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<p>Attention-Deficit/Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental condition characterized by inattention, hyperactivity, and impulsivity, frequently associated with catecholaminergic dysregulation, neuroimmune imbalance, and alterations in frontostriatal and prefrontal networks. Although pharmacological and behavioral treatments remain first-line, up to one-third of patients exhibit limited response or adverse effects, underscoring the need for complementary strategies. Physical exercise has emerged as a promising non-pharmacological intervention with acute and chronic benefits on core symptoms and functional outcomes. This narrative review critically synthesizes evidence from 2010 to 2025, integrating clinical, mechanistic, and prescription-focused findings. Acute exercise reliably enhances sustained attention and inhibitory control, while long-term aerobic, resistance, combined, and mind–body programs improve executive functions, sleep, mood regulation, and classroom behavior. These outcomes are supported by well-described neurobiological mechanisms, including modulation of dopamine and norepinephrine transmission, upregulation of neurotrophins such as BDNF and VEGF, regulation of the HPA axis, attenuation of pro-inflammatory signaling, enhancement of cortical perfusion, and positive shifts in gut microbiota. Martial arts and mind–body modalities further highlight the potential of structured, discipline-based exercise programs, though safety protocols are required for contact practices. Despite encouraging findings, heterogeneity in study design, exercise prescription, and population characteristics limits cross-study comparability, and optimal “doses” for specific subgroups remain undefined. Future trials should adopt harmonized protocols, embed mechanistic endpoints, and clarify responder profiles to enable exercise prescriptions tailored to age, sex, comorbidities, and pharmacological status. Collectively, the evidence positions physical exercise as a generally safe, biologically plausible intervention showing promise as an adjunct in ADHD management, with potential for integration into multimodal care models.</p> Graphical abstract <p></p>

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Physical exercise as a non-pharmacological strategy for ADHD considering neurobiological mechanisms, cognitive benefits, and practical recommendations: a narrative review

  • 期刊论文

  • 发表日期：

    2026年4月24日

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  • Álvaro A. Vergara Nieto,
  • Andrés Halabi Diaz,
  • Millaray Hernández Millán,
  • Daniel Sagredo Oyarzo,
  • Javier Arriagada Gacitúa

摘要

Attention-Deficit/Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental condition characterized by inattention, hyperactivity, and impulsivity, frequently associated with catecholaminergic dysregulation, neuroimmune imbalance, and alterations in frontostriatal and prefrontal networks. Although pharmacological and behavioral treatments remain first-line, up to one-third of patients exhibit limited response or adverse effects, underscoring the need for complementary strategies. Physical exercise has emerged as a promising non-pharmacological intervention with acute and chronic benefits on core symptoms and functional outcomes. This narrative review critically synthesizes evidence from 2010 to 2025, integrating clinical, mechanistic, and prescription-focused findings. Acute exercise reliably enhances sustained attention and inhibitory control, while long-term aerobic, resistance, combined, and mind–body programs improve executive functions, sleep, mood regulation, and classroom behavior. These outcomes are supported by well-described neurobiological mechanisms, including modulation of dopamine and norepinephrine transmission, upregulation of neurotrophins such as BDNF and VEGF, regulation of the HPA axis, attenuation of pro-inflammatory signaling, enhancement of cortical perfusion, and positive shifts in gut microbiota. Martial arts and mind–body modalities further highlight the potential of structured, discipline-based exercise programs, though safety protocols are required for contact practices. Despite encouraging findings, heterogeneity in study design, exercise prescription, and population characteristics limits cross-study comparability, and optimal “doses” for specific subgroups remain undefined. Future trials should adopt harmonized protocols, embed mechanistic endpoints, and clarify responder profiles to enable exercise prescriptions tailored to age, sex, comorbidities, and pharmacological status. Collectively, the evidence positions physical exercise as a generally safe, biologically plausible intervention showing promise as an adjunct in ADHD management, with potential for integration into multimodal care models.

Graphical abstract