Is the weekend warrior physical activity pattern associated with executive functions in children with attention-deficit/hyperactivity disorder?

Physical activity may improve executive functions in children with attention-deficit/hyperactivity disorder (ADHD), but little is known about whether the weekly distribution of activity, such as a weekend warrior pattern, is associated with executive functions in this population. This cross-sectional study included 206 children aged 6–10 years with ADHD. Physical activity was assessed using the ActiGraph GT9X accelerometer. Participants were classified as inactive if they accumulated <420 min/week of moderate-to-vigorous physical activity (MVPA). Among children who accumulated ≥ 420 min/week of MVPA, those who accumulated ≥50% of weekly MVPA on 1–2 days were classified as weekend warriors, whereas those who accumulated MVPA over >2 days were classified as regularly active. Executive function outcomes were assessed using the Stroop Color and Word Test, Rey-Osterrieth Complex Figure Test, and Trail Making Test. Multivariable linear regression models were fitted for each outcome, with the inactive group as the reference. The sample included 206 children with ADHD (mean age, 8.43 years; 84.0% boys), comprising 69 inactive, 61 regularly active, and 76 weekend warrior participants. Compared with the inactive group, both the regularly active and weekend warrior groups showed better inhibitory control across all models, with these associations remaining significant in the fully adjusted model for the regularly active (β = 0.81, 95% CI 0.48 to 1.14; p < 0.001; Holm-adjusted p < 0.001) and weekend warrior (β = 0.75, 95% CI 0.44 to 1.07; p < 0.001; Holm-adjusted p < 0.001) groups. The regularly active group showed better immediate recall than the inactive group before multiplicity correction (β = 0.40, 95% CI 0.06 to 0.75; p = 0.022), but this association did not remain significant after Holm correction and was interpreted as exploratory. No statistically significant differences between physical activity patterns were detected for delayed recall or cognitive flexibility. Direct comparisons between the regularly active and weekend warrior groups were not significant for any executive function outcome. Sufficient weekly MVPA, whether accumulated regularly or in concentrated bouts, was associated with better task-based inhibitory control performance in children with ADHD. These findings should be considered hypothesis-generating and do not establish causality or support recommending a specific weekly MVPA accumulation pattern. Clinical trial number: Not applicable. Not applicable.