How Exercise Can Turn the Tide in ADHD

By Dr. Allison Smith, ZRT Laboratory

“Our sons were both diagnosed with ADHD by kindergarten. More than just dealing with the disciplinary and academic issues at school, my husband and I struggled to maintain a productive and nurturing household with the kids having regular meltdowns and outbursts. Our ability to connect with them became compromised. We were at our wits’ end considering medications and home school.

We turned inward and analysed our habits and routines. One thing we noticed with both the boys was that a strict routine in the mornings and evenings seemed to help, and that physical interventions — getting them outside, running them around, engaging them in a physical activity — worked best to correct behavioural problems. There were particularly frenetic times when we would take them to the track at the local middle school and have them run laps. The more we intervened in that way, the fewer the outbursts and behaviour issues and, ironically, the better they slept.

We figured if we were all involved in a healthy movement regimen, it would be more of a lifestyle than a penalty. We became a running family. We started with an early morning jog around our neighbourhood before school and work — all of us, the whole family. At ages 8 and 5, our boys loved it. The results were immediate. Behaviour at home and at school improved drastically, our parent-teacher conferences became a pleasure, and even their little personalities shifted from quick emotion to much more flexibility and understanding. Not only are our kids not on stimulants or antidepressants, we all feel fit and healthy and we get to do it together every day.”

I find this case and others like it fascinating. How can such a simple lifestyle change make such an impact on ADHD outcome? It turns out, there are a number of reasons.

Understanding ADHD: What’s Happening in the Brain and Body

ADHD, with its many subtypes, affects the lives of around 10% of American children. Inattentive type, hyperactive/impulsive type and the combined type all have their own clinical features, but children with ADHD in general may have problems with controlling impulses, concentrating, focusing, sleeping, sitting still, paying attention and listening. Inappropriate emotional outbursts can present and anger is often associated.

A diagnosis typically leads to a trial of medications to “wake the brain up” and increase concentration and focus. The most popular drugs for ADHD today are stimulants such as amphetamine-salts (Adderall) and methylphenidate (Ritalin) — both work to increase norepinephrine and dopamine activity in the brain. Atomoxetine (Strattera) increases serotonin and norepinephrine activity. All of these drugs excite the brain and carry similar common side effects despite their unique mechanisms of action.

Daydream-State Brain Waves

EEG studies have shown that there may be different brain wave patterns in different subtypes of ADHD. The theme, however, seems to be a higher ratio of theta to beta waves than in a non-ADHD brain [1]. Theta waves are normally higher during sleep just before waking, while beta waves are highest when we are concentrating and processing information. So a child with ADHD is literally asleep at the wheel when expected to concentrate and function at school.

Low Sympathetic Tone and Neurotransmitter Imbalances

Urinary phenethylamine (PEA) tends to be low in children with untreated ADHD [2]. As a modulator of norepinephrine transmission in the central nervous system, PEA enhances sympathetic tone — the baseline function that enables our bodies to appropriately react to stressors and provides the terrain for brain activity, wakefulness and concentration. This low urinary PEA is more often than not seen in concert with low urinary dopamine in patients with ADHD.

Urinary dopamine, norepinephrine and PEA give us information about sympathetic tone — and when it is low, it explains much of the symptomatology associated with ADHD. The result of effective treatment, whether conventional or alternative, is to raise dopamine, serotonin and PEA levels in the urine. Our Neurotransmitter Testing (Dried Urine Spot) measures dopamine, serotonin, norepinephrine, PEA, GABA, glutamate and other key neurotransmitters — providing a detailed biochemical picture of the imbalances commonly seen in ADHD.

Abnormal Stress Response and Cortisol Dysrhythmia

The urinary diurnal rhythms of free cortisol, norepinephrine and epinephrine are often dysfunctional in ADHD, and HPA axis dysfunction is common in the inattentive type [3]. When these diurnal markers are out of rhythm, symptoms such as anxiety, nervousness, insomnia and that “over-tired” burned-out emotional feeling start to emerge. Typically, a child with combined-type ADHD will show elevated or normal pooled cortisol levels with an abnormal diurnal rhythm, low norepinephrine with an inverted diurnal rhythm, and high pooled epinephrine with an inverted diurnal curve.

To assess whether adrenal and cortisol dysrhythmia may be contributing to ADHD symptoms, our Adrenal Stress Profile (Saliva) measures cortisol at four time points across the day alongside DHEA-S — revealing whether the stress hormone rhythm is disrupted in ways that compound attention and behavioural difficulties.

Hyperexcitation and Neurotoxicity: The Glutamate–GABA Balance

Urinary glutamate may be elevated alongside a functionally low urinary GABA in children with ADHD who have the perfect storm of diet and susceptible biochemistry. Glutamate is one of the major “on-switches” in the brain, and its rise may represent either a compensatory mechanism in ADHD to counter low sympathetic tone, or simply the result of genetic mutations leading to glutamatergic dysfunction. In either case, taking steps to protect the brain from neurotoxicity as a result of overexcitation is key to good clinical outcomes.

Outside the brain, GABA is synthesised in the adrenal glands and acts as the gatekeeper of norepinephrine and epinephrine synthesis — an important modulator of the stress response. Assessing the balance between GABA and norepinephrine/epinephrine may be even more telling than absolute levels alone. For a comprehensive view of both adrenal hormones and neurotransmitters, our Stress & Adrenal Imbalance testing page explains the full range of tests available and how they work together.

Why Exercise Works for ADHD

The Science Behind Physical Activity and the ADHD Brain

It turns out there is a therapy that can rouse the ADHD brain and raise PEA and norepinephrine levels to improve sympathetic tone — and it is not administered in a pill. It is exercise. Physical activity for ADHD has been well studied:

• An 8-week yoga intervention twice a week for 40 minutes significantly improved cognitive inhibition and attention in children with ADHD [4].
• The FITKids Trial (2014) found that children engaged in a 9-month afterschool physical activity programme performed significantly better on attention and cognitive inhibition testing than their wait-listed counterparts [5].

The key take-home points from the research are:

• Exercise changes brain waves and improves cognitive inhibition in children with ADHD [6, 7, 8].
• Exercise improves sympathetic tone [9, 10].
• Exercise influences glutamate and GABA balance in the brain and body [11, 12].

Exercise Is Not a Punishment — It Is a Gift

To teach our children the power of exercise is to give them a tool for life. For children with ADHD, you could be empowering them to modulate their moods and impulses with something they can control. I hope that parents searching for answers beyond supplements and medications — or who seek adjunct lifestyle therapies for children already managed on medications — consider talking to their paediatricians about incorporating physical activity into the regimen.

Exercise supports cardiovascular, mental, immune and endocrine health — and it raises the levels of hormones like oxytocin and neurotransmitters in the body that make us feel closer and more connected. It is exactly the physical help families need to work together through some of the more difficult challenges of ADHD [13, 14, 15].

References

1. Markovska-Simoska S, Pop-Jordanova N. Quantitative EEG in Children and Adults With ADHD. Clin EEG Neurosci. 2017;48(1):20–32.
2. Kusaga A. Decreased beta-phenylethylamine in urine of children with ADHD and autistic disorder. No To Hattatsu. 2002;34(3):243–8.
3. Randazzo WT, et al. The stress response in adolescents with inattentive type ADHD symptoms. Child Psychiatry Hum Dev. 2008;39(1):27–38.
4. Chou CC, Huang CJ. Effects of an 8-week yoga program on sustained attention in children with ADHD. PeerJ. 2017;5:e2883.
5. Hillman CH, et al. Effects of the FITKids Randomized Controlled Trial on Executive Control and Brain Function. Pediatrics. September 2014.
6. Wang CH, et al. The relationship between aerobic fitness and neural oscillations during visuo-spatial attention. Exp Brain Res. 2015;233(4):1069–78.
7. Gutmann B, et al. Effects of physical exercise on individual resting state EEG alpha peak frequency. Neural Plast. 2015;2015:717312.
8. Mierau A, et al. Acute exercise induces cortical inhibition and reduces arousal in response to visual stimulation in young children. Int J Dev Neurosci. 2014;34:1–8.
9. Wigal SB, et al. Catecholamine response to exercise in children with ADHD. Pediatr Res. 2003;53(5):756–61.
10. Robinson AM, et al. Physical exercise affects attentional orienting behavior through noradrenergic mechanisms. Behav Neurosci. 2015;129(3):361–7.
11. Streeter CC, et al. Effects of yoga versus walking on mood, anxiety, and brain GABA levels. J Altern Complement Med. 2010;16(11):1145–52.
12. Herbst EAF, Holloway GP. Exercise increases mitochondrial glutamate oxidation in the mouse cerebral cortex. Appl Physiol Nutr Metab. 2016.
13. Sasaki T, et al. Decreased levels of serum oxytocin in pediatric patients with ADHD. Psychiatry Res. 2015;228(3):746–51.
14. Hew-Butler T, et al. Acute changes in endocrine and fluid balance markers during exercise. Eur J Endocrinol. 2008;159(6):729–37.
15. Elbe AM, et al. The importance of cohesion and enjoyment for the fitness improvement of 8–10-year-old children. Eur J Sport Sci. 2017;17(3):343–350.

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Originally by Dr. Allison Smith, ZRT Laboratory. Reproduced with permission. Last reviewed: May 2026.