Structured Physical Training With and Without Cognitive Support for Adults With ADHD

Study Overview
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Brief Summary
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Studies in children and adolescents with Attention-Deficit-Hyperactivity-Disorder (ADHD) have shown that physical exercise can improve the core symptoms of ADHD; inattention and hyperactivity. For adults, the evidence is deficient and there is a great need to investigate whether adults have the same effect on ADHD symptoms of physical exercise, as children and young people have. Adults with ADHD often have a sedentary lifestyle and suffer from obesity and have sleep problems. In a normal population, these problems have been shown to be affectable with physical exercise. START (Support in Activity, Movement and Exercise) is a randomized controlled intervention study where physical exercise is given for 12 weeks, with or without cognitive support. The effect is measured with rating scales as well as cognitive and physical tests. The purpose is to investigate whether START works as a treatment for ADHD in terms of ADHD symptoms and disability, and what impact the intervention has on mental health, physical condition and activity level, body awareness and everyday functioning. Outcome measures are registered within 3 weeks before and after the end of treatment, after 6 months and 12 months. The randomization takes place in three groups; physical exercise (i), physical exercise and extra cognitive support (ii), and control group on waiting list (iii).

Official Title
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Support in Activity, Movement and exercise-for Adults With ADHD. A Randomized Controlled Trial Intervention Study With 12 Weeks of Physical Training With and Without Cognitive Support.

Conditions
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ADHD

Intervention / Treatment
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* Behavioral: Physical training
* Behavioral: Physical training combined with cognitive support.


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosed with ADHD. Exclusion Criteria: Ongoing depression with points on MADRS-S over 21 Suicidality Bipolar disorder Psychosis Ongoing addiction Reported threatening behavior. Severe autism that makes group participation impossible Inability to read and understand the Swedish language

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Physical training<br>Medium-high-intensity physical training 3 times a week, 60 min / time for 12 weeks. | Behavioral: Physical training<br>* Medium-high-intensity physical training 3 times a week, 60 min / time for 12 weeks, consisting of fitness, strength and mobility exercises with a target level of 60-90% of maximum heart rate. Two sessions per week take place in a group led by a physiotherapist and once a week the training consists of self-chosen training individually or in group.<br>|
| Active Comparator: Physical training combined with cognitive support<br>Medium-high-intensity physical training 3 times a week, 60 min / time for 12 weeks. The cognitive support consists of person centred individual occupational therapy. | Behavioral: Physical training combined with cognitive support.<br>* Medium-high-intensity physical training 3 times a week, 60 min / time for 12 weeks, consisting of fitness, strength and mobility exercises with a target level of 60-90% of maximum heart rate. Two sessions per week take place in a group led by a physiotherapist and once a week the training consists of self-chosen training individually or in group. The cognitive support consists of person centred individual occupational therapy with focus on daily time management skills and planning and organisation in daily life, i.e. make time for physical exercise. The number of session during the intervention period depend on the participants needs and is estimated to 4-6 sessions.<br>|
| No Intervention: Control group<br>The control group receive no intervention. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in Clinical Global Impression-Improvement (CGI-I) | Assess total improvement on a Richter scale. Range 1-7, Higher scores mean worse outcome | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes in Adult ADHD Self-Report Scale (ASRS-v.1.1) | Range 0-72, higher scores mean worse outcome | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in Cardio Respiratory Fitness | Measured in millilitre per kilogram per minute with the Ekblom-Bak test, a submaximal exercise test. Higher value means better outcome | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes in Grip Strength | Measured in kilogram with JAMAR hand dynamometer. Higher value means better outcome | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes in Balance | Measured with Flamingo test. The test person is standing on the preferred leg on a low balance profile for 60 seconds. The number of times that the test person puts his/her foot to the ground is counted. Lower value means better outcome | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes in Body Mass Index | Weight and height will be measured in kilograms and centimeters, and combined to report BMI in kg/m^2. Lower value means better outcome | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes in Abdominal Circumference | Measured with a measuring tape in centimeters. Lower value means better outcome | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes in Body Awareness | Body Awareness Scale - movement quality and experience (BAS MQ-E). Higher value means better outcome. | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes in Blood pressure | Both systolic and diastolic blood pressure will be measured in mm Hg with a blood pressure monitor on the arm. | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes in Satisfaction with Daily Occupations-Occupational Balance (SDO-OB) activity score | Range 0-17, higher scores are better | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes in Satisfaction with daily occupations and occupational balance (SDO-OB) satisfaction score | Global satisfaction score, range 1-5, lower scores are better | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes in Canadian Occupational Performance Measure (COPM) perfomance score | Range 5-50, higher scores are better | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes in Canadian Occupational Performance Measure (COPM) satisfaction score | Range 5-50, higher scores are better | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes in Adult ADHD Quality of Life Measure (AAQoL) | Range 29-145, higher scores are better | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes in Self Efficacy Scale (GSE-10) | Range 0-40, higher scores are better | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes in Assessment of Time Management Skills-Swedish (ATMS-S) Time management subscale | 11 items, reported as 0-100 ATMS units, higher scores are better | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes in Assessment of Time Management Skills-Swedish (ATMS-S), Organization and planning sub scale | 11 items, reported as 0-100 ATMS units, higher scores are better | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Change in Assessment of Time Management Skills-Swedish (ATMS-S), Regulation of emotions sub scale | 5 items, reported as 0-100 ATMS units, higher scores are better | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes in EuroQuality of Life - 5 dimensions - 5 levels (EQ-5D-5L): item scores | 5 items scored 1-5 | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Change in EuroQuality of Life - 5 dimensions - 5 levels (EQ-5D-5L): global score | One visual-analogue-scale answer (range 0-100), higher scores are better | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes in Continuous Performance Test (AX-CPT) | Measures cognitive flexibility. Will be done in conjunction with functional Magnetic resonance imaging (fMRI). | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes in GO/NoGO | Measures impulse control. Will be done in conjunction with functional Magnetic resonance Imaging (fMRI) | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes Affective Picture series (IAPS) | Measures emotion regulation. Will be done in conjunction with functional Magnetic resonance imaging (fMRI) | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes in blood hemoglobin levels (Hb) | Used to assess general health and to screen for conditions that affect red blood cells. Is measured in g/L. Low and high balus indicate worse outcome. | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes in blood platelet count (PC/TBK) | Used to assess general health and screen for conditions that affect blood platelets. Is measued in10*9/L. Low and high values indicate worse outcome. | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes in blood leukocyte count (WBC / LPK) | Used to Asses general health and screen for changes in white blood count. Is measured in 10*6/L. Low and high values indicate worse outcome | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes in plasma alanine transaminase levels (ALT /ALAT) | Part of the hepatic panel used to assess general health related to liver disease. Is measured in microkat/L. High values indicate worse outcome | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes in plasma aspartate aminotransferase levels (AST /ASAT) | Part of hepatic panel used to assess general health related to liver disease. Is measured in microkat/L. High values indicate worse outcome | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes in plasma thyroid-stimulating hormone levels (TSH) | Part of general health screening to assess the function of the thyroid hormone. Is measured in mIE/L. Low and high values indicate worse outcome | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes in plasma creatinine levels (Krea) | Part of a general health screening to assess the function of the kidneys. Is measured in micromol/L. High values indicate worse outcome | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes in serum sodium leves (s-Na) | Part of a general health screening to assess electrolyte balance. Is measured in mmol/L. Low and high values indicate worse outcome | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes in serum potassium levels (s-K) | Part of a general health screening to assess electrolyte balance. Is measured in mmol/L. Low and high values indicate worse outcome | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes in blood phosphatidylethanol levels (PeTH) | A test to assess alcohol overconsumption. Is measured in micromol/L. High values indicate worse outcome | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes in high-sensitivity plasma C-reactive protein levels (CRP-high sensitive). | Assesses general levels of inflammation in the body. Is measured in mg/L. High values indicate worse outcome | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes in blood interleukin- 6 levels (IL-6) | A marker of immune system activation. Is measured in ng/L. High values indicate worse outcome. | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes in blood hemoglobin A1c levels (HbA1c) | Assesses the level of sugar attached to hemoglobin and indicates the level of blood sugar of the past 2-3 months. Is measured in mmol/mol. High values indicate worse outcome | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes in total plasma cholesterol levels (cholesterol) | Assesses cardiovascular disease risk. Is measured in mmol/L. High values indicate worse outcome | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes in HDL plasma cholesterol levels (HDL-cholesterol) | Assesses cardiovascular disease risk. Is measured in mmol/L. High values indicate worse outcome | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes in LSL plasma cholesterol levels (LDL-cholesterol | Assesses cardiovascular disease risk. Is measured in mmol/L. High values indicate worse outcome | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 
| Changes in plasma triglyceride levels | Assesses cardiovascular disease risks. Is measured in mmol/L. High values indicate worse outcome | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Physical exercise, Cognitive support, Group intervention