Exercise: An Alternative Approach to the Treatment of ADHD

Steve Putnam and Stuart A. Copans

Theories abound to explain the rapid increase in the diagnosis and treatment of ADHD. It has been argued that the increase is due to an increased awareness of the condition, that it is a side effect of television programming with five- to fifteen-second sound bites, or that it is due to decreased parenting in single-parent families or in families with two working parents. Some people point to food additives, and others to the increasing sugar content of children's diet in the Western world. Scientologists blame it on a shared psychiatric-pharmacological conspiracy. Whatever the cause, however, most agree that it is an increasing problem.

Among these possible explanations, there is a slowly emerging body of literature that suggests at least part of the increased frequency of ADHD diagnoses may be due to the decreased physical activity seen in American and Canadian children (Alexander, 1990; Allen, 1980; Bass, 1985). At the present time, over 50% of these children ride a school bus to school. The average child in the United States today sits in front of a television for six to eight hours a day. Even children's sports, which were daily and self-organized in the 1950s, have been replaced by organized sports run by adults, in which the time sitting on the bench far exceeds the time playing.

Theoretical and Experimental Support for Exercise’s Connection to ADHD

There is some theoretical and also some experimental support for the notion that exercise may improve attention and learning (Allen, 1980; Bass, 1985). Part of the theoretical support comes from a new field called evolutionary medicine, in which theoreticians try to understand the evolutionary underpinnings of common problems. Some things we now consider diseases actually served a useful function at the time they evolved. For example, while sickle cell anemia is an illness in the Western world, it protected people from malaria in Africa where it evolved. It has been suggested that the high activity level and the scanning of the environment that characterize ADHD may have been functional in an environment where noticing potential food or predators was actually an important function (Jensen et al., 1997). It has also been suggested that experiential learning, which was the primary mode of learning up until recent history, was usually associated with motor activity, not with the need to sit still for long periods of time.

Experimental work has followed two different approaches. First, experiments in laboratory animals have suggested a possible model for ADHD. Dopamine, one of the important neurotransmitters (chemicals that nerves use to communicate with one another), appears to play an important role in ADHD. Rats given a dopamine blocker early in life appear more hyperactive and also appear to be slower learners (Shaywitz et al., 1976). In other studies, exercise has been shown to lead to increases in dopamine (Bliss & Ailion, 1971). Finally, people with ADD have been found to have lower levels of homovanillic acid (a breakdown product of dopamine) in their urine (Post, 1973).

Another second group of experimental studies has gone directly into the classroom to study the effect of exercise on children:

In two classroom studies (Allen, 1980; Bass, 1985), researchers compared student classroom behavior on days that students jogged with days they did not jog. Running improved attention span and impulse control, and it decreased the number of disruptions by 50%. The beneficial effects of running appeared to last from two to four hours.
For her dissertation, Elsom (1980) studied the effects of exercise on four hyperactive boys. Her research suggested that light aerobic exercise had effects comparable to low doses of stimulant medication. In all four subjects, exercise led to substantial improvements in attention as well as significant decreases in depression.
Shipman (1985) found that jogging decreased hyperactivity and impulsivity. He also found that students who were taking stimulant medication required less medication when they were jogging regularly. Again, exercise was found to have its most obvious effects during the first two to four hours after jogging.

Exercise as an Intervention

Given the evidence that a regular school-based program of physical exercise may lead to fewer children with symptoms of ADHD, and to lower stimulant doses for those who still need medication (Klein & Deffenbacher, 1977; Elsom, 1980; Shipman, 1985), it seems reasonable to ask whether one intervention for ADHD might be a program of regular physical exercise.

While at first glance, the idea of a class jogging together may sound impractical, there are teachers like Jill Allen (1980) who have run with their classes for years. ln Allen's class, daily 10-minute jogs improved fitness, reduced stress, allowed students to be successful, and improved their self- concepts. Students were allowed to walk, jog, or run on a one-third mile track alone, with a friend, or with the teacher. While Allen and her students motivated classmates with verbal encouragement to keep going, students competed only against themselves. From the warm-up to the beginning of class, the jog took only 15 minutes.

However, exercise need not be restricted to school. It can be incorporated into a student’s life at home as well. For example, the mother of a seven-year-old who was having both behavior and academic problems at school worked out a plan to run with him to and from school each day. He was also involved in swimming on a regular basis and in other extracurricular sports. Once the exercise program was started, the boy’s grades and behavior both improved significantly.

Studies of college athletes have shown that they get higher grades in the semesters they are involved in sports than the semesters they are not. Until recently, it had been assumed that this was due to their need to be more organized and efficient because of the relative lack of time for study during the semesters they were practicing and playing. It may well be, however, that those higher grades were actually related to their regular exercise and the consequent increase in their ability to concentrate.

How to incorporate exercise into a classroom or home routine

The following recommendations can be helpful to anyone who would like to try incorporating exercise into their classroom, agency, or home routine:

Approval. Teachers or youth workers wishing to integrate exercise into a classroom or agency routine obviously need approval from their administrations and need to be willing to jog with their students.
Background knowledge. Knowledge of warm-up and cool-down procedures, as well as age-appropriate physical limitations, are important. For example, a five-minute warm-up, such as walking, not only prevents strained muscles and increases the heart rate to adequate levels, it makes the mental transition to jogging easier. A five-minute cool-down (walking and stretching) will lower students” heart rates and loosen their muscles.
Timing. Since the effects of exercise usually last from two to four hours, students should run before classes begin and ideally at mid-day as well.
Track. A quarter-mile track is an ideal setting, because each child can run at his or her own speed while the entire class can be monitored and supervised. The running surface should be smooth.
Duration. The duration of exercise that has been used has varied from l0 to 45 minutes.
Intensity. The intensity of the exercise should be mild to moderate. While jogging, children should be able to carry on a normal conversation. If they are running so fast or are so out of breath they cannot talk, they are running too fast or too far. Longer workouts also require knowledge of running at appropriate intensities for the best physical and mental effects. An increase in irritability and depression from over-training and fatigue would obviously be counterproductive in the classroom.
Clothing. Students need suitable running or walking shoes that absorb shock. While there are fabrics that “wick out" sweat, a moderate l0- to 15-minute jog should not require expensive, “high tech" clothing. In winter, cold temperatures, snow, and ice may make indoor work- outs necessary.
Water. Teachers who want to conduct longer workouts with their students need to make drinking water available and should be able to recognize heat stroke and heat exhaustion (both avoidable conditions if students are hydrated and adequately trained).
Choice. Children cannot be forced to exercise, but the joy of setting and achieving goals, supplemented perhaps by the judicious use of photos, praise, or awards when children reach personal milestones, is generally more than enough motivation.

Promising but Unproven
Although clearly, additional studies are needed, there is significant data to suggest that periods of regular exercise, every two to four hours, might lead to improvements in the functioning of children with ADHD in school: For some children, it might lead to lower required doses of stimulant medication and, for others, to improved functioning without medication. In any case, it is an area in which additional studies are urgently needed.

REFERENCES

Alexander, J. L. (1990). Hyperactive children: Which sports have the right stuff? The Physician and Sports Medicine, 18(4), 105-107.

Allen, J. I. (1980, Winter). Jogging can modify disruptive behaviors. Teaching Exceptional Children, 66-70.

Bass, C. K. (1985). Running can modify classroom behavior. Journal of Leaming Disabilities, 18(3), l6(k161. '

Bliss, E. L., & Ailion, J. (1971). Relationship of stress and activity to brain dopamine and homovanillic acid. Ly–e Sciences, 10(1), 160-161.

Elsom, S. D. (1980). Selfmanagement of hyperactivity: Children “s use ofjogging. UMI Dissertation Services.

Jensen, P. S., Mrazek, M. D., Knapp, P. K., Steinberg, L., Pfeffer, C., Schowalter, J., & Shapiro, T. (1997). Evolution and revolution in child psychiatry: ADHD as a disorder of adaptation. Journal of the American Academy of Child and Adolescent Psychiatry; 36(12), 1672-1679.

Klein, S. A., & Deffenbacher, J. L. (1977). Relaxation and exercise for hyperactive, impulsive children. Perceptual and Motor Skills, 45, 1159-1162.

Shaywitz, B. A., et al. (1976). Selective brain dopamine depletion in developing rats: An experimental model of minimal brain dysfunction. Science, 191, 305-308.

Shipman, W. M. (1985). Emotional and behavioral effects of long-distance running on children. ln M. L. Sachs & G. W. Buffone (Eds.), Running as therapy (pp. 125-137). Lincoln, NE: University of Nebraska Press.

This feature: Putnam, S. and Copans, S.A. (1998). Exercice: An Alternative Approach to the Treatment of ADHD, Reaching Children and Youth, 2(2) pp.66-68