Effects of a Multicomponent App-Based Exercise Program on Motor Skill Development in Children With Attention Deficit Hyperactivity Disorder: A Secondary Outcome Analysis of a Three-Arm Randomized Controlled Trial

Motor skill deficits are common in children with attention deficit hyperactivity disorder (ADHD), while traditional face-to-face exercise interventions are often limited by cost and accessibility. This secondary outcome analysis of a three-arm randomized controlled trial examined the effects of a multicomponent app-based exercise program on motor skill outcomes in children with ADHD. A total of 145 children aged 6-10 years were assigned to an app-based exercise group (Experimental Group 1, EG1; n = 53), a traditional offline exercise group (Experimental Group 2, EG2; n = 45), or a minimal-intervention control group (CG, n = 47). Both intervention groups received a 12-week program (3 sessions/week, 45-60 min/session) involving integrated physical and cognitive exercises, delivered either through a custom-developed WeChat applet ("LeDongYing") or through coach-led in-person sessions. Motor skills were assessed using the Test of Gross Motor Development, Third Edition (TGMD-3) for locomotor and ball skills, and the Movement Assessment Battery for Children, Second Edition (MABC-2) for manual dexterity, aiming and catching, and balance. Intervention effects were examined using linear mixed-effects models. Both EG1 and EG2 showed significant improvements across all motor skill domains (all p < 0.01), whereas the CG showed no significant changes. Pairwise comparisons showed that both intervention groups were superior to the CG on all motor skill outcomes (all p < 0.05), with no statistically significant differences between EG1 and EG2. These findings support the short-term efficacy of a multicomponent app-based exercise intervention for motor-test performance in children with ADHD compared with minimal intervention, suggesting potential as an alternative delivery when access to face-to-face exercise services is limited.