Low Fitness and ADHD: an additional comorbidity?

It is well known that depression and obesity are comorbidities highly prevalent in ADHD patients (Cortese et al., 2016; Michielsen et al., 2013). Given that obesity and depression are closely related with a lower physical fitness level, it is reasonable to think that a poor physical fitness could potentially be a novel, less studied, comorbidity associated with ADHD.

Physical fitness is a set of attributes related to a person’s ability to perform physical activities that require aerobic fitness, endurance, strength or flexibility and and also makes reference to a full range of psychological qualities (Ortega, Ruiz, Castillo, & Sjöström, 2008). Epidemiological studies have consistently demonstrated that being physically fit have a crucial role in overall health status. In fact, Ortega, Silventoinen, Tynelius, & Rasmussen (2012) observed in more than one million of Swedish adolescents than those who had low muscle strength had a higher risk of being diagnose with a psychiatric in the future disorder and to die due to suicide.


Information about physical fitness levels in ADHD patients compared with age-matched controls is scarce. Jeoung (2014) found that those university students with low muscular strength and muscular endurance were more likely to have ADHD than those with greater muscular strength and endurance. Children with ADHD had lower performance on aerobic capacity using a field shuttle run test (Verret, Gardiner, & Beliveau, 2010). Harvey & Reid (2003) indicated on their systematic review that children with ADHD are at risk for poor levels of physical fitness. In contrast, Golubović, Milutinović, & Golubović, (2014) found no differences on physical fitness among children with and without hyperactivity.

Although the information is limited, there seems to be emerging evidence suggesting that a low fitness level could be another comorbidity of ADHD, yet further study on this is warranted. CoCA project includes measures of cardiorespiratory fitness and muscular fitness, and will provide new and fresh data about the relationship of fitness with ADHD symptomatology and comorbidities. Waiting for the results of the CoCA project!


Adrià Muntaner-Mas, Antonio Martínez-Nicolás and Francisco B. Ortega

The PROFITH research group: http://profith.ugr.es/

University of Granada, Spain.




Cortese, S., Moreira-Maia, C. R., St Fleur, D., Morcillo-Peñalver, C., Rohde, L. A., & Faraone, S. V. (2016). Association between ADHD and obesity: A systematic review and meta-analysis. American Journal of Psychiatry.

Golubović, Š., Milutinović, D., & Golubović, B. (2014). Benefits of physical exercises in developing certain fitness levels in children with hyperactivity. Journal of Psychiatric and Mental Health Nursing, 21(7), 594–600.

Harvey, W. J., & Reid, G. (2003). Attention-deficit/hyperactivity disorder: A review of research on movement skill performance and physical fitness. Adapted Physical Activity Quarterly. Retrieved from

Jeoung, B. J. (2014). The relationship between attention deficit hyperactivity disorder and health-related physical fitness in university students. Journal of Exercise Rehabilitation, 10(6), 367–71.

Michielsen, M., Comijs, H. C., Semeijn, E. J., Beekman, A. T. F., Deeg, D. J. H., & Sandra Kooij, J. J. (2013). The comorbidity of anxiety and depressive symptoms in older adults with attention-deficit/hyperactivity disorder: A longitudinal study. Journal of Affective Disorders, 148(2–3), 220–227.

Ortega, F. B., Ruiz, J. R., Castillo, M. J., & Sjöström, M. (2008). Physical fitness in childhood and adolescence: a powerful marker of health. International Journal of Obesity (2005), 32(1), 1–11.

Ortega, F. B., Silventoinen, K., Tynelius, P., & Rasmussen, F. (2012). Muscular strength in male adolescents and premature death: cohort study of one million participants. BMJ, 345, e7279.

Verret, C., Gardiner, P., & Beliveau, L. (2010). Fitness level and gross motor performance of children with attention-deficit hyperactivity disorder. Adapted Physical Activity Quarterly : APAQ, 27(4), 337–351.





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