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The Science Behind the Impact of Exercise on ADHD and Executive Functioning

Monday, May 6, 2019

Regularly moving the body has immediate, protective, long-lasting, benefits for executive functioning and brain health.

By J.D. Ball, Ph.D., ABPP
By J.D. Ball, Ph.D., ABPP

Having written previously for CBA’s blogs series on the relationship between Sleep and Neurodevelopmental Disorders, I find it interesting that there is now a surging need to address a hot new research topic that will seem to many to be another call-back to common sense within the broad field of “good mental hygiene”– the relationship between exercise and executive functioning (EF). But I love it when new science validates an old idea, and this one is a beaut!

In my retirement from a patient-centered clinical neuropsychology practice at EVMS, I have been editing the journal, Perceptual and Motor Skills.  In this journal and in many others, there has been an explosion of new research over recent years on the benefits of physical activity for better health generally and for improved neurocognitive and especially EF skills across the life span. As an ADHD researcher/clinician, I have long been interested in this topic for its potential relevance to children, adolescents, and adults with ADHD. 

We have long known that impatience, inattention, overactivity, and distractibility associated with ADHD creates a buzz saw of activity in homes and schools that threaten to overwhelm parents, teachers, and care providers, especially those who fail to give adequate time to physical activity. For much of my career, exercise was seen to be valuable for its powers in providing to children a needed release. Some viewed it, usually with more hope than merit, as a means of inducing fatigue as a path to settling symptoms. Parents on family road trips would require children in the back seat to “run it off” at rest stops in the feint hope that the kids would then sleep for a few hundred miles.

Now, there is a wealth of new evidence for even more extraordinary benefits of physical exercise as a direct means of enhancing executive functioning (working memory, attention, response inhibition, planning, flexible thinking, etc.) in children, adolescents, young adults, and even the elderly.  One recent study demonstrated that a short period of very intense well supervised weight lifting exercise among adolescents led to their improved in-school cognitive functioning and learning over a subsequent 48-hour period, relative to a control group of more sedentary adolescents. More practically, study after study has shown that improving children’s motor coordination skills, and perhaps particularly their combined motor coordination and decision making abilities from directed participation in open-skilled sports, has generated specific improvements in varied aspects of EF. Acute benefits last for hours, and regular exercise has long lasting protective benefits for the brain. Hats off to our physical education teachers at CBA and around the world for their long and too infrequently recognized roles in these gains. They  are now fast receiving the research attention they deserve. 

Enthusiasm for exercise is not entirely new, of course. Health and mental health benefits of physical activity for all of us have been well established for many years, including, for example, the specific benefits of running to ameliorate symptoms of depression, first studied and published in the late 1970’s at the University of Virginia, when I was a graduate student there, by Robert Brown, psychiatrist. In time, further neuroscience progress has led to a greater understanding of the underlying mechanisms for some remarkable benefits to brain functioning. We first came to understand that exercise boosts the brain’s blood flow and that it is associated with the release of endorphins that produce good feelings like an athlete’s feeling of “flow” and the runner’s “high”. More recently, we’ve come to understand that exercise is also associated with the brain’s release of neurotransmitters, like serotonin (whose increased presence in the brain is a well-known treatment for depression through SSRI medications – selective serotonin reuptake inhibitors) and dopamine (the neurotransmitter that is most heavily represented in frontal lobe brain functioning that governs EF and that is integrally related to both the epigenetic basis and symptom management of ADHD). Since we know that ADHD is characterized by slower frontal lobe brain activity, these findings of relationships between physical activity and brain blood flow and dopamine release logically suggest that physical activity may alter the slower frontal brain activity in children and adults with ADHD, making it particularly beneficial to those with ADHD or what Russell Barkley has called “dysexecutive syndrome”. Dr. Barkley has advised parents and teachers to consider the “10-3” Rule, meaning that we should limit difficult EF work for children with ADHD to 10 minutes of hard work followed by a 3-minute exercise break because (a) children rapidly reach a point of diminishing returns in this EF work, and (b) exercise is the “fuel” for better EF.

If this wisdom were not already sufficiently salient to those who have or are caring for ADHD, the world’s neuroscientific community has recently even further advanced our understanding of exercise advantages to brain health. Physical activity produces neurotrophins that regulate growth, survival and the differentiation of brain neurons during development. More specifically, exercise is associated with an increased level of BDNF or brain-derived neurotrophic factor. BDNF is the brain’s “miracle grow.” It is closely associated with brain growth and development and with neuronal survival for the protection of the brain against neurocognitive decline; while not a cure for Alzheimer’s disease, more BDNF can delay a dementia onset. Perhaps for children, particularly, physical activity facilitates synaptogenesis (the growth of neural connections) that occurs simultaneously with myelination (the growth of the insulative neuronal sheath around fibers between neurons) and angiogenesis (influencing glucose and oxygen distribution through the brain). Since we know that ADHD is associated with alterations in brain maturation, particularly of the brain’s frontal lobes, regular periods (3-4 times per week) of significant (30-minute) aerobic exercise bouts can, through BDNF expression, assist a child’s brain growth and may yet be shown to have particularly important frontal lobe brain development benefits for persons with ADHD. We know already that the single most important cognitive benefit to exercise is improved attention. Implications are enormous for both the benefits of scheduling physical activity, physical education content, and the specific scheduling of in-school physical education (e.g., early in the day so as to benefit the rest of the school day and at-home exercise (e.g., before homework regimens).

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References
Alesi, M., Brianco, A., Lappina, G., Palma, A. & Pepi, A. (2016).  Improving children’s coordinative skills and executive functions:  The effects of a football exercise program. Perceptual and Motor Skills, 122 (1), 5-26. Archer, T. & Kostizewa, R.M. (2012).  Physical exercise alleviates ADHD symptoms: Regionaldeficits and development trajectory. Neurotoxicity Research, 21, (2), 195-209.
Berwid, O.G., & Halperin, J.M. (2012). Emerging support for a role of exercise on ADHD intervention planning. Current Psychiatric Reports, 14 (5), 543-551.
Brown, R.T., Ramirez, D. & Taub, J.M. (1978). The prescription of exercise for depression. The Physician and Sports Medicine, 35-45.
Crush, E.A. & Loprinzi, P.D. (2017). Dose-response effects of exercise duration and recovery on cognitive functioning. Perceptual and Motor Skills, 124, (6), 1164-1193.
Ieraci, A., Mallei, H., Musazzi, L. & Popoli, M. (2015).  Physical exercise and acute restraint stress differentially modulate hippocampal brain-derived neurotrophic factor transcripts and epigenetic mechanisms in mice.  Hippocampus, 25 (11), 1380-92.
Kashfi, T.E., Sohrabi, M., Kakhki, A., Mashhadi, A. & Nooghabi, J. (In press) Effects of a motor intervention program on motor skills in executive functions in children with learning disabilities. Perceptual and Motor Skills.
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Medina, J.A., Netto, T.L.B., Muszkat, M., Medino, A.C., Botter, D., Orbetelli, R., Scaramuzza, L.F.C., Sinnes, E.G., Vilela, M., & Mrianda, M.D. (2010).  Exercise impact on sustained attention of ADHD children, methylphenidate effects.  ADHD, 2, 49-58.
Mercua-Hidalgo, A., Ruiz-Ariza, A., Martinez-Lopez, E. (in press). 48-hour effects of monitored cooperative high intensity interval training on adolescent cognitive functioning. Perceptual and Motor Skills.
Sleiman, S.F., Henry, J., Al-Haddad, R., Hayek, L., Haider, E., Stringer, T., Ulja, D.,   Karuppagounder, S., Holson, E., Ratan, R., Ninan, I. & Chao, M. (2016).  Exercise promotes the expression of brain derived neurotrophic factor (BDNF) through the actor of the ketone body B-hydroxybutrate.  eLife, 5, 15092.
Toscanao, C.V.A., Carvalho, H.M., & Ferreira, J.P. (2017).  Exercise effects for children with Autism Spectrum Disorder: Metabolic health, autistic traits, and quality of life. Perceptual and Motor Skills, 125 (1), 126-146.
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