Abstract
BACKGROUND: Adolescents with attention-deficit hyperactivity disorder (ADHD) represent a high-risk population with an elevated likelihood of developing mental health disorders. Physical activity (PA) has emerged as a promising intervention to enhance mental health in youth. However, no studies to date have comprehensively examined the immediate and sustained effects of PA, especially aerobic exercise-based PA, on mental ill-being-including internalizing problems (e.g., depression, anxiety, and stress) and externalizing problems (e.g., aggression)-as well as on two other critical indicators of mental health: psychological well-being (e.g., resilience) and cognitive function (e.g., inhibitory control) in adolescents with ADHD. Therefore, this study aimed to investigate whether an aerobic exercise-based PA intervention could elicit immediate and sustained benefits for mental health outcomes, including internalizing problems, externalizing problems, psychological well-being, and cognitive function, in adolescents with ADHD. METHOD: This study was an assessor-masked, multicenter, randomized clinical trial. A total of 88 adolescents with ADHD were enrolled. Eligible participants were randomized in a 1:1 ratio to either the exercise group or the control group. Participants in the exercise group attended a 60-min session of aerobic exercise once a week for 12 weeks. Depression, anxiety, stress, aggression, and resilience were assessed using self-report questionnaires, and inhibitory control was evaluated through computer-based neurocognitive tasks. Assessments were conducted at baseline (T0), at the end of the intervention (T1), and 3 months following the intervention (T2). RESULTS: The 80 eligible participants included 72 (90%) males with a mean age of 14.74 (± 1.59) years. Generalized estimating equation analyses revealed that the current PA intervention resulted in significantly better and sustained improvements in depression, anxiety, stress, and inhibitory control. Compared to the control group, the exercise group showed a significant increase in resilience at T1, but this effect was not sustained at T2. No significant reduction in aggression was found. CONCLUSIONS: The current aerobic exercise-based PA intervention was found to be effective in reducing depression, anxiety, and stress, as well as in promoting inhibitory control and resilience in adolescents with ADHD. The current findings suggest that an aerobic exercise-based PA intervention may be an alternative or adjunctive approach to enhancing mental health, particularly in alleviating internalizing problems, in this population. TRIAL REGISTRATION: ChiCTR, ChiCTR2400087025. Registered 17 July 2024-Retrospectively registered, https://www.chictr.org.cn/showproj.html?proj=230614 .