Exercise improves social functioning in children with ADHD, optimal dose identified

BACKGROUND: Children with ADHD frequently face social dysfunction hindering neurodevelopment. While exercise shows promise, the relative efficacy of specific modalities and precise dose-response relationships remain undefined. This study compares exercise modalities to identify the optimal dose for enhancing social functioning. METHODS: Seven databases were systematically searched from inception to March 2025 for randomized controlled trials of exercise interventions targeting social outcomes in children with ADHD. Exercise interventions were categorized by modality (closed-skill exercise, open-skill exercise, multicomponent exercise and mind-body therapy). Doses were harmonized to MET-min/week. Bayesian network meta-analysis (Hedges' g) synthesized relative efficacy, while a 4-knot natural-spline model identified the optimal dose-response range. RESULTS: Thirteen trials including 703 participants aged 6-13 years were eligible. Closed-skill exercise produced the largest improvements in social functioning (Hedges' g = -0.96, 95% CrI: -1.18 to -0.75). Multicomponent exercise (Hedges' g = -0.74, 95% CrI: -1.13 to -0.34) and mind-body therapy (Hedges' g = -0.53, 95% CrI: -0.79 to -0.28) showed moderate, clinically meaningful effects, whereas open-skill exercise had small effects (Hedges' g = -0.16, 95% CrI: -0.36 to -0.04). Dose-response analysis indicated an inverted U-shaped relationship, with a minimum effective dose of 660 MET-min/week and an optimal dose of 1290 MET-min/week. Both age and gender had a significant impact on the outcomes. CONCLUSION: Closed-skill and multicomponent exercise appear most effective for improving social functioning in children with ADHD, with benefits maximised at around 1290 MET-min/week.