Currently submitted to: JMIR Serious Games
Date Submitted: May 24, 2026
Open Peer Review Period: May 27, 2026 - Jul 22, 2026
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Exergaming as a Potential Digital Therapeutic (DTx) for ADHD: A Meta-Analysis Proving Consistent Efficacy Regardless of Medication Background
ABSTRACT
Background:
Attention-Deficit/Hyperactivity Disorder (ADHD) is primarily characterized by deficits in core executive functions (EF)—inhibitory control, attention, and working memory—which lead to decreased academic achievement and social adaptation issues.
Objective:
This study aimed to systematically evaluate the efficacy of exergame interventions on EF in children(mean age 8.3~11.5) with ADHD and to investigate the moderating effect of medication status to provide a scientific basis for digital therapeutics (DTx).
Methods:
Following PRISMA guidelines, a meta-analysis was conducted on randomized controlled trials (RCTs) published between 2018 and 2025. Using CMA 2.0 software, pooled effect sizes (Hedges' g) were calculated based on a random-effects model.
Results:
Significant improvements (p < .05) were observed across all domains: inhibitory control (g = -0.408), attention (g = -0.328), and working memory (g = 0.634). Notably, moderator analysis revealed no significant difference between groups in inhibitory control based on medication status (Q = 0.002, p = .961), demonstrating comparable improvement in drug-naive children. While heterogeneity was low for inhibitory control and attention, working memory showed a moderate level (I2 = 54.451%), suggesting variance due to the sensitivity of measurement tools.
Conclusions:
These findings demonstrate that exergames are an effective non-pharmacological intervention applicable regardless of clinical background. Specifically, the robust effect observed in working memory (g = 0.927) establishes a scientific foundation for designing evidence-based DTx for children with ADHD.
Citation
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