Neurobiological Mechanisms and Intervention Strategies of Moderate-to-Vigorous Intensity Physical Activity on Executive Functions in Children with Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by core symptoms of inattention, hyperactivity, and impulsivity. The associated impairments in executive functions significantly affect cognitive development and social adaptation in affected children. In recent years, moderate-to-vigorous intensity physical activity (MVPA) has emerged as a promising non-pharmacological and easily implementable intervention for improving executive functions in children with ADHD. This study systematically reviewed the effects of MVPA on executive functions in children with ADHD and the underlying neurobiological mechanisms. It examined both acute and long-term intervention dimensions, exploring the impacts of different types of exercise (aerobic, mixed, high-intensity interval training, etc.) on core subdomains of executive function (inhibitory control, working memory, and cognitive flexibility). Long-term MVPA interventions demonstrate more stable and significant improvements, while the effects of acute interventions remain inconsistent due to individual differences and intervention heterogeneity. Regarding neurobiological mechanisms, MVPA may function through the following pathways: (1) activating the PGC-1α/FNDC5/BDNF pathway and enhancing hippocampal synaptic plasticity; (2) upregulating dopamine and norepinephrine levels, thereby strengthening functional connectivity in the prefrontal-striatal circuit; (3) optimizing activity within the default mode network to improve attentional regulation. Integrating neurobiological insights with clinical evidence, this study proposes the following recommendations for acute MVPA interventions in children with ADHD: (1) single session of moderate-intensity aerobic or mixed exercise lasting ≥20 minutes, maintained at 50%-75% of maximum heart rate (HRmax); (2) single session of moderate-to-vigorous aerobic or mixed exercise lasting 5-25 minutes, maintained at 64%-95% of HRmax; (3) suitable activities including rope skipping, cycling, treadmill running, swimming, and mixed exercises. For long-term regular MVPA interventions, two modes are recommended: (1) traditional moderate-to-vigorous aerobic exercise, with single session lasting 25-90 minutes, at a frequency of 1-3 times per week, over 3-14 weeks, including physical conditioning, skill-based ball games, and mixed exercises; (2) high-intensity interval training (HIIT), with single session lasting 10-16 minutes, at a frequency of 3 times per week, over 3-6 weeks, including activities such as 20-meter shuttle runs, rope skipping, stair climbing, and swimming. This study aims to provide a theoretical foundation and practical reference for developing precise and personalized exercise interventions for children with ADHD.