# Exercise as it relates to Disease/Exercise as a prescribed treatment for ADHD
## Exercise as a Prescribed Treatment for ADHD
### Background

Attention Deficit Hyperactive Disorder (ADHD) is a neurobehavioral developmental disorder characterised by symptoms of inattention, hyperactivity and impulsivity that is more frequent and severe than are typically seen at a given stage of development. ADHD is mostly observed in children, however it often persists into adolescence and adulthood, with some changes in symptoms.

### Pathophysiology

ADHD is believed to be a dysfunction of three catecholamines: epinephrine, norepinephrine and dopamine. Low concentrations of these catecholamines have been associated with impairments in working cognitive and executive functioning.

### Identification/Diagnosis

For an individual to be diagnosed with the disorder, they must have symptoms observed by a health professional for 6 or more months and to a degree that is judged to be beyond the extent that is normal for the person’s age. This should be carried out according to the symptoms defined by the Diagnostic & Statistical Manual of Mental Disorders criteria (DSM-5).
| Symptoms Of ADHD | |
| Difficulty sustaining attention | Inability to listen |
| Cannot follow through on instructions | Impulsivity |
| Reluctant to engage in tasks that require sustained effort | Outbursts |
| Lack of organizational skills | Hyperactivity |
| Inability to manage own time | Mood Swings |

### Treatment
##### Stimulant Medication

Treatments for ADHD are predominantly via stimulant medication. These medications help normalize the production of dopamine, epinephrine, and norepinephrine. The two most common medications are Methylphenidate (Ritalin) and Amphetamine salts (Adderall).
* Methylphenidate, the most commonly prescirbed medication, works though inhibiting dopamine reuptake.
* Amphetamin Salts works as a dopamine releaser, a dopamine reuptake inhibitor, monoamine oxidase inhibitor (deaminates epinephrine, norepinephrine and dopamine).
However the pharmacological treatment of ADHD may have negative and unintended side effects that compromise learning and attention:
| Side Effects of Pharmacological Treatment | |
| Appetite suppression | Sleep disturbance |
| Irritability | Palpitations |
| Gastrointestinal complaints | Anxiety |
| Tachycardia | Hypertension |
| Impaired growth | Risk of serious cardiovascular events |
| Increased resting and sub-maximal heart rate, decreasing aerobic performance. | |

##### Exercise

Due to the side effects of medication treatment, Exercise should be used as another way to treat the disorder to reduce the amount of medication that is used.
Exercise has been found to be beneficial to ADHD patients. Physical exercise may be used in multiple ways to complement current therapeutic approaches in the treatment of ADHD by increasing the availability of catecholamines in the brain and regulating stress hormones and antioxidant production. Exercise may be advantageous in managing the symptoms of ADHD because the physiological effects of physical activity influences the same systems that stimulant medications for ADHD target (Catecholamines).
Physical exercise reduces stress, anxiety, and depression, negative behaviour, poor impulse control and inattentiveness. Exercise also improves attention, social behaviour, cognitive function and overall learning ability. and has thereby proved beneficial for the relief of ADHD symptoms.

### Recommendations

Several studies demonstrate and confirm the effectiveness of exercise as a treatment for ADHD:
* Participants completed a 10-week physical activity program, of 45-min periods of moderate-vigorous exercise 3 times per week. This was found to be significantly beneficial to the management of ADHD.
* Participants completed a short 6-week physical activity program of 20-min moderate exercise 5 times per week. Results also showed a significantly beneficial effect on ADHD symptoms.
Therefore, individuals diagnosed with ADHD should spend up a minimum of 30 minutes moderate intensity exercise 5–7 days of the week in accordance to the National Physical Activity Guildelines. This would not only assist in the management of ADHD, it would provide the individual other major health benefits.

### Further reading

* Australian Guidelines (RACP) on Attention Deficit Hyperactivity Disorder (ADHD)
* USA Guidelines (NIH) Attention Deficit Hyperactivity Disorder (ADHD)
* UK Guidelines (NHS) Attention Deficit Hyperactivity Disorder

### References

* 1 2 Meckel, Y., Nemet, D., & Eliakim, A. (2011). The effect of methylphenidate treatment on exercise performance in children with attention-deficit hyperactivity disorder. Acta Kinesiologiae Universitatis Tartuensis, 17, 109-116.
* 1 2 3 4 5 6 Lewis, K. (2013). Exercise & ADHD. American Fitness, 31(3), 52-53.
* 1 2 3 The Royal Australasian College of Physicians. (2009). Australian Guidelines on Attention Deficit Hyperactivity Disorder (ADHD). Retrieved from: http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/ch54_draft_guidelines.pdf.
* 1 2 3 4 Zivkovic, D., Zivanovic, N., Zivkovic, M., Milojkovic, O., & Djordjevic, M. (2012). Physical activity in ADHD children treatment. Healthmed, 6(11), 3822-3825.
* 1 2 3 4 5 6 Kreher, J. B. (2012). Attention Deficit/Hyperactivity Disorder (ADHD) in Athletes. International Journal Of Athletic Therapy & Training, 17(3), 15-19.
* 1 2 3 Tantillo, M., Kesick, C. M., Hynd, G. W., & Dishman, R. K. (2002). The effects of exercise on children with attention-deficit hyperactivity disorder. Medicine and science in sports and exercise, 34(2), 203-212.
* 1 2 3 4 5 6 7 8 9 Wigal, S. B., Emmerson, N., Gehricke, J. G., & Galassetti, P. (2013). Exercise: Applications to childhood ADHD. Journal Of Attention Disorders, 17(4), 279-290.
* 1 2 National Institute of Medical Health (NIMH). (2012). Attention Deficit Hyperactivity Disorder (ADHD). Retrieved from: http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/index.shtml.
* ↑ American Psychiatric Association. (2013). DSM 5. American Psychiatric Association.
* 1 2 Verret, C., Gardiner, P., & Beliveau, L. (2010). Fitness Level and Gross Motor Performance of Children with Attention-Deficit Hyperactivity Disorder. Adapted Physical Activity Quarterly, 27(4), 337-351.
* 1 2 3 Hatfield, B. D. (2012). Kinesiology and Mental Health: The Promise of Exercise Neuroscience Research for Diseases and Disorders of the Brain.
* 1 2 Etnier, J. (2009). Physical activity and cognitive performance in children with attention deficit hyperactivity disorder (ADHD). Journal of Sport & Exercise Psychology, 31 S11-S13.
* ↑ Archer, T., & Kostrzewa, R. (2012). Physical Exercise Alleviates ADHD Symptoms: Regional Deficits and Development Trajectory. Neurotoxicity Research, 21(2), 195-209.
* ↑ The Department of Health. (2013). The National Physical Activity Guidelines. Retrieved from: http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys-act-guidelines.
* ↑ National Institute for Health and Clinical Excellence. (2013). Attention deficit hyperactivity disorder. Retrieved from:http://www.nice.org.uk/nicemedia/live/12061/42059/42059.pdf.