Associations between accelerometer-measured physical activity and sleep duration and health indicators in children and adolescents with attention-deficit hyperactivity disorder: A systematic review and meta-analysis.

Objective: This systematic review and meta-analysis synthesized available studies to explore relationships between accelerometer-measured physical activity (PA) levels or sleep duration and health-related outcomes in children and adolescents with attention-deficit hyperactivity disorder (ADHD). Methods: Following the Preferred Reporting Items for Systematic Review and Meta-analyses guidelines, the six databases APA PsychInfo, CINAHL Ultimate, Embase, MEDLINE, SPORTDiscus with Full Text and Web of Science were searched from inception through July 2024. The correlation coefficient (r) was employed to determine the effect size in the meta-analysis. A random-effects model was utilised to estimate the potentially heterogeneously distributed effect sizes with a 95 % confidence interval (CI) between groups. Statistical heterogeneity was assessed using I 2 , with a p-value derived from Q statistics. Results: Thirteen eligible studies were included, involving 738 children and adolescents with ADHD (71.1 % boys). The health indicators assessed were executive functions (EFs), motor development, psychological health, and core ADHD symptoms. We found that higher PA levels (i.e., moderate-to-vigorous physical activity [MVPA]) (k = 9, r = 0.36, 95 %CI 0.22 to 0.49) with medium heterogeneity (Q = 13.006, I 2  = 38 %, p = 0.112), and longer sleep duration (k = 6, r = 0.20, 95 %CI 0.06 to 0.35) with medium heterogeneity (Q = 7.495, I 2  = 33 %, p = 0.186), were significantly correlated with better overall EFs. Additionally, MVPA was negatively associated with psychopathology (k = 5, r = -0.19, 95 %CI -0.35 to -0.03) with medium heterogeneity (Q = 8.058, I 2  = 50 %, p = 0.089) in children and adolescents with ADHD. Conclusion: The findings provide support for significant relationships between PA levels (i.e., MVPA) and sleep duration with overall EFs and MVPA with psychopathology in children and adolescents with ADHD. It is recommended that future studies conduct moderation analyses to examine factors that affect the generalisability of the findings, such as age, sex, and ADHD subtypes. However, these analyses could not be conducted in the current meta-analysis due to the limited number of included studies.