ADHD and exercise

ADHD and exercise

Research shows that 2.6 million people in the UK have been diagnosed with ADHD, and only 8.2% of the UK population is taking ADHD medication.

Perhaps an indicator of under diagnosis, or, as some experts say, a sign that GPs are increasingly prescribing exercise in place of a pack of pills.

As psychiatrist and ADHD specialist Dr Kampers says, movement works on your brain in the same way that movement does.

I get my ADHD patients to think of exercise as an essential component of their treatment — something that makes it easier to sustain mental focus for extended periods of time, he says.

Science corroborates his approach. One study showed that physical exercise could contribute to a significant improvement in anxiety and depression associated with ADHD, while another found that as little as ten minutes of cycling or yoga could reduce impulsive ADHD tendencies (i.e., reacting spontaneously or rashly), and a third showed that short-term aerobic exercise could mitigate symptoms including reduced attention span, hyperactivity, impulsivity, anxiety and executive function disorders.

Exercise is one of the bests gifts you can give an ADHD brain, Dr Kampers adds. It increases blood flow to your brain, stimulating the release of brain-derived neurotropic factor (BDNF), which promotes the growth of new brain cells (neurons). This keeps your brain operating at peak efficiency, which typically suffers as a symptom of ADHD.

Here, we share exactly what each type of exercise could do for ADHD and how, along with the stories of two women who, after being diagnosed with ADHD, now swear by exercise to alleviate their symptoms.

What is ADHD?

Attention-deficit/hyperactivity disorder (ADHD) is a disorder characterized by difficulties with inattentiveness, hyperactivity, or impulsivity, says Dr Kampers. ADHD symptoms may be identified as early as three years of age and can continue throughout development and into adulthood.

How is ADHD diagnosed?

Dr Kampers signposts the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for definition of the specific symptoms and diagnostic criteria for ADHD.

He tells me that in order to be diagnosed with ADHD:

  • Symptoms must be present for ≥6 months in ≥2 settings, which include, but are not limited to, school, home, and work.
  • Symptoms must hinder one's academic performance, social skills, and/or occupational functioning.
  • Symptoms must be present prior to the age of 12 and must not occur due to other psychiatric disorders (e.g., anxiety disorder, personality disorder).
  • In those <17 years of age, 6 or more symptoms must be present for each ADHD subtype. For those ≥17 years old, 5 or more symptoms must be present for diagnosis.

Based on symptoms and presentation, individuals can be classified as having ADHD inattentive type, hyperactive/impulsive type, or combined type. For combined type, criterion for both inattentive and hyperactive/impulsive type must be met over the past 6 months.

Of course, the best port of call is your GP, as you may well fall outside of the criterion listed above, but still show signs of ADHD.

How does exercise help ADHD?

The benefits of exercise for ADHD may or may not seem obvious - it tires you out and keeps you active, right? - but there are specific mechanisms that explain exactly how it could help. Buckle up for the deets.

How does exercise promote dopamine, and how does this help ADHD?

Exercise can promote dopamine in adults with ADHD

As my chat with Dr Kampers continues, he's keen to assert that the core symptoms of ADHD result from abnormalities in various prefrontal cortex circuits [parts of your brain, in other words], and/or the dysregulation of dopamine and noradrenaline.

I know that dopamine and noradrenaline are types of neurotransmitters, both of which play leading roles in regulating your attention span, according to Dr Kampers, but I'm not sure how exercise can help.

With regular physical activity, you can raise the baseline levels of dopamine and noradrenaline by spurring the growth of new receptors in certain brain areas, which increases the production of dopamine and noradrenaline,he tells me, with research proving so.

The more complex the exercise you do, the better, as this also increases the tone of something called your locus coeruleus, which is your brain stem's arousal centre. The more aroused this is, the more noradrenaline you will produce. The result is that you feel less irritable, and less likely to react out of proportion to any given situation, which can be a common symptom of ADHD.

We'll come onto what qualifies as complex exercise,below but think anything that stimulates your brain or requires a skill, such as yoga, martial arts, or even resistance training (learning new exercises is a skill, guys).

How does exercise improve cognitive function, and how does this help ADHD?

What do we mean by cognitive function? Learning, thinking, reasoning, remembering, problem solving, decision making, and attention span all come under this very large umbrella.

These are all improved by blood flow to your brain, Dr Kampers explains. The better your blood flow, the more able your brain is to change its activity in response to internal or external stimuli, meaning you'll have improved executive function, which can struggle as a symptom of ADHD.

Studies show that exercise improves blood flow in the following way: Your large arteries and veins stiffen slightly with reduced blood flow, but regular exercise counteracts this stiffening of your vascular system and prevents any cognitive symptoms. Both aerobic exercise (longer duration, lower intensity), and anaerobic (short duration, higher intensity) exercise can improve your vascular function, says Dr Kampers.

What's more, noradrenaline - that neurotransmitter we were harping on about above - is responsible for producing something known as your alpha-2A adrenergic receptor (ADRA2A), which is a neurotransmitter needed for cognitive function. And as we know, exercise promotes the production of noradrenaline.

Sure enough, one study found a link between increased exercise and better executive function.

How does exercise normalise BDNF function, and how does this help ADHD?

A succinct Brain Derived Neurotrophic Factor (BDNF) definition: The master molecule in your brain, responsible for learning and memory, says Dr Kampers.

It has been shown that exercise can enhance the concentration of BDNF in your brain, which correlates with better memory,Dr Kampers adds. The existing research on how this works suggests there are various mechanisms at play; one showing that exercise induces the expression of certain proteins in your brain which are consistent with elevated BDNF levels, and another study proved that aerobic exercise increased BDNF concentrations in your body.

Dr Kampers adds that the benefits last beyond the length of your workout, too. There is evidence for an increase in resting concentrations of peripheral blood BDNF after exercise intervention, he says.

How does exercise regulate mood, and how does this help ADHD?

Chances are you're all familiar with the concept of exercise > endorphins. This also runs true in an ADHD context, but there's more to it.

Exercise has a positive effect on your limbic system - the part of your brain involved in behavioural and emotional responses - as it helps regulate your amygdala - the structure in your brain that plays a part in emotional control, memory and learning, Dr Kampers explains. With ADHD, your amygdala blunts the hair-trigger responsiveness a lot of people experience, and evens out the reaction to a new source of stimulus, making us more responsive and less reactive.

He adds that, besides endorphins, exercise releases a molecule called endocannabinoids, which when released into your bloodstream, can help you feel deeply relaxed, Dr Kampers says.

Best exercise for ADHD

Take the above subheading with a pinch of salt; as you'll understand once you've read this whole article, there isn't necessarily a 'best exercise for ADHD'. It's more about what you enjoy, but if you're wondering where to start, read on for Dr Kampers' words of wisdom.

How is aerobic exercise good for adults with ADHD?

Aerobic exercise such as cycling can alleviate ADHD symptoms

Dr Kampers says: Aerobic exercise increases BDNF concentrations in your body. When you are in your aerobic heart rate range (between 70 and 80% of your max heart rate) for most of the time in any sporting activity, it boosts your cognitive abilities and makes it easier to absorb new moves and strategies.Aerobic exercise also elevates your neurotransmitters dopamine and noradrenaline, creates new blood vessels, with an increase in growth factors, and encourages the formation of new cells in your brain.

Do any aerobic activity two or three times per week — jogging, riding a bike, or playing a sport that involves sprinting or running.

How is resistance training good for adults with ADHD?

Resistance training is a skill. You're learning new movements, and the resistance means more demand on your attention and judgement, in order for you to maintain control within every exercise says Dr Kampers. All of this exponentially increases the complexity of the activity, which beefs up your brain's infrastructure.

How is yoga good for adults with ADHD?

Yoga has been proven to help manage ADHD symptoms
Yoga is a complex skill activity which strengthens and expands your brain's networks. The more complex the movements in your yoga sessions, the more complex the synaptic connections. These new, stronger connections are recruited to help you think and learn more efficiently, Dr Kampers says.

Yoga also promotes mindfulness. Mindfully paying attention to your breath and body can increase focus, calm racing thoughts, and improve self-regulation, he adds.

Not a yoga fan? Dr Kampers says rock climbing, karate, Pilates, gymnastics, and figure skating all offer the same benefits.

How is HIIT good for adults with ADHD?

HIIT combines aerobic activity with a skill activity, says Dr Kampers. It improves both your cardiovascular system - as I've mentioned, more blood flow to your brain via exercise means better cognitive function - and brain function as you are required to learn a new skill in each exercise.

How is boxing good for adults with ADHD?

*Boxing involves complex motor skills, which improves your levels of brain-derived neurotrophic factor (BDNF) most dramatically, and sparks the growth of new receptors in your brain, responsible for regulating how you react and respond to internal and external stimuli*says Dr Kampers.

It's all down to the technical movement. Boxing means working on your balance, timing, sequencing, evaluating consequences, switching, error correction, fine motor adjustments, inhibition, and, of course, intense focus and concentration, Dr Kampers adds.

*_As a survival-avoiding sport, it also activates your fight-or-flight response, which means you are forced to learn the skills needed as efficiently as possible. As far as your brain is concerned, it's do or die.
You will also be in the aerobic range most of the time during a boxing session, which boosts your cognitive abilities and makes it easier to absorb new moves and strategies._*

How often should adults with ADHD exercise and why?

I recommend a minimum 30 minutes of aerobic exercise a day, says Dr Kampers. He cites a particular study: MRI scans show that walking as few as three days a week for six months increased the volume of the prefrontal cortex in older adults with ADHD.

Are there any types of exercise adults with ADHD should avoid and why?

Not really - even prolonged, strenuous workouts raise bloodstream levels of endorphins, which help diminish pain while boosting feelings of well-being, Dr Kampers tells me.

Is exercise a viable form of treatment for ADHD patients?

If Dr Kampers has anything to do with it, absolutely.

I explain to every one of my ADHD patients that exercise boosts levels of dopamine and noradrenaline, he tells me. For most of my patients, I suggest exercise as a tool to help them manage their symptoms, along with their medication. The best strategy is to exercise in the morning, and take the medication about an hour later, when the immediate focusing effects of exercise begin to wear off. With many of my patients, if they exercise daily, they often need a lower dose of stimulant medication.Exercise promotes a structure and sets the right tone for the day. I advise my patients who need medication to take it at the point when the effects of exercise are wearing off, to get the most benefit from both approaches.The spike in dopamine and noradrenaline after an exercise session, lasts about 60 to 90 minutes, with a feeling of calm and clarity. Participating in a variety of activities will prevent you from getting mentally burned out, which is especially important for maintaining focus if you have ADHD. It is most beneficial to include a combination of aerobic and resistance training to maximise overall health benefits.