BACKGROUND: Increased understanding of the etiology of attention-deficit hyperactivity disorder (ADHD) emphasizes the importance of non-pharmaceutical treatments. This study compares the effects of Baduanjin exercise, a Qigong-based body therapy from traditional Chinese medicine (TCM), with routine physical exercise on school-aged children diagnosed with ADHD. METHODS: In this two-arm, single-blind, randomized controlled trial, eligible school-aged children with ADHD were randomly assigned (1:1) to Baduanjin exercise or regular physical exercise using a permuted block randomization procedure. Both groups performed the designated exercise for at least 30 minutes a day and were monitored for exercise quality at least 5 days a week for 3 months. The primary outcome was a doctor-assessed hyperactivity/impulsivity score change, using the Swanson, Nolan, and Pelham rating scale (DSNAP_HYP) at the end of the third month since intervention initiation. RESULTS: Between October 2020 and January 2023, 120 eligible children were randomly allocated to two exercise interventions. After 3 months, the DSNAP_HYP decreased by 3.67 ± 4.81 and 4.68 ± 4.44 of Baduanjin exercise and regular physical exercise, respectively, with no significant between-group difference [mean difference = 1.52
95% confidence interval (CI) = - 0.08 to 3.13
P = 0.06]. No adverse events were reported during the whole study period. CONCLUSIONS: This study did not demonstrate the expected superiority of 3-month Baduanjin exercise in improving ADHD symptoms compared with routine physical exercise. However, the results suggest that both types of exercise may improve core symptom scores, providing preliminary evidence for Baduanjin as a potential supplementary intervention for children with ADHD.