Cardio is ADHD Medicine
You are feeling worse than you need to if you aren’t doing aerobic activities.
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In my deepest, darkest bouts of depression, I wasn’t working out at all.
Despite the well-intentioned advice of loved ones and medical experts to “get some exercise, it will help you feel better,” I couldn’t get myself out of the house — I didn’t see the point. I figured that my lack of motivation was a result of the depression itself.
At the beginning of 2023, I was ready to emerge from one of those deep dark bouts, so I committed to the 52 Hike Challenge. Because I’d had transformative experiences with hiking in the past (including a 5-month hike on the Pacific Crest Trail and a successful 52 Hike Challenge in 2017), I trusted that time on the trails would help rehabilitate me.
I didn’t understand the science. I just had some vague thoughts around freedom from societal expectations, reconnecting with my physical form, and basking in beautiful scenery.
At first, motivating myself to step out the door and begin the hike in the first place was painfully difficult, but I began to notice little upticks in my mood and attitude after the first 10–15 minutes of walking. And while I can’t say that I was necessarily happy right away, the less-depressed-than-before aura stuck with me for a few days after each hike.
As I got stronger and rebuilt my endurance, the onset of the mood boost came earlier and earlier.
By the time March rolled around, I was motivated to prepare for each hike and was excited just thinking about it. The “medicine” was working. I began to wonder: Was I more motivated to be active because the depression was lifting, or was the depression lifting because of the exercise I was getting?
In July, my endurance and confidence had increased so dramatically that I was seeking out huge doses of hike-medicine on multi-day backpacking trips and 10–12 mile day hikes.
July was also the month I discovered that I have ADHD. Relieved by the neuroscientific explanation for all my major struggles in life (including the pandemic-induced pit of despair I’d just climbed out of), I dove into the research to learn about lifestyle factors like food, exercise, and nature time.
In exploring the treatment options beyond medication, I wanted to know:
How does exercise impact a person’s experience of ADHD?
How could ADHD-friendly fitness strategies help ease our symptoms and improve our quality of life?
The research is clear: aerobic activity is a proven method of treatment for ADHD.
It also helps prevent and heal from depression and anxiety, both of which we’re often plagued by.
Cardio does the same thing that meds do.
According to this article, ADHD “is an impulse disorder with genetic components that results from imbalances of neurotransmitters” including dopamine, GABA, norepinephrine, and serotonin.
ADHD medications (stimulants) work by increasing the number of neurotransmitters in the brain.
Depression symptoms like hopelessness, indifference, and persistent sadness are related to imbalances of neurotransmitters including acetylcholine, dopamine, GABA, glutamate, norepinephrine, and serotonin.
Depression medications like SSRIs and SNRIs work by increasing the number and/or availability of neurotransmitters in the brain.
Anxiety symptoms including irritability, restlessness, and difficulty concentrating are linked to imbalances in neurotransmitters dopamine, GABA, norepinephrine, and serotonin.
Anxiety medications work by increasing the activity and/or the number of neurotransmitters in the brain.
Guess what aerobic activity does?
It increases the number, activity, and availability of neurotransmitters in the brain.
We need aerobic activity to feel “normal.”
Let’s be clear: all humans need aerobic exercise. Our bodies and minds rely on it to balance out all our systems and function on Planet Earth as the upright apes we are.
But for those of us with highly sensitive nervous systems and/or “atypical” neurotransmitter function, aerobic exercise is non-negotiable. Without it, we aren’t able to access the brain functions that enable us to think clearly, make good decisions, take action on important tasks, manage our time appropriately, or make sense of our emotional experiences.
In all of the groups around the country that are trying to develop cognitive therapies, they often use aerobic exercise as another type of therapy. For example, Art Kramer’s group at the University of Illinois-Champaign has done aerobic exercise quite a bit, and they can find it just as effective as cognitive therapy at improving executive function — just straight-up aerobic exercise.
-Mark D’Esposito, M.D.
For reasons perhaps best explained by the Hunter-Farmer Theory popularized by Thom Hartmann, some of us are biologically unable to follow the orders of a society that insists on productivity, consistency, profitability, and the expectation to remain sedentary 23 hours a day while pursuing those values.
As a result of the astonishingly fast cultural evolution of the human species and subsequent environmental changes, particularly in the last 10,000 years, ADHD traits have become maladaptive in present-day societies, and are therefore evolving to meet the demands of current environments.
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When we try to assimilate, we get very sick: depressed, anxiety-ridden, emotionally volatile. Our bodies, too, get distressed by the toxic combination of mental anguish and physical inactivity, resulting in chronic pain, autoimmune conditions, hormonal imbalances, high blood pressure…the list goes on.
How do we resolve this?
Medications offer a superficial solution, allowing us to feel and act more like the “typical” folks who seemingly aren’t harmed by these societal demands, but meds only work while we’re taking them. As soon as we stop, we plummet right back into the same overwhelm and destitution we were in before.
While many of us do require meds to function in our mismatched environment, the best long-term, sustainable solution is to live more closely to the ways our ancestors lived. Whether we take meds or not, we can balance our own brain chemistry by doing the things that we are biologically designed to do, like aerobic activity.
Can exercise alone treat ADHD?
Physical capabilities obviously play a role here, but even the ablest of ADHDers won’t want to rely on cardio alone as their only treatment, primarily because we live in a society that isn’t set up for us to just scamper around outside all day long, smelling flowers, climbing mountains, listening for critters, and gathering little objects of interest. (Doesn’t that sound absolutely delightful though?)
More often, cardio makes sense as one part of a greater plan — first for the initial recovery of living untreated, next for the ongoing maintenance of ADHD — and it’s a crucial part of the plan.
Because exercise is a self-directed activity, it positions the ADHDer as an influential and empowered manager of their own body and brain, rather than the defective victim of a disorder who relies on external substances to fix them.
The confidence that results from a regular cardiovascular exercise routine cannot be emphasized enough. Building strength, endurance, and skill in a physical endeavor also brings self-awareness and deepens the mind-body connection that so many of us have lost.
How to begin a new ADHD-friendly exercise routine
Before you go embarking on any new physical pursuits, take a deep breath and remember: it’s healthy to take it slow. If you haven’t been exercising regularly, or haven’t tried a specific type of activity before, don’t overdo it.
Start where you are. Not where you want to be. Not where you know you’re capable of being. Not where you once were before years of office job/before children/before recent health crisis.
It’s so tempting for us to go rocketing into something new when we’re excited about it, but our bodies need time to limber up and build strength so we don’t injure ourselves and end up right back on the couch, scrolling through the socials and watching other people do the thing we now cannot do because we went hurdling into it 11/10 and got hurt.
Don’t let an injury be the reason you have to stop doing something you enjoy that’s good for you.
What are the best exercises for ADHD?
Cardiovascular exercise, also known as aerobic exercise, is the kind that gets your heart pumping, makes you sweat, and deepens your breath. While there is scientific evidence supporting both anaerobic and aerobic exercise as helpful methods for ADHD management, cardio is the kind that more powerfully balances your brain chemistry.
A single session of exercise can lead to immediate improvements in ADHD symptoms and cognitive functions.
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The best cardio exercise for ADHD is the one you enjoy. You won’t stick with it if you don’t like it (you know this to be true) so let your instincts and interests guide you toward the best activities for you.
Neuroscientist and ADHD expert Dr. Daniel Amen suggests, “Walk like you’re late for 45 minutes, four to five times a week.”
Some other ideas:
Dance or Zumba
HIIT or Tabata
Running or jogging
Bicycling
Swimming
Hiking
Hiking is my personal favorite (no surprise here!) and it deserves a little bit of extra attention, because spending time in nature offers us extra relief in addition to all the benefits of the other activities on the list.
Natural environments with many different plants and animals give us plenty of stimulation while soothing our nervous system and lowering our stress hormones. The wilder the better: traveling far away from familiar urban environments helps us harness the power of “out of sight, out of mind,” giving us a break from the overwhelming stuff at home. And if we’re in the midst of any big life transitions or conflicts, immersing ourselves in a natural environment helps us zoom out, remember the bigger picture, and see our problems in a different light.
When is the best time to work out to manage ADHD?
In my research for this article, I came across a few suggestions from MDs and psychiatrists to work out in the morning before taking meds, letting the endorphins and boosted neurotransmitter activity act as a natural stimulant for the first few hours of the day.
This feels very much to me like a piece of neurotypical advice. Most of the ADHDers I know struggle just to get out of bed on time and jam some breakfast, especially the ones with kids. (I could certainly be wrong about this — if you’re an ADHDer with first-thing-in-the-morning workouts as a sustainable part of your routine, let me know!)
The best time for you to work out is the time when you actually feel like doing it, because as you know, if you don’t feel like doing it, it’s not happening.
Maybe you want to do a quick HIIT routine during your lunch break, or go for a jog in the evening to shake off stress from the day.
I like to work out in the late afternoon when my morning stimulants have worn off (whether they be coffee, yerba mate, or medications, all of which I’ve utilized at different times in my life). Around 4pm, I’m usually feeling restless and unfocused, so I know my body is begging me to get up from the desk and do something!
Exercise as an Outlet for Intense Emotions
In addition to the cumulative benefits of regular cardio activities, high-intensity exercise also acts as an on-the-spot salve for the dreaded “emotional dysregulation.”
Aerobic fitness may be an essential pathway which mediates the efficacy on implicit emotion regulation ability.
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Because we are wired to process information during physical movement, we can use exercise as a channel for our big feelings, morphing painful mental and emotional experiences into satisfying body movements or physical expressions of those feelings. Mental clarity ensues only after we’ve sufficiently expressed ourselves.
Long before I had a clinical term for my big feelings, I knew I was different: crying in graduate school in front of my classmates when I didn’t understand the material, freaking out on the job when overwhelmed by peak customer activity, completely melting down during ostensibly small conflicts with my partner.
I’m sure you can relate.
When possible, I’ve tried to relegate my most extreme emotions to private places like my bedroom or my car, because these kinds of outbursts make other people extremely uncomfortable (especially the ones without big feelings).
But the best place I’ve ever found to really let it all out — screams, sobs, expletives, and all — is a difficult hiking trail in the middle of nowhere. I might even throw some rocks or pine cones if I’m really upset.
There’s nothing there to judge me, look at me weird, tell me to calm down, or accuse me of overreacting. In nature, I tend to “get over it” much more quickly than when I try to resolve things in my living room, and I always come out of the woods with confidence about the resolution or action plan.
Cardio is ADHD Medicine
Aerobic activity works with chemicals in our brain structures the same way that medications do, optimizing our brain function while simultaneously improving our blood pressure, hormonal balance, sleep patterns, immunity, lung capacity, and more.
“Is your ‘kid’ getting enough exercise?” I ask ADHD adults. Lack of exercise leads to an internal sluggishness that undermines alertness and attention.
-Gabor Mate, M.D.
A single workout can provide relief from acute stress or emotional pain, as well as boost executive functioning in the hours afterward.
A regular cardio routine with three to six weekly workouts can balance our brain chemistry, reducing some of the most painful symptoms associated with ADHD. Regular aerobic activity builds self-confidence, fosters a healthier mind-body connection, and improves our quality of life.
This is the second article in a series on simple strategies in food and nature for adults with ADHD. The suggestions in this series will help you feed your brain and balance your nervous system, therefore easing your symptoms and improving your quality of life.
Follow along here or on Medium.