ADHD + Exercise: sorry, it really does help.

There I was, being lapped by every single kid in my year, while my gym teacher bellowed ‘keep moving, you’re not even trying’ - I felt sick, with embarrassment as well as the pain in my legs and wheezing chest.

Two years before, I’d been going to dance classes three days a week and dancing on stage whenever I could.

Twenty years later, I’d develop shin splints after realising that running made it easy to focus, let me think and improved my mood enormously…

Let’s just say that although I know the evidence for ADHD responding to exercise is true, my relationship to it has been mixed at best.

But could it actually replace my medication - and what kind is best for ADHD brains?

There’s absolutely no doubt - anywhere, in any study I looked at, that exercise is amazing for ADHD. It has to be adapted to our unique circumstances and physical abilities (Looking hard at my 1970s gym instructors) but it has positive effects on every measure of human health - including those connected with ADHD. It’s incredibly powerful for improving mood, especially when we exercise regularly (the improvement is almost doubled - but it’s still significant if you’re new to exercise).

The relationship to ADHD is becoming clearer all the time too - which you would expect as it has an impact on mood, i.e. our perceived cognitive state lifts with all the lovely neurotransmitters increased by getting our heart rate up.

If you were offered a medication that - as well as potentially being free of charge AND accessible at any time -

• improved attention

• reduced anxiety

• reduced impulsivity

• improved overall executive functions

• and had no negative side effects

would you say ‘no, I’m good’ or would you GRAB IT with both hands?

Why is exercise so amazing for ADHD then?

Let’s go back to our brains (since it’s a brain based, neurodevelopmental difference that can be measured):

in ADHD, the fronto-striatal part of our brains is affected & we have less dopamine and noradrenaline produced - which affects our focus and attention (among other things). When we use a stimulant medication, that ‘hypoactivity’ - or low activity - is increased and suddenly, we can get things done.

Exercise can also increase the activity of these areas - and can have the same effect on our executive functions. This isn’t limited to young people either - a study looking at 6 month exercise program and ‘neural specificity’ and efficiency - which are connected to the decline in dopamine activity as we age - found that all participants (age 59+) improved their responses regardless of high or low intense activity. So even if we start at a low level of fitness and can’t follow an intense program, our brain function improves at any age with regular exercise.

What do the studies say about ADHD brains though - most of them focus on children and look at 20 minutes of moderate intensity. In general, there’s a measurable improvement in areas like reduced impulsivity, improved attention, task switching and cognitive flexibility (which is a really common difficulty but more associated with autism spectrum by the general public). Although reading and maths results both improved, higher executive functions like planning and problem solving didn’t (in one study anyway). Overall, the results are positive enough for us to agree that

Exercise is a benefit for ADHD impacted individuals of any age and reduces the severity of traits.

Even if adults with ADHD who are more used to exercise and have a high level of fitness show MORE changes, there is no doubt that even 30 minutes can improve our responses in the lab. Out in the real world, we have to be on the look out for the changes - as well as keeping a note of how we feel as we face the challenges that crop up every day.

Although we have most support for ‘moderate’ intensity of exercise, it’s just not been studied enough for us to say that ‘low’ intensity wouldn’t be as beneficial - or more.

Studies show that our brains benefit from aerobic exercise at any age.

What does this mean in practice - for YOU right now?

Since it’s been seen that exercise AND medication together can create a significant improvement - it means you don’t have to choose one or the other.

We also know that adults with untreated ADHD - or under-treated ADHD - are much more likely to have Type 2 Diabetes, have an obese range BMI (although it’s NOT just about our individual responsibility) and increased risk of Alzheimers - and the risk of every one of these negative conditions is reduced with exercise.

So what holds us back?

• Making time: when we are already overwhelmed with executive function challenges, adding ONE MORE (with the myriad tasks around it) feels just impossible for many of us.

• Self- confidence: the negative messages many ADHDers receive throughout their life could have been about our bodies, our spatial awareness (or lack of it) and of course, the co-occurrence of dyspraxia and hyper mobility can make sports or exercise a NOT FUN category. Even knowing the positive impact, for adults with this history… it’s going to require a serious level of support.

• Choice/boredom: on the one hand, we can join in almost any type of exercise online from the our front rooms. On the other.. well we might need new trainers. Might look over at this .. oh wait which trainers should I buy… and the rabbit hole drags us off, so we don’t start, we delay, we get overwhelmed…

So the very traits we know are improved by exercise often hold us back from starting exercise in the first place!

Start small & choose what’s most easy to add for YOU

Aerobic exercise is the one that most of the studies look at - rather than ‘pure’ weight training (I’ll come back to that) - so what kind of exercise would that include?

via GIPHY

1980s male aerobic video

• walking

• gardening (no really - try a push mower)

• dancing (lycra optional)

• cycling

  are the ‘low entry bar’ options and can be adapted for your own personal level of fitness and equipment.

other ‘aerobic’ options include:

• cross fit

• gym equipment (elliptical, treadmill, rowing, spinning)

The important thing is just to get started - and try to increase the frequency as well.

It’s going to have more impact to walk briskly for 30 minutes 5 times a week than manage 2 cross-fit classes a month - even if you feel that the Cross-fit is more challenging. (That’s the recommended 150 minutes per week)

But what about strength training? I am delighted to see many more women discovering the enjoyment of lifting heavy weights - not so much the competitions - but research is conclusive that strength training - safely - can improve depression and anxiety. Since the rates of both conditions in the ADHD population are higher than their non-ADHD peers, this is an excellent argument for adding in two sessions of strength training per week. To grow muscle, aim to lift as heavy as you can - as Susan Niebergall says, you want to find the last 2-3 reps challenging.

Now add ADHD…

Knowing that we will all have individual struggles what can you do about the most common ones?

Consistency:

I know, the C word. Yes, ideally, 5 days is the gold standard. If we are averaging 2 days a month right now, how about picking one day per week? Just one. Then, when that’s feeling really easy, add one more - just one at a time. You will maybe resist this and try to do 5. If that doesn’t work out - let’s use our ‘Learner’ questioning mind and work out what got in the way - are you a busy parent juggling all the fires at once? If that’s not going to change, we have to adjust our expectations of ourself. Bring in that self-compassion. This isn’t forever.

Everything all at once Now:

The black & white, all or nothing mindset does seem to be one I spot in many clients. I totally understand (as a person who’s committed to writing 30 blog posts in 30 days, does it seem likely I’m NOT an all or nothing person?).

The curiosity (learner) questions and self-compassion are even more important here. Why do we want to do everything right now? What happened the last time we tried that? How can we mitigate this tendency with the knowledge we might pickup a beginners over-use injury that will knock us out?

Getting started - or not:

We know we want to do it. We can’t do it. We hate on ourselves and then can’t do it even more. Rinse, repeat, for as many months/years as you like. Our friendly Executive Functions are involved here. You might have a difficulty getting started because it’s hard to break out of the ‘paralysis’ state - and I do have a selection of resources for that - but it might just be that you’re jumping ahead too quickly instead of taking the time to work out what you’ll need to achieve that - and knowing what your first goal might be.

Working with an ND affirming trainer can make a big difference. Carly Killen of the Strong Bones Club and George Eastwood are examples of several trainers who really understand that we need to do things differently - and have a lot of positive support and feedback to keep us going.

Ignoring or discounting our achievements

Again, not diagnostic or officially ADHD but it’s so common I have to include this one so you can watch out for it.

Record where you are when you start. Can you walk for 1 mile? how long does it take? If that’s your chosen exercise, when can you do it in 10-15 minutes?

Without data or evidence, it’s too easy to feel we haven’t made a change or achieved anything. And since celebrating those achievements is important, recording them will be important.

Are you convinced?

I am - I just finished listening to a terrifying podcast (it was supposed to be inspiring but that’s not how I heard it) by Dr Peter Attia and Dr Chatterjee, I know I need to exercise and exercise a LOT. The last year, I’ve seen a huge decline in my physical strength and fitness for several reasons.

The great news is that like our brains, our bodies respond to loving care and regular exercise too - so I’m going to get started.

I am creating a really strong, positive vision for next May (2024), that really inspires me and helps me focus on what I want. I’ve found two possible ways to get there - using online, flexible programs that are easily accessible given my home life and fitness level. Now, I need to identify where I can move things around to prioritise my well being - and that’s where I use my self-compassion, my own coach and the flexibility that helps me approach that amazing vision with determination - and a LOT Of humour.

Even though it won’t completely replace my medication, during the current shortage it will definitely help - and it has so many other positive results, I can’t think of a single reason not to include it in my own daily toolkit.

It’s something that I hope at least one other member of my new group coaching program will choose to include - because it’s got built in accountability, cheer leading and progress. Learn more about it - just a few weeks to go (30 October 2023)…

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Katherine

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Further reading

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Mehren A, Reichert M, Coghill D, Müller HHO, Braun N, Philipsen A. Physical exercise in attention deficit hyperactivity disorder - evidence and implications for the treatment of borderline personality disorder. Borderline Personal Disord Emot Dysregul. 2020 Jan 6;7:1. doi: 10.1186/s40479-019-0115-2. PMID: 31921425; PMCID: PMC6945516.

Chang YK, Labban JD, Gapin JI, Etnier JL. The effects of acute exercise on cognitive performance: a meta-analysis. Brain Res. 2012 May 9;1453:87-101. doi: 10.1016/j.brainres.2012.02.068. Epub 2012 Mar 4. Erratum in: Brain Res. 2012 Aug 27;1470:159. PMID: 22480735.

Vaidya CJ, Stollstorff M. Cognitive neuroscience of Attention Deficit Hyperactivity Disorder: current status and working hypotheses. Dev Disabil Res Rev. 2008;14(4):261-7. doi: 10.1002/ddrr.40. PMID: 19072750; PMCID: PMC4437560.

Wigal SB, Emmerson N, Gehricke JG, Galassetti P. Exercise: applications to childhood ADHD. J Atten Disord. 2013 May;17(4):279-90. doi: 10.1177/1087054712454192. Epub 2012 Aug 3. PMID: 22863768.

Kleemeyer MM, Polk TA, Schaefer S, Bodammer NC, Brechtel L, Lindenberger U. Exercise-Induced Fitness Changes Correlate with Changes in Neural Specificity in Older Adults. Front Hum Neurosci. 2017 Mar 16;11:123. doi: 10.3389/fnhum.2017.00123. PMID: 28360850; PMCID: PMC5352677.

Tantillo M, Kesick CM, Hynd GW, Dishman RK. The effects of exercise on children with attention-deficit hyperactivity disorder. Med Sci Sports Exerc. 2002 Feb;34(2):203-12. doi: 10.1097/00005768-200202000-00004. PMID: 11828226.

Lee SK, Lee CM, Park JH. Effects of combined exercise on physical fitness and neurotransmitters in children with ADHD: a pilot randomized controlled study. J Phys Ther Sci. 2015 Sep;27(9):2915-9. doi: 10.1589/jpts.27.2915. Epub 2015 Sep 30. PMID: 26504324; PMCID: PMC4616125.

Mehren A, Özyurt J, Lam AP, Brandes M, Müller HHO, Thiel CM, Philipsen A. Acute Effects of Aerobic Exercise on Executive Function and Attention in Adult Patients With ADHD. Front Psychiatry. 2019 Mar 26;10:132. doi: 10.3389/fpsyt.2019.00132. PMID: 30971959; PMCID: PMC6443849.

Choi JW, Han DH, Kang KD, Jung HY, Renshaw PF. Aerobic exercise and attention deficit hyperactivity disorder: brain research. Med Sci Sports Exerc. 2015;47(1):33–39. doi: 10.1249/MSS.0000000000000373

Chou CC, Huang CJ. Effects of an 8-week yoga program on sustained attention and discrimination function in children with attention deficit hyperactivity disorder. PeerJ. 2017 Jan 12;5:e2883. doi: 10.7717/peerj.2883. PMID: 28097075; PMCID: PMC5237364.

Tabka O, Sanaa I, Mekki M, Acheche A, Paillard T, Trabelsi Y. Effect of a pulmonary rehabilitation program combined with cognitive training on exercise tolerance and cognitive functions among Tunisian male patients with chronic obstructive pulmonary disease: A randomized controlled trial. Chron Respir Dis. 2023 Jan-Dec;20:14799731231201643. doi: 10.1177/14799731231201643. PMID: 37691169; PMCID: PMC10494516.

Park KS, Buseth L, Hong J, Etnier JL. Music-based multicomponent exercise training for community-dwelling older adults with mild-to-moderate cognitive decline: a feasibility study. Front Med (Lausanne). 2023 Aug 21;10:1224728. doi: 10.3389/fmed.2023.1224728. PMID: 37671396; PMCID: PMC10475546.
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Gordon BR, McDowell CP, Hallgren M, Meyer JD, Lyons M, Herring MP. Association of Efficacy of Resistance Exercise Training With Depressive Symptoms: Meta-analysis and Meta-regression Analysis of Randomized Clinical Trials. JAMA Psychiatry. 2018;75(6):566–576. doi:10.1001/jamapsychiatry.2018.0572

Gordon BR, McDowell CP, Lyons M, Herring MP. The Effects of Resistance Exercise Training on Anxiety: A Meta-Analysis and Meta-Regression Analysis of Randomized Controlled Trials. Sports Med. 2017 Dec;47(12):2521-2532. doi: 10.1007/s40279-017-0769-0. PMID: 28819746.