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Effects of Exercise on Cognitive Performance with ADHD (nih.gov)
181 points by nocoder 13 days ago | hide | past | web | favorite | 86 comments





Found a link to another article in the sidebar: Attention-deficit Hyperactivity Disorder: A Category or a Continuum? Genetic Analysis of a Large-Scale Twin Study https://pubmed.ncbi.nlm.nih.gov/9183127/

Their conclusion: "These findings suggest that ADHD is best viewed as the extreme of a behavior that varies genetically throughout the entire population rather than as a disorder with discrete determinants."

As someone who has been diagnosed with ADHD, this seems like a more natural explanation. If 5-10% of the population allegedly have a disorder, then maybe the "disorder" is in fact just the tail end of a normal genetic distribution. Doesn't mean that the condition is "made up" or that those people don't deserve some kind of treatment, of course.


I always come back to the analogy of nearsightedness. You can be a little bit nearsighted, or a lot nearsighted. It’s a continuum. It isn’t even precisely a problem to be nearsighted, in theory. It’s just a problem in our society which is designed around being able to see things that are far away (e.g. road signs.) Glasses aren’t technically a treatment for an illness; they’re an optional prosthesis—a “body mod” in the cyberpunk sense. But there’s no stigma to getting them (nor should there be); and anyone who has any degree of nearsightedness has no reason not to get them.

But there used to be a stigma around wearing glasses.

Still is to some extent, and a lot of people just cannot pull them off, so stigma or no they do look worse just like if they were wearing crappier clothes (I'm this way, a bit—hard to find glasses that look at least OK on me rather than awful).

Perhaps better to say that there's no stigma to finding out that someone wears contacts or has had LASIK surgery. Those match the intuition of ADHD as something that's a personal/"invisible" problem, with a personal/"invisible" treatment.

Ah, yes, that's true. The social benefit to having 20/20 vision naturally instead of through surgery or wearing contacts is very low, even if people know about the contacts or surgery.

So was a number of other perceived biological outliers, including left handedness and melanin content. Although not perfect, as society progresses, these outliers are accepted more over time.

I prefer to view it as a trait. It's only a disorder if it's not managed properly. By way of analogy to software, consider parallel processing. A program written by someone ignorant of thread safety will be unreliable or even entirely useless; OTOH, there are huge advantages to multi-core processors and distributed systems. IMHO it's a lazy mistake to label everyone whose mind works in this more complicated way as impaired or flawed. I suggest embracing how your unique mind works, learning more about meta-cognition, and finding whatever combination of tools* works best for you, in order to realize your true potential. Many of the most powerful and successful and happy people in the world have figured this out. Don't let your diagnosis be an excuse for mediocrity or failure!

*eg counseling | coaching, medication, meditation, exercise, productivity systems, journaling, etc.


I think what makes it a disorder is its severity makes it difficult for an individual to manage it properly without treatment or intervention.

Everything you've suggested are things that most people who are aware that they have the disorder try or do already in order to manage it, I would be surprised if a lot of people found out they had ADHD and used their diagnosis as "an excuse for mediocrity or failure!"

If I were being uncharitable I'd say you were just using this comment as a way to dole out unasked for advice to either make yourself feel better or put down some straw-man you've made up. But since I'm not, I'll just leave it at you ain't said nothing slick to a can of oil.


Respectfully, other than your first sentence (which agrees w my post) you've completely misunderstood and mischaracterized what I wrote.

I'm speaking from personal experience about what's been profoundly helpful to me in successfully overcoming a set of challenges related to how my mind works. My intent was and is to share and encourage others. FYI, learning to view this condition as a trait that can be advantageous (vs a defect or impairment) can be transformational for people suffering needlessly from frustration, guilt and self-doubt -- which mental health issues are rampant in my ADHD cohort. My aim is to speak directly to this group in saying "don't give up! try looking at things in this way, keep searching for the right solution and there's a good chance your life could radically improve, as did mine."

As for your ideas about what constitutes being "charitable", the less said the better. May I politely suggest taking a few slow breaths, ideally w your eyes closed, outside, w the sun on your face, and remember how lucky we all are to be alive.

Have a great day!


Left-handedness was considered to be pathological until comparatively recently.

There's a whole neurodiversity frontier to be explored. As well as mind-body frameworks. The news that exercise is better for ADHD reminds me of "fidgiting" or the sometimes more visible behaviours known as "stimming" in the context of autism.


> "disorder" is in fact just the tail end of a normal genetic distribution

This is pretty much the fundamental question that psychiatry has grappled with since inception: what distinguishes "disorder" or "illness" from healthy but aberrant behavior. Over the years, we've seen homosexuality, being black [1], and increasingly today autism, all be considered "normal". Right now, the big one is how you determine what is sadness vs. depression that requires treatment. There isn't a clear answer yet. But all of these designations are inextricably tied to social/cultural mores.

[1] https://www.psychologytoday.com/us/blog/witness/201011/how-t...


Based on my experience the difference is whether something interferes with a major life function.

Of course, the downside to that is two people can have the same "disorder", but if one will be fired from their job because of that "disorder" and the other won't because they are retired, then one may be diagnosed with it and the other may not be.


As someone with ADHD, I've noticed that I can stick to a schedule and control my symptoms throughout the day by exercising first thing in the morning. I'll run to work and for the first portion of the day, I can focus effortlessly, and after a short workout or bit of cardio at lunch I can extend that a little bit into the afternoon. It's vastly helped my mood and my ability to maintain an even keel.

I'm happy to see this posted, it's always been told to me that exercise is as or more important than my medication or organizational skills when it comes to managing my disorder, and when I can get myself to stick to it, it's a pretty amazing difference


I've found periods where I've gone to the gym have been characterized by improvements elsewhere too. But then either the novelty of going to the gym wore off or life circumstances changed (move house / workplace etc) and gym stopped. That's gotten me like 3 times now.

Come to think of it in uni when I first started going to the gym coincides with the semester I actually got a D+ and a D- because I got distracted by going to the gym and chasing girls.

Mixed bag. Keen to start up again though, I do think it's helped when I can manage.


Before I make a change in residence or work, I have a plan for continuity of good habits.

Sign up for the new gym. Figure out where going will fit into my likely future schedule. Set an explicit period of lapse due to the effort of moving (or whatever life change is disrupting the norm).

Of course that is in an ideal situation. Sometimes you don't have enough notice for this (COVID stay-at-home threw me off).


>Of course that is in an ideal situation. Sometimes you don't have enough notice for this (COVID stay-at-home threw me off).

Sometimes the impulsive behavior gets the better of you too.


Try picking up a routine that doesn't require a gym. If you've got a pair of running shoes and a pull up bar in your house, you have no excuse any more :)

Other than a brain that just won't do it.

Do you have extra clothes at work or how does that part work out?

I don't do it, but I do run right after work, just before dinner. I find that just wiping the sweat off with a dry washcloth and putting on clean clothes cleans me up just as well as a shower. So if I did run to work, I'd just throw a washcloth and clean change of clothes in my backpack, and feel confidently clean all day.

EDIT: YMMV (I may not sweat as much as some people.)


Woah, would not work for me, I sweat like Niagra falls after a run.

Coincidentally, my running buddy does too. I didn't think of that, so thanks for reminding me. I guess I should add a ymmv to my original comment.

i ran ~3miles to work for a year and biked 10+ miles daily for many years. Having a change of clothes is a requirement. a shower nearby helps a lot, but I really don't think it's a requirement. 10-15minutes of cool off time in the shade or a walk about will help remove all the sweat. If you're still self conscience then you should bring some baby naps and do a sort of hobo shower.

I wish I could exercise first thing in the morning. Is it about getting cardio/increased heart rate, is that where the benefit is derived?

Why can't you?

I've found that it's difficult at first to start a new habit, but that if I stick with it for a few weeks to months it becomes a routine and I'll adapt.


What kind of exercise do you do early in the day? Once thing that stops me from doing, say, jumping jacks in my bedroom is that I don't want to upset the neighbor downstairs.

Oh hey, I can answer this -- I work out to ease ADHD symptoms and live in a shitty wood-framed SF apartment. Using a kettlebell or any heavy object you can hold in your hands, you can do the following routine in near-silence first thing in the morning:

Goblet squat, deadlift, bent-over row, pushups, overhead press. It's reasonably comprehensive, takes less than 10 minutes, and involves enough exercise to keep me moderately sane all morning.


Thank you. I'm going to get a kettlebell. What's a good weight to start off with? 15, 20 pounds?

I run. I go before sunrise usually and enjoy the fresh air.

The plank is a great silent exercise.

You can buy a home elliptical.

If exercise was a drug, no one would believe it could have so many positive effects.

It would never get approved. Side effects include shortness of breath, profuse sweating, variety of small aches and it renders you unable to do anything for 30-90 minutes, depending on the dosage.

There are also reports of inducing psychological dependency.


Also major injury and death

It'd be the most valuable pill ever created, by far. Literally everyone would benefit from it.

abuse of exercise can be pretty detrimental though.

I consider it similar to drinking water. You have to try pretty hard to get to the point where you're doing too much of it.

And like with water and dehydration, if you get too much too quickly when you've gone without it for too long, it can be detrimental

If you’re young maybe!

Its pretty hard to get to that point unless you undergo a serious sudden change in volume.

Agreed, I've had friends get issues where they hit one particular form of exercise really hard, for me I'm more about flexibility and trying to keep a good allover balance. Not that I am a shining example of fitness...

https://adhd-institute.com/burden-of-adhd/epidemiology/gende...

“Evidence suggests that the prevalence of attention-deficit hyperactivity disorder (ADHD), or hyperkinetic disorder (HKD), is greater in males than females.”

A more plausible explanation is that those doing the diagnosing are female teachers who perceive the more naturally boisterous play of young males as symptomatic of a mental disorder.


ADHD or not, “if your brain is tired make your body tired, too” is a good idea.

It’s not for ecology that I prefer to be a bicycle commuter; my reasons are much more selfish.


I'm not sure about the long term, but it's working pretty well immediately after exercise.

I'm WFH these days, and follow a relatively flexible schedule, so basically every day whenever I find it is hard to concentrate as usual I would go downstairs and have a 15mins running. Then I can focus for quite a while. I usually do this two to three times a day.


As someone recently diagnosed with ADHD(Inattentive) I've worked through years of misdiagnosis directed towards depression. I adopted the sport of Ultra-running years ago and with that extreme amount of exercise I've seen benefits and unlocked potential others have without difficulty.

There's obvious connections to exercise levels and my overall health, but with the depression it never resolved it. Only recently we found the ADHD diagnosis through reduced running, then tracking all symptoms and doing a deeper analysis on how I interact and think. When you live your entire life struggling to focus you build patterns and tricks to fit in. Turns out these are super bizarre when you speak them out-loud for someone to hear for the first time. I recently explained this break through as similar to how we all do some specific behavior such as sanitary cleaning after a bowel movement, but no one actually talks about their process in detail to know how different we all are. Thinking and focus are sort of like that for me.

I'm seeing a lot of comments here that didn't maybe read the article and see how small an impact exercise has, especially compared to medication. After now taking medication for the I've been on a strong emotional ride realizing this correct diagnosis and prescription years ago would have greatly changed my life. With exercise back up to normal levels again I'm seeing 90% improvement by medication is in no way replaceable with running 120 miles a week for a 10-20% improvement.

As I'm now working on finding a plan to reduce and then quit the medication these studies are fascinating for me to potentially know the upper limits each coping mechanism provides. This might make me consider quitting my sport and only contributing enough effort to maximize the return so I can then pick up other habits for a greater duration.

To anyone else suffering through inattentive ADHD I wish you the best.


It's actually amazing for how many conditions exercise helps, depression is another one.

And it is even more amazing to think that these conditions would not even be conditions if we didn't become more sedentary each generation.

Aren't their conclusions small and inconclusive? The 'effect of exercise' in this case is, indeterminate.

I'm a layperson with an interest so welcome input, my takeaway was this bit 'preliminary evidence suggests that exercise can improve cognitive performance intimately linked to ADHD presentations in children with and without an ADHD diagnosis' which seems to suggest you are incorrect? Given that essentially no harm would come from all children taking a good amount of exercise it would seem following the recommendations would give a good outcome, there are many other benefits to exercise, obviously the odd broken leg, but injuries aside am I missing something?

To quote

   Paucity of studies probing the effect of different exercise parameters impedes finite conclusions in this regard.
I took that to mean, no idea what works or why.

And there's a cost to getting an ADHD child to consistently exercise. Its can be challenging to do anything for any duration, regularly. Lets not discount the parental effort for this to succeed. Lets not throw this at parents as another thing they should all be doing, without more than very-qualified evidence. There's enough things to make ADHD parents feel guilty about already.


Parenting an ADHD kiddo is hard enough, for sure. But I read that sentence with emphasis on the word, "different" rather than "exercise" -- so they would be saying that there's such variety in exercise, it's hard to say with enough certainty WHICH exercise. (But I'm also just an interested layperson.)

And the return was almost unmeasurable.

Spark [1], the book talks about same in details. I enjoyed reading it.

[1]: Spark: The Revolutionary New Science of Exercise and the Brain Paperback – 1 January 2013 by John J. Ratey MD (Author), Eric Hagerman


For those with ADHD; exercise is good for you.

Works even without the first bit!

If only there would be a way to stick regularly to exercise schedule! :)

This, really.

I'm not sure if you're delivering that line straight, or sarcastically, but this is actually an important problem I've had to explain to to my doctor. I initially started a year ago on an ADD medication that worked very well, but only if taken every day. It takes about two weeks of utterly consistent usage to reach proper effectiveness, after which it's very good at what it does. If you miss a single day, it flushes out of your system and you have to start the two weeks again.

This makes it fucking useless for treating ADD, because ADD (among other things) makes it very hard to maintain consistent schedules, so those two weeks are more like 6 weeks, because you keep missing a dosage. Once you make it to the effective stage, better avoid going out on the town because if you get a hangover and sleep late you can't take it in the afternoon or it'll fuck with your sleep and now you've reset the clock.

When it comes to exercise, god damn is exercise boring for me. I can physically exercise for a long time, but mentally I can do it for about 10 minutes before I'm out of focus and ready to build statues out of paperclips just to have something to do. Yes, I've tried audiobooks.

I can see exercise working very well as a force multiplier a correctly managed medication, allowing people to keep their dosage low enough to avoid side effects while still getting the benefits.

However, asking people to exercise their way out of ADD is kinda like asking them to exercise out of depression. You need something else to get the momentum of the process rolling first, or the "static friction" of the condition is going to prevent the exercise from happening in the first place.


Just exercise when you cannot decide what to prioritise ;)

You have to find something that you genuinely enjoy doing, there's no other way.

I tried many things (found out I really hate running with passion). I really liked skateboarding, but I have broken my leg and a wrist bone short afterwards. So I didn’t continue.

I see what you did there.

Anyone have a TLDR? Tried reading but the formatting on mobile didn’t work out for me.

Or maybe it’s my ADHD.


> In summary, the existing preliminary evidence suggests that exercise can improve cognitive performance intimately linked to ADHD presentations in children with and without an ADHD diagnosis. Based on the findings from both PBC and ADHD children, we cautiously provide recommendations for parameters of exercise.

Exercising seems to help people with ADHD perform better.

Anecdotal, I’ve found this out through years of living with it. I work better after working out in the mornings. If I don’t, I end up being productive in the afternoons when I finally get a bit tired.


I don't know if I have it or not. But exercises also helps me just to focus and I enjoy more the work.

I got diagnosed with it a couple of years back. I knew I had it, but I wasn’t diagnosed.

The evaluation is simple. They gave me a questionnaire with ‘have you ever’ questions. You rank them (think “a lot”, “often”, “sometimes“, “no”). Then they score based on that.

And let me tell you, filling that out made me start crying. All the shit I had put my mom through while growing up, school, college, etc.

But hey, I got the diagnosis. I have meds I can take if I need them. I currently don’t do it everyday because I simply don’t have to for what I do day to day. But if I’m working on something that requires me to hold regular hours at work or on some projects that are more conceptual, I have to.

All this to say, the test is simple and pretty quick. If you are curious, you could take it.


> All this to say, the test is simple and pretty quick.

Just to curb peoples expectations a bit, I started the process of getting diagnosed about two years ago, got the diagnosis less than a year ago, and I'm having the first meeting with a doctor who can actually prescribe meds next week. No part of it has been simple or quick. So I guess YMMV.


Oh wow. I didn’t expect it to vary that much.

I’m actually near a big university and I’ve heard it’s hard to get diagnosed here. I however don’t attend the university so the doctors I went to are outside.

My experience is in Indiana.


Have you ever noticed whether it's easier to be productive late in the evening?

Yes.

Like @disiplus, that happened to me for a long time.

During high school, college and afterwards, it was just easier to work at night and just stay up until very late. Also having a deadline around the corner gave me the right amount of stress to finally code the solution.

It’s not like I didn’t try to work during the day or wasn’t thinking of trying to solve the problem. I actually thought of it and worked out things in my head, I just had trouble sitting and coding it during the day. At night, very late until early in the morning I would just sit and dump it all out.

Side projects can still be like that.

At work, I’ve learned to manage it. I really enjoy the position I’m in. I work on a lot of projects, have a set of tasks that maybe fill half my day during the week but I can be pulled into meetings, called to fix something else, review code, or help other devs.

It’s can be a lot, but it’s working right now.


That's very similar to my experience.

for years that was how i worked, without medicine i cannot work in the morning. but i would regularly stay till 2am working.

I have no diagnosticed mental health issue but I was like that too until very recently. I started running once (sometimes twice) a week since a month and I noticed I can wake up before twelve now, I’m generally happier during the day and I can start doing things instead of just thinking a bit easier, even if it’s still far from perfect.

My advices for people who didn’t run for years like I was:

- starting low (500m or 2min) is the key. Better run a little than not

- increment a bit each time

- an Apple Watch (or other tracker) is awesome to set a goal and track progression during running. You can export health data on a PC and then do geek stuff with it


Something good to know: the tldr is usually on the article itself, in the Conclusion part of the article (sometimes this is on the abstract as well)

A bit on the ironic side, the Conclusion section of this article is very hard to find (it's on page 36 of 86, depending on your zoom level) and this reading mode on the website doesn't work so well

But here it is

> In line with previous research, we find that exercise benefits executive functions and attentional control in children with ADHD. The beneficial effects are comparable to those reported in PBC with substantial and consistent improvement on test of several cognitive functions following particularly long-term exercise. An important notion is also that no study has reported negative or adverse effects of exercise.


I really wish a lot of things started with the conclusion or TLDR. I have ADHD and I have issues reading to the end of an email without skipping and quitting before the end.

I mean, I know there is a certain way to write research articles and that they aren’t exactly meant for people with attention problems, but without people like you I’d never see the conclusion. Hell I might even look for it and then not find it and forget all about it.

I kind of knew exercise was good for me though. I even like doing it. The real issue is to begin to exercising instead of just thinking about starting it for a whole day without actually getting started.


Well, research articles have abstracts for exactly this purpose. They're one paragraph right at the start.

idd long text. One aspect that I found helpful were the references to sources that suggest the timing of exercise is important to lower the symptoms:

> The effects of acute exercise appear less robust. Of great interest, Chang et al., found that only exercise carried out during the first half of the day yielded positive outcomes [66]. This underlines the importance of timing exercise. This is supported by Hart who found that 15 min of exercise provided at the beginning of the day can reduce behaviors associated with ADHD and that while this effect dissipates over time, a short bout of 3–5 min. moderate-to-vigorous physical activity 90 m after the initial exercise, can maintain the benefits [375]


tl;dr it definitely helps, we're not sure how much, a proper large-scale trial is needed.

TLDR Aerobic exercise improves the cognitive function of humans. A tremendous breakthrough.

And yet our schools require kids to sit still in the morning before classes start when a few minutes of running around would do them a world of good. Madness.

They've reduced recess time down to almost nothing. Even for kindergarteners. Ours gets (well, got) about half an hour, and this is full-day kindergarten, none of that half-day stuff. Also they've gotten really lazy/risk-averse about letting kids go outside if it's a tad cold, or a tad drizzly, or a tad snowy, which it is, you know, a lot of days, so then they just have no recess.

How much ADHD is ADHD and how much is humans and especially kids aren't supposed to sit still so damn much and one of the ways the universal ill effects of this manifest is as ADHD symptoms in a lot of people?


This was done in my elementary school... most kids arrived 10-15 minutes early and milled around outside of the building. Teachers would open the doors at a set time to let us in...

Run them around before they get to school?

Yup

Even just the abstract shows pretty clearly that this is a sound and useful scientific inquiry into the hows and the whys that also shows a difference in the effect response of exercise on cognitive function - between an ADHD group vs. the control group. This is good stuff.

Eh. Results weren't conclusive.



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