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Studies in children and adolescents with Attention-Deficit-Hyperactivity-Disorder (ADHD) have shown that physical exercise can improve the core symptoms of ADHD; inattention and hyperactivity. For adults, the evidence is deficient and there is a great need to investigate whether adults have the same effect on ADHD symptoms of physical exercise, as children and young people have. Adults with ADHD often have a sedentary lifestyle and suffer from obesity and have sleep problems. In a normal population, these problems have been shown to be affectable with physical exercise. START (Support in Activity, Movement and Exercise) is a randomized controlled intervention study where physical exercise is given for 12 weeks, with or without cognitive support. The effect is measured with rating scales as well as cognitive and physical tests. The purpose is to investigate whether START works as a treatment for ADHD in terms of ADHD symptoms and disability, and what impact the intervention has on mental health, physical condition and activity level, body awareness and everyday functioning.
Outcome measures are registered within 3 weeks before and after the end of treatment, after 6 months and 12 months. The randomization takes place in three groups; physical exercise (i), physical exercise and extra cognitive support (ii), and control group on waiting list (iii).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Physical training | Experimental | Medium-high-intensity physical training 3 times a week, 60 min / time for 12 weeks. |
|
| Physical training combined with cognitive support | Active Comparator | Medium-high-intensity physical training 3 times a week, 60 min / time for 12 weeks. The cognitive support consists of person centred individual occupational therapy. |
|
| Control group | No Intervention | The control group receive no intervention. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Physical training | Behavioral | Medium-high-intensity physical training 3 times a week, 60 min / time for 12 weeks, consisting of fitness, strength and mobility exercises with a target level of 60-90% of maximum heart rate. Two sessions per week take place in a group led by a physiotherapist and once a week the training consists of self-chosen training individually or in group. |
| Measure | Description | Time Frame |
|---|---|---|
| Changes in Clinical Global Impression-Improvement (CGI-I) | Assess total improvement on a Richter scale. Range 1-7, Higher scores mean worse outcome | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start |
| Changes in Adult ADHD Self-Report Scale (ASRS-v.1.1) | Range 0-72, higher scores mean worse outcome | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start |
| Measure | Description | Time Frame |
|---|---|---|
| Changes in Cardio Respiratory Fitness | Measured in millilitre per kilogram per minute with the Ekblom-Bak test, a submaximal exercise test. Higher value means better outcome | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start |
| Changes in Balance |
| Measure | Description | Time Frame |
|---|---|---|
| Changes in Cortical thickness | Structural Magnetic resonance imaging (MRI) | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Mussie Msghina, Assoc.Prof | Örebro University and Regional Örebro County | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Öppenvårdspsykiatrisk mottagning, Universitetssjukhuset Örebro | Örebro | Örebro County | 70116 | Sweden |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 41244864 | Derived | Svedell LA, Lindvall MA, Holmqvist KL, Cao Y, Msghina M. Physical exercise as add-on treatment in adults with ADHD - the START study: a randomized controlled trial. Front Psychiatry. 2025 Oct 30;16:1690216. doi: 10.3389/fpsyt.2025.1690216. eCollection 2025. | |
| 37749523 | Derived | Lindvall MA, Holmqvist KL, Svedell LA, Philipson A, Cao Y, Msghina M. START - physical exercise and person-centred cognitive skills training as treatment for adult ADHD: protocol for a randomized controlled trial. BMC Psychiatry. 2023 Sep 25;23(1):697. doi: 10.1186/s12888-023-05181-1. |
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Data will be shared with researchers within the research group only.
Data will become available from study start to the end of the study
To get access the person have to be involved in all parts of the study. Access is decided by PI. Access to data is password protected in accordance with the European General Data Protection Regulation (GDPR).
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| ID | Term |
|---|---|
| D001289 | Attention Deficit Disorder with Hyperactivity |
| D009043 | Motor Activity |
| ID | Term |
|---|---|
| D019958 | Attention Deficit and Disruptive Behavior Disorders |
| D065886 | Neurodevelopmental Disorders |
| D001523 | Mental Disorders |
| D001519 | Behavior |
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| ID | Term |
|---|---|
| D064797 | Physical Conditioning, Human |
| ID | Term |
|---|---|
| D015444 | Exercise |
| D009043 | Motor Activity |
| D009068 | Movement |
| D009142 | Musculoskeletal Physiological Phenomena |
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|
| Physical training combined with cognitive support. | Behavioral | Medium-high-intensity physical training 3 times a week, 60 min / time for 12 weeks, consisting of fitness, strength and mobility exercises with a target level of 60-90% of maximum heart rate. Two sessions per week take place in a group led by a physiotherapist and once a week the training consists of self-chosen training individually or in group. The cognitive support consists of person centred individual occupational therapy with focus on daily time management skills and planning and organisation in daily life, i.e. make time for physical exercise. The number of session during the intervention period depend on the participants needs and is estimated to 4-6 sessions. |
|
Measured with Flamingo test. The test person is standing on the preferred leg on a low balance profile for 60 seconds. The number of times that the test person puts his/her foot to the ground is counted. Lower value means better outcome |
| Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start |
| Changes in Body Mass Index | Weight and height will be measured in kilograms and centimeters, and combined to report BMI in kg/m^2. Lower value means better outcome | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start |
| Changes in Abdominal Circumference | Measured with a measuring tape in centimeters. Lower value means better outcome | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start |
| Changes in Body Awareness | Body Awareness Scale - movement quality and experience (BAS MQ-E). Higher value means better outcome. | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start |
| Changes in Blood pressure | Both systolic and diastolic blood pressure will be measured in mm Hg with a blood pressure monitor on the arm. | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start |
| Changes in Satisfaction with Daily Occupations-Occupational Balance (SDO-OB) activity score | Range 0-17, higher scores are better | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start |
| Changes in Satisfaction with daily occupations and occupational balance (SDO-OB) satisfaction score | Global satisfaction score, range 1-5, lower scores are better | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start |
| Changes in Canadian Occupational Performance Measure (COPM) perfomance score | Range 5-50, higher scores are better | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start |
| Changes in Canadian Occupational Performance Measure (COPM) satisfaction score | Range 5-50, higher scores are better | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start |
| Changes in Adult ADHD Quality of Life Measure (AAQoL) | Range 29-145, higher scores are better | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start |
| Changes in Self Efficacy Scale (GSE-10) | Range 0-40, higher scores are better | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start |
| Changes in Assessment of Time Management Skills-Swedish (ATMS-S) Time management subscale | 11 items, reported as 0-100 ATMS units, higher scores are better | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start |
| Changes in Assessment of Time Management Skills-Swedish (ATMS-S), Organization and planning sub scale | 11 items, reported as 0-100 ATMS units, higher scores are better | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start |
| Change in Assessment of Time Management Skills-Swedish (ATMS-S), Regulation of emotions sub scale | 5 items, reported as 0-100 ATMS units, higher scores are better | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start |
| Changes in EuroQuality of Life - 5 dimensions - 5 levels (EQ-5D-5L): item scores | 5 items scored 1-5 | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start |
| Change in EuroQuality of Life - 5 dimensions - 5 levels (EQ-5D-5L): global score | One visual-analogue-scale answer (range 0-100), higher scores are better | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start |
| Changes in Continuous Performance Test (AX-CPT) | Measures cognitive flexibility. Will be done in conjunction with functional Magnetic resonance imaging (fMRI). | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start |
| Changes in GO/NoGO | Measures impulse control. Will be done in conjunction with functional Magnetic resonance Imaging (fMRI) | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start |
| Changes Affective Picture series (IAPS) | Measures emotion regulation. Will be done in conjunction with functional Magnetic resonance imaging (fMRI) | Pre-intervention, post-intervention (12 weeks) and 3, 6 and 12 months after intervention start |
| 37255729 | Derived | Svedell LA, Holmqvist KL, Lindvall MA, Cao Y, Msghina M. Feasibility and tolerability of moderate intensity regular physical exercise as treatment for core symptoms of attention deficit hyperactivity disorder: a randomized pilot study. Front Sports Act Living. 2023 May 15;5:1133256. doi: 10.3389/fspor.2023.1133256. eCollection 2023. |
| D055687 |
| Musculoskeletal and Neural Physiological Phenomena |