The influence of chronic exercise intervention on the executive function of children with neurodevelopmental disorders: a meta-analysis.

Background: This meta-analysis examined whether chronic exercise interventions can improve executive function in children with neurodevelopmental disorders and aimed to identify the conditions under which these benefits are most pronounced. Although the review was framed within the broader category of neurodevelopmental disorders, the available randomized controlled evidence was mainly concentrated on attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Therefore, the findings should be interpreted primarily in relation to these two diagnostic groups rather than the full spectrum of neurodevelopmental disorders. Methods: A systematic search of six major databases was conducted to identify randomized controlled trials examining the effects of chronic exercise interventions on executive function in children with neurodevelopmental disorders. Thirteen randomized controlled trials involving 527 children were included, comprising 10 studies on children with ADHD and 3 studies on children with ASD. Executive function outcomes were synthesized across three core domains: inhibitory control, working memory, and cognitive flexibility. Effect sizes were pooled using a random-effects model, and subgroup analyses were performed according to exercise type, intervention duration, exercise intensity, diagnostic subtype, and control condition. Results: The pooled results showed that chronic exercise produced a moderate overall improvement in executive function. Among the three executive function domains, the largest effect was observed for inhibitory control, followed by a smaller but significant improvement in working memory. Cognitive flexibility also showed a small but statistically significant benefit after harmonization of outcome direction. Subgroup analyses indicated that intervention effects varied across exercise type, duration, intensity, diagnostic subtype, and control condition. In particular, closed-skill exercise appeared to produce more stable benefits for inhibitory control and working memory. Longer interventions were more favorable for improving inhibitory control, while moderate-to-higher intensity exercise showed greater promise for working memory. Discussion: These findings suggest that chronic exercise may be a promising and accessible non-pharmacological approach for supporting executive function in children with ADHD and ASD. The results further indicate that exercise should not be regarded as a uniform intervention for executive function, because its effects differ across cognitive subdomains and intervention characteristics. Conceptually, this study advances the field by moving beyond the general question of whether exercise is effective and instead clarifies how, for whom, and for which aspects of executive function exercise may be most beneficial. However, the findings should be interpreted with caution because of substantial between-study heterogeneity and the limited number of trials included in several subgroup analyses. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/search, identifier CRD420261329177.