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"I've Always Been Known as the Troublemaker."


"I have always been known in the family as the troublemaker, and spent most of my childhood in the doghouse and the dunce's corner," says Sam, a 36-year-old venture capitalist who came to see me to understand his challenges, which were manifesting themselves in his son.

Sam is no dunce, but like many others with ADHD, his erratic behavior led everyone around him to label him as stupid or stubborn or spoiled. He didn't want his son to suffer the same shame, and he was now seeking help at the encouragement of his business partner and his wife. "Neither understands how I function with so much chaos in my life," he told me.

Chaos, high drama, deadline pressure — acute stress in any form acts like a drug for Sam's brain. His letter to me outlining his history acknowledges that he had disciplinary problems because he didn't deal well with authority figures and that he got into drugs at age 14. Yet he wasn't a delinquent. When he turned 16, his parents forbade him from getting his driver's license until he shaped up, and he boosted his GPA from 1.5 to 3.5 almost overnight. Proof, many would argue, that his teachers were right: He just needed to try.

But the problem with Sam wasn't his attitude. ADHD stems from a malfunction of the brain's attention system. Let's look at one element of the attention system: motivation. While it's true that people with ADHD "just need to get motivated," it's also true that, like every other aspect of our psychology, motivation is biological. What about the child who can't pay attention in class but can sit perfectly still for hours playing a video game? Or the woman who spaces out when her husband is talking but has no trouble focusing on magazine gossip about Brad and Angelina? Obviously, they can pay attention when they want to, right? Not exactly. If we were to look at functional MRI scans of the brains of these people, we would see differences in activity at the reward center in each situation. The reward center doles out pleasure or satisfaction signals to the prefrontal cortex, providing the motivation to focus.

The stimulation that will activate the reward center enough to capture the brain's attention varies from person to person. What wound up working for Sam was the rigid structure and rigorous physical activity of college athletics — and the desire to prove to everyone back home that he wasn't stupid. "I believe participating in a sporting regimen which required five a.m. practice sessions allowed me to see that I could function better in all endeavors," he wrote.

Now he runs several miles every morning and is a partner in a venture capital firm. He schedules important work and meetings early in the day, when he can still feel the calming effects of his morning run, knowing that he gets progressively more scattered as the day goes on.


The best strategy is to exercise in the morning, and then take medication about an hour later, which is generally when the immediate focusing effects of exercise begin to wear off. I try to do my workout first thing in the morning, both for the structure it affords and to set the right tone for the day. A lot of times, that keeps me going. And once I get into the intensity of conducting therapy sessions, it's easy for me to hyperfocus. Researchers haven't quantified how long the spike in dopamine and norepinephrine lasts after exercise, but anecdotal evidence suggests an hour or more of clarity.

The truth is, everyone has a different level of attention deficit, and you'll have to experiment to see what works for you. If you want a minimum, I would say 30 minutes of aerobic exercise a day. It's not a lot of time, considering that it will help you focus long enough to make the most of the rest of your day.

Excerpted from Spark, by JOHN J. RATEY, M.D. Copyright © 2008 by John J. Ratey, M.D. Reprinted with permission of Little, Brown and Company, New York, N.Y. All rights reserved.

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TAGS: Exercise and ADHD, Alternative Treatments for ADHD

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