Data_Sheet_1_Comparative effectiveness of various physical exercise interventions on executive functions and related symptoms in children and adolescents with attention deficit hyperactivity disorder: A systematic review and network meta-analysis.pdf

BackgroundPhysical exercise has been recommended as an important nonpharmacological therapeutic strategy for managing attention deficit hyperactivity disorder (ADHD). We conducted a network meta-analysis (NMA) to assess the comparative impact of different physical exercise modalities on enhancing executive functions (EFs) and alleviating symptoms in children and adolescents with ADHD.
MethodsWe searched Web of Science, PubMed, Embase, Cochrane Central Register of Controlled Trials, SPORTDiscus, PsycINFO, CNKI, and clinical trials databases from inception to October 20, 2022. Randomized controlled trials (RCTs) and quasi-experimental studies investigating physical exercise for ADHD-related symptoms of hyperactivity/impulsivity and inattention, and executive functions were included. The frequentist random-effect NMA method was applied to pool the results.
ResultsA total of 59 studies (including 39 RCTs, 5 quasi-RCTs, and 15 self-controlled trials) published between 1983 and 2022 were incorporated into the systematic review, of which 44 studies with 1757 participants were eligible for meta-analysis. All types of physical exercise were effective in improving EFs (SMD = 1.15, 95% CI: 0.83 to 1.46), and open-skill activities which require participants to react in a dynamically changing and externally paced environment induced the most incredible benefits for executive functions (SUCRA = 98.0%, SMD = 1.96, and 95% CI: 1.15 to 2.77). Subgroup analyses for EFs revealed varied findings that open-skill activities were the most promising physical exercise type for improving inhibitory control (SUCRA = 99.1%, SMD = 1.94, and 95% CI: 1.24 to 2.64), and closed-skill activities dominated by aerobic exercises had a slightly higher probability of being the most promising physical exercise intervention for working memory (SUCRA = 75.9%, SMD = 1.21, and 95% CI: −0.22 to 2.65), and multicomponent physical exercise tended to be the most effective in cognitive flexibility (SUCRA = 70.3%, SMD = 1.44, and 95% CI: −0.19 to 3.07). Regarding ADHD-related symptoms, closed-skill activities dominated by aerobic exercises might be more advantageous for hyperactivity/impulsivity (SUCRA = 72.5%, SMD = -1.60, and 95% CI: −3.02 to −0.19) and inattention (SUCRA = 96.3%, SMD = -1.51, and 95% CI: −2.33 to −0.69) improvement.
ConclusionPhysical exercise can significantly help to alleviate the symptoms of ADHD and improve executive functions in children and adolescents with ADHD. Most of all, to promote adherence to treatment, they should be encouraged to perform the physical exercises that they enjoy most.

背景
运动疗法已被推荐为治疗注意缺陷多动障碍（attention deficit hyperactivity disorder, ADHD）的重要非药物干预策略。本研究开展了一项网状Meta分析（network meta-analysis, NMA），旨在评估不同运动干预方式对注意缺陷多动障碍儿童青少年执行功能（executive functions, EFs）的改善作用及其症状缓解效果。
方法
本研究检索了建库至2022年10月20日的Web of Science、PubMed、Embase、Cochrane对照试验中心注册库（Cochrane Central Register of Controlled Trials）、SPORTDiscus、PsycINFO、中国知网（CNKI）及临床试验数据库。纳入探讨运动干预对注意缺陷多动障碍相关多动/冲动症状、注意障碍及执行功能影响的随机对照试验（randomized controlled trials, RCTs）与类实验研究。采用频率学派随机效应网状Meta分析方法合并研究结果。
结果
本系统评价共纳入1983年至2022年发表的59项研究（含39项随机对照试验、5项类随机对照试验及15项自身对照试验），其中44项研究（共1757名受试者）符合Meta分析纳入标准。所有类型的运动干预均可有效改善执行功能（标准化均数差（standardized mean difference, SMD）=1.15，95%置信区间（95% confidence interval, 95% CI）=0.83~1.46）；其中要求受试者在动态变化且受外部节奏调控的环境中做出反应的开放技能运动，对执行功能的改善获益最为显著（累计排序概率曲线下面积（surface under the cumulative ranking curve, SUCRA）=98.0%，SMD=1.96，95% CI=1.15~2.77）。执行功能亚组分析结果显示不同运动类型的效果存在差异：开放技能运动是改善抑制控制的最优运动类型（SUCRA=99.1%，SMD=1.94，95% CI=1.24~2.64）；以有氧运动为主的封闭技能运动，在改善工作记忆方面成为最优干预方案的概率略高（SUCRA=75.9%，SMD=1.21，95% CI=-0.22~2.65）；而多组分运动则对认知灵活性的改善效果最佳（SUCRA=70.3%，SMD=1.44，95% CI=-0.19~3.07）。针对注意缺陷多动障碍相关症状的分析显示，以有氧运动为主的封闭技能运动在改善多动/冲动症状（SUCRA=72.5%，SMD=-1.60，95% CI=-3.02~-0.19）及注意障碍（SUCRA=96.3%，SMD=-1.51，95% CI=-2.33~-0.69）方面更具优势。
结论
运动干预可显著缓解注意缺陷多动障碍儿童青少年的症状，并改善其执行功能。尤为重要的是，为提升治疗依从性，应鼓励患儿参与其喜爱的运动项目。