Ease Your Symptoms with Sweat Equity

Ready to trade some time and effort for greater focus and calm? Regular exercise gives an amazing return on investment.

long, skinny graphic shows how exercise, nutrition, and cutting down on screen time can improve focus and help manage ADHD symptoms.

Being calmer and more focused is one of the happy consequences of exercise.

   
 

Hooked on a Feeling

It seems that about one-third of people with ADHD use aerobic exercise to treat the condition. The trade-off seems to be three or four hours or more of attention, productivity, and good mood for every hour engaged in aerobic exercise.

The benefits of exercise for this sub-population of ADHDers go well beyond the stress relief and endorphin rush experienced by the other two-thirds of people with ADHD who exercise. For this sub-group, the benefits are often equal to the effect from stimulant medication, in terms of their ability to remove the impairments of ADHD for extended periods of time. Aerobic exercise kicks off endorphins in just about everyone. For this group, though, exercise has become central to how they manage their ADHD nervous symptoms and their life.

All sports require self-discipline, which is greatly needed in a patient population that is defined by impulsivity. One study on the benefits of exercise on ADHD compared children who did not exercise to kids who did aerobic exercise and to a third group who did aerobic exercise and a martial art. The third group did best, but the aerobic group did much better than the sedentary group. The benefits went beyond helping kids burn off extra energy. All aspects of ADHD improved with aerobic exercise.

This is not to say that medication has no role to play. Medication can be another compensation for this group, allowing them the flexibility of not exercising as rigorously when their day gets busy. Medication can also help with symptom management when they can't exercise at all due to weather, injury, or advancing age. The more symptom strategies a person has, the better. —WILLIAM DODSON, M.D.

 
   

A fellow psychiatry professor came in for treatment after overhearing me talk about an ADHD case study at a party. "I think you described me," he said, and launched into a highly intellectual rendition of his own history. Charles, I'll call him, was the classic absentminded professor, wearing glasses and unkempt tweed, and he knew a lot more about psychiatry than I did.

The twist to Charles's story is that he had been a marathon runner who had blown out his knee. He became depressed when he was forced to set aside his passion. That's also when he noticed the symptoms of ADHD. He explained that he would have a tantrum if his girlfriend interrupted his writing, or yank the phone out of the wall if it rang while he was trying to concentrate. He was slipping out of touch with his friends. He fit the profile, and we decided to put him on ADHD medication. It helped.

Charles was on antidepressants when he came to see me, but once he finished physical therapy and started training again, he dropped them because he felt so much better. As he closed in on his old fitness level, he became convinced that the ADHD medication was holding back his performance.

He decided to try a few days without the ADHD medication, and he found that as long as he was training, he could focus. Looking back on it, we recognized that his attention hadn't hampered him before because he had always been a serious runner. Without a steady diet of exercise during his injury, he'd been unable to control his attention the way he needed to. Exercise had a powerful effect.

Most people instinctively know that exercise burns off energy. Any teacher who has dealt with a hyperactive child will tell you that kids are much calmer after recess. Being calmer and more focused is one of the happy consequences of exercise. Given the leading role of dopamine and norepinephrine in regulating the attention system, the broad scientific explanation for how exercise tempers ADHD is that it increases these neurotransmitter levels. It does so immediately. With regular exercise, we can raise the baseline levels of dopamine and norepinephrine by spurring the growth of new receptors in certain brain areas.

In the brain stem, balancing norepinephrine in the arousal center also helps. "Chronic exercise improves the tone of the locus coeruleus," says Amelia Russo-Neustadt, M.D., Ph.D., a neuroscientist and psychiatrist at California State University. The result is that we're less prone to startle or to react out of proportion to any given situation. We feel less irritable.

Next: I've Always Been Known as the Troublemaker

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