摘要Background Attention de? cit hyperactivity disorder(ADHD)is a prevalent neurodevelopmental disorder.While physical exercise is a promising non-pharmacological intervention,the e? cacy of integrating cognitive demands with physical activ-ity remains underexplored.This trial compared the e? ects of integrated cognitive-motor exercise,aerobic exercise,and a minimal intervention on core symptoms and executive functions(EFs)in children with ADHD.Methods In this randomized,controlled,multicenter trial,107 children with ADHD(aged 6–10 years)were allocated to one of three groups for 12 weeks:(1)integrated cognitive-motor exercise(EG1,n=36);(2)aerobic exercise(EG2,n=35);or(3)wait-list control(CG,n=36).Both EG1 and EG2 performed their respective interventions three times per week in 45-min-ute sessions.The primary outcomes were inattention and hyperactivity-impulsivity symptoms and EFs(inhibitory control,working memory,and cognitive ? exibility).The analysis followed the intention-to-treat principle with linear mixed models.Results Compared with the CG,both exercise groups presented signi? cant,comparable reductions in inattention and hyper-activity-impulsivity symptoms(all P≤0.01).However,EG1 demonstrated superior improvements in speci? c EFs.For inhibi-tory control(Stroop color-word interference),EG1 resulted in a signi? cantly greater reduction in color-word interference time than both EG2[β=? 6.24,95%con? dence interval(CI)=? 12.28 to ? 0.20,P=0.045]and CG(β=? 13.97,95%CI=? 19.97 to ? 7.97,P<0.001).For immediate working memory,the improvement in EG1 was greater than that in both EG2(β=2.09,95%CI=0.33–3.85,P=0.032)and CG(β=3.57,95%CI=1.83–5.31,P<0.001).Both exercise groups improved similarly in cognitive ? exibility compared with the CG.Parental satisfaction was signi? cantly greater in EG1 than in EG2(P<0.001).No adverse events were reported.Conclusions A structured integrated cognitive-motor exercise intervention is an e? ective and safe non-pharmacological treatment for children with ADHD.Compared with aerobic exercise alone,it not only alleviates core symptoms but also yields superior bene? ts for key EFs,speci? cally inhibitory control and immediate working memory.