at":"2025-05-19 08:54:30","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":6559681,"visible":true,"origin":"","legend":"\u003cp\u003eLeague table on inhibitory control.\u003c/p\u003e","description":"","filename":"Fig.5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6437789/v1/21b8fe5543d3afe4330691c9.jpg"},{"id":83028493,"identity":"e20cc109-e003-4aab-928e-36f5f8aebfff","added_by":"auto","created_at":"2025-05-19 08:46:30","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":6404129,"visible":true,"origin":"","legend":"\u003cp\u003eFunnel plot on publication bias.\u003c/p\u003e","description":"","filename":"Fig.6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6437789/v1/9fcb26ae804f2eabb0ba9079.jpg"},{"id":83028492,"identity":"5ee743c0-0e83-4660-871f-27912265a13c","added_by":"auto","created_at":"2025-05-19 08:46:30","extension":"jpg","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":971023,"visible":true,"origin":"","legend":"\u003cp\u003eSUCRA plot of inhibitory control.\u003c/p\u003e","description":"","filename":"Fig.7.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6437789/v1/22cb7c24f9fa0c7c6f152516.jpg"},{"id":90344890,"identity":"53ff25cb-94ed-413e-8129-d142796927e0","added_by":"auto","created_at":"2025-09-01 16:07:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":36640262,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6437789/v1/092013f2-4fb4-4693-b981-8460e2e0b71f.pdf"},{"id":83029983,"identity":"963ca799-02d1-4856-9006-8b0f14db1276","added_by":"auto","created_at":"2025-05-19 08:54:30","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":384498,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterial.docx","url":"https://assets-eu.researchsquare.com/files/rs-6437789/v1/246067e2004c5248fde81ae7.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effects of Aerobic Exercise on Executive Function in Children and Adolescents with Attention Deficit Hyperactivity Disorder: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eAttention deficit hyperactivity disorder (ADHD), commonly referred to as hyperactivity disorder, is a neurodevelopmental disorder frequently diagnosed in childhood\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. The global prevalence of ADHD is about 5.29%\u003csup\u003e2\u003c/sup\u003e, and the prevalence among children and adolescents up to 7.2%\u003csup\u003e3\u003c/sup\u003e. Individuals with ADHD typically exhibit age-inappropriate inattention, hyperactivity, and impulsive behavior\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e, with comorbidities such as learning disabilities, conduct disorders, and emotional disorders\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. If no effective interventions are implemented during childhood, ADHD symptoms may persist into adolescence and adulthood\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. The adverse consequences of such conditions include antisocial behavior, substance abuse, criminal activity, psychiatric hospitalization, and accidental death\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. A meta-analysis of prison inmates with ADHD shows that the prevalence of ADHD in juvenile inmates is 30.1% and in adult inmates 26.2%\u003csup\u003e8\u003c/sup\u003e. Furthermore, individuals with ADHD have higher risks of suicide, unemployment, and divorce compared to the general population, leading to significant economic, psychological, and social effects on families and society\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eExecutive function impairment is a core symptom of ADHD, and the degree of impairment in executive function is positively correlated with the severity of ADHD\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Executive function refers to an advanced cognitive process in which individuals can flexibly and efficiently regulate multiple cognitive processes when given complex cognitive tasks. Its ultimate goal is to achieve purposeful and orderly behaviors\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Executive function includes three core sub-functions: inhibitory control, working memory, and cognitive flexibility\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. Inhibitory control, also known as inhibition, refers to the ability to consciously control one\u0026rsquo;s attention, thoughts, behaviors, emotions, and other factors during cognitive activities, blocking out strong internal tendencies, external temptations, and other irrelevant information to focus on relevant information\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Working memory, also known as refreshing, refers to the ability to temporarily process and store newly presented information, allowing individuals to continuously revise existing information\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. Cognitive flexibility, also known as shifting, refers to the ability to switch between different operations or mental sets according to the requirements of the current task\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. Studies have shown that among children with ADHD, the likelihood of impairment in at least one of the three core dimensions of executive function is as high as 89%\u003csup\u003e17\u003c/sup\u003e, and they usually exhibit varying degrees of deficits across all three core dimensions\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e.Inhibitory control impairment in children with ADHD is closely related to poor emotional self-regulation, defects in self-directed language, and reduced allocation of attention resources\u003csup\u003e\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. Working memory impairment often indicates a lack of sustained visual attention\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. Children with this condition may remain focused during specific tasks, such as playing video games and watching TV. However, they find it extremely difficult to maintain attention when it comes to learning or academic activities. Besides, they usually cannot effectively grasp and process information and may also have social disorders\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. Abnormal cognitive flexibility in children with ADHD shows poor academic performance and inefficient problem-solving ability\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. Executive function impairment is only one aspect of the cognitive and behavioral problems of children with ADHD, but it has a significant negative effect. Improving executive function can treat the symptoms of ADHD effectively\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn recent years, research has reported that exercise intervention, as a new therapeutic approach, can improve the executive function of individuals with ADHD\u003csup\u003e\u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. Traditional pharmacological treatments are not only expensive but may also lead to adverse reactions such as headaches, nausea, anorexia, and even stunted growth and development\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. In contrast, exercise intervention can be well integrated into the daily lives of children and adolescents without adverse reactions. Among various forms of exercise, aerobic exercise has the advantages of strong operability and high compliance. It is currently widely applied to improve the executive function of normal children and adolescents\u003csup\u003e\u003cspan additionalcitationids=\"CR32\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e. Recently, a large number of studies have found that aerobic exercise can also improve the executive function of children with ADHD\u003csup\u003e\u003cspan additionalcitationids=\"CR35\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e. However, Diamond and Ling argue that aerobic exercise and resistance exercise are the least effective forms of exercise interventions\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e,\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e. Additionally, some studies conclude that aerobic exercise cannot achieve a significant improvement in executive function\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003ePrevious systematic reviews and meta-analyses on the effects of aerobic exercise interventions on executive function have mostly focused on individuals without ADHD\u003csup\u003e\u003cspan additionalcitationids=\"CR41 CR42\" citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e. There are few studies on aerobic exercise intervention reviews involving people with ADHD. Only Yang et al.\u0026rsquo;s study explored the effect of aerobic exercise intervention on the executive function of children with ADHD\u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e. However, their study did not identify which type of aerobic exercise yields the greatest benefits for the executive function of children and adolescents with ADHD. Moreover, it did not investigate the effect of aerobic exercise frequency on their executive function. Therefore, there is currently a lack of a comprehensive systematic review on the effect of aerobic exercise interventions on the executive function of children and adolescents with ADHD, making further exploration necessary. This study starts from the core dimensions of executive function (inhibitory control, working memory, and cognitive flexibility) and conducts meta-analysis and network meta-analysis based on RCTs of aerobic exercise interventions. The goal is to provide valuable insights into the treatment of children and adolescents with ADHD through aerobic exercise interventions.\u003c/p\u003e"},{"header":"2 Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1Protocol and registration\u003c/h2\u003e \u003cp\u003e This systematic review and meta-analysis were conducted under the Cochrane Handbook for Systematic Reviews of Interventions. The results are reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement\u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e. The research protocol has been registered in the international prospective systematic review registry PROSPERO (CRD42024595660).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Retrieval Strategy\u003c/h2\u003e \u003cp\u003eWe retrieved the following databases: PubMed, Web of Science, EMbase, Cochrane Library, ProQuest, Scopus, CNKI, Wanfang, and VIP, with the search period ranging from the database inception to September 10, 2024. We retrieved the following four groups of subject words and free words. For example: (1) Population: \u0026ldquo;children\u0026rdquo; OR \u0026ldquo;adolescents\u0026rdquo;; (2) Disease type: \u0026ldquo;attention deficit hyperactivity disorder\u0026rdquo; OR \u0026ldquo;hyperactivity disorder\u0026rdquo;; (3) Intervention: \u0026ldquo;exercise\u0026rdquo; OR \u0026ldquo;aerobic exercise\u0026rdquo;; (4) Outcome measures: \u0026ldquo;executive function\u0026rdquo; OR \u0026ldquo;inhibitory control\u0026rdquo; OR \u0026ldquo;inhibition,\u0026rdquo; \u0026ldquo;working memory\u0026rdquo; OR \u0026ldquo;refreshing\u0026rdquo; OR \u0026ldquo;cognitive flexibility\u0026rdquo; OR \u0026ldquo;shifting.\u0026rdquo; The Boolean logical operator \u0026ldquo;AND\u0026rdquo; was used to connect the search results between each group. The database retrieval was completed independently by two researchers, and the retrieval results were cross-checked. Any discrepancies were resolved through group discussions among team members until a consensus was reached. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the comprehensive search strategy for PubMed. The search strategies for other databases are shown in Appendix B.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSearch strategy on PubMed\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e#1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\"Exercise\"[Mesh]\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e#2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\"Exercise\"[Title/Abstract] OR \"Physical Exercise\"[Title/Abstract] OR \"Physical Activity\"[Title/Abstract] OR \"Aerobic Exercise\"[Title/Abstract] OR \"Isometric Exercise\"[Title/Abstract] OR \"Acute Exercise\"[Title/Abstract] OR \"Exercise Training\"[Title/Abstract] OR \"Running\"[Title/Abstract] OR \"Jogging\"[Title/Abstract] OR \"Marathon Running\"[Title/Abstract] OR \"Swimming\"[Title/Abstract] OR \"Walking\"[Title/Abstract] OR \"Nordic Walking\"[Title/Abstract] OR \"Stair Climbing\"[Title/Abstract] OR \"Exergaming\"[Title/Abstract] OR \"Aerobic Training\"[Title/Abstract] OR \"Dancing\"[Title/Abstract] OR \"Cycling\"[Title/Abstract] OR \"Endurance Training\"[Title/Abstract] OR \"Qigong\"[Title/Abstract] OR \"Taichi\"[Title/Abstract] OR \"Baduanjin\"[Title/Abstract] OR \"Wuqinxi\"[Title/Abstract] OR \"Yijinjing\"[Title/Abstract] OR \"Yoga\"[Title/Abstract] OR \"Ball\"[Title/Abstract] OR \"soccer ball\"[Title/Abstract] OR \"Soccer\"[Title/Abstract] OR \"Football\"[Title/Abstract] OR \"Basketball\"[Title/Abstract] OR \"ping pong\"[Title/Abstract] OR \"Badminton\"[Title/Abstract] OR \"Tennis\"[Title/Abstract] OR \"Baseball\"[Title/Abstract] OR \"Volleyball\"[Title/Abstract] OR \"Softball\"[Title/Abstract] OR \"Softball\" OR \"racket sport\"[Title/Abstract] OR \"Lacrosse\"[Title/Abstract] OR \"Racquetball\u0026rdquo;[Title/Abstract]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e#3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e#1 OR #2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e#4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\"Executive Function\"[Mesh]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e#5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\"Executive Function\"[Title/Abstract] OR \"Executive Control\"[Title/Abstract] OR \"Cognitive Function\"[Title/Abstract] OR \"Cognitive Performance\"[Title/Abstract] OR \"Inhibitory Control\"[Title/Abstract] OR \"Shifting\"[Title/Abstract] OR \"Working Memory\"[Title/Abstract] OR ((\"refresh\"[All Fields] OR \"refreshable\"[All Fields] OR \"refreshed\"[All Fields] OR \"refresher\"[All Fields] OR \"refreshers\"[All Fields] OR \"refreshes\"[All Fields] OR \"refreshing\"[All Fields] OR \"refreshment\"[All Fields] OR \"refreshments\"[All Fields]) AND \"function\"[Title/Abstract]) OR \"cognitive flexibility\"[Title/Abstract] OR \"Updating\"[Title/Abstract] OR \"Inhibition\"[Title/Abstract]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e#6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e#4 OR #5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e#7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\"Attention Deficit Disorder with Hyperactivity\"[Mesh]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e#8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\"Attention Deficit Hyperactivity Disorder\"[Title/Abstract] OR \"Attention Deficit Disorder with Hyperactivity\"[Title/Abstract] OR \"ADHD\"[Title/Abstract] OR \"ADDH\"[Title/Abstract] OR \"Attention Deficit Disorder\"[Title/Abstract] OR \"Hyperkinetic Syndrome\"[Title/Abstract]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e#9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e#7 OR #8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e#10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\"Child\"[Mesh]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e#11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\"Adolescent\"[Mesh]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e#12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\"Children\"[Title/Abstract] OR \"Adolescent\"[Title/Abstract] OR \"Child\"[Title/Abstract] OR \"Teenager\"[Title/Abstract] OR \"Adolescence\"[Title/Abstract]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e#13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e#10 OR #11 OR #12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e#14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e#3 AND #6 AND #9 AND #13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Inclusion and Exclusion Criteria\u003c/h2\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.3.1 Inclusion Criteria\u003c/h2\u003e \u003cp\u003eThe inclusion criteria for this study were as follows: (1) Research subjects: Individuals diagnosed with ADHD based on parental reports, physician diagnoses, or criteria from the International Classification of Diseases (ICD) or the Diagnostic and Statistical Manual of Mental Disorders (DSM) [32], with an age of \u0026lt;18 years. (2) Intervention type: Any form of aerobic exercise intervention. (3) Control type: No-exercise intervention or daily activities. (4) Trial design: All included studies are RCTs. (5) Outcome measures: At least one outcome measure with data that could be used to calculate the effect size for executive function (inhibitory control, working memory, cognitive flexibility).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.3.2. Exclusion Criteria\u003c/h2\u003e \u003cp\u003eThe exclusion criteria of this study include: (1) non-Chinese and non-English study; (2) non-randomized controlled trials; (3) no original data provided; (4) the provided original data cannot be used to calculate the effect size of executive function; (5) significant baseline differences between the experimental and control groups; (6) full text not available.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Study selection\u003c/h2\u003e \u003cp\u003eAfter removing duplicate studies, two independent researchers screened the studies using EndNote X9 software. Initial screening was conducted based on titles and abstracts. A study that preliminarily met the criteria was further evaluated through detailed full-text reading. Finally, the study that fully meets the criteria will be included in this study. If there are differences in the process of selecting and excluding studies by the two independent researchers, a consensus will be reached through group discussions among team members.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Data Extraction\u003c/h2\u003e \u003cp\u003eTwo independent researchers extracted and recorded the following data from the final selected study: (1) basic information: author, year of study publication, and country where data was collected; (2) characteristics of trial participants: age, gender ratio, ADHD diagnostic criteria, and sample size; (3) components of the intervention: intervention content, intervention duration period, intervention frequency, intervention duration time, intervention intensity, and intervention type; (4) outcome measures and evaluation tools.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Quality Assessment\u003c/h2\u003e \u003cp\u003eTwo independent researchers assessed the risk of bias in the included study using Reviewer Manager 5.4 software based on the Cochrane Risk of Bias Tool [33]. Seven items were included: random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective reporting, and other bias. The risk of bias in the study is categorized as \u0026ldquo;low,\u0026rdquo; \u0026ldquo;high,\u0026rdquo; or \u0026ldquo;unclear.\u0026rdquo; If the evaluation results of two independent researchers fail to reach an agreement, a consensus is reached through group discussions among team members.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.7 Statistical Analysis\u003c/h2\u003e \u003cp\u003e Meta-analysis was conducted using Reviewer Manager 5.4 software. The data in the included studies are all continuous variables. However, due to the differences in the assessment tools used across studies, we use the standardized mean difference (SMD) as the effect size and calculate its 95% confidence interval (95% CI). Effect size\u0026thinsp;\u0026lt;\u0026thinsp;0.2 is a small effect, 0.20\u0026ndash;0.49 is a small to moderate effect, 0.50\u0026ndash;0.79 is a moderate effect, and effect size\u0026thinsp;\u0026ge;\u0026thinsp;0.8 is a large effect\u003csup\u003e\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e. If the directions of the effect sizes are inconsistent, we multiplied the results by -1 to ensure consistency\u003csup\u003e\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u003c/sup\u003e. Heterogeneity among studies was assessed using the I\u0026sup2; test and the Q test. If p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 or I\u0026sup2;\u0026gt;50%, it indicated that there is heterogeneity among the studies, and a random-effects model was used to combine the effect sizes; otherwise, a fixed-effects model is used for effect size combination. In addition, The level of heterogeneity was quantified using I\u0026sup2; statistics and classified as low (I\u0026sup2;\u0026le;25%)), moderate (25%\u0026lt;I\u0026sup2;\u0026le;50%), significant (50%\u0026lt;I\u0026sup2;\u0026le;75%), and very high (I\u0026sup2;\u0026gt;75%)\u003csup\u003e48\u003c/sup\u003e. When heterogeneity was present, subgroup analyses were conducted to explore its sources. A network meta-analysis was conducted using a frequentist framework with Stata 17.0 software. A network relationship graph was plotted, followed by statistical analysis. The Surface Under the Cumulative Ranking Curve (SUCRA) was used to predict and rank the intervention effects of different types of aerobic exercise. The SUCRA values were expressed as percentages, with higher percentages indicating better effectiveness. Publication bias was assessed using both visual funnel plots and quantitative methods, including Egger\u0026rsquo;s test and Begg\u0026rsquo;s test. A P-value of 0.05 was used as the threshold: p\u0026thinsp;\u0026gt;\u0026thinsp;0.05 indicated no publication bias; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicated the presence of publication bias. In addition, sensitivity analysis was performed by sequentially excluding individual studies to examine the degree of influence of each study result on the combined effect size.\u003c/p\u003e \u003c/div\u003e"},{"header":"3 Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Study selection\u003c/h2\u003e \u003cp\u003eTo ensure the accuracy of the study retrieval and screening process, two researchers with expertise in attention deficit hyperactivity disorder and exercise science independently screened the titles, abstracts, and full-text literature after the completion of study retrieval and duplicate removal. The reliability of the two screening stages was calculated using Cohen\u0026rsquo;s kappa for both the title and abstract screening stage and the full-text screening stage. The agreement levels are categorized as follows: fair agreement (0.40\u0026ndash;0.59), good agreement (0.60\u0026ndash;0.74), and excellent agreement (\u0026gt;\u0026thinsp;0.75)\u003csup\u003e49\u003c/sup\u003e. We conducted a comprehensive search of nine Chinese and English databases from their inception to September 10, 2024, identifying a total of 1,875 papers. After removing duplicates, 1,538 relevant studies remained. Subsequently, two independent researchers conducted initial screening through titles and abstracts. Among them, 1474 studies were excluded, and 64 studies met the criteria for full-text review. At this stage, the reliability between the two reviewers was rated as \u0026ldquo;good\u0026rdquo; (Cohen\u0026rsquo;s kappa\u0026thinsp;=\u0026thinsp;0.71). After full-text review, 52 studies were excluded: 7 studies were non-randomized controlled trials, 7 studies used interventions that did not meet the inclusion criteria, 4 studies lacked access to the full text, 10 studies did not meet the outcome measure criteria, 8 studies had participants who did not meet the inclusion criteria, 16 studies had incomplete data. Therefore, in the final meta-analysis, we included 12 eligible studies\u003csup\u003e\u003cspan additionalcitationids=\"CR51 CR52 CR53 CR54 CR55 CR56 CR57 CR58 CR59 CR60\" citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e\u003c/sup\u003e for qualitative synthesis (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). At this stage, the reliability between the two reviewers was rated as \u0026ldquo;excellent\u0026rdquo; (Cohen\u0026rsquo;s kappa\u0026thinsp;=\u0026thinsp;0.75).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Study characteristics\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e lists the characteristics of the 12 included studies. All studies were randomized controlled trials. The publication years of the study range from 2012 to 2022. The research sample included 504 participants diagnosed with ADHD. Among them, 257 participants were assigned to the experimental group, and another 247 participants were assigned to the control group. 5 studies simultaneously focused on inhibitory control, working memory, and cognitive flexibility\u003csup\u003e\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e,\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e,\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e,\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e,\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e\u003c/sup\u003e; 2 studies simultaneously focused on inhibitory control and cognitive flexibility\u003csup\u003e\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e,\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e\u003c/sup\u003e; 4 studies only focused on inhibitory control\u003csup\u003e\u003cspan additionalcitationids=\"CR52\" citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e,\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e\u003c/sup\u003e; 1 study only focused on working memory\u003csup\u003e\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u003c/sup\u003e. Among the 12 studies, 2 had acute aerobic exercise as the intervention\u003csup\u003e\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e,\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e\u003c/sup\u003e, and the others were all chronic aerobic exercises. The duration time of a single chronic aerobic exercise intervention ranged from 25 to 90 minutes; the intervention frequency ranged from 2 to 5 times per week, and the most common intervention frequency was 3 times per week; the intervention duration period ranged from 6 to 78 weeks. The specific aerobic exercise interventions included ball aerobic exercise\u003csup\u003e\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e,\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e,\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e,\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e\u003c/sup\u003e, combat aerobic exercise\u003csup\u003e\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e,\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u003c/sup\u003e, acute aerobic exercise\u003csup\u003e\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e,\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e\u003c/sup\u003e, combined aerobic and neurocognitive-exercise\u003csup\u003e\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e,\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e\u003c/sup\u003e, cycling\u003csup\u003e\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e\u003c/sup\u003e, and combined aerobic exercise\u003csup\u003e\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary table of included reviews\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"14\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003estudy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c7\" namest=\"c3\"\u003e \u003cp\u003eParticipant Characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c13\" namest=\"c8\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge Range;\u003c/p\u003e \u003cp\u003eSex-M (%) Diagnostic Methods\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSample Size\u003c/p\u003e \u003cp\u003e(EG/CG)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003cp\u003e(Control)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c10\" namest=\"c6\"\u003e \u003cp\u003eEG\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c13\" namest=\"c11\"\u003e \u003cp\u003eCG\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c14\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003cp\u003eMeasures\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIntervention content\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eIntervention time, frequency, period\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eIntensity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eType\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eIntervention content\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eIntervention time, frequency, period\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003eType\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiang et al.,2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u0026ndash;12;M-78%;\u003c/p\u003e \u003cp\u003eDSM-5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78\u003c/p\u003e \u003cp\u003e(39/39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.37\u0026thinsp;\u0026plusmn;\u0026thinsp;1.42\u003c/p\u003e \u003cp\u003e(8.29\u0026thinsp;\u0026plusmn;\u0026thinsp;1.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCombined aerobic and neurocognitive-exercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e60 mins/\u003c/p\u003e \u003cp\u003e3 sessions/\u003c/p\u003e \u003cp\u003e12 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMVI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eCombined aerobic and neurocognitive-exercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNo intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNo-exercise intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eIC:Flanker Task\u003c/p\u003e \u003cp\u003eWM:Tower of London Test\u003c/p\u003e \u003cp\u003eCF:Trail Making Test\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLudyga et al.,2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSwitzerland\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u0026ndash;12;M-70%;\u003c/p\u003e \u003cp\u003eDSM-5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57\u003c/p\u003e \u003cp\u003e(29/28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e \u003cp\u003e(10.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eJudo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e60 mins/\u003c/p\u003e \u003cp\u003e2 sessions/\u003c/p\u003e \u003cp\u003e12 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eCombat aerobic exercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNo intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNo-exercise intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eWM:Change Detection Paradigm Test\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChen et al.,2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u0026ndash;10;M-83%;\u003c/p\u003e \u003cp\u003eDSM-5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64\u003c/p\u003e \u003cp\u003e(32/32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.37\u0026thinsp;\u0026plusmn;\u0026thinsp;1.68\u003c/p\u003e \u003cp\u003e(7.89\u0026thinsp;\u0026plusmn;\u0026thinsp;2.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCycling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e25 mins/\u003c/p\u003e \u003cp\u003e3 sessions/\u003c/p\u003e \u003cp\u003e12 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMVI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eCycling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eWatching cartoons\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e20 mins/\u003c/p\u003e \u003cp\u003e3 sessions/\u003c/p\u003e \u003cp\u003e12 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNo-exercise intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eIC:Stroop Test\u003c/p\u003e \u003cp\u003eCF:odd Even Size Test\u003c/p\u003e \u003cp\u003eWM:N-back Test\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChang et al.,2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNR;M-81%;\u003c/p\u003e \u003cp\u003eDSM-5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32\u003c/p\u003e \u003cp\u003e(16/16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.31\u0026thinsp;\u0026plusmn;\u0026thinsp;1.30\u003c/p\u003e \u003cp\u003e(8.38\u0026thinsp;\u0026plusmn;\u0026thinsp;1.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eActual table tennis training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e60 mins/\u003c/p\u003e \u003cp\u003e3 sessions/\u003c/p\u003e \u003cp\u003e12 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eBall aerobic exercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSimulated table tennis training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e60 mins/\u003c/p\u003e \u003cp\u003e3 sessions/\u003c/p\u003e \u003cp\u003e12 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eCognitive training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eIC:Stroop Test\u003c/p\u003e \u003cp\u003eCF:Wisconsin Card Sorting Test\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKadri et al.,2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKadri\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNR;M-90%;\u003c/p\u003e \u003cp\u003epsychiatric\u003c/p\u003e \u003cp\u003ephysician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40 (20/20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e \u003cp\u003e(14.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTaekwondo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e50 mins/\u003c/p\u003e \u003cp\u003e2 sessions/\u003c/p\u003e \u003cp\u003e78 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eCombat aerobic exercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNo intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNo-exercise intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eIC:Stroop Color-Word Test\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBenzing et al.,2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSwitzerland\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u0026ndash;12;M-84%;\u003c/p\u003e \u003cp\u003eICD-10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51\u003c/p\u003e \u003cp\u003e(28/23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.46\u0026thinsp;\u0026plusmn;\u0026thinsp;1.30\u003c/p\u003e \u003cp\u003e(10.39\u0026thinsp;\u0026plusmn;\u0026thinsp;1.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eExergaming\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e30 mins/\u003c/p\u003e \u003cp\u003e3 sessions/\u003c/p\u003e \u003cp\u003e8 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eCombined aerobic and neurocognitive-exercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNo intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNo-exercise intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eIC:Simon Task \u003c/p\u003e \u003cp\u003eCF:Flanker Task\u003c/p\u003e \u003cp\u003eWM:Color Span Backwards Task\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBenzing et al.,2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSwitzerland\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u0026ndash;12; M-83%;\u003c/p\u003e \u003cp\u003eICD-10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46\u003c/p\u003e \u003cp\u003e(24/22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.46\u0026thinsp;\u0026plusmn;\u0026thinsp;1.35\u003c/p\u003e \u003cp\u003e(10.50\u0026thinsp;\u0026plusmn;\u0026thinsp;1.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eExergaming\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e15 mins/\u003c/p\u003e \u003cp\u003e1 session\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMVI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eAcute aerobic exercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eWatching video\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e15 mins/\u003c/p\u003e \u003cp\u003e1 session\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNo-exercise intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eIC:Flanker Task\u003c/p\u003e \u003cp\u003eCF:Flanker Task\u003c/p\u003e \u003cp\u003eWM:Color Span Backwards Task\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePan et al.,2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u0026ndash;12;M-100%;\u003c/p\u003e \u003cp\u003eDSM-IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32 (16/16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.93\u0026thinsp;\u0026plusmn;\u0026thinsp;1.49\u003c/p\u003e \u003cp\u003e(8.87\u0026thinsp;\u0026plusmn;\u0026thinsp;1.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTable tennis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e70 mins/\u003c/p\u003e \u003cp\u003e2 sessions/\u003c/p\u003e \u003cp\u003e12 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eBall aerobic exercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNo intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNo-exercise intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eIC: Stroop Color-Word Test\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChang et al.,2012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u0026ndash;13;M-93%;\u003c/p\u003e \u003cp\u003eDSM-IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40 (20/20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/p\u003e \u003cp\u003e(10.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTreadmill running\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e30 mins/\u003c/p\u003e \u003cp\u003e1 session\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eAcute aerobic exercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eWatching videos\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e30 mins/\u003c/p\u003e \u003cp\u003e1 session\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNo-exercise intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eIC: Stroop Test\u003c/p\u003e \u003cp\u003eCF༚Wisconsin Card Sorting Test\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMemarmoghaddam et al.,2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIran\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u0026ndash;11;M-100%;\u003c/p\u003e \u003cp\u003eSNAP-IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (19/17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.31\u0026thinsp;\u0026plusmn;\u0026thinsp;1.29\u003c/p\u003e \u003cp\u003e(8.29\u0026thinsp;\u0026plusmn;\u0026thinsp;1.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBall exercise (table tennis, bowling, football, basketball, etc.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e90 mins/\u003c/p\u003e \u003cp\u003e3 sessions/\u003c/p\u003e \u003cp\u003e8 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMVI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eBall aerobic exercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNo intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNo-exercise intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eIC: Go-No-Go Test\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLee et al.,2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKorea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u0026ndash;10;M-100%;\u003c/p\u003e \u003cp\u003eDSM-4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12(6/6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98\u003c/p\u003e \u003cp\u003e(8.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRope skipping and ball exercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e60 mins/\u003c/p\u003e \u003cp\u003e3 sessions/\u003c/p\u003e \u003cp\u003e12 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMVI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eCombined aerobic exercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNo intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNo-exercise intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eIC: Stroop Color-Word Test\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSong et al.,2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.75\u0026ndash;8.58;M-100;DMS-IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16(8/8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.56\u003c/p\u003e \u003cp\u003e(7.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFootball\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e60 mins/\u003c/p\u003e \u003cp\u003e5 sessions/\u003c/p\u003e \u003cp\u003e6 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eBall aerobic exercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003ePhysical education class\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e40 mins/\u003c/p\u003e \u003cp\u003e4 sessions/\u003c/p\u003e \u003cp\u003e6 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003ePhysical education class\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eIC: Stroop Color-Word Test\u003c/p\u003e \u003cp\u003eWM༚Complex Figure Test\u003c/p\u003e \u003cp\u003eCF༚Trail Making Test\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"14\"\u003eEG: experimental group; CG: control group; NR: no report; M: male; DSM-5: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; ICD-10: International Classification of Diseases, 10th Revision; DSM-4/IV: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; MI: moderate intensity; MVI: moderate to vigorous intensity; IC: inhibitory control; WM: working memory; CF: cognitive flexibility.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Quality Assessment\u003c/h2\u003e \u003cp\u003eTwelve studies had no selective reporting or other bias. 5 studies\u003csup\u003e\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e,\u003cspan additionalcitationids=\"CR58 CR59\" citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u003c/sup\u003e had a low risk of bias in the Random Sequence Generation section, and the others were all unclear. 2 studies\u003csup\u003e\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e,\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u003c/sup\u003e implemented Allocation Concealment and had a low risk of bias, and the others were all unclear. Since all the studies included in this meta-analysis are exercise intervention studies, all studies had a high risk of bias in the Blinding of Participants and Personnel section. 2 studies\u003csup\u003e\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e,\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u003c/sup\u003e had a low risk of bias in the Blinding of Outcome Assessment section, and the others were all unclear. In the Incomplete Outcome Data section, 2 studies were rated as having a high risk of bias\u003csup\u003e\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e,\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e,\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e\u003c/sup\u003e, 1 study was unclear\u003csup\u003e\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e\u003c/sup\u003e, and the other studies all had a low risk of bias. Detailed information on the risk of bias assessment is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Meta-Analysis\u003c/h2\u003e \u003cdiv id=\"Sec17\" class=\"Section3\"\u003e \u003ch2\u003e3.4.1 Effect of Aerobic Exercise on Inhibitory Control\u003c/h2\u003e \u003cp\u003eA total of 11 studies investigated the effect of aerobic exercise interventions on inhibitory control in children and adolescents with ADHD, involving 447 participants diagnosed with ADHD. As shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA, aerobic exercise interventions had a large overall effect size compared to the control group (SMD=-0.91, 95% CI: -1.31, -0.51, p\u0026lt;0.05). This effect shows significant heterogeneity (I\u0026sup2;=73%, p\u0026lt;0.05). Subgroup analysis was performed, and the results are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResult of subgroup analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSubcategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEffect\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c7\" namest=\"c6\" rowspan=\"2\"\u003e \u003cp\u003eEffet Size\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c9\" namest=\"c8\" rowspan=\"2\"\u003e \u003cp\u003eThe Result\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c11\" namest=\"c10\" rowspan=\"2\"\u003e \u003cp\u003eHeterogeneity Test\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModel\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSMD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eZ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eI\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eDuration period\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRandom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.69, -0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.09, -0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.03*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e34%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;12weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eWM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFixed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.95, -0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.000***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e55%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6-8weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.88, 0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e62%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFixed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.05, -0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.000***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.06, -0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.03*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e48%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRandom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-2.52, -1.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.000***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.05, -0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.002**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e59%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 weekly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eWM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFixed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.72, 0.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u0026ndash;5 weekly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.00, -0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.000***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e41%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eDuration Time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRandom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.35, 0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e73%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.42, -0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.000***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e73%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15-30min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eWM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRandom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.87, 0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e63%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50-90min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.25, -0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.02*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e59%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFixed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.82, -0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.000***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.19, -0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.000***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eintensity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRandom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-2.05, -0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.000***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.12, -0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.004**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e61%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eWM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRandom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.52, 0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e61%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMVI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.14, -0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.03*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e69%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFixed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.78, -0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.000***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.88, -0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.000***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"11\"\u003e*: P\u0026lt;0.05; **: P\u0026lt;0.01; ***: P\u0026lt;0.001; N/A: not applicable; IC: inhibitory control; WM: working memory; CF: cognitive flexibility.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section3\"\u003e \u003ch2\u003e3.4.2 Effect of Aerobic Exercise on Working Memory\u003c/h2\u003e \u003cp\u003eA total of 6 studies examined the effect of aerobic exercise intervention on the working memory of children and adolescents with ADHD, involving 312 participants diagnosed with ADHD. As shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eB, compared with the control group, aerobic exercise intervention has a moderate effect size (SMD=-0.50, 95%CI: -0.86, -0.15, p\u0026lt;0.05). This effect shows significant heterogeneity (I\u0026sup2;=56%, p\u0026lt;0.05). A subgroup analysis was conducted, and the results are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section3\"\u003e \u003ch2\u003e3.4.3 Effect of Aerobic Exercise on Cognitive Flexibility\u003c/h2\u003e \u003cp\u003eA total of 7 studies examined the effect of aerobic exercise interventions on cognitive flexibility in children and adolescents with ADHD, involving 327 participants diagnosed with ADHD. As shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eC, compared with the control group, aerobic exercise interventions have a moderate effect size (SMD=-0.65, 95%CI:-0.87, -0.42, p\u0026lt;0.05). This effect shows relatively low heterogeneity (I\u0026sup2;=0%, p\u0026gt;0.05). A subgroup analysis was conducted, and the results are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e3.5 Network Meta-Analysis\u003c/h2\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e illustrates the network meta-analysis graph of inhibitory control. Due to the limited number of studies included in working memory and cognitive flexibility, only network meta-analysis of inhibitory control is conducted. Interventions with a large sample size include no-exercise intervention, ball aerobic exercise, and combined aerobic and neurocognitive-exercise. The most common comparisons are ball aerobic exercise and no-exercise intervention, acute aerobic exercise and no-exercise intervention, and combined aerobic and neurocognitive-exercise and no-exercise intervention. The frequency of comparison is indicated by the thickness of the connecting line. Other interventions, such as combined aerobic exercise and cycling, have a small sample size and only one comparison, as shown by the smaller nodes and thinner connecting lines in the figure.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThis study shows the changes in inhibitory control in children and adolescents with ADHD after various aerobic exercise interventions. Due to the use of different measurement tools, standardized mean difference (SMD) and 95% confidence interval (CI) are used to show the effect on inhibitory control. As shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, pairwise comparisons show that compared with the no-exercise intervention group, combat aerobic exercises [SMD= -1.81, 95%CI= (-3.41, -0.20)] and ball aerobic exercises [SMD=-1.26, 95%CI= (-2.41, -0.12)] both show significant improvements. Cycling [SMD= -1.47, 95%CI= (-2.99, 0.06)] shows improvement but has not reached statistical significance. Based on the SUCRA ranking of aerobic exercise interventions. Combat aerobic exercise has the highest ranking (SUCRA\u0026thinsp;=\u0026thinsp;82.3%). Cycling and ball aerobic exercises rank second and third with 72.8% and 69.2% (see Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e and Appendix C). Although cycling has a relatively high SUCRA value, its intervention effect does not show statistical significance. Therefore, combined with statistical significance analysis, we believe that combat aerobic exercise and ball aerobic exercise are more empirically supported interventions and may have more reliable effects in improving inhibitory control in children and adolescents with ADHD.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eRanking of SUCRA probabilities\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" style=\"background-color: rgb(204, 204, 204);\"\u003e\n \u003cp\u003eIntervention\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"background-color: rgb(204, 204, 204);\"\u003e\n \u003cp\u003eSucra\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"background-color: rgb(204, 204, 204);\"\u003e\n \u003cp\u003eRank\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" class=\"fr-cell-fixed \" style=\"background-color: rgb(84, 172, 210);\"\u003e\n \u003cp\u003eCombat aerobic exercise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"background-color: rgb(84, 172, 210);\"\u003e\n \u003cp\u003e82.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"background-color: rgb(84, 172, 210);\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"background-color: rgb(84, 172, 210);\"\u003e\n \u003cp\u003ecycling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"background-color: rgb(84, 172, 210);\"\u003e\n \u003cp\u003e72.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" class=\"fr-cell-handler \" style=\"background-color: rgb(84, 172, 210);\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBall aerobic exercise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCognitive training\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcute aerobic exercise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCombined aerobic and neurocognitive-exercise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCombined aerobic exercise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ephysical education class\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo-exercise intervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cbr\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003e3.6 Publication bias\u003c/h2\u003e \u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e, publication bias tests were conducted on the meta-analysis results of inhibitory control, working memory, and cognitive flexibility, respectively. Visual inspection of the funnel plots showed that the study distributions of the three indicators did not show any asymmetry. Publication bias tests were also conducted on the network meta-analysis results of inhibitory control, and visual inspection did not show any asymmetry. In addition, the results of Egger\u0026rsquo;s and Begg\u0026rsquo;s tests showed no statistically significant bias for inhibitory control (P\u0026thinsp;=\u0026thinsp;0.493 and P\u0026thinsp;=\u0026thinsp;0.697), working memory (P\u0026thinsp;=\u0026thinsp;0.800 and P\u0026thinsp;=\u0026thinsp;0.260), and cognitive flexibility (P\u0026thinsp;=\u0026thinsp;0.108 and P\u0026thinsp;=\u0026thinsp;0.230) (see Appendices D1, D2, and D3). This proves that there is no publication bias in each indicator of this study. The results of sensitivity analysis showed that there was no significant difference between the combined effect size after excluding each study one by one and the original combined effect size from the included study, indicating that the results of this study are relatively stable (see Appendix E).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Main results\u003c/h2\u003e \u003cp\u003eIn this study, we conducted traditional meta-analysis and network meta-analysis, including a total of 12 studies to evaluate the effect of aerobic exercise intervention on the executive function of children and adolescents with ADHD. The results of traditional meta-analysis show that aerobic exercise intervention generally has a moderate to large positive effect on inhibitory control, working memory, and cognitive flexibility of children and adolescents with ADHD. Specifically, aerobic exercise interventions that achieve the best intervention effect are shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. It can be observed that for the three outcome measures involved, the optimal single intervention duration time is 50\u0026ndash;90 minutes. The optimal intervention frequency is twice a week for inhibitory control, and working memory requires three to five times a week. Regarding the intervention duration period, all three outcome measures required a minimum of 12 weeks or longer to achieve the optimal intervention effect. In terms of exercise intensity, the optimal intervention intensity for inhibitory control and cognitive flexibility is moderate intensity, while the optimal intervention intensity for working memory is medium-high intensity. The research results of network meta-analysis show that different types of aerobic exercise have different effects in improving the inhibitory control of this population, indicating that not all aerobic exercise interventions have the same effect. Specifically, combat aerobic exercise and ball aerobic exercise show significant benefits in improving the inhibitory control of this population. This result is supported by the SUCRA ranking (see Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe optimal form of aerobic exercise intervention for the best outcomes in each measure\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndicator\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003cp\u003e(min)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003cp\u003e(weekly)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePeriod\u003c/p\u003e \u003cp\u003e(weeks)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eintensity\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInhibitory control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u0026ndash;90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorking memory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u0026ndash;90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMVI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCognitive flexibility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u0026ndash;90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eTime: single intervention duration time; Frequency: number of interventions per week; Period: total intervention duration period; intensity: exercise intensity; MI: moderate intensity; MVI: moderate to vigorous intensity\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Comparison with existing study\u003c/h2\u003e \u003cp\u003eWe further explored the executive function of children and adolescents with ADHD, expanding the scope of previous studies on aerobic exercise interventions for the ADHD population. Our study is consistent with earlier findings, and the results support the positive effects of aerobic exercise interventions\u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e,\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e\u003c/sup\u003e. That is, in general, aerobic exercise interventions can have a positive effect on the executive function of children and adolescents with ADHD. In the subgroup analysis of aerobic exercise intervention, aerobic exercise with a single duration of 50\u0026ndash;90 minutes and at a moderate intensity has a better effect on improving executive functions of children and adolescents with ADHD. This finding is almost consistent with the conclusions of scholars such as Yang\u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e. Their meta-analysis examined the effect of aerobic exercise intervention on the executive functions of children with ADHD and confirmed that aerobic exercise intervention is an effective way to improve the executive functions of children with ADHD. However, when conducting the subgroup analysis, they only explored inhibitory control and cognitive flexibility and did not involve working memory. Secondly, their subgroup analysis did not examine the effect of aerobic exercise at different frequencies on the executive functions of children with ADHD. Finally, they divided aerobic exercise into only two categories: single aerobic exercise and combined aerobic exercise, and no specific differentiation were made for different forms of aerobic exercise interventions.This study extends the age range to under 18 years old, aiming to explore the effect of aerobic exercise on the executive function of children and adolescents with ADHD and to determine the most effective aerobic exercise intervention to help improve their executive function. The effects of aerobic exercise were mainly analyzed in three core dimensions of executive function, namely, inhibitory control, working memory, and cognitive flexibility.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec25\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Mechanism of Aerobic Exercise on Executive Function in Children and Adolescents with ADHD\u003c/h2\u003e \u003cp\u003eAerobic exercise intervention affects the executive function of children and adolescents with ADHD mainly based on the following aspects. First, individuals with ADHD have abnormalities in brain structure and function, such as in the dorsolateral prefrontal cortex, ventromedial prefrontal cortex, parietal cortex, and other regions\u003csup\u003e\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e\u003c/sup\u003e. The prefrontal cortex is the main brain region related to executive function\u003csup\u003e\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e\u003c/sup\u003e. Abnormalities in this area will lead to a decline in executive function\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. However, due to the theory of brain plasticity, the structure and function of the brain will be continuously modified and reorganized as a result of external environmental changes and experiences\u003csup\u003e\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e\u003c/sup\u003e. This provides the possibility to improve the executive function of children and adolescents with ADHD. When performing aerobic exercise, brain regions related to executive function are activated, such as increased activity in the bilateral prefrontal cortex, remodeling of white matter integrity, and enhanced efficiency of overall neural circuits in the brain\u003csup\u003e\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e,\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e\u003c/sup\u003e. This has a positive effect on improving the executive function of children and adolescents with ADHD. Secondly, performing aerobic exercise will also have an effect on cardiovascular function. Aerobic exercise can enhance the heart\u0026rsquo;s ability to supply oxygen to various working muscles, increase the blood supply to cortical capillaries and the number of synaptic connections, and promote the development of new neurons\u003csup\u003e\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e\u003c/sup\u003e. This process leads to a more efficient and more plastic brain. Finally, some scholars believe that dysregulation of catecholamine function and insufficient secretion of neurotransmitters such as norepinephrine and dopamine may also be the pathogenesis of ADHD\u003csup\u003e\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e,\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e\u003c/sup\u003e. However, studies have found that physical activity can cause changes in cerebral blood flow, serotonin, and brain-derived neurotrophic factors\u003csup\u003e\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e\u003c/sup\u003e and enhance the release of catecholamine neurotransmitters such as norepinephrine and dopamine\u003csup\u003e\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e\u003c/sup\u003e. These neurotransmitters facilitate communication across different signal transmission pathways in the brain, enhancing overall brain arousal levels, which in turn improves executive function in children and adolescents with ADHD\u003csup\u003e\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e\u003c/sup\u003e. In addition, animal-based experiments have also confirmed that aerobic exercise promotes the proliferation and differentiation of hippocampal neurons by regulating the brain-derived neurotrophic factor pathway\u003csup\u003e\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u003c/sup\u003e. These mechanisms contribute to the improvement of executive function in children and adolescents with ADHD.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003ch2\u003e4.4 Discussion of subgroup analysis results\u003c/h2\u003e \u003cp\u003eOur subgroup analysis shows that to improve the overall executive function of children and adolescents with ADHD, the most suitable intervention duration time is 50\u0026ndash;90 minutes per period with an intervention duration period of 12 weeks or more. In terms of intervention frequency, the improvement in inhibitory control can be achieved twice per week, while working memory requires 3 to 5 times per week. This may be because compared to inhibitory control, working memory involves a more complex and extensive brain area network (such as the dorsolateral prefrontal cortex, parietal cortex, cerebellum, and other areas) and requires more frequent training to achieve significant results\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e,\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e\u003c/sup\u003e. The subgroup analysis of different exercise intensities shows that moderate-intensity aerobic exercise seems to have more advantages in improving inhibitory control and cognitive flexibility in children and adolescents with ADHD. This is consistent with previous studies\u003csup\u003e\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e\u003c/sup\u003e. According to the arousal theory, there is an inverted U-shaped relationship between brain arousal level and exercise intensity\u003csup\u003e\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e\u003c/sup\u003e. When the exercise intensity is at a moderate load, the arousal level reaches the optimum, which is most conducive to the development of cognitive function. Specifically, moderate-load exercise can optimize the release of catecholamines (such as dopamine, norepinephrine, etc.) and, at the same time, increase the general biological arousal effect of the central nervous system, thus better allocating cognitive resources\u003csup\u003e\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e,\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e\u003c/sup\u003e. However, our study shows that moderate-intensity aerobic exercise does not have a significant effect on working memory. Instead, moderate-to-high-intensity aerobic exercise has a significant effect on working memory. This may be because, compared to moderate-intensity exercise programs, moderate-high-intensity exercise leads to a greater increase in brain-derived neurotrophic factor levels, which leads to better regulating the neural structure and functional plasticity, thereby promoting the improvement of working memory\u003csup\u003e\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e\u003c/sup\u003e. As for why moderate-intensity aerobic exercise does not have a significant effect on working memory, it may be due to the small number of studies included, resulting in a certain deviation in the results. Therefore, further research is needed in the future once sufficient studies are available.\u003c/p\u003e \u003cp\u003eIn short, aerobic exercise has a positive effect on improving the executive function of children and adolescents with ADHD. However, the effect of aerobic exercise intervention varies depending on the intervention duration period, frequency, duration time, and intensity.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section2\"\u003e \u003ch2\u003e4.5 Discussion of network meta-analysis results\u003c/h2\u003e \u003cp\u003eIn this study, a network meta-analysis was conducted to evaluate the effects of different types of aerobic exercise on inhibitory control in children and adolescents with ADHD. The results show that combat aerobic exercise and ball aerobic exercise have shown significant benefits in improving inhibitory control in this population. These two types of aerobic exercise have a common characteristic: they are open-skill activities. The characteristics of open-skill activities are variability and unpredictability\u003csup\u003e\u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e\u003c/sup\u003e. Before performing skill movements, participants cannot decide in advance what the next movement should be. They need to respond according to the stimulation of the external environment, which requires the body to carry out overall organization, coordination, and control of various information processing processes\u003csup\u003e\u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e\u003c/sup\u003e. Training in this dynamic environment can promote the development of neurocognitive function, enhance neuroplasticity, and improve various functions of the brain, including increasing the number of dendritic branches and spines, synaptogenesis, angiogenesis, and the growth of glial cells\u003csup\u003e\u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e\u003c/sup\u003e. In addition, the patterns of these two aerobic exercises are relatively complex. According to Picard and Strick, the complexity of exercise changes together with the brain activation pattern and the speed of information processing\u003csup\u003e\u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e\u003c/sup\u003e. The more complex the exercise is, the higher the degree of brain activation will be, and the more activity there will be in the prefrontal cortex\u003csup\u003e\u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e,\u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e\u003c/sup\u003e. As a result, the ability of inhibitory control will be enhanced. Finally, combat aerobic exercise and ball aerobic exercise show significant effects, which may also be because they can activate the pleasure processing network in the brain. Studies have shown that the movement of scoring a goal in football can trigger a strong sense of pleasure and activate the pleasure-processing network in the brain\u003csup\u003e\u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e\u003c/sup\u003e, and the brain regions involved in the pleasure-processing network are closely related to inhibitory control\u003csup\u003e\u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e87\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003e4.6 Heterogeneity\u003c/h2\u003e \u003cp\u003eIn the inhibitory control and working memory sections of this meta-analysis, the study included showed a very high heterogeneity, which remained significant even after subgroup analysis, with reductions observed only in certain subgroups. After a detailed reading of the original study and discussions among the research team, we identified several potential reasons for the high heterogeneity. First, in different studies, different scholars use different measurement tools when measuring inhibitory control and working memory, which may be the most important reason for the high heterogeneity. Second, there are certain differences in aerobic exercise types, such as ball aerobic exercise, combat aerobic exercise, acute aerobic exercise, etc. Therefore, the specific effects of aerobic exercise intervention on the executive function of children and adolescents with ADHD can be explored in more detail in subsequent studies.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003e4.7 Strengths and limitations\u003c/h2\u003e \u003cp\u003eThis study has the following strengths. Firstly, the studies included only contain randomized controlled trials and exclude non-randomized controlled trials. Secondly, the objects of studies included are limited to children and adolescents under 18 years old, which allowed for more targeted and relevant findings. Thirdly, this study separately examined the effects of the duration period, frequency, duration time, and intensity of aerobic exercise on the executive function of children and adolescents with ADHD. Finally, the network meta-analysis of this study shows that combat aerobic exercise and ball aerobic exercise can significantly affect the development of inhibitory control in children and adolescents with ADHD.\u003c/p\u003e \u003cp\u003eThis study still has certain limitations. Firstly, the sample size of studies included is relatively small, and there are differences in the assessment methods of executive function, which may affect the statistical power of meta-analysis. Secondly, only published studies in Chinese and English are included, and studies in other languages are excluded, which may introduce a selection bias. Thirdly, the number of available studies is relatively small, and the number of studies included in some subgroup analyses is insufficient, resulting in a lack of expected results in certain subgroups. Fourthly, although this study includes two groups of children and adolescents with ADHD, due to the scarcity of studies on adolescents, subgroup analysis between children and adolescents is not conducted. Considering that being in different age stages may have a certain effect on the results. Therefore, the specific effects of aerobic exercise intervention remain to be explored further in the future. Fifthly, due to the limited number of literature, when conducting a network meta-analysis of aerobic exercise interventions, only inhibitory control was analyzed. In the future, analyses of working memory and cognitive flexibility need to be conducted when sufficient studies are available.\u003c/p\u003e \u003c/div\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003eOur research shows that aerobic exercise intervention can effectively improve the development of executive function in children and adolescents with ADHD. However, the intervention effect is affected by the intervention duration period, frequency, duration time, and intensity. In addition, in terms of the development of inhibitory control function, combat aerobic exercise and ball games aerobic exercise may bring the optimal intervention effect. The specific intervention to be selected should be adjusted flexibly according to the individual\u0026rsquo;s condition.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eADHD (attention deficit hyperactivity disorder)\u003c/p\u003e\n\u003cp\u003eRCTs (randomized controlled trials)\u003c/p\u003e\n\u003cp\u003ePRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)\u003c/p\u003e\n\u003cp\u003eSMD (Standardized Mean Difference)\u003c/p\u003e\n\u003cp\u003eCI (confidence interval)\u003c/p\u003e"},{"header":"Declarations","content":" \u003ch2\u003eConflict of interest\u003c/h2\u003e \u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.\u003c/p\u003e \u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNone.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to the study conception and design; P.W. and D.L. conceived and designed the study; P.W. and D.L. collected the data; P.W., F.R., K.X., Y.G. and Z.X. analyzed and interpreted the data; P.W., F.R. and D.L. drafted the manuscript; P.W., F.R. and D.L. revised the manuscript; All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to thank Tiance Jiang for his contributions to the preliminary preparations of this study.\u003c/p\u003e\u003ch2\u003eData Availability Statement\u003c/h2\u003e \u003cp\u003eAll datasets generated for this study are included in the article/supplementary material.\u003c/p\u003e \u003cp\u003e \u003cb\u003eEthics approval\u003c/b\u003e Not applicable.\u003c/p\u003e \u003cp\u003e \u003cb\u003eConsent to participate\u003c/b\u003e Not applicable.\u003c/p\u003e \u003cp\u003e\u003cb\u003eConsent to publish\u003c/b\u003e Not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eThapar A, Cooper M, Rutter M. 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Cereb Cortex. 2006;16:1040\u0026ndash;55. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/cercor/bhj046\u003c/span\u003e\u003cspan address=\"10.1093/cercor/bhj046\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-sports-science-medicine-and-rehabilitation","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ssmr","sideBox":"Learn more about [BMC Sports Science, Medicine and Rehabilitation](http://bmcsportsscimedrehabil.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ssmr/default.aspx","title":"BMC Sports Science, Medicine and Rehabilitation","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"aerobic exercise, executive function, ADHD, children, adolescents, Meta-Analysis","lastPublishedDoi":"10.21203/rs.3.rs-6437789/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6437789/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe benefits of aerobic exercise interventions on the executive function of children and adolescents have been fully confirmed. However, the effects of such interventions on the executive function of children and adolescents with attention deficit hyperactivity disorder (ADHD) require further exploration. This study is a systematic review of randomized controlled trials (RCTs) of aerobic exercise interventions for children and adolescents with ADHD, aiming to provide valuable intervention suggestions to enhance the executive function of children and adolescents with ADHD.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eA comprehensive search was conducted across multiple databases, including PubMed, Web of Science, EMbase, Cochrane Library, ProQuest, Scopus, CNKI, Wanfang, and VIP databases, to identify relevant RCTs. Study screening, data extraction, quality assessment, and data analysis were independently performed by two researchers. Meta-analysis was performed using Reviewer Manager 5.4 software, and network meta-analysis was performed using Stata 17.0 software. A total of 12 studies involving 504 participants diagnosed with ADHD were included.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe meta-analysis showed that aerobic exercise interventions positively affect the executive function of children and adolescents with ADHD. A large effect size was observed for inhibitory control (SMD= -0.91, 95% CI: -1.31, -0.51, p\u0026lt;0.05), moderate effect size for working memory (SMD= -0.50, 95% CI -0.86, 0.15, p\u0026lt;0.05) and cognitive flexibility (SMD= -0.65, 95% CI -0.87, 0.42, p\u0026lt;0.05). The network meta-analysis results showed that compared to the group without exercise intervention, combat aerobic exercise (SMD= -1.81, 95% CI -3.41, -0.20) and ball aerobic exercise (SMD= -1.26, 95% CI: -2.41, -0.12) significantly improved the inhibitory control of children and adolescents with ADHD. Combat aerobic exercise ranked the highest SUCRA (82.3%), followed by cycling (SUCRA\u0026thinsp;=\u0026thinsp;72.8%) and ball aerobic exercise (SUCRA\u0026thinsp;=\u0026thinsp;69.2%).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe research shows that aerobic exercise interventions can effectively enhance the executive function of children and adolescents with ADHD. However, the effect of the intervention is affected by factors like duration period, frequency, duration time, and intensity. In addition, combat aerobic exercise and ball aerobic exercise may provide the most optimal effects for improving inhibitory control. The specific choice of intervention should be flexibly adjusted based on individual needs.\u003c/p\u003e","manuscriptTitle":"Effects of Aerobic Exercise on Executive Function in Children and Adolescents with Attention Deficit Hyperactivity Disorder: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-19 08:46:25","doi":"10.21203/rs.3.rs-6437789/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-12T07:24:25+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-31T11:46:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-16T19:16:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"87254786155285014961154067403984829282","date":"2025-05-16T16:20:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"17373572268300384388923668735944474600","date":"2025-05-16T12:18:37+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-14T12:11:14+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-21T13:40:22+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-15T06:09:55+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-15T06:06:35+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Sports Science, Medicine and Rehabilitation","date":"2025-04-13T07:11:44+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-sports-science-medicine-and-rehabilitation","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ssmr","sideBox":"Learn more about [BMC Sports Science, Medicine and Rehabilitation](http://bmcsportsscimedrehabil.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ssmr/default.aspx","title":"BMC Sports Science, Medicine and Rehabilitation","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"57c608f0-a7b6-494a-baeb-2dd4cd2b9ec0","owner":[],"postedDate":"May 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-09-01T16:00:57+00:00","versionOfRecord":{"articleIdentity":"rs-6437789","link":"https://doi.org/10.1186/s13102-025-01304-1","journal":{"identity":"bmc-sports-science-medicine-and-rehabilitation","isVorOnly":false,"title":"BMC Sports Science, Medicine and Rehabilitation"},"publishedOn":"2025-08-30 15:57:26","publishedOnDateReadable":"August 30th, 2025"},"versionCreatedAt":"2025-05-19 08:46:25","video":"","vorDoi":"10.1186/s13102-025-01304-1","vorDoiUrl":"https://doi.org/10.1186/s13102-025-01304-1","workflowStages":[]},"version":"v1","identity":"rs-6437789","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6437789","identity":"rs-6437789","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}