Physical activity offers mental health boost for children with neurodevelopmental disorders

Physical activity offers mental health boost for children with neurodevelopmental disorders | Image Credit: © fotosr52 - © fotosr52 - stock.adobe.com.

A new systematic review and meta-analysis published in JAMA Pediatrics revealed that physical activity interventions among children and adolescents with various neurodevelopmental disorders (NDDs) were associated with significant benefits to overall mental health.

These interventions could serve as an alternative, evidence-based approach to improve mental health, including psychological well-being, internalizing and externalizing problems, and cognitive function.

According to the study authors, NDDs “represent a new diagnostic category for a wide range of neurological and psychiatric disorders, including attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), intellectual disability, specific learning disorder, communication disorders, and motor disorders.”

Children affected by these NDDs are encouraged to be brought together in real-life treatment, though physical activity has only been examined in children and adolescents “with certain types of NDDs,” the investigators wrote.

Thus, the investigative team sought to examine the association of physical activity intervention with overall mental health in children and adolescents with NDDs. To do so, the team did a systematic search using Web of Science, PsycINFO, SPORTDiscus with full text, MEDLINE, CINAHL Complete, and ERIC from inception to May 2023.

Searches were limited to human-related, the English language, and peer-reviewed articles.

Nonrandmonized studies and randomized clinical trials that investigated physical activity-induced effects on mental health in children and adolescents aged 5 to 17 years who were diagnosed with NDDs were included. A pair of independent reviewers assessed and selected the studies.

Using Hedges g, a random multilevel meta-analysis was performed, with data extraction and risk-of-bias assessment conducted by multiple reviewers. If there were more than 3 effect sizes, the pooled effect sizes of subtopics that fell under each mental health subgroup would be calculated.

Positive effect sizes indicated the positive physical activity-induced effects and Hedges g was defined as less than 0.2 (small), 0.5 (moderate), or more than 0.8 (large). I² statistic indicated the degree of heterogeneity as small (≤25%), medium (50%), or large (≥75%). The 95% prediction interval (95% PI) of pooled effect size was also calculated “as an absolute measure of heterogeneity,” the authors noted.

Following study selection, a total of 76 studies that featured 3007 patients were included in the systematic review. Of these, 59 were used for meta-analysis.

Results demonstrated that physical activity interventions were associated with “significant benefits for overall mental health,” (g, 0.67 [95% CI, 0.50-0.85]). Benefits were also observed in cognitive functioning (g, 0.74 [95% CI, 0.53-0.95]), psychological well-being (g, 0.56 [95% CI, 0.16-0.96]), internalizing (g, 0.72 [95% CI, 0.34-1.10]), and externalizing problems (g, 0.58 [95% CI, 0.28-0.89]).

A moderate to large pooled effect size was observed for cognitive function (g, 0.74; 95% CI, 0.48 to 0.99; P < .001; 95% PI, −0.86 to 2.33). The pooled effect sizes for 6 subtopics that fell under cognitive functioning, of which were all significant, were:

• cognitive flexibility (g, 0.49; 95% CI, 0.31 to 0.66; P < .001)
• inhibitory control (g, 0.54; 95% CI, 0.18 to 0.91; P = .006)
• working memory (g, 0.40; 95% CI, 0.14 to 0.67; P = .007)
• high-level executive function (g, 0.83; 95% CI, 0.25 to 1.41; P = .01)
• complex attention (g, 1.47; 95% CI, 0.66 to 2.27; P = .002)
• behavior-rating executive function (g, 0.40; 95% CI, 0.14 to 0.65; P = .006)

A moderate to large pooled effect size was demonstrated for internalizing problems (g, 0.72; 95% CI, 0.34 to 1.10; P < .001; 95% PI, −0.77 to 2.21), derived from 26 effect sizes from 15 studies. Effect sizes for anxiety and depression and somatic complaints, 2 subtopics under internalizing problems, were examined:

• anxiety and depression (g, 0.81; 95% CI, 0.31 to 1.32; P = .003)
• somatic complaints (g, 0.29; 95% CI, −0.79 to 1.37; P = .37)

For externalizing problems, a moderate pooled effect size was observed based on 22 sizes from 14 studies (g, 0.58; 95% CI, 0.28 to 0.89; P < .001; 95% PI, −0.37 to 1.54). Conduct disorders and oppositional defiant disorders were 2 subtopics under externalizing problems:

• conduct disorders (g, 0.61; 95% CI, 0.19 to 1.04; P = .008)
• oppositional defiant disorders (g, 0.38; 95% CI, −0.02 to 0.79; P = .06)

Overall, analysis of several moderators “showed that type of [NDD] did not modify the associations between physical activity and overall mental health or its subgroups,” the study investigators revealed.

Physical activity could serve as an alternative or adjunctive, evidence-based approach to boost overall mental health, the study authors concluded. Findings suggest that children and adolescents with NDDs “may be grouped together when performing physical activity interventions, which were confirmed to be beneficial to overall mental health and its subgroups in this new diagnostic population, but that physical activity interventions should be tailored when targeting different mental health domains.”

Reference:

Liu C, Liang X, Sit CHP. Physical activity and mental health in children and adolescents with neurodevelopmental disorders: A systematic review and meta-analysis. JAMA Pediatr. Published online January 29, 2024. doi:10.1001/jamapediatrics.2023.6251