Effects of chronic physical exercise on executive functions in children and adolescents with attention-deficit/hyperactivity disorder: a systematic review and meta-analysis

This systematic review and meta-analysis analyzed the effects of chronic physical exercise interventions on executive functions in children and adolescents with attention-deficit/hyperactivity disorder (ADHD), with emphasis on inhibitory control and working memory. The review was conducted according to the PRISMA 2020 guidelines. Studies involving chronic, structured physical exercise interventions in children and adolescents with ADHD were considered eligible when they assessed at least one executive-function outcome. Searches were performed in PubMed/MEDLINE, Web of Science, LILACS/BVS, Scopus, and Embase from February 10, 2026, to February 25, 2026. Methodological quality was appraised using the National Institutes of Health/National Heart, Lung, and Blood Institute tools at the item level. Random-effects meta-analyses were conducted in R using Hedges’ g, with between-study variance estimated by the Paule-Mandel method and confidence intervals adjusted using the Hartung-Knapp approach. Fifteen reports, representing 14 independent study clusters, were included in the qualitative synthesis. The meta-analysis for inhibitory control included seven reports and showed a statistically significant effect favoring physical exercise interventions (Hedges’ g = 0.55; 95% CI: 0.33 to 0.78), with no observed heterogeneity (I² = 0.0%; τ² = 0.000). The meta-analysis for working memory included six reports and also showed a statistically significant effect favoring physical exercise interventions (Hedges’ g = 0.62; 95% CI: 0.22 to 1.03), although with moderate-to-substantial heterogeneity (I² = 61.0%; τ² = 0.082). Chronic physical exercise interventions may improve performance in executive-function tasks among children and adolescents with ADHD. The evidence appears more consistent for inhibitory control, whereas findings for working memory remain promising but more heterogeneous. Further randomized trials with standardized executive-function outcomes, transparent reporting, and clearly isolable exercise components are needed.