Effects of long-term physical exercise on attention, behavioral problems, and emotional function in children and adolescents with ADHD and its moderating factors: a systematic review and meta-analysis

The aim of this study is to provide a comprehensive review of the effects of long-term physical exercise on attention, behavioral problems and emotional functioning in children and adolescents with attention-deficit/hyperactivity disorder (ADHD), and to explore its efficacy and moderating factors. In April 2026, a literature search was conducted in PubMed, Web of Science, Embase, PsycNET, SPORTDiscus and the Cochrane Library. A meta-analysis using a random-effects model was conducted to estimate the pooled effect size. Subgroup analysis and meta-regression were conducted to reveal potential moderating factors. The risk of bias was assessed using the RoB 2 tool, and the level of evidence was assessed according to the GRADE system. A total of 36 trials were included, involving 1,514 participants. Compared with the control group, long-term physical exercise led to moderate improvements in attention (g = 0.74, p < 0.01), behavioral problems (g = 0.66, p < 0.01), and emotional function (g = 0.79, p < 0.01). Subgroup analysis indicated that the type of exercise had a significant moderating effect on attention ( p < 0.01); meanwhile, exercise frequency had a significant moderating effect on behavioral problems and emotional function ( p < 0.01). Regression analysis showed that attention was affected by exercise cycle (β = 0.03, P < 0.01), while age had a trend of affecting attention (β = 0.15, P = 0.06). Long-term physical exercise may have some beneficial effects on attention, behavioral problems and emotional function in children and adolescents with ADHD. However, there is significant heterogeneity across existing studies, and the extent of the benefits may depend on the characteristics of the intervention and the methodological quality of the research. Not applicable.