Abstract: Objective To systematically evaluate the effects of exercise interventions on executive function among children and adolescents with attention deficit hyperactivity disorder (ADHD), in order to provide a basis for developing non-pharmacological treatments for children with ADHD. Methods Literature related to the effects of exercise interventions on executive function in children and adolescents with ADHD published to November 8th, 2022 was captured through searching PubMed, Web of Science, Cochrane Library, Embase, CNKI and Wanfang databases. Reviewer Manager 5.4 was used for Meta-analysis, combined effect sizes were calculated. Heterogeneity test, sensitivity analysis and subgroup analysis were performed. Egger's test in Stata 15.0 was used to test for publication bias in the literature. Results Fifteen studies with a total number of 592 participants with ADHD were included. Meta-analysis showed that exercise interventions improved inhibitory control (SMD=0.54, 95%CI: 0.23 - 0.86,P<0.001), working memory (SMD=0.61, 95%CI: 0.29 - 0.93,P<0.001), and cognitive flexibility (SMD=0.66, 95%CI: 0.23 - 1.09,P＝0.003) of ADHD children and adolescents. Subgroup analysis showed the following results: 1) Moderate-intensity exercise had a moderate effect on inhibitory control and working memory, and moderate-to-vigorous-intensity exercise had a moderate effect on cognitive flexibility(P＜0.05). 2) Open-skilled sports had a moderate effect on inhibitory control, working memory and cognitive flexibility(P＜0.05),while closed-skilled sports did not significantly improve executive functions (P＞0.05). 3) Exercising regularly two times/week produced a large effect on inhibitory control (P＜0.05), and a more frequent (≥3 times/week) had a moderate-to-large effect on cognitive flexibility. 4) Interventions ranging from 6 to 8 weeks had a positive effect on inhibitory control and cognitive flexibility, and interventions with 12 weeks had a moderate-to-large effect on working memory (P＜0.05). Conclusions Exercise interventions are effective in improving executive function in children and adolescents with ADHD. Moderate-intensity exercise is most effective in improving inhibitory control and working memory, and moderate- to high-intensity exercise interventions are required in order to improve cognitive flexibility. Open-motor skills improve executive function of ADHD children. Exercise 2 times/week for 6-8 weeks can improve inhibitory control, while improving working memory requires more frequent and longer periods of exercise intervention.

Key words: attention deficit hyperactivity disorder, executive function, inhibitory control, working memory, cognitive flexibility, exercise

摘要： 目的 系统评价运动干预对注意缺陷多动障碍(ADHD)儿童青少年执行功能的改善效果,为开拓ADHD的非药物治疗手段提供依据。方法 计算机检索Pubmed、Web of Science、Cochrane Library、Embase、中国知网、万方数据库中有关运动干预对ADHD儿童青少年执行功能影响的文献,检索期限为自建库至2022年11月8日;采用Rev Man 5.4进行Meta分析,计算效应量合并、异质性检验、敏感性分析和亚组分析,采用Stata 15.0中的Egger's检验进行文献发表偏倚检验。结果 共纳入15篇文献,包括592名研究对象。Meta分析显示:运动干预可改善ADHD儿童青少年的抑制控制(SMD=0.54,95%CI:0.23~0.86,P<0.001)、工作记忆(SMD=0.61,95%CI: 0.29~0.93,P<0.001)和认知灵活性(SMD=0.66,95%CI:0.23~1.09,P=0.003)。亚组分析显示:1)中等强度运动对抑制控制和工作记忆均达到中等效应量的改善(P＜0.05),中至高强度运动对认知灵活性的改善为中等效应(P＜0.05);2)开式运动技能对抑制控制、工作记忆、认知灵活性的改善均达到中等效应(P＜0.05),闭式运动技能对执行功能的改善不显著(P＞0.05);3)2次/周的运动对抑制控制达到大效应量的改善(P＜0.05),≥3次/周的运动对工作记忆的改善为中等偏上的效应(P＜0.05);4)6~8周的运动可有效改善抑制控制和认知灵活性(P＜0.05),12周的运动对工作记忆的改善为中等偏上的效应(P＜0.05)。结论 运动干预可有效改善ADHD儿童青少年的执行功能,其中中等强度运动对抑制控制、工作记忆的改善效果最佳,改善认知灵活性需中至高强度的运动干预。开式运动技能可改善患儿的执行功能,2次/周且持续6~8周的运动可改善患儿的抑制控制,而改善工作记忆需更多频次和更长周期的运动干预。

关键词: 注意缺陷多动障碍, 执行功能, 抑制控制, 工作记忆, 认知灵活性, 运动