Effects of Gince Zumba and Square Stepping Exercises on Motor and Cognitive Functions in Children With Attention-Deficit/Hyperactivity Disorder
Phase: NA
Conditions: Attention Deficit Hyperactivity Disorder (ADHD)
Sponsor: Cukurova University

 
 
 
Official Title 
Effects of Structured Exercise Programs on Cognitive Function, Motor Skills, and Behavioral 
Outcomes in Children with Attention Deficit Hyperactivity Disorder 
 
NCT Number: Pending 
 
Document Type: Study Protocol 
 
Date: November 4, 2022 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

1. Introduction 
Attention 
Deficit 
Hyperactivity 
Disorder 
(ADHD) 
is 
one 
of 
the most common 
neurodevelopmental disorders in childhood and is characterized by symptoms of inattention, 
hyperactivity, and impulsivity. In addition to behavioral symptoms, children with ADHD 
frequently experience impairments in executive functions, attention control, working memory, 
and motor coordination. 
Recent research suggests that structured physical exercise programs may positively influence 
cognitive and motor functions in children with ADHD. Exercise-based interventions are thought 
to enhance neurocognitive functioning through increased arousal, improved neural efficiency, 
and enhanced executive control processes. Among these interventions, rhythm-based and 
cognitively demanding exercises have gained increasing attention. 
Gince Zumba is a movement-based exercise program that combines rhythmic movements, 
coordination, and aerobic activity, whereas Square Stepping Exercise (SSE) involves 
structured step patterns requiring visuospatial processing, motor planning, and executive 
control. Both exercise types may provide cognitive stimulation in addition to physical activity. 
The aim of this study was to investigate the effects of Gince Zumba and Square Stepping 
exercises on motor and cognitive functions in children with ADHD. 
 
2. Methods 
2.1 Study Design 
This study was designed as a randomized controlled experimental trial with three parallel 
groups. 
 
2.2 Participants 
Children diagnosed with Attention Deficit Hyperactivity Disorder were recruited for the study. 
Participants were within the age range of 8-12 years and were diagnosed according to DSM 
criteria by a qualified clinician. 
Inclusion criteria included: 
 
A clinical diagnosis of ADHD 
 
Being within the specified age range 
 
Ability to follow verbal instructions 
 
Ability to read and understand Turkish langugage 
 
Being under medication at least 2 months prior to the study 
 
Exclusion criteria included: 
 
Presence of neurological, orthopedic, or psychiatric disorders other than ADHD 
 
Participation in regular structured exercise programs during the study period 
 
Inability to perform any physical activity 

Written informed consent was obtained from parents or legal guardians prior to participation. 
 
2.3 Randomization and Groups 
Participants were randomly assigned to one of three groups: 
1. Gince Zumba Group (GZG) 
2. Square Stepping Exercise Group (SSEG) 
3. Control Group 
 
2.4 Intervention Programs 
Gince Zumba Group (GZG): 
Participants in the Gince Zumba group participated in a structured exercise program for 8 
weeks, with 2 sessions per week, each session lasting approximately 50 minutes. The 
program included rhythmic movements, coordination tasks, and aerobic components 
appropriate for children. 
Square Stepping Exercise Group (SSEG): 
Participants in the Square Stepping Exercise group followed an 8-week SSE program with 2 
sessions per week, each lasting 50 minutes. The exercises involved progressively complex 
stepping patterns designed to challenge motor coordination and cognitive processing. 
Control Group: 
Participants in the control group did not participate in any regular pysical activity program 
during the study period and continued their usual daily activities. 
 
2.5 Outcome Measures 
Assessments were conducted at baseline and after the 8-week intervention period. 
Primary outcome measures included: 
 
Cognitive functions assessed using standardized neuropsychological tests (e.g., 
Stroop Test, Visual-Auditory Digit Span Test) 
Secondary outcome measures included: 
 
Motor performance assessments (Blaze Pod Reaction Time Test) 
 
Behavioral symptoms evaluated using parent-reported questionnaires (Conners Parent 
Rating Scale) 
 
 
2.6 Procedure 
Baseline assessments were conducted prior to randomization. Following baseline 
measurements, participants were randomly assigned to one of the three groups. Exercise 

interventions were conducted over an 8-week period. Post-intervention assessments were 
performed using the same measurement tools as at baseline. 
 
2.7 Ethical Considerations 
The study was conducted in accordance with the Declaration of Helsinki and was approved by 
the Çukurova University Non-Interventional Clinical Research Ethics Committee (decision no: 
127/64, dated November 4, 2022) and was conducted in accordance with the Declaration of 
Helsinki. Written informed consent was obtained from all parents or legal guardians before 
participation. 
 
2.8 Statistical Analysis 
A per-protocol analysis approach was used, and pre-test and post-test measurements were 
analyzed for all three groups. Statistical analyses were performed using SPSS software (IBM 
Corporation, Version 22, Armonk, NY, USA). One-way analysis of variance (ANOVA) and 
Pearson’s chi-square test were used to analyze baseline demographic characteristics of the 
participants. To examine the primary outcome variables, a two-factor repeated measures 
analysis of variance (group × time) with Bonferroni post hoc correction was applied. Within-
group changes were analyzed using paired-samples t-tests. A p-value of less than 0.05 was 
considered statistically significant.
 
4. 
Results 
 
Primary Outcomes 
Cognitive Function 
Cognitive function was assessed using the Stroop Test and the Visual-Auditory Digit Span Test. 
Changes from baseline to post-intervention scores were used to evaluate attention, executive 
functions, working memory, and cognitive processing speed. Both intervention groups 
demonstrated improvements in cognitive functions. The Gince Zumba group demonstrated 
greater gains in attention-related abilities, while the Square Stepping Exercise group showed 
more pronounced improvements in high-level cognitive functions.” 
 
Secondary Outcomes 
Motor Performance 
Motor performance was evaluated using the BlazePod Reaction Time Test. Changes in 
reaction time from baseline to post-intervention were analyzed. While both intervention groups 
exhibited significant improvements in motor performance relative to the control group, the 
enhancements were more pronounced in the Square Stepping Exercise group 
Behavioral Symptoms 
Behavioral outcomes were assessed using the Conners Parent Rating Scale. Changes in total 
and subscale scores from baseline to post-intervention were used to evaluate ADHD-related 
behavioral symptoms. Both intervention groups demonstrated significant reductions in ADHD-
related behavioral symptoms relative to the control group and baseline measurements. 
 
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