Does exercise actually help? The evidence

I keep prescribing exercise as an adjunct and I keep getting the same look from patients. So let's talk about what the evidence actually says.

The Mehren 2020 systematic review is the gold standard here. 18 studies. Consistent moderate effect sizes for acute exercise on attention and executive function in ADHD.

Key word being acute. A single bout of exercise produces measurable cognitive improvement for 60-90 minutes. The chronic exercise data is less clean.

But here's what's interesting — the type of exercise matters. Complex motor tasks (martial arts, dance, rock climbing) show larger effects than simple cardio. The coordination demand seems to matter.

The hypothesis is that complex movement requires the same prefrontal engagement that ADHD brains struggle with. You're essentially training the same circuits.

My practical advice to patients: find something that requires enough coordination that you can't zone out. Running on a treadmill? Your ADHD brain will get bored. Brazilian jiu-jitsu? You literally can't think about anything else.

I've started framing it as 'medication for your brain that you do with your body.' Reframing helps with compliance. Nobody wants another thing on their to-do list.