Research Proposal: The Effects of Resistance Training on Females with ADHD

Bri Rehborg

College of Science, Engineering, and Technology, Grand Canyon University

EXS-485: Research Methods of Exercise Science

Dr. Zeigler

4/17/22
 Abstract
Worldwide females with attention deficit hyperactivity disorder (ADHD) are often overlooked and
underdiagnosed, which causes women to suppress their symptoms to fit who society expects them to be. Thus,
there is an urgent need for studies done on women with ADHD and how it is affecting their brains and bodies.
We propose to match two groups of females that have ADHD: one group will be given a 4-week resistance
training program, and the other group will be the control group, told to not change their lifestyle. The objective
of this application is to assess woman with ADHD and explore different ways for females to manage their
symptoms. Our central hypothesis is, when women consistently perform a resistance training program there
ADHD symptoms will be easier to manage, and their productivity levels will go up. Also, we will determine if
managing ADHD by exercise will also minimize symptoms of depression and anxiety. By decreasing the
overwhelming amount of ADHD symptoms, women should note a change in their depression, anxiety, and quality
of life. The rational for the proposed research is that women with ADHD are dismissed and their symptoms lead
to depressive actions such as self-harm, along with an abnormal amount of anxiety. Therefore, there should be
more of a concern regarding the mental health of females with ADHD, and how it affects their lifestyle. Our long-
term goal is to create a personalized exercise program for women with ADHD that will help them control their
symptoms.

Project Narrative
The proposed research is relevant to public health because women are overlooked when it comes to ADHD, and
this leads to high numbers in depression and anxiety. This leads to higher suicide rates which is the second leading
cause of death in US for young females. The contribution of this project is relevant to NIH’s mission because this
research will improve the management of these symptoms for women and reduce the burden of their mental
illnesses.

Specific Aims
There is a trend of women being overlooked and dismissed that have attention deficit hyperactivity disorder
(ADHD); women with ADHD also often suppress their symptoms to fit societies expectations 11. Women are
neglected in ADHD studies that are done and these studies most often focus on males and ADHD. This causes
women with ADHD are often overlooked compared to men being diagnosed with ADHD. College females with
ADHD engaged in impulsive and the most severe forms of non-suicidal self-harm; they were often self-
destructive but not looking to end their life15. Over the years women have delt with an overwhelming number of
symptoms that society has taught them to hide15. Females and males show different symptoms and functions of
ADHD compared to males, and our society tends to focus on the male side of ADHD symptoms 11. To focus on
how exercise relates to ADHD and how it can help decrease symptoms, there needs to be more research on this
topic. Women with ADHD had significantly high amounts of sleep problems, chronic pain, limitations in daily
activities compared to women without ADHD. Even Acute ADHD that remained undiagnosed affected women
and impaired their daily living as they came into adulthood12. Thus, there is an urgent need for studies done on
women with ADHD and how it is affecting their brains and bodies.
Our long-term goal is to create a personalized exercise program for women with ADHD that will help them
control their symptoms. It has been suggested that women with ADHD are often, easily irritable, annoyed, angry,
and more aggressive6. Females with ADHD have higher levels of fatigue, stress, and mental health problems 6.
Society focuses so much on males with ADHD, that females are ignored and often but in more distress because
of this10. The objective of this application is to assess woman and the short- and long-term side effects specially.
Also, to explore if there are different ways for females to manage their ADHD symptoms. Further, we will be
assessing if resistance training is more effective that medications, because it has been found that ADHD
medication doesn’t work as well on women than it does in males 5. Our central hypothesis is that when women
consistently perform resistance training there ADHD symptoms will suppress, and their productivity level will
go up. In addition, with the performing of resistance training, there may be a correlation between women with
ADHD and their depression and anxiety levels going down, so that will something that is also tested for. The
rational for the proposed research is that women with ADHD are dismissed and their symptoms lead to depressive
through such as self-harm, along with an abnormal amount of anxiety.
We plan to test our hypothesis and thereby the objective of this application by pursing the following of the specific
aims.
1. To discover if there is a correlation of having college females with ADHD doing an hour of resistance
training to see if their productivity goes up, and there ADHD symptoms are easier to manage.
2. To determine if managing ADHD by exercise will also minimize symptoms of depression and anxiety.
By decreasing the overwhelming amount of ADHD symptoms, women should be able to note a change in
their depression, anxiety, and quality of life.
With respect to the expected outcomes, amplifying the importance of productivity levels and the correlation of
women with ADHD and resistance training. If women preform at last 5 days of resistance training a week, they
should notice an increase in productivity levels and a decrease in their ADHD symptoms. Along with managing
their ADHD symptoms, these women should be able to see an improvement in being able to manage their
depression and anxiety6.

Significance
Due to the limited research on women with ADHD, there is a need for more information concerning the correlation
of college females and ADHD, which is often overlooked and goes undiagnosed 1. Females with ADHD are
standardly shown to have high levels of fatigue, mental health issues, optimism, role overload, and stress 6.
Because ADHD is often only associated with males and children, it was found that females with ADHD have a
harder time transitioning into college and finding a way to be successful6. This study can help females in their
progression to higher education and improve their productivity time6. There is a gap in the research regarding
ways females cope with their ADHD symptoms. As females come into adulthood and go through college, their
symptoms often manifest and become worse12. If females integrate resistance training consistently into their
lifestyle, their ADHD symptoms will be easier to manage. The contribution of the proposed research is expected
to give females coping mechanisms to manage and control their ADHD symptoms.
The contribution of more research being done concerning females and ADHD will be significant because it will
provide college females that have ADHD to be heard among the society and provide them with proper ways to
help manage their ADHD. Along with giving these females a voice, their depression and anxiety symptoms will
decrease2. There is a high correlation between females with ADHD and depression rather than females without
ADHD2. Based on that knowledge, if there is a way to manage ADHD symptoms, specifically with resistance
training, depression will decrease2. It is often shown, when females with ADHD are given high inhibitory
concentration exercises, they are better at problem solving and their schoolwork 1. This shows that there were
increased productivity levels after preforming physical activity.
The most evident benefit to be expected is that college females with ADHD will have increased productivity and
ability to focus when they consistently work in resistance training. Along with helping manage ADHD symptoms,
other benefits of resistance training include increased muscular fitness, movement skills, injury prevention, and
decreased risk for cardiovascular disease, diabetes, and obesity 7. It is important to help females with treatment
from pharmacological and psychological interventions to decrease symptoms and improve long-term outcomes
of ADHD at this age, so their symptoms do not get worse19. Outcomes to be expected are increased productivity
in females with ADHD and decreased depression and anxiety when consistently completing resistance training 1,2.

Innovation
By exploring the theory of consistent resistance training with women that have ADHD, they will see a
development in ways to handle their symptoms. Along with that, once someone’s ADHD symptoms go down,
they should see a correlation of their depression and anxiety being easier to manage13.There have been previous
studies on females with ADHD and the correlation of the increase in depression 3. It has been shown that there is
a large correlation in females that have ADHD with severe depressive disorder compared to females who do not
have ADHD3. It is previously found that there is a clear link between young females with ADHD and high
destructive habits such as self-harm13. Therefore, there should be more of a concern regarding the mental health
of females with ADHD. Research is lacking on the cross-sectional differences between college females with
ADHD and their symptoms and the absence of the relationship to depression and anxiety8. It has been shown that
exercise can help someone become more optimistic and increase their mental health 16. This study is going to focus
on the relationship between each of these prior studies and focusing directly on females. Consequently, there is
an inferred relationship between completing consistent resistance training in college females with their ADHD
symptoms and depression being easier to manage.
Prior research examining ADHD has been primarily done on males 6. This study will produce a new methodology
of research for females. It is understood that ADHD causes hyperactivity, inability to be attentive, struggle to
focus and having a difficult time sitting still8. It is not however determined if exercise, specifically resistance
training, can help be able to manage those symptoms in college females. This study seeks to establish a
relationship between adverse ADHD symptoms and resistance training in college females. There is shown a
relationship between people with ADHD and exercise and how it can decrease hyperactivity 8. Nevertheless, there
is a lack in that relationship to ability to focus and be attentive. This foundation would support the advancement
of other ways to cope with ADHD. The proposed research is innovative, in our opinion because we propose to
link college females with ADHD to their consistency in resistance training. By doing this, females are expected
to feel like they can control their ADHD symptoms.

Approach
Research Methodology and Design
The overall design and methodology that will be used to accomplish the specific aims will be to assess the
quantitative data of the target population of women with ADHD, with a correlational design.

Population and Sample Selection

The population of interest is females who are in college, ages of 18-24. The target population will be taken from
this group of females and who have ADHD and hindering anxiety and depression. The sample will be chosen by
simple random sampling. Chosen from the target population there will be two independent groups: 88 females
with ADHD in each group, in total being 176 chosen females. To account for attrition, 10% will be added with a
final sample size of 194. This results in 97 females being in each group. Sample size was calculated using a 2-
sided hypothesis a=0.05 and B=0.95.

Data Collection Procedures

Three total measurements will be taken for experimental outcomes. Baseline measurements will be assessed prior
to any exercise sessions. After the completion of each workout, participants will be given a brief survey being the
ADHD RS-SRV to compare throughout the 4-week program. Experimental and control groups will be given to
the surveys: ADHD RS-SRV and PH4 each night. The information will be used to assess if participants are
noticing any changes in resistance training compared to those in the control group. During the pretest and posttest,
subjects will be asked to take in-depth surveys being, ADHD RS-IV, PHQ-9, and GAD-7. Each of the survey
provided will be self-report. The researchers collecting data will publish inter- and intra- reliability measurements
alongside the final collected data.

1. Pretest. Once subjects are chosen, they will be given a series of test to be completed 3 times throughout
the study. The PHQ-4 and ADHD RS-IV surveys are to be completed each night after the day is completed.
(See below for a brief description of measurement procedures)

a. The ADHD Rating Scale (ADHD RS-IV). This assessment is an 18-item scale that is made for
those which ADHD that provides a series of questions rating the severity of ADHD symptoms 9.
This creates a framework and accesses impairment of symptoms.

b. PHQ-9. This assessment is a measure of validity in depression severity. This is a patient health
questionnaire that is self-administered13.

c. GAD-7. This assessment is an in-depth questionnaire about anxiety disorders. This measurement
has the best performance for identifying generalized anxiety10.

d. ADHD Rating Scale- Self-Report Version (ADHD RS-SRV). This is a modified version of the
ADHD RS-IV assessment. This allows for brief screening purposes

e. PHQ- 4. This assessment is an ultra-brief 4- item patient health questionnaire which consists of a
2 item depression scales and a 2-item anxiety scale4. This survey supports the reliability and
validity of the PHQ-4, PHQ-2, and GAD-2 ad a brief measure of depression and anxiety to
compare the subject’s scale to general population.

2. Intervention. This will be a randomized experimental design with two independent groups. There will be
a group of females with ADHD who perform a 4-week resistance training program compared to a control
group that will continue their lifestyle with ADHD and no resistance training. The control group will be
told to not change their lifestyle. The primary comparison will be the magnitude of reduction in ADHD
symptoms in the experimental group. Subjects in the experimental group will be prescribed the same
exercise prescription for their resistance training program (resistance training split, 5x/week for 4-weeks).
Subjects will be required to perform exercise at the laboratory under supervision of one of the researchers.
 The workout should be completed before the subject completes their day of school and work, so each
workout should be in the morning. Both the experimental and control subjects will be given a qualitative
survey to complete each night based on how they are feeling; they will also fill out a survey of how they
would access their productivity was throughout day, and how they managed there ADHD symptoms.
Before the exercise intervention, after week two and week 4, there will be given a qualitative survey to
the two groups, comparing each of the weeks. This survey will ask about productivity levels, ADHD
symptoms mood, anxiety, depression, and how each person has felt then have managed their ADHD
symptoms and balancing it will their school workload. The study will be closely observing the two groups
and comparing their productivity rates, and depression and anxiety symptoms

3. Post-test. Upon the completion of 20 exercise sessions (4-weeks) surveys will be assessed in the same
conditions as the pretest. This consist of the ADHD RS-IV, PHQ-9, and GAD-7 surveys to be completed
and analyze the effect of resistance training on ADHD along with anxiety and depression.

Data Analysis
Data will be analyzed using SPSS software (version 28). The alpha error for the primary end point was set at .05
and the beta error level at 0.95. All P values will be calculated assuming two-tailed hypothesis; P< 0.05 will be
considered statistically significant. Data will be analyzed for normality and transformed if necessary. Descriptive
statistics will be used for the demographics of the subjects. Baseline characteristics will be assessed using two
independent t-tests. Quantitative measurements change over time depending on when the assessment was given,
how the subject was feeling and other various factors affecting the subject’s data. It is expected that the individual
variability will be large. To control this data in a secure manner, there is no identifying information linked to the
subjects. Then after three years the files will be deleted.
Throughout this study it is hypothesized that if college females consistently follow a resistance training program,
then they will be able to manage their ADHD in a healthier manner; they also should see a decrease in depression
and anxiety symptoms. If college females continue with their sedimentary, it is predicted that they will not be
able to manage their ADHD as well and will not necessarily see an improvement in their depression and anxiety.

Ethical Considerations
Considering ethical issues, this study will follow the guidelines of the Belmont report. It is separating the
difference between practice and research. Following the Belmont report allows for safety for each of the subjects
within the study. There are possible risks for harm in this study, this consist of injury, muscle pulls, muscle strain,
soreness, and safety if equipment is not used properly. Informed consent will be given to participants before any
sort of research is conducted

Potential Problems and Alternative Strategies

There are limitations to this study design. First, our subjects are measured using qualitative study surveys. We
have no control whether they answer accurately to how they are feeling. However, the primary aim is to masses
the change in ADHD, depression and anxiety symptoms when comparing the groups. This is accounted for within
the inflation rate of 10% being added to the sample size. A second limitation of the study is the experimental
subjects not fully following the program. This would be not giving full effort during workouts, or not following
the criteria of the study. There are strengths to this study. The design allows for direct comparison of those with
ADHD and which group is to be completing the resistance training program. Participant in the experimental group
will complete their program at the laboratory fitness center. This ensures adherence to the exercise prescription.
Along with this, subjects will be asked to not change physical activity (outside what is prescribed) and not alter
their diet. Activity logs will be given to ensure no changes in physical activity over the course of the intervention
and from baseline occur. Dietary recall will be given weekly to ensure diet remains constant over the 4-week
intervention and has not changed from baseline. This information will be reviewed weekly and discussed with
the participant.

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