An expert and two women on how exercise could help ADHD

Bridie Wilkins

30 September 2024 at 6:32 am·18-min read

adhd and exercise — An expert & two women on how exercise helps ADHDJordi Salas - Getty Images

Research shows that 2.6 million people in the UK have been diagnosed with ADHD, while only 8.2% of the UK population is taking ADHD medication. Perhaps an indicator of underdiagnosis, or, as some experts say, a sign that GPs are increasingly prescribing exercise in place of a pack of pills.

As psychiatrist and ADHD specialist Dr Kampers says, movement works on your brain in the same way that medication does. ‘I get my ADHD patients to think of exercise as an essential component of their treatment — something that makes it easier to sustain mental focus for extended periods of time,’ he says.

Science corroborates his approach. One study showed that physical exercise could contribute to a significant improvement in anxiety and depression associated with ADHD, while another found that as little as ten minutes of cycling or yoga could reduce impulsive ADHD tendencies (i.e., reacting spontaneously or rashly), and a third showed that short-term aerobic exercise could mitigate symptoms including reduced attention span, hyperactivity, impulsivity, anxiety and executive function disorders.

‘Exercise is one of the bests gifts you can give an ADHD brain,’ Dr Kampers adds. ‘It increases blood flow to your brain, stimulating the release of brain-derived neurotropic factor (BDNF), which promotes the growth of new brain cells (neurons). This keeps your brain operating at peak efficiency, which typically suffers as a symptom of ADHD.’

Here, we share exactly what each type of exercise could do for ADHD and how, along with the stories of two women who, after being diagnosed with ADHD, now swear by exercise to alleviate their symptoms.

What is ADHD?

‘Attention-deficit/hyperactivity disorder (ADHD) is a disorder characterized by difficulties with inattentiveness, hyperactivity, or impulsivity,’ says Dr Kampers. ‘ADHD symptoms may be identified as early as three years of age and can continue throughout development and into adulthood.’

How is ADHD diagnosed?

Dr Kampers signposts the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for definition of the specific symptoms and diagnostic criteria for ADHD.

He tells me that in order to be diagnosed with ADHD:

Symptoms must be present for ≥6 months in ≥2 settings, which include, but are not limited to, school, home, and work.
Symptoms must hinder one’s academic performance, social skills, and/or occupational functioning.
Symptoms must be present prior to the age of 12 and must not occur due to other psychiatric disorders (e.g., anxiety disorder, personality disorder).
In those <17 years of age, 6 or more symptoms must be present for each ADHD subtype. For those ≥17 years old, 5 or more symptoms must be present for diagnosis.

‘Based on symptoms and presentation, individuals can be classified as having ADHD inattentive type, hyperactive/impulsive type, or combined type. For combined type, criterion for both inattentive and hyperactive/impulsive type must be met over the past 6 months.’

Of course, the best port of call is your GP, as you may well fall outside of the criterion listed above, but still show signs of ADHD.

How does exercise help ADHD?

The benefits of exercise for ADHD may or may not seem obvious – it tires you out and keeps you active, right? – but there are specific mechanisms that explain exactly how it could help. Buckle up for the deets.

How does exercise promote dopamine, and how does this help ADHD?

As my chat with Dr Kampers continues, he’s keen to assert that ‘the core symptoms of ADHD result from abnormalities in various prefrontal cortex circuits [parts of your brain, in other words], and/or the dysregulation of dopamine and noradrenaline.’ I know that dopamine and noradrenaline are types of neurotransmitters, both of which ‘play leading roles in regulating your attention span’, according to Dr Kampers, but I’m not sure how exercise can help.

‘With regular physical activity, you can raise the baseline levels of dopamine and noradrenaline by spurring the growth of new receptors in certain brain areas, which increases the production of dopamine and noradrenaline,’ he tells me, with research proving so.

'The more complex the exercise you do, the better, as this also increases the tone of something called your locus coeruleus, which is your brain stem’s arousal centre. The more aroused this is, the more noradrenaline you will produce. The result is that you feel less irritable, and less likely to react out of proportion to any given situation, which can be a common symptom of ADHD.’

We’ll come onto what qualifies as ‘complex exercise’ below but think anything that stimulates your brain or requires a ‘skill’, such as yoga, martial arts, or even resistance training (learning new exercises is a skill, guys).

How does exercise improve cognitive function, and how does this help ADHD?

What do we mean by cognitive function? Learning, thinking, reasoning, remembering, problem solving, decision making, and attention span all come under this very large umbrella.

‘These are all improved by blood flow to your brain,’ Dr Kampers explains. ‘The better your blood flow, the more able your brain is to change its activity in response to internal or external stimuli, meaning you’ll have improved executive function, which can struggle as a symptom of ADHD.’

Studies show that exercise improves blood flow in the following way: ‘Your large arteries and veins stiffen slightly with reduced blood flow, but regular exercise counteracts this stiffening of your vascular system and prevents any cognitive symptoms. Both aerobic exercise (longer duration, lower intensity), and anaerobic (short duration, higher intensity) exercise can improve your vascular function,’ says Dr Kampers.

What’s more, noradrenaline – that neurotransmitter we were harping on about above – is responsible for producing something known as your alpha-2A adrenergic receptor (ADRA2A), which is a neurotransmitter needed for cognitive function. And as we know, exercise promotes the production of noradrenaline. Sure enough, one study found a link between increased exercise and better executive function.

How does exercise normalise BDNF function, and how does this help ADHD?

A succinct Brain Derived Neurotrophic Factor (BDNF) definition: ‘The master molecule in your brain, responsible for learning and memory,’ says Dr Kampers.

‘It has been shown that exercise can enhance the concentration of BDNF in your brain, which correlates with better memory,’ Dr Kampers adds. The existing research on how this works suggests there are various mechanisms at play; one showing that exercise induces the expression of certain proteins in your brain which are consistent with elevated BDNF levels, and another study proved that aerobic exercise increased BDNF concentrations in your body.

Dr Kampers adds that the benefits last beyond the length of your workout, too. ‘There is evidence for an increase in resting concentrations of peripheral blood BDNF after exercise intervention,’ he says.

How does exercise regulate mood, and how does this help ADHD?

You're probably all familiar with the ''exercise = endorphins = happy' concept. This also runs true in an ADHD context, but there’s more to it.

‘Exercise has a positive effect on your limbic system – the part of your brain involved in behavioural and emotional responses – as it helps regulate your amygdala – the structure in your brain that plays a part in emotional control, memory and learning,’ Dr Kampers explains. ‘With ADHD, your amygdala blunts the hair-trigger responsiveness a lot of people experience, and evens out the reaction to a new source of stimulus, making us more responsive and less reactive.’

He adds that, besides endorphins, exercise releases a molecule called endocannabinoids, which when released into your bloodstream, can help you feel ‘deeply relaxed’.

Best exercise for ADHD

Take the above subheading with a pinch of salt; as you’ll understand once you’ve read this whole article, there isn’t necessarily a ‘best exercise for ADHD’. It’s more about what you enjoy, but if you’re wondering where to start, read on for Dr Kampers’ words of wisdom.

How is aerobic exercise good for adults with ADHD?

Dr Kampers says: ‘Aerobic exercise increases BDNF concentrations in your body. When you are in your aerobic heart rate range (between 70 and 80% of your max heart rate) for most of the time in any sporting activity, it boosts your cognitive abilities and makes it easier to absorb new moves and strategies.

‘Aerobic exercise also elevates your neurotransmitters dopamine and noradrenaline, creates new blood vessels, with an increase in growth factors, and encourages the formation of new cells in your brain.

‘Do any aerobic activity two or three times per week — jogging, riding a bike, or playing a sport that involves sprinting or running.’

How is resistance training good for adults with ADHD?

‘Resistance training is a skill. You’re learning new movements, and the resistance means more demand on your attention and judgement, in order for you to maintain control within every exercise’ says Dr Kampers. ‘All of this exponentially increases the complexity of the activity, which beefs up your brain’s infrastructure.’

How is yoga good for adults with ADHD?

‘Yoga is a complex skill activity which strengthens and expands your brain’s networks. The more complex the movements in your yoga sessions, the more complex the synaptic connections. These new, stronger connections are recruited to help you think and learn more efficiently,’ Dr Kampers says.

‘Yoga also promotes mindfulness. Mindfully paying attention to your breath and body can increase focus, calm racing thoughts, and improve self-regulation,’ he adds.

Not a yoga fan? Dr Kampers says rock climbing, karate, Pilates, gymnastics, and figure skating all offer the same benefits.

How is HIIT good for adults with ADHD?

‘HIIT combines aerobic activity with a skill activity,’ says Dr Kampers. ‘It improves both your cardiovascular system – as I’ve mentioned, more blood flow to your brain via exercise means better cognitive function – and brain function as you are required to learn a new skill in each exercise.’

How is boxing good for adults with ADHD?

‘Boxing involves complex motor skills, which improves your levels of brain-derived neurotrophic factor (BDNF) most dramatically, and sparks the growth of new receptors in your brain, responsible for regulating how you react and respond to internal and external stimuli,’ says Dr Kampers.

‘Boxing means working on your balance, timing, sequencing, evaluating consequences, switching, error correction, fine motor adjustments, inhibition, and, of course, intense focus and concentration,’ Dr Kampers adds.

‘As a survival-avoiding sport, it also activates your fight-or-flight response, which means you are forced to learn the skills needed to box as efficiently as possible. As far as your brain is concerned, it’s do or die.

‘You will also be in the aerobic range most of the time during a boxing session, which boosts your cognitive abilities and makes it easier to successfully learn new moves and strategies.’

How often should adults with ADHD exercise and why?

‘I recommend a minimum 30 minutes of aerobic exercise a day,’ says Dr Kampers. He cites a particular study: ‘MRI scans show that walking as few as three days a week for six months increased the volume of the prefrontal cortex - needed for efficient cognitive function - in older adults with ADHD.’

Are there any types of exercise adults with ADHD should avoid and why?

‘Not really – even prolonged, strenuous workouts raise bloodstream levels of endorphins, which help diminish pain while boosting feelings of well-being,’ Dr Kampers tells me.

Is exercise a viable form of treatment for ADHD patients?

If Dr Kampers has anything to do with it, absolutely.

‘I explain to every one of my ADHD patients that exercise boosts levels of dopamine and noradrenaline,’ he tells me. ‘For most of my patients, I suggest exercise as a tool to help them manage their symptoms, along with their medication.

‘The best strategy is to exercise in the morning, and take the medication about an hour later, when the immediate focusing effects of exercise begin to wear off. With many of my patients, if they exercise daily, they often need a lower dose of stimulant medication.

‘Exercise promotes a structure and sets the right tone for the day. I advise my patients who need medication to take it at the point when the effects of exercise are wearing off, to get the most benefit from both approaches.

‘The spike in dopamine and noradrenaline after an exercise session, lasts about 60 to 90 minutes, with a feeling of calm and clarity.

‘Participating in a variety of activities will prevent you from getting mentally burned out, which is especially important for maintaining focus if you have ADHD.

‘It is most beneficial to include a combination of aerobic and resistance training to maximise overall health benefits.’

Two women share how exercise has helped them manage ADHD

Rosie Turner, 33, a Pilates, yoga and ADHD coach shares her story.

‘Exercise saved my life. I was struggling so much before I found yoga. In a paper named ‘The Misunderstandings of ADHD’, the author shares a study from Los Angeles that states a that the ADHD suicide rates with ADHD are 3 in 4, which is truly devastating.

‘I know my mental health struggles were due to untreated ADHD and because I was unaware of what my brain needed in order for me to work with it. I was always chasing unhealthy dopamine hits, which would then lead to extreme lows and an unhealthy lifestyle. Finding exercise meant my brain was now getting its dopamine from something that was enriching my life in so many ways. I made better life choices and finally started to take some form of control of my life.

‘People always joked about my ADHD tendencies. My life was a whirlwind of chaos – a Vegas proposal, married and divorced before 27 (and that is just one of the more tame stories!). Chaos felt normal, the pursuit of extreme highs was in my nature as I sought out more fun, more friends and more achievements. But these highs didn't bring fulfilment; I blamed my lifestyle of heavy partying and as I was in my 20s, decided that was the reason.

‘During a trip to the Philippines, I discovered yoga and meditation. It was life-changing and for the first time, things started to feel better. I was more present, focused and had a new armour of tools to help me emotionally. However, this new self-awareness brought a new realisation that there was still something that was unbalanced – and I couldn’t blame hangovers anymore.

‘Returning from the Philippines, I started to become so aware of how extremely sensitive I was to rejection, and it was hard to ignore my impulsive actions, job changes, unstable relationships, constant boredom, misplacing belongings daily. I acted when things turned dangerous - leaving hobs on, doors unlocked and important bills unpaid. After a series of brain scans (sounds extreme but that’s how convinced I was that something wasn’t right), I naturally began to google symptoms when those scans came back clear. ADHD was highlighted front and centre and hit all of the symptoms I presented.

‘I filled out some forms from the doctors and heard nothing for 18 months. By the time I heard back in 2021, I was living in Amsterdam and was referred to an online Psychiatrist, who diagnosed me with Extreme Combined ADHD.

‘I became hyper-focused on all things ADHD, and the more I learned the more I could not believe how much ADHD impacted every area of my life. I spent weeks in tears thinking how lost I used to be and never feeling good enough. When in fact most, if not all, of the things that led me to believe I was unintelligent, unstable, and unreliable was due to having a brain that was uniquely wired.

‘I was lucky enough to find the exercise that worked for me (yoga) and my ADHD brain before I was diagnosed so I already had something to work with.

‘I do most of my workouts in the morning and the reason for this is to do with my ADHD. To get us to be motivated to tasks or have a productive day – we don't do the hard thing first, we have to have fun first. We have to ignite our brains. Now, I do reformer Pilates, yoga, walking and boxing every week.

‘Do I take medication? I was never interested in it; I never even took a painkiller when I had a headache. But when I started my Untangled podcast, I heard stories of how medication changed people’s lives, so I started taking a stimulant medication at a very low dose of 30mg as I had some big life transitions. I was leaving the home I had bought with an ex-partner, starting a new and fast-growing business (I teach reformer Pilates at Power Pilates UK and yoga and host my podcast) and experiencing early menopause symptoms, and I was struggling with my sleep. I decided that maybe I should see if the medication could help me.

‘It has; I haven’t misplaced a belonging in seven weeks! I haven't experienced any procrastination, and I remain calm and focused despite working on my business alongside a busy teaching schedule every day.

‘Exercise is life-changing for those with ADHD as we don’t retain dopamine, which is why we struggle to focus, act impulsively, and are more likely to have a struggle with addiction. Studies show that on average we lose around 13 years of our life expectancy due to our struggles.

'I believe if we can start to have a better self-care routine that involves exercise that we enjoy, we can start to have a regular hit of healthy dopamine to support our ADHD brain instead of working against it. This is what will help us live more fulfilling lives. I am grateful every single day for finding exercise that I loved because I truly believe I wouldn't be here without it.’

Rosie is hosting an ADHD reformer Pilates class on 29th October 2023 at Power Pilates UK in Beckenham, Kent.

India Bailey, 31, a PT and Technogym coach shares her story.

'I was diagnosed with combined ADHD when I was 18. It took me quite some time to get diagnosed; I had been showing symptoms throughout high school, although I didn't really understand what they meant. Teachers would always write on my report cards, “India has so much potential, you know, she has the capabilities to do anything. But she simply gets too distracted. She’s always talking. She isn't attentive in class, but when she does work, it's almost like half finished.” It made sense when I was diagnosed, and the process was pretty straightforward as I had been seeing psychiatrists for a while.

‘As for exercise, I used to be an athlete but that didn't work out as I suffered an injury which meant I had to leave the sport, so I headed to university. It was then that I began to treat exercise in a different way. I started to work out to look good in a bikini, or for my next trip. For the first time, I began to use exercise as a form of punishment. It was all superficial; always about how I wanted to look. I knew I needed to turn this around, and I decided to become a coach, which is where I'm at now, as a talent trainer for Technogym, and an in-person coach in London.

‘I’m the most present I ever am when teaching a class, because it's not about me and my internal dialogue. It's about who I’m teaching, and I've realised that that is the only time I'm in this state.

‘I used to take medication, but I no longer do, thanks to exercise. I felt like it stunted my creativity. I felt like it stunted who I was and didn't allow for my full spectrum of colours to show. Yes, there are moments where I'm like, “Woah, I need something because this is getting out of control.” But I've learned to manage these moments with exercise, whether I’m working out myself or coaching. I'm omnipresent in my classes, and I try to carry that feeling outside of my classes or when I’m teaching.

‘More than anything, I use exercise as a tool to combat certain emotions and feelings that come up with ADHD. I know that I need to calm down, because I always want to move at a million miles per hour, which is my hyperactivity in play. My goal now is to learn to slow down, which exercise helps me do.

‘Fitness has been the biggest blessing of my life. High-intensity exercise works particularly well for me; it allows me to release all of my excess energy, and I always feel clear-headed afterwards. It’s because of fitness that I no longer rely on medication. Fitness allows me to connect with my body and to understand what it's trying to tell me.’

Read now: How to practise self-compassion and become more confident

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