Better Cardiorespiratory Fitness in ADHD Positively Related With Mental Health Status

There is a link between CRF levels and mental health in patients with ADHD.

Cardiorespiratory fitness (CRF) levels in patients with attention-deficit/hyperactivity disorder (ADHD) were related, in part, with mental health status. Results of this cross-sectional study were published in the Journal of Attention Disorders.

Young adults (N=72) with (n=36) and without (n=36) ADHD were recruited for this study between 2020 and 2022 in Canada. Participants underwent CRF testing using the 6-minute walk test (6MWT) and perceived CRF was evaluated by asking participants what they thought their current aerobic fitness level was. Fitness was related with ADHD outcomes assessed using the Conner’s Adult ADHD Rating Scale (CAARS) and the Depression Anxiety and Stress Scale (DASS) instruments.

This study included individuals with a mean age of 21.0 (SD, 3.0) years and 75% were women. Among the ADHD group, 67% were taking ADHD medications.

The ADHD group had significantly higher CAARS (mean, 79.86 vs 49.14 points; P <.001), depression (mean, 13.69 vs 5.69 points; P <.001), stress (mean, 17.94 vs 9.75 points; P <.001), and anxiety (mean, 12.19 vs 6.08 points; P =.001) scores compared with controls, respectively. These values indicated that fewer of the ADHD group had normal levels of depression (39% vs 86%), anxiety (36% vs 72%), and perceived stress (47% vs 81%) than controls, respectively.

[P]articipants with ADHD had poorer mental health than neurotypical controls.

The ADHD and control cohorts reported their CRF was excellent (6% vs 17%), very good (28% vs 42%), good (44% vs 31%), fair (14% vs 8%), and poor (8% vs 3%), respectively. The overall perceived CRF level did not differ significantly between groups (P =.10). Estimated CRF was also similar among participants with ADHD (mean, 41.55 points) and controls (mean, 42.35 points; P =.43).

In the linear regression analysis, estimated CRF was related with stress (β, -0.27; P =.03) and perceived CRF was related with stress (β, -0.42; P <.001), depression (β, -0.35; P <.01), and anxiety (β, -0.28; P =.02).

The relationship between higher perceived CRF and levels of depression was significantly moderated by group (b, 7.39; P =.01). Perceived CRF was not moderated by group for the outcomes of anxiety (P =.26) or stress (P =.10).

Within the ADHD group, medication moderated anxiety (b, 7.84; P =.02) and stress (b, 8.40; P =.01) outcomes.

The major limitation of this study was not performing the gold-standard CRF test for maximal oxygen consumption (VO2 max).

These data indicated that young adults with ADHD who had poorer mental health may also have worse CRF than their counterparts. The study authors concluded, “[P]articipants with ADHD had poorer mental health than neurotypical controls. However, having higher fitness was associated with better mental health. Specifically, among those with less severe ADHD symptoms, higher CRF was associated with less depression, anxiety, and perceived stress.”


Ogrodnik M, Karsan S, Heisz JJ. Mental health in adults with ADHD: examining the relationship with cardiorespiratory fitness. J Atten Disord. 2023;10870547231158383. doi:10.1177/10870547231158383