Exercise as it relates to Disease/Swimming training as a physical intervention for children with ADHD

The following is a critique on the scientific study Swimming training improves mental health parameters, cognition and motor coordination in children with Attention Deficit Hyperactivity Disorder published in the International journal of health Research in 2019.

What is the background to this research?
Attention deficit hyperactive disorder (ADHD) is a mental disorder effects approximately 7.2% or 129 million adolescents worldwide. This disorder impacts individuals in a wide range of areas including but not limited to their attention, executive function and motivation. As a result, individuals diagnosed with ADHD score significantly lower in attention and executive functioning tasks. The aim of this study was to analyse the effects of the exercise intervention of a swimming program on the mental health, cognition and motor coordination in adolescents diagnosed with ADHD. This study addresses the effects of chronic physical training on adolescents with ADHD. With the large percentage of adolescents diagnosed with ADHD, it is essential to develop easily implemented techniques that can minimise the impact of this disability on their development.

Where is the research from?
The fields of study amongst the authors were exercise psychophysiology, advanced aquatic exercise research group, exercise biochemistry in health, school of medicine, molecular iron metabolism, college of life science. Many of these same authors worked on a similar article using swimming as an intervention looking at mental health and functional autonomy for elderly diabetics.

The authors reported no conflict of interest; however, the study was funded from a scholarship where all the participants were students drawn from the same private catholic school in Brazil. Also, the authors thanked the undergrad students who participated from the local university funding this research, but their actual participation is unclear and undocumented.

What kind of research was this?
This study was a randomised control trial (RCT). An RCT is a type of scientific experiment where the participants are randomly divided into two groups, the experimental group will be administered the independent variable known as the intervention while the Control group will not be given the intervention. Both groups will be administered the dependent variable that will be used to determine the results.

In this study the participants were all adolescents between the ages of 11-14 years old and had been diagnosed with ADHD for more than 6 months. These participants were randomly assigned to either the trained (experimental) or untrained (control) groups. The study does not state what randomised allocation process was used for dividing the participants into the two groups. The dependent variable was the mental health, cognition, motor coordination and physical fitness tests. The independent variable was the intervention of the swimming program.

This level of evidence shows genuine correlations between exercise interventions on improving testing results for adolescents with ADHD. However, the statistical sample is small and this study is not representative of the global population due to all participants are from the same country and school, there is a noticeable gender imbalance within the study with 14/20 participants being male.

What did the research involve?
This study began with researchers first receiving consent from the parents of the participants. Next the researchers conducted a semi structured interview is accordance to the DSM-IV. The interview aimed to investigate the diagnosis of the adolescents ADHD, the parents and teachers also completed the Brazilian version of the questionnaire SNAP-IV(Mattos et al.). All of the participants were given a brief explanation of the study on the schools premises, then the participants undertook mental health, cognition, motor coordination and physical tests at the same time before and after 48hours of starting the program.

The adolescents in the intervention group participated in an 8 week swimming-learning program that ran two times a week for 45 minutes each, with a total of 16 sessions. The data from the tests conducted was recorded and present as means with standard deviations for error. It is unclear as to if the methodology used in this study was the best approach as it is not documented thoroughly enough for replication.

This study did not include a sample group of adolescents without ADHD to ensure that the results are related to those with ADHD. The study referred to their sample selection process as non-probability convenience sampling. This type of sampling is fast, cost-effective and is used for easy availability of the sample. Convenience sampling holds no consideration for sampling bias and is based solely on the subjective judgement of the researcher.

What were the basic results?
-       Significant increase in the trained (intervention) groups results when comparing the participants before and after testing scores in depression, stress, cognitive flexibility and selective attention.

-       There was no noticeable increase for either group for anxiety, balance and velocity tests.

-       Significant increase for trained (intervention) group in coordination tests of lower limb, lateral, flexibility and resistance abdominal tests.

The researchers interpreted these results as positive data indicating the swimming program as an effective intervention for adolescents with ADHD. The researchers highlighted the increases in testing results with little-to-no consideration to variables that might have swayed these figures. For example, the mean age was higher in the intervention group and the gender difference was very significant but not addressed at any point during this study. This study demonstrates the importance of physical activity for adolescents with ADHD but there is no exploration of any correlation suggesting that physical intervention wouldn’t show the same results for adolescents without ADHD.

What conclusions can we take from this research?
Physical activity interventions such as a swimming program does improve the mental health, cognition, motor coordination for adolescents with ADHD. There are many studies that outline the importance of physical activity for individuals with ADHD. A study conducted by Teresa Dail and Caroline Smith discusses the importance of swimming for children with disabilities such as ADHD. This Article highlights the benefits that swimming interventions have on the executive brain function, motor skills and physical fitness has on adolescents with ADHD.

Practical advice
Encouraging physical activity for adolescents with ADHD is important as it could improve their mental health, cognition and motor coordination. Physical activity has also shown to improve attention and focus which is essential for school age children. Exercise stimulates the production of dopamine to the body, this hormone assists with learning, memory, pleasurable sensations such as love and hope, and motor system function. People with ADHD present with a deficit of dopamine as their brain naturally doesn’t produce enough. A relatively simple way of acquiring dopamine is with a regular exercise routine as the brains dopamine levels can increase, assisting with motivation, etc within people diagnosed with ADHD.

Further information/resources
https://childmind.org/article/adhd-and-exercise/

https://www.mayoclinic.org/diseases-conditions/adhd/symptoms-causes/syc-20350889

https://www.cdc.gov/ncbddd/adhd/diagnosis.html