Exercise as it relates to Disease/Can physical activity and decreased sedentary behaviours reduce associated symptoms of ADHD?

This is a critique of the article titled 'Association of Symptoms of Attention-Deficit/Hyperactivity Disorder with Physical Activity, Media Time, and Food Intake in Children and Adolescents' by van Egmond-Fröhlich A, Weghuber D, de Zwaan M

What is the background to this research?
Attention Deficit Hyperactivity Disorder (ADHD) is a chronic neurodevelopmental disorder, often characterized by inattention, hyperactivity and impulsivity. ADHD is often diagnosed in childhood but symptoms can last well into adulthood, if left untreated can interfere with social and emotional as well as education and work. Children and adolescents with ADHD often show increased physical activity during the night and more evidently during work or school. Additionally children and adolescents are seen to be less likely to engage in vigorous physical activity and organized sports on a regular basis. Higher TV exposure is consequently met with higher rates of sedentary behavior, viewing of advertisements of high energy snacks as well as the consumption of said energy dense foods. Cross sectional studies have linked inattention and symptoms of ADHD to higher levels of media time successfully linking higher media times as a risk factor for subsequent inattention problems. Although there are many studies linking ADHD and obesity, there are few studies that draw associations between energy balance factors such as increased sedentary behaviors as well as decreased sedentary behavior, demonstrating the need for further studies in the area.

Where is the research from?
The study was published on November 14 2012 by:

1 Andreas W. A. van Egmond-Frohlich of the Department of Pediatrics, SMZ-Ost Donauspital, Vienna, Austria.

2  Daniel Weghuber from the Department of Pediatrics, Paracelsus Private Medical School, Salzburg, Austria.

3 Martina de Zwaan Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Germany.

The researchers declared there were no competing interests.

What kind of research was this?
The research conducted was a cross sectional population survey named KiGGS. The Robert Koch Institute of the Federal Ministry of Health has been running the ‘German Health Interview and Examination Survey for Children and Adolescents’ or KiGGS since 2003. The survey has collected comprehensive health data used to formulate health decisions federally as the cohort data is seen to represent the country as a whole.

What did the research involve?
The study involved 17641 adolescents and children aged 0-17 derived from 167 German communities. Data on screen time was collected via self reports and parental reports on average weekday screen time as well as average weekend screen time. Additionally, physical activity was also collected via self reports for medium to high intensity physical activity, this was measured in the questionnaire by the amount of time they really started to sweat or were out of breath.

Potential parental confounders were selected on their high Strengths and Difficulties Questionnaire as well as overweight status indicated by a previous study from the same database. In order to confirm these a general linear model was conducted with high Strengths and Difficulties Questionnaire candidates and the possible parental confounders as independent variables. Then an examination was undertaken in order to determine that possible parental confounders were independently linked to health behavioral outcomes. Health behavior outcomes were examined with the high Strengths and Difficulties Questionnaire scores with sex and age. All of the analysis and P values were found via SPSS statistics software.

What were the basic results?

 * The results of analysis found that of the children 5.2% were obese and 15.1% were overweight according to BMI scales.
 * conduct problems, emotional problems, peer problems, prosocial behavior were statistically notable with  high Strengths and Difficulties Questionnaire.


 * Higher prevalence of medium to high intensity physical activity and total energy consumption were negatively correlated with behavioral outcomes.

What conclusions can we take from this research?
The study showed significant correlation between ADHD symptoms with low diet quality as well as high total caloric intake. Additionally it found that food quality was more closely correlated with these behavioral symptoms more than food volume indicating that these symptoms are more to do with food selection. Moreover females demonstrated a significantly stronger correlation with dietary quality and volume with ADHD symptoms than males. The study also confirmed an independent association that  increased media time can consequently cause ADHD symptoms, another study finds a dosage of one hour or more had increased association with inattention and hyperactivity. In terms of physical activity the study found a weak but positive correlation with medium to high intensity exercise and the behavioral symptoms of ADHD.

Practical advice
In order to decrease ADHD symptoms among children and adolescents the children should eat a balanced diet including high in vitamins, minerals and other nutrients along with low amounts of unnecessary fats. Next limiting screen time to less than an hour on weekdays. Both these factors have been shown to decrease the behavioral symptoms of ADHD. Furthermore, extensive longitudinal research is needed to understand more comprehensively ways to decrease the symptoms of ADHD among children, adolescents and adults.

Further information/resources
The following links provide information and fact sheets about ADHD:


 * 1) Attention Deficit Hyperactivity Disorder (ADHD) in Children
 * 2) What is ADHD - ADHD Australia?
 * 3) Attention deficit hyperactivity disorder - ADHD/ADD symptoms, causes and diagnosis | health direct
 * 4) What Is ADHD? Where can I get help for ADHD in Australia? - ADHD Foundation