Exercise & Green Time

Sweat Equity

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

An ADHD adult exercising on the beach to combat symptoms
An ADHD adult exercising on the beach to combat symptoms

A fellow psychiatry professor came in for treatment after overhearing me talk about an attention deficit disorder (ADHD or ADD) 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.

[Daily Exercise Ideas that Build Focus]

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.

Sam’s Story

“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.

[The Neuroscience of Movement]

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 Exercise Prescription

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.

John Ratey, M.D., is a member of the ADDitude ADHD Medical Review Panel.