Purpose
To test feasibility and impact of a 10-week after-school exercise program for children with ADHD and/or disruptive behavior disorders (DBD) living in an urban poor community.
Methods
Children were randomized to exercise (n=19) or a comparable but sedentary attention control program (n=16). Cognitive and behavioral outcomes were collected pre-post. Intent-to-treat mixed models tested group × time and group × time × attendance interactions. Effect sizes were calculated within and between groups.
Results
Feasibility was evidenced by 86% retention, 60% attendance, and average 75% maximum heart rate. Group × time results were null on the primary outcome, parent-reported executive function. Among secondary outcomes, between-group effect sizes favored exercise on hyperactive symptoms (d=0.47) and verbal working memory (d=0.26), and controls on visuospatial working memory (d=-0.21) and oppositional defiant symptoms (d=-0.37). In each group, within-group effect sizes were moderate-large on most outcomes (d=0.67 to 1.60). A group × time × attendance interaction emerged on visuospatial working memory (F[1,33]=7.42, p<.05), such that attendance to the control program was related to greater improvements (r=.72, p<.01) while attendance to the exercise program was not (r=.25, p=.34).
Conclusions
While between-group findings on the primary outcome, parent-reported executive function, were null, between-group effect sizes on hyperactivity and visuospatial working memory may reflect adaptations to the specific challenges presented by distinct formats. Both groups demonstrated substantial within-group improvements on clinically relevant outcomes. Findings underscore the importance of programmatic features such as routines, engaging activities, behavior management strategies, and adult attention; and highlight the potential for after-school programs to benefit children with ADHD and DBD living in urban poverty where health needs are high and services resources few.