Mehren et al.

Borderline Personality Disorder and Emotion Dysregulation

(2020) 7:1
https://doi.org/10.1186/s40479-019-0115-2

REVIEW Open Access

Physical exercise in attention deficit

hyperactivity disorder – evidence and
implications for the treatment of borderline
personality disorder
Aylin Mehren1* , Markus Reichert2,3, David Coghill4, Helge H. O. Müller5, Niclas Braun5† and Alexandra Philipsen5†

Abstract
A growing body of literature indicates a potential role for physical exercise in the treatment of attention deficit
hyperactivity disorder (ADHD). Suggested effects include the reduction of ADHD core symptoms as well as
improvements in executive functions. In the current review, we provide a short overview on the neurophysiological
mechanisms assumed to underlie the beneficial effects of exercise. Further, we review the current evidence from
experimental studies regarding both acute exercise and long-term interventions in ADHD. While the positive effects
observed after acute aerobic exercise are promising, very few well-designed long-term intervention studies have
been conducted yet. Moreover, although exercise effects have not yet been studied in borderline personality
disorder (BPD), in the end of this paper we derive hypotheses why exercise could also be beneficial for this patient
population.
Keywords: Exercise, Physical activity, Attention deficit hyperactivity disorder (ADHD), Borderline personality disorder
(BPD), Cognitive, Executive function, Attention, Intervention, Treatment

Background considerably overlap with the neuropathological mecha-

Physical exercise is known to have positive effects on nisms implicated in ADHD [141].
general health and well-being [123], to bear potential to In the following paper, we first provide a short over-
improve mood and quality of life [48, 129], and to re- view on neurophysiological mechanisms suggested to
duce stress responses [131]. In addition, a growing body underpin the beneficial effects of exercise on cognition
of literature suggests beneficial effects of exercise on and behavior. We then review results from studies with
symptoms of attention deficit hyperactivity disorder different experimental approaches (i.e., acute effects and
(ADHD). Improvements in neurobehavioral functions long-term interventions) to investigate the effectiveness
have been demonstrated, including reduced impulsivity of exercise in improving ADHD symptoms. We comple-
and hyperactivity, improved attention, and enhanced ment previous reviews by providing a comprehensive
performance on executive functioning tasks [14, 16, 45, overview on effects of different types of exercise on be-
82]. Moreover, an association between increased exercise havioral, cognitive, and neurophysiological parameters in
levels and alleviated ADHD symptoms in the general ADHD, including the most recent studies in children,
population has been found [8]. Interestingly, the neuro- adolescents, and adult patients. Finally, we discuss over-
physiological changes found to be induced by exercise lapping symptoms and neurophysiological substrates of
ADHD and borderline personality disorder (BPD). On
this basis, we provide a first attempt to discuss potential
* Correspondence: [email protected]
benefits of exercise for BPD and encourage research
†
Niclas Braun and Alexandra Philipsen are shared senior authorship. endeavours.
1
Department of Psychology, Biological Psychology Lab, European Medical
School, University of Oldenburg, Oldenburg, Germany
Full list of author information is available at the end of the article

© The Author(s). 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Mehren et al. Borderline Personality Disorder and Emotion Dysregulation (2020) 7:1 Page 2 of 11

Neurophysiological effects induced by physical exercise reflect central concentrations. Very few studies have in-
Neurophysiological effects of exercise include increased vestigated exercise-related changes in brain metabolism
central arousal associated with elevated release of using positron emission tomography (PET) and these
fronto-striatal neurotransmitters such as dopamine, epi- studies have themselves revealed mixed results. While
nephrine, norepinephrine, and serotonin [4, 18, 81, 84]. Boecker et al. [9] found evidence for reductions in opi-
In ADHD patients, abnormalities in fronto-striatal func- oid receptor availability after a single session of exercise,
tioning, in particular hypoactivity in the dopaminergic Wang et al. [140] did not detect any changes in dopa-
and noradrenergic systems, have been related to the at- mine receptor availability. Neuroimaging and electro-
tentional and executive impairments [12, 30, 103, 107, physiological studies have, however, demonstrated
134]. Stimulants are the first-line medication in ADHD changes in brain structure and function after exercise in-
[103, 104]. These extremely effective medications in- terventions in several participant groups, supporting the
crease the availability of dopamine and norepinephrine proposed neuroprotective effects of exercise. These
in the prefrontal cortex and result in a reduction of changes include gray matter increases in frontal [24] and
symptoms and improvement of executive functioning in hippocampal areas [33, 97], as well as modified brain ac-
the majority of patients [22, 25, 87, 113, 118, 133]. In a tivation patterns and changes in functional connectivity
similar way, exercise might compensate for dysregulated [60, 137]. In both ADHD and BPD, structural and func-
catecholamine levels in ADHD and thereby improve tional abnormalities in fronto-striato-limbic brain areas
cognitive and behavioral functioning [141]. have been demonstrated [26, 62, 120, 121]. ADHD and
Similarly, diverse studies have suggested that dysregu- BPD often co-occur within individuals [101], share com-
lations in fronto-striatal neurotransmitter systems might mon genetic factors, and co-aggregate in relatives [35,
contribute to the development of BPD. In particular, 63, 77]. Consequently, it seems probable that those pa-
genetic variations in the serotonin system have been tient groups could benefit from physical exercise.
shown, but also alterations in dopaminergic and norad- However, so far only very few studies have assessed
renergic functioning as well as in the endogenous opioid the effects of exercise on neurophysiological parameters
system have been proposed [6, 13, 36, 92, 95, 138, 146]. in patients with ADHD, and for BPD there are no stud-
Notably, besides increased levels of catecholamines and ies upon this issue at all. Wigal et al. [142] tested the ef-
serotonin, also endorphins are released during exercise fects of a single session of cycling on plasma
[38, 85], which might not only enhance or stabilize catecholamine levels in boys with ADHD and without
mood and contribute to reward experiences during pro- ADHD. For both groups, they found epinephrine and
longed exercising, but might also modulate emotional norepinephrine increases after exercise. The increases
functioning and stress reactivity, which are core hall- were, however, smaller in the ADHD group than in the
marks of BPD [67, 91]. Further proposed mechanisms of healthy control group. Moreover, dopamine levels only
action include an upregulation of growth factors, such as increased in healthy participants, but not in those with
the brain-derived neurotrophic factor (BDNF) [33, 69]. ADHD. In contrast, in a group of children with ADHD,
BDNF is expressed in the hippocampus and plays a cru- Tantillo et al. [128] observed acute exercise-related
cial role in brain development and plasticity as well as in changes in spontaneous eye blink rate and acoustic eye
learning and memory processes [64, 71]. Interestingly, blink startle response, which are considered as noninva-
dysregulation of BDNF has also been implicated in sive indicators of dopaminergic activity as they are sensi-
ADHD [70, 130] and in BPD [89, 100]. tive to dopamine agonists. These results were, however,
Experimental studies on the neurophysiological effects dependent on exercise intensity and differed between
of exercise have mainly been conducted in animals. In boys and girls. Changes in boys were only observed after
rodents, changes in central neurotransmitters and neu- maximal exercise, while changes in girls were only ob-
rotrophins have been demonstrated consistently after served after submaximal exercise. Gapin et al. [39] fo-
single bouts of exercise as well as after longer phases of cused on acute exercise-related BDNF serum changes,
regular exercises [27, 85, 135]. In animal models for but could neither find any changes in young adults with
ADHD, exercise-induced catecholamine and BDNF in- ADHD nor in healthy controls. Finally, one study
creases have been related to cognitive enhancements assessed peripheral epinephrine and serotonin levels
(e.g., [54, 59, 112]). While these results from animal after a long-term exercise intervention in a small group
studies are fairly robust, findings in humans are more of boys with ADHD [65]. After 3 months of mixed exer-
heterogeneous and depend on more specific exercise cises, the boys showed significant increases in epineph-
characteristics, such as duration and intensity (e.g., [127, rine concentration, whereas serotonin levels did not
149]). In addition, only peripheral concentrations of neu- increase significantly. To conclude, evidence from em-
rotransmitters (i.e., plasma or serum) have been mea- pirical studies supporting the suggested mechanisms of
sured in humans so far, and these may not accurately exercise in patients with ADHD is still scarce and
Mehren et al. Borderline Personality Disorder and Emotion Dysregulation (2020) 7:1 Page 3 of 11

neurophysiological changes due to exercise need to be in children with ADHD as well as in healthy children.
further investigated. In addition, up to now, no research Hung et al. [50] further demonstrated exercise-related
has linked the neurophysiological effects of exercise to P300 amplitude increases during a task switching para-
BPD. digm. All three studies in addition observed improve-
ments in behavioral task performance, supporting
Neurocognitive effects of physical exercise in ADHD enhanced attention and inhibition due to exercise.
Acute effects Chuang et al. [21] investigated the effects of acute exer-
There is increasing evidence that a single session of ex- cise on the contingent negative variation (CNV), another
ercise can lead to immediate improvements in ADHD component of the event-related potential. The CNV is
symptoms and cognitive functions. Studies have mainly regarded as an electrophysiological marker for anticipa-
focused on the effects of aerobic exercise (e.g., cycling or tory attention to an upcoming stimulus and preparation
running) with moderate intensities and minimum dura- of motor response [10, 139]. In this study, a group of
tions of 20 min on executive and attentional functions. children with ADHD performed a Go/No-go task after
In children with ADHD, the majority of studies 30 min of treadmill running and after a control condi-
have revealed positive effects of acute exercise on execu- tion. After exercise, they showed shorter reaction times
tive task performance with small to large effect sizes. and a decreased CNV amplitude, which the authors
Most studies compared task performance after exercise interpreted as facilitation of motor preparation.
to task performance after a cognitively and physically Far fewer studies have been conducted with adults
undemanding control condition (e.g., watching a video). with ADHD. Gapin et al. [39] assessed the effects of 40
The studies have hereby identified exercise-induced im- min of moderate exercise on different aspects of execu-
provements in response inhibition, impulsivity, and at- tive function in 10 young adults with ADHD and 10
tention as assessed by the flanker task [72, 105], Go/No- healthy controls. While healthy controls showed
go task [21], and Stroop task [17, 102]. In addition, exercise-related improvements in all cognitive domains
exercise-induced enhancements in task switching [17, assessed, ADHD patients only improved in a response
50,] and cognitive flexibility [73] have been shown. Piep- inhibition task, but not in working memory or task
meier et al. [102] further demonstrated that some as- switching. It should be noted, however, that in this study
pects of executive functioning seem to benefit from the authors did not compare task performance after ex-
acute exercise while others do not. Compared to watch- ercise to a control condition. In another adult ADHD
ing a movie, both children with ADHD and healthy con- study, Fritz and O’Connor [37] reported improvements
trols showed faster reaction times in all conditions of in mood, motivation, fatigue, and depression after 20
the Stroop Task after 30 min of cycling. However, exer- min of cycling as compared to a control condition. Inter-
cise did not improve performance on the Tower of estingly, no changes in vigilance or hyperactivity were
London and the Trail Making Test, which are measures observed in this study. A very recent fMRI study from
to assess planning and problem solving as well as cogni- our lab [86] investigated the effects of a single session of
tive flexibility and set-shifting. Another study found ben- aerobic exercise on attention and executive function as
efits in academic performance following exercise [105]. measured by a flanker task in adult patients with ADHD
Both children with ADHD and healthy controls im- and healthy controls. Following 30 min of cycling at
proved in reading comprehension and arithmetic after moderate intensity compared to watching a movie, we
20 min of moderate aerobic exercise compared to a observed improved reaction times in patients with
seated reading condition. ADHD but not in healthy controls. However, unlike as
The number of studies complementing behavioral out- in the previously described EEG studies, no exercise-
comes with electrophysiological measures has increased induced changes in brain activation were identified in
over the last years. To our knowledge, Pontifex et al. this study. In a further exploratory analysis, however, for
[105] were the first to explore the electrophysiological which the sample was divided into two groups according
effects of acute exercise in ADHD using electroencephal- to individual fitness level, brain activation changes were
ography (EEG). They observed an amplitude increase found in task-related brain areas for those patients with
and latency decrease in the P300 component during a a higher degree of cardiorespiratory fitness. This finding
flanker task following acute exercise. The P300 compo- suggests a moderating role of fitness in acute exercise
nent is an important electrophysiological subcomponent effects.
within the event-related potential that is typically associ- A few studies have also investigated the effects of dif-
ated with the allocation of attentional resources [104]. ferent types of exercise, different intensities, and the role
These findings were independently replicated in 2017. of medication status. Ludyga et al. [72], for instance,
Using a similar flanker task paradigm, Ludyga et al. [72] compared acute cognitive effects of aerobic exercise to
also observed exercise-induced P300 amplitude increases those of coordinative exercise in children with ADHD.
Mehren et al. Borderline Personality Disorder and Emotion Dysregulation (2020) 7:1 Page 4 of 11

Coordinative exercise consisted of exercises requiring As stated, some studies reporting beneficial effects of
object control skills and bilateral coordination, while exercise interventions did not include any control condi-
aerobic exercise included cycling at moderate intensity. tion (e.g., [44, 47, 124]) and thus may not rule out the
Compared to a control condition (watching a video), possibility of practice effects. On the other hand, many
both exercise types led to an improved flanker task per- studies compared an exercise intervention to a control
formance and P300 amplitude increase, but the effects group receiving no treatment and found positive effects
were larger after aerobic exercise. Two further studies on neurobehavioral performance, such as attention,
examined the effects of intermittent high-intensity exer- working memory, inhibition, impulsivity, emotional
cise and revealed mixed results. While Medina et al. [83] functioning, motor skills, cognitive flexibility, or class-
reported exercise-induced improvements in attention, room behaviour [1, 15, 80, 88, 98, 99, 136]. At a first
Mahon et al. [75] did not find any enhancements. Note- glance, these results seem promising, but the lack of an
worthy, results of studies examining the effects of acute alternative treatment as control condition makes it al-
high-intensity exercise in other participant groups are most impossible to separate exercise-specific effects
also highly heterogeneous [82]. Further, it is noteworthy from other factors such as increased patient care, partici-
that these two studies were the only ones which pation in an intervention in general, and social engage-
accounted for the role of medication status. While the ment. In fact, results from the few available randomized
beneficial effects observed by Medina et al. [83] were in- controlled trials which included an active control condi-
dependent of medication status, Mahon et al. [75] re- tion or compared the effects of different exercise pro-
ported even worsened performance after exercise when grams are by far more heterogeneous.
children were on medication. The crucial role of an active control condition is fur-
To sum up, in line with findings in healthy partici- ther underlined by a study by Bustamante et al. [11]. In
pants and other clinical populations, beneficial effects of this study, 35 children with ADHD and/or disruptive be-
acute exercise on ADHD symptomatology are so far havior disorders were divided into two groups, both of
most robustly observed after aerobic exercise at moder- which participated in a 10-week after-school program on
ate intensity. It should be noted, however, that studies 5 days per week. The program consisted of various activ-
on other exercise modalities and intensities are still very ities, which were identical for both groups, with the ex-
scarce and need to be further investigated. Also, patient ception of one group-specific treatment hour. During
characteristics like cardiorespiratory fitness and medica- that hour the intervention group participated in physic-
tion status should be more carefully considered when ally active games and exercises, whereas the control
evaluating exercise effects. group took part in physically inactive games and arts.
For both groups, the authors reported improvements in
Long-term interventions behavioral and neuropsychological outcome measures
Also the findings from long-term exercise intervention from pre- to post-intervention assessments. From this,
studies point towards positive effects on ADHD symp- they concluded that routines, engagement in activities,
toms and related cognitive impairments. In most of and behavior management strategies might facilitate
these studies, patients participated in programs consist- ADHD symptomatology. In another study, Hoza et al.
ing of various cardio exercises over several weeks (e.g., [49] demonstrated beneficial effects of 30 min before-
running, swimming, cycling, rope skipping, ball sports, school exercises on parent and teacher ratings of ADHD
or sports games). Almost all studies found exercise- symptoms, moodiness, and peer functioning, which were
related improvements with small to large effect sizes in for most measures greater than in the control group per-
ADHD symptoms (inattention, hyperactivity, and impul- forming arts in a sedentary classroom setting. However,
sivity), executive functions, academic performance, or improvements in some of the assessed areas (e.g., peer
motor skills (for previous reviews see e.g., [14, 93]). functioning and teacher ratings in ADHD symptom se-
However, most of these studies had methodological verity) did not differ between the groups.
shortcomings, such as small sample sizes, no To investigate whether effects depend on the type of
randomization or blinding procedure, no adequate con- exercise, Ziereis and Jansen [148] divided 43 children
trol condition, or no healthy control group, and should with ADHD into two intervention groups and one non-
therefore be interpreted with caution. Further, studies active control group. The two intervention groups par-
were highly heterogeneous with respect to patient char- ticipated in a 12-week training program (one 60-min
acteristics (e.g., age, gender, diagnosis criteria, and medi- session per week) with different foci: While group 1 was
cation status), exercise characteristics, and trained in specific abilities like ball handling, balance,
neurocognitive assessment. This heterogeneity as well as and manual dexterity, group 2 engaged in a non-specific
methodological considerations render it difficult to com- exercise program that consisted of swimming, running,
pare and to generalize the results. climbing, and sports games. The control group received
Mehren et al. Borderline Personality Disorder and Emotion Dysregulation (2020) 7:1 Page 5 of 11

no treatment at all. Both intervention groups, but not symptoms in both groups, whereas no improvements in
the control group, improved in working memory and a neuropsychological attention task were found. These
motor performance, indicating that specific as well as findings indicate only limited effects of yoga and in
unspecific exercises can have beneficial effects. However, addition no superiority of yoga compared to cooperative
also in this study a potential influence of other psycho- activities. Haffner et al. [46] compared the effects of yoga
social factors such as an increased patient care cannot to those of a motor training. In a crossover design, 21
be fully ruled out. children with ADHD participated in two interventions,
Two randomized controlled trials investigated the ef- each consisting of 8 weeks of training that took place
fects of exercise in addition to pharmacological treat- twice a week. The yoga intervention consisted of typical
ment. Kang et al. [57] divided 28 boys with ADHD into yoga poses and breathing exercises, while the motor
two groups, which both received methylphenidate and in training involved sports games such as tossing, catching,
addition a 6-week therapy program. While the exercise dexterity games, concentration, and group games. Both
intervention group performed a 90-min workout twice a interventions had positive effects on attention and
week that entailed various sports elements (running, ADHD symptoms, but the effects of the yoga interven-
throwing, rope skipping), the control group received 12 tion were greater compared to the motor training. In
educational sessions for behavioral control. Both groups line with this finding, Chou and Huang [20] also re-
showed improvements in ADHD symptoms (attention, ported improvements in sustained attention and dis-
hyperactivity, impulsivity), executive functioning (trail crimination after 8 weeks of a yoga exercise program in
making test), and social behavior. For most measures, 24 children with ADHD as compared to a control group
these improvements were significantly greater in the ex- receiving no intervention.
ercise intervention group than in the control group. In In conclusion, results from exercise intervention stud-
addition, Choi et al. [19] included fMRI to investigate ies appear promising for developing alternative or ad-
the effects of a 6-week adjunct exercise program in junct treatment approaches for ADHD. At present,
addition to methylphenidate treatment on Wisconsin however, randomized controlled trials that included an
Card Sorting test performance in adolescents with active control condition do not reveal a clear superiority
ADHD. They found that exercise in addition to medica- of exercise compared to other activities. Furthermore,
tion improved task performance and increased frontal many studies applied combinations of different exercise
lobe activity to a greater extent than educational sessions types, making it difficult to determine which elements
and medication. Hence, both studies indicate that exer- actually caused the desired therapeutic effect. It will be a
cise can enhance the effects of medication. challenge of future studies to detect specific aspects of
In a large multi-centre randomized controlled trial exercise interventions that lead to positive effects as well
that included 112 children with ADHD, the effects of as to include adequate control conditions. In addition,
neurofeedback on several outcome measures (e.g., rat- including healthy control groups might provide insight if
ings of ADHD symptoms, neurocognitive functions, benefits due to exercise are more pronounced or specific
EEG components) were compared to pharmacological to ADHD or might occur in diverse participant groups.
treatment with methylphenidate and to physical exercise
[41–43, 51, 52]. Methylphenidate was superior to neuro- Implications for BPD
feedback and exercise in improving most outcome mea- Core symptoms of BPD include emotional dysregulation,
sures, while exercise had positive effects on only very impulsivity, identity disturbances, stress-related dissoci-
few measures. It should be mentioned, however, that the ation, non-suicidal self-injury, and suicidal behavior [3].
study specifically focused on the effects of neurofeed- In the following, we illustrate how exercise affects se-
back, while exercise was only used as control condition lected BPD-relevant symptoms, and from this, we cau-
and differed from most exercise intervention studies in tiously deduce conceivable effects of exercise in BPD
terms of frequency and intensity (30 sessions of 20 min which, of course, will have to be investigated by studies
moderate to vigorous intensity exercises over 10–12 in BPD samples to derive substantial evidence. Here, we
weeks). first highlight similarities between ADHD and BPD and
A few studies have also investigated the effects of yoga try to apply the findings described in ADHD to BPD.
in ADHD patients, with heterogeneous results. Jensen Further, we incorporate relevant research conducted in
and Kenny [53], for instance, divided 19 boys with different participant groups, which revealed enhance-
ADHD, who were stabilized on medication, into an ments in functions that are typically impaired in BPD.
intervention group taking part in 20 weekly 1-h yoga To start with, there is a substantial overlap in the clin-
sessions and a control group performing cooperative ical presentation of ADHD and BPD (for a review, see
group activities once a month. Subjective measures (par- [77]) and both disorders often co-occur [35, 101]. Both,
ent ratings) indicated some improvements in ADHD ADHD and BPD are characterized by the clinical
Mehren et al. Borderline Personality Disorder and Emotion Dysregulation (2020) 7:1 Page 6 of 11

symptoms affective instability and impulsive behavior [77] who exercised on a regular basis showed more efficient
as well as impairments in executive functioning [79, 114, control of negative emotions. One relevant study in this
132]. The effects of exercise on executive functions and context [31] compared autonomic nervous system pro-
impulsivity have not only been demonstrated in ADHD cesses between patients with BPD and healthy controls. It
patients, but also studies in healthy and diverse clinical was found that elevations of heart rate in BPD patients
populations have established robust evidence that those at rest and in response to emotional stimuli were fully
functions greatly benefit from engagement in physical ex- mediated by exercise activities in the past year (less in
ercise [16, 23, 82]. BPD patients than in healthy controls). In another study
These benficial effects might be related to the fact that from Dunton et al. [29], active children showed higher
exercise-induced changes in neurophysiological pro- emotional stability compared to their less active counter-
cesses mainly involve fronto-striatal brain functioning, parts. Moreover, a recent study across 661 participants
which is highly relevant for cognitive and behavioral aged 8–73 years found that people with higher fluctua-
control [2, 5, 110, 111]. Notably, neuroimaging studies tions in perceived subjective energy showed less physical
have found neurochemical, structural, and functional ab- activity. From this, the authors concluded that instability
normalities in the prefrontal cortex in BPD patients [62] in emotional states may either deplete self-regulatory
that overlap with brain changes in ADHD [120]. Similar capabilities for physical activity planning or that physical
to as in ADHD, exercise-related release of catechol- activity can stabilize emotional states [74]. Another com-
amines could be a potential mechanism of action in mon symptom in BPD is unbearable inner tension,
BPD, not only improving executive functioning and re- which patients sometimes can only manage by engaging
ducing impulsivity, but also influencing mood-related in non-suicidal self-injury, substance abuse, or other ul-
symptoms. Likewise, structural and functional changes timately maladaptive behaviors. Interestingly, naturalistic
in prefrontal brain areas due to exercise [24] might posi- investigations in community-based populations point to-
tively impact BPD symptomatology. wards a critical potential of physical activity to regulate
In addition, limbic structures including hippocampus affective states including inner tension [40, 58, 61, 66].
and amygdala have been identified as candidate endo- In particular, we [109] assessed physical activity via
phenotypes for BPD [28, 62, 115]. Reduced hippocampal accelerometry and psychological states for 1 week in 106
volume has been associated with behavioral symptoms adults during their daily routines and participants re-
like impulsivity [119]. Interestingly, there is increasing ported about their exercise activities. We found that ex-
evidence that exercise and physical fitness are related ercise (i.e., structured activities characterized by high
with greater hippocampal volume in older adults [32, energy consumption such as jogging, skating, swimming,
33], possibly due to a prevention of age-related deterior- or playing tennis) and non-exercise activity (i.e., unstruc-
ation [34]. Furthermore, alterations in the endogenous tured activities in everyday life such as climbing stairs to
opioid system and neuroendocrine responses mediated fetch papers from the basement) differed regarding their
by the hypothalamic-pituitary-adrenal axis (e.g., cortisol) psychological effects. That is, while non-exercise activity
have been proposed in BPD, which may contribute to increased energetic arousal and inner tension, exercise
symptoms like emotional dysregulation and increased increased valence and calmness. Therefore, we propose
sensitivity to stress [6, 56, 125, 144, 145]. Exercise has that patients suffering from inner tension, such as BPD
shown to affect the endogenous opioid system [9] and to patients, may gain if they engage in exercise sessions.
enhance mental stress sensitivity [7, 116, 131] and there- An additional argument for the application of physical
fore might positively impact those symptoms in BPD as exercise in BPD patients are the well-known beneficial
well. effects on further psychological and organic symptoms
Exercise-induced release of endorphins and catechol- that may be of relevance in BPD. Among other areas,
amines may also lead to enhancements in mood-related therapeutic effects have been demonstrated against obes-
symptoms such as emotional dysregulation, affective in- ity [143], cardiovascular disease risk and symptoms [96],
stability, low mood, inner emptiness, or hopelessness. body dissatisfaction [94, 106], and poor self-esteem [90,
The therapeutic effects of exercise on these symptoms 147]. While these symptoms do not represent the core
are well-known from studies in healthy participants and symptomatology of BPD, they often accompany a BPD,
in patients with affective disorders (for recent reviews, and physical exercise may help to alleviate these accom-
see [55, 126]). Naturalistic studies have further shown panying symptoms. In addition, exercise can increase
ecological validity of those findings, providing evidence self-efficacy [78], which may improve adherence to be-
that physical activity and exercise behavior indeed relate havioral therapies [122].
to emotional (in) stability and the ability to regulate In sum, there are several indirect empirical indications
emotions in healthy populations [76, 108]. In a recently that physical exercise could be an interesting and helpful
published study, Ligeza et al. [68] found that women adjunctive intervention option for BPD. We therefore
Mehren et al. Borderline Personality Disorder and Emotion Dysregulation (2020) 7:1 Page 7 of 11

encourage empirical studies to explore the therapeutic Consent for publication

potential of physical exercise in BPD patients. Not applicable.

Competing interests
Conclusions AM, MR, HM, and NB declare that they have no competing interests. DC
Results from experimental studies indicate potential declares that he served on advisory boards, gave lectures, performed phase
3 studies, or received travel grants within the last 5 years from Eli Lilly and
benefits of both acute exercise and long-term exercise Co, MEDICE, Novartis, Servier, and Shire; and has received Royalties from
interventions for patients with ADHD. However, while Oxford University Press. AP declares that she served on advisory boards, gave
fairly robust effects of acute aerobic exercise with lectures, performed phase 3 studies, or received travel grants within the last
5 years from Eli Lilly and Co, Janssen-Cilag, Lundbeck, MEDICE Arzneimittel,
moderate intensity on ADHD symptoms and execu- Pütter GmbH and Co KG, Novartis, Servier, and Shire; and has authored books
tive functions have been demonstrated in children and articles on ADHD published by Elsevier, Hogrefe, Schattauer, Kohlham-
with ADHD, other exercise modalities and intensities mer, Karger, Oxford Press, and Springer.
as well as effects in adults have not been investigated Author details
sufficiently. Due to methodological shortcomings (e.g., 1
Department of Psychology, Biological Psychology Lab, European Medical
lack of an adequate control condition), findings from School, University of Oldenburg, Oldenburg, Germany. 2Department of
Applied Psychology, Mental mHealth Lab, Institute of Sports and Sports
long-term intervention studies have to be interpreted Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany.
with caution. Nevertheless, the existing findings mo- 3
Department of Psychiatry and Psychotherapy, Central Institute of Mental
tivate further well-designed randomized controlled tri- Health, Medical Faculty Mannheim, Heidelberg University, Mannheim,
Germany. 4Royal Children’s Hospital, Melbourne, Victoria, Australia.
als examining exercise as an adjunct or stand-alone 5
Department of Psychiatry and Psychotherapy, University of Bonn, Bonn,
therapy for ADHD. Germany.
Interestingly, in contrast to a broad range of studies
Received: 2 April 2019 Accepted: 23 October 2019
on psychological interventions, exercise effects in BPD
have not been researched yet. One reason for this could
be that BPD is highly associated with altered body image References
and shame-proneness making it difficult to engage in 1. Ahmed GM, Mohamed A. Effect of regular aerobic exercises on behavioral,
cognitive and psychological response in patients with attention–deficit/
physical activities [85]. However, due to partly overlap- hyperactivity disorder. Life Sci J. 2011;8(2):366–71.
ping symptoms, neuropathological correlates, and high 2. Alvarez J, Emory E. Executive function and the frontal lobes: a meta-analytic
comorbidity between ADHD and BPD and the beneficial review. Neuropsychol Rev. 2006;16(1):17.
3. American Psychiatric Association. Diagnostic and statistical manual of
effects evidenced in healthy and diverse clinical popula- mental disorders. 5th ed. Arlington: American Psychiatric Publishing Inc;
tions, we suggest to investigate whether exercise entails 2013.
potential benefits for the therapy of BPD. Further advan- 4. Anish EJ. Exercise and its effects on the central nervous system. Curr Sports
Med Rep. 2005;4(1):18–23.
tages of physical exercise include low costs, easy imple- 5. Aron AR. The neural basis of inhibition in cognitive control. Neuroscientist.
mentation, absence of side-effects, an active role of the 2007;13(3):214–28.
patient including possibly enhanced compliance, non- 6. Bandelow B, Schmahl C, Falkai P, Wedekind D. Borderline personality
disorder: a dysregulation of the endogenous opioid system? Psychol Rev.
invasiveness, as well as additional psychological and 2010;117(2):623–36 https://doi.org/10.1037/a0018095.
physiological benefits. 7. Basso JC, Suzuki WA. The effects of acute exercise on mood, cognition,
neurophysiology, and neurochemical pathways: a review. Brain Plasticity.
Abbreviations 2017;2(2):127–52. https://doi.org/10.3233/bpl-160040.
ADHD: Attention deficit hyperactivity disorder; BDNF: Brain-derived 8. Berger NAA, Müller A, Brähler E, Philipsen A, Zwaan M. Association of
neurotrophic factor; BPD: Borderline personality disorder; CNV: Contingent symptoms of attention-deficit/hyperactivity disorder with symptoms of
negative variation; EEG: Electroencephalography; fMRI: Functional magnetic excessive exercising in an adult general population sample. BMC Psychiatry.
resonance imaging; PET: Positron emission tomography 2014;14:250 https://doi.org/10.1186/s12888-014-0250-7.
9. Boecker H, Sprenger T, Spilker ME, Henriksen G, Koppenhoefer M, Wagner
Acknowledgements KJ, et al. The runner’s high: opioidergic mechanisms in the human brain.
The authors would like to acknowledge Dr. Jale Özyurt for proofreading of Cereb Cortex. 2008;18(11):2523–31 https://doi.org/10.1093/cercor/bhn013.
the final manuscript and for her valuable advices. 10. Brunia CH, van Boxtel GJ. Wait and see. Int J Psychophysiol. 2001;43(1):59–
75.
11. Bustamante EE, Davis CL, Frazier SL, Rusch D, Fogg LF, Atkins MS, Marquez
Authors’ contributions
DX. Randomized controlled trial of exercise for ADHD and disruptive
AM and NB wrote major parts of the manuscript. MR, DC, HM, and AP
behavior disorders. Med Sci Sports Exerc. 2016;48(7):1397–407 https://doi.
contributed to, reviewed, and edited the manuscript. All authors read and
org/10.1249/MSS.0000000000000891.
approved the final manuscript.
12. Casey BJ, Castellanos FX, Giedd JN, Marsh WL, Hamburger SD, Schubert AB,
et al. Implication of right frontostriatal circuitry in response inhibition and
Funding attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry.
Not applicable. 1997;36(3):374–83 https://doi.org/10.1097/00004583-199703000-00016.
13. Cattane N, Rossi R, Lanfredi M, Cattaneo A. Borderline personality disorder
Availability of data and materials and childhood trauma: exploring the affected biological systems and
Not applicable. mechanisms. BMC Psychiatry. 2017;17(1):221 https://doi.org/10.1186/s12888-
017-1383-2.
Ethics approval and consent to participate 14. Cerrillo-Urbina AJ, Garcia-Hermoso A, Sanchez-Lopez M, Pardo-Guijarro MJ,
Not applicable. Santos Gomez JL, Martinez-Vizcaino V. The effects of physical exercise in
Mehren et al. Borderline Personality Disorder and Emotion Dysregulation (2020) 7:1 Page 8 of 11

children with attention deficit hyperactivity disorder: a systematic review Natl Acad Sci U S A. 2011;108(7):3017–22 https://doi.org/10.1073/pnas.
and meta-analysis of randomized control trials. Child Care Health Dev. 2015; 1015950108.
41(6):779–88 https://doi.org/10.1111/cch.12255. 34. Firth J, Stubbs B, Vancampfort D, Schuch F, Lagopoulos J, Rosenbaum S, et
15. Chang YK, Hung CL, Huang CJ, Hatfield BD, Hung TM. Effects of an aquatic al. Effect of aerobic exercise on hippocampal volume in humans: a
exercise program on inhibitory control in children with ADHD: a preliminary systematic review and meta-analysis. Neuroimage. 2018;166:230–8. https://
study. Arch Clin Neuropsychol. 2014;29(3):217–23 https://doi.org/10.1093/ doi.org/10.1016/j.neuroimage.2017.11.007.
arclin/acu003. 35. Fossati A, Novella L, Donati D, Donini M, Maffei C. History of childhood
16. Chang YK, Labban JD, Gapin JI, Etnier JL. The effects of acute exercise on attention deficit/hyperactivity disorder symptoms and borderline personality
cognitive performance: a meta-analysis. Brain Res. 2012a;1453:87–101 disorder: a controlled study. Compr Psychiatry. 2002;43(5):369–77.
https://doi.org/10.1016/j.brainres.2012.02.068. 36. Friedel RO. Dopamine dysfunction in borderline personality disorder: a
17. Chang Y-K, Liu S, Yu H-H, Lee Y-H. Effect of acute exercise on executive hypothesis. Neuropsychopharmacology. 2004;29(6):1029–39 https://doi.org/
function in children with attention deficit hyperactivity disorder. Arch Clin 10.1038/sj.npp.1300424.
Neuropsychol. 2012b;27(2):225–37 https://doi.org/10.1093/arclin/acr094. 37. Fritz KM, O'Connor PJ. Acute exercise improves mood and motivation in
18. Chmura J, Nazar K, Kaciuba-Uscilko H. Choice reaction time during graded young men with ADHD symptoms. Med Sci Sports Exerc. 2016;48(6):1153–
exercise in relation to blood lactate and plasma catecholamine thresholds. 60 https://doi.org/10.1249/MSS.0000000000000864.
Int J Sports Med. 1994;15(4):172–6 https://doi.org/10.1055/s-2007-1021042. 38. Fumoto M, Oshima T, Kamiya K, Kikuchi H, Seki Y, Nakatani Y, et al. Ventral
19. Choi JW, Han DH, Kang KD, Jung HY, Renshaw PF. Aerobic exercise and prefrontal cortex and serotonergic system activation during pedaling
attention deficit hyperactivity disorder: brain research. Med Sci Sports Exerc. exercise induces negative mood improvement and increased alpha band in
2015;47(1):33–9 https://doi.org/10.1249/MSS.0000000000000373. EEG. Behav Brain Res. 2010;213(1):1–9 https://doi.org/10.1016/j.bbr.2010.04.
20. Chou CC, Huang CJ. Effects of an 8-week yoga program on sustained 017.
attention and discrimination function in children with attention deficit 39. Gapin JI, Labban JD, Bohall SC, Wooten JS, Chang Y-K. Acute exercise is
hyperactivity disorder. PeerJ. 2017;5:e2883 https://doi.org/10.7717/peerj. associated with specific executive functions in college students with ADHD:
2883. a preliminary study. J Sport Health Sci. 2015;4(1):89–96 https://doi.org/10.
21. Chuang L-Y, Tsai Y-J, Chang Y-K, Huang C-J, Hung T-M. Effects of acute 1016/j.jshs.2014.11.003.
aerobic exercise on response preparation in a go/no go task in children 40. Gauvin L, Rejeski WJ, Norris JL. A naturalistic study of the impact of acute
with ADHD: an ERP study. J Sport Health Sci. 2015;4(1):82–8 https://doi.org/ physical activity on feeling states and affect in women. Health Psychol.
10.1016/j.jshs.2014.11.002. 1996;15(5):391–7.
22. Coghill DR, Seth S, Pedroso S, Usala T, Currie J, Gagliano A. Effects of 41. Gelade K, Bink M, Janssen TW, van Mourik R, Maras A, Oosterlaan J. An RCT
methylphenidate on cognitive functions in children and adolescents with into the effects of neurofeedback on neurocognitive functioning compared
attention-deficit/hyperactivity disorder: evidence from a systematic review to stimulant medication and physical activity in children with ADHD. Eur
and a meta-analysis. Biol Psychiatry. 2014;76(8):603–15 https://doi.org/10. Child Adolesc Psychiatry. 2017;26(4):457–68 https://doi.org/10.1007/s00787-
1016/j.biopsych.2013.10.005. 016-0902-x.
23. Colcombe S, Kramer AF. Fitness effects on the cognitive function of older 42. Gelade K, Janssen TW, Bink M, van Mourik R, Maras A, Oosterlaan J.
adults: a meta-analytic study. Psychol Sci. 2003;14(2):125–30. Behavioral effects of Neurofeedback compared to stimulants and physical
24. Colcombe SJ, Erickson KI, Scalf PE, Kim JS, Prakash R, McAuley E, et al. activity in attention-deficit/hyperactivity disorder: a randomized controlled
Aerobic exercise training increases brain volume in aging humans. J trial. J Clin Psychiatry. 2016;77(10):e1270–7 https://doi.org/10.4088/JCP.
Gerontol A Biol Sci Med Sci. 2006;61(11):1166–70 https://doi.org/10.1093/ 15m10149.
gerona/61.11.1166. 43. Gelade K, Janssen TWP, Bink M, Twisk JWR, van Mourik R, Maras A,
25. Cortese S, Adamo N, Del Giovane C, Mohr-Jensen C, Hayes AJ, Carucci S, et Oosterlaan J. A 6-month follow-up of an RCT on behavioral and
al. Comparative efficacy and tolerability of medications for attention-deficit neurocognitive effects of neurofeedback in children with ADHD. Eur Child
hyperactivity disorder in children, adolescents, and adults: a systematic Adolesc Psychiatry. 2018;27(5):581–93 https://doi.org/10.1007/s00787-017-
review and network meta-analysis. Lancet Psychiatry. 2018;5(9):727–38 1072-1.
https://doi.org/10.1016/S2215-0366(18)30269-4. 44. Golubovic S, Milutinovic D, Golubovic B. Benefits of physical exercises in
26. Cortese S, Kelly C, Chabernaud C, Proal E, Di Martino A, Milham MP, developing certain fitness levels in children with hyperactivity. J Psychiatr
Castellanos FX. Toward systems neuroscience of ADHD: a meta-analysis of Ment Health Nurs. 2014;21(7):594–600 https://doi.org/10.1111/jpm.12091.
55 fMRI studies. Am J Psychiatry. 2012;169(10):1038–55 https://doi.org/10. 45. Grassmann V, Alves MV, Santos-Galduroz RF, Galduroz JC. Possible cognitive
1176/appi.ajp.2012.11101521. benefits of acute physical exercise in children with ADHD. J Atten Disord.
27. Dishman RK, Berthoud HR, Booth FW, Cotman CW, Edgerton VR, Fleshner 2017;21(5):367–71 https://doi.org/10.1177/1087054714526041.
MR, et al. Neurobiology of exercise. Obesity (Silver Spring). 2006;14(3):345– 46. Haffner J, Roos J, Goldstein N, Parzer P, Resch F. The effectiveness of body-
56 https://doi.org/10.1038/oby.2006.46. oriented methods of therapy in the treatment of attention-deficit
28. Driessen M, Herrmann J, Stahl K, Zwaan M, Meier S, Hill A, et al. Magnetic hyperactivity disorder (ADHD): results of a controlled pilot study. Z Kinder
resonance imaging volumes of the hippocampus and the amygdala in Jugendpsychiatr Psychother. 2006;34(1):37–47 https://doi.org/10.1024/1422-
women with borderline personality disorder and early traumatization. Arch 4917.34.1.37.
Gen Psychiatry. 2000;57(12):1115–22. https://doi.org/10.1001/archpsyc.57.12. 47. Hernandez-Reif M, Field TM, Thimas E. Attention deficit hyperactivity
1115. disorder: benefits from tai chi. J Bodyw Mov Ther. 2001;5(2):120–3 https://
29. Dunton GF, Huh J, Leventhal AM, Riggs N, Hedeker D, Spruijt-Metz D, et al. doi.org/10.1054/jbmt.2000.0219.
Momentary assessment of affect, physical feeling states, and physical 48. Hoffman MD, Hoffman DR. Exercisers achieve greater acute exercise-
activity in children. Health Psychol. 2014;33(3):255–63. https://doi.org/10. induced mood enhancement than nonexercisers. Arch Phys Med Rehabil.
1037/a0032640. 2008;89(2):358–63 https://doi.org/10.1016/j.apmr.2007.09.026.
30. Durston S. A review of the biological bases of ADHD: what have we learned 49. Hoza B, Smith AL, Shoulberg EK, Linnea KS, Dorsch TE, Blazo JA, et al. A
from imaging studies? Ment Retard Dev Disabil Res Rev. 2003;9(3):184–95 randomized trial examining the effects of aerobic physical activity on
https://doi.org/10.1002/mrdd.10079. attention-deficit/hyperactivity disorder symptoms in young children. J
31. Eddie D, Bates ME, Vaschillo EG, Lehrer PM, Retkwa M, Miuccio M. Rest, Abnorm Child Psychol. 2015;43(4):655–67 https://doi.org/10.1007/s10802-
reactivity, and recovery: a psychophysiological assessment of borderline 014-9929-y.
personality disorder. Front Psychiatry. 2018;9:505. https://doi.org/10.3389/ 50. Hung CL, Huang CJ, Tsai YJ, Chang YK, Hung TM. Neuroelectric and
fpsyt.2018.00505. behavioral effects of acute exercise on task switching in children with
32. Erickson KI, Prakash RS, Voss MW, Chaddock L, Hu L, Morris KS, et al. Aerobic attention-deficit/ hyperactivity disorder. Front Psychol. 2016;7:1589 https://
fitness is associated with hippocampal volume in elderly humans. doi.org/10.3389/fpsyg.2016.01589.
Hippocampus. 2009;19(10):1030–9. https://doi.org/10.1002/hipo.20547. 51. Janssen TW, Bink M, Gelade K, van Mourik R, Maras A, Oosterlaan J. A
33. Erickson KI, Voss MW, Prakash RS, Basak C, Szabo A, Chaddock L, et al. randomized controlled trial into the effects of neurofeedback,
Exercise training increases size of hippocampus and improves memory. Proc methylphenidate, and physical activity on EEG power spectra in children
Mehren et al. Borderline Personality Disorder and Emotion Dysregulation (2020) 7:1 Page 9 of 11

with ADHD. J Child Psychol Psychiatry. 2016a;57(5):633–44 https://doi.org/ 71. Lu B, Nagappan G, Lu Y. BDNF and synaptic plasticity, cognitive function,
10.1111/jcpp.12517. and dysfunction. Handb Exp Pharmacol. 2014;220:223–50 https://doi.org/10.
52. Janssen TW, Bink M, Gelade K, van Mourik R, Maras A, Oosterlaan J. A 1007/978-3-642-45106-5_9.
randomized controlled trial investigating the effects of Neurofeedback, 72. Ludyga S, Brand S, Gerber M, Weber P, Brotzmann M, Habibifar F, Puhse U.
methylphenidate, and physical activity on event-related potentials in An event-related potential investigation of the acute effects of aerobic and
children with attention-deficit/hyperactivity disorder. J Child Adolesc coordinative exercise on inhibitory control in children with ADHD. Dev
Psychopharmacol. 2016b;26(4):344–53 https://doi.org/10.1089/cap.2015.0144. Cogn Neurosci. 2017;28:21–8 https://doi.org/10.1016/j.dcn.2017.10.007.
53. Jensen PS, Kenny DT. The effects of yoga on the attention and behavior of 73. Ludyga S, Gerber M, Mucke M, Brand S, Weber P, Brotzmann M, Puhse U.
boys with attention-deficit/ hyperactivity disorder (ADHD). J Atten Disord. The acute effects of aerobic exercise on cognitive flexibility and task-related
2004;7(4):205–16 https://doi.org/10.1177/108705470400700403. heart rate variability in children with ADHD and healthy controls. J Atten
54. Jeong HI, Ji ES, Kim SH, Kim TW, Baek SB, Choi SW. Treadmill exercise Disord. 2018:1087054718757647 https://doi.org/10.1177/1087054718757647.
improves spatial learning ability by enhancing brain-derived neurotrophic 74. Maher JP, Dzubur E, Nordgren R, Huh J, Chou CP, Hedeker D, et al. Do
factor expression in the attention-deficit/hyperactivity disorder rats. J Exerc fluctuations in positive affective and physical feeling states predict physical
Rehabil. 2014;10(3):162–7. https://doi.org/10.12965/jer.140111. activity and sedentary time? Psychol Sport Exerc. 2019;41:153–61. https://
55. Josefsson T, Lindwall M, Archer T. Physical exercise intervention in doi.org/10.1016/j.psychsport.2018.01.011.
depressive disorders: Meta-analysis and systematic review. Scand J Med Sci 75. Mahon AD, Dean RS, McIntosh DE, Marjerrison AD, Cole AS, Woodruff ME,
Sports. 2014;24(2):259–72. https://doi.org/10.1111/sms.12050. Lee MP. Acute exercise effects on measures of attention and impulsivity in
56. Kalin NH, Shelton SE, Barksdale CM. Opiate modulation of separation- children with attention deficit/hyperactivity disorder. J Educ Dev Psychol.
induced distress in non-human primates. Brain Res. 1988;440(2):285–92. 2013;3(2):65.
https://doi.org/10.1016/0006-8993(88)90997-3. 76. Mata J, Thompson RJ, Jaeggi SM, Buschkuehl M, Jonides J, Gotlib IH. Walk
57. Kang KD, Choi JW, Kang SG, Han DH. Sports therapy for attention, on the bright side: physical activity and affect in major depressive disorder.
cognitions and sociality. Int J Sports Med. 2011;32(12):953–9 https://doi.org/ J Abnorm Psychol. 2012;121(2):297–308. https://doi.org/10.1037/a0023533.
10.1055/s-0031-1283175. 77. Matthies SD, Philipsen A. Common ground in attention deficit hyperactivity
58. Kanning MK, Ebner-Priemer UW, Schlicht WM. How to investigate within- disorder (ADHD) and borderline personality disorder (BPD)–review of recent
subject associations between physical activity and momentary affective findings. Borderline Personal Disord Emot Dysregul. 2014;1(1):3 https://doi.
states in everyday life: a position statement based on a literature overview. org/10.1186/2051-6673-1-3.
Front Psychol. 2013;4:187. https://doi.org/10.3389/fpsyg.2013.00187. 78. McAuley E, Blissmer B. Self-efficacy determinants and consequences of
59. Kim H, Heo HI, Kim DH, Ko IG, Lee SS, Kim SE, et al. Treadmill exercise and physical activity. Exerc Sport Sci Rev. 2000;28(2):85–8.
methylphenidate ameliorate symptoms of attention deficit/hyperactivity 79. McClure G, Hawes DJ, Dadds MR. Borderline personality disorder and
disorder through enhancing dopamine synthesis and brain-derived neuropsychological measures of executive function: a systematic review.
neurotrophic factor expression in spontaneous hypertensive rats. Neurosci Personal Ment Health. 2016;10(1):43–57. https://doi.org/10.1002/pmh.1320.
Lett. 2011;504(1):35–9 https://doi.org/10.1016/j.neulet.2011.08.052. 80. McKune AJ, Pautz J, Lombard J. Behavioural response to exercise in children
60. Kleemeyer MM, Polk TA, Schaefer S, Bodammer NC, Brechtel L, with attention-deficit/hyperactivity disorder. S Afr J Sports Med. 2003;15(3):
Lindenberger U. Exercise-induced fitness changes correlate with changes in 17–21.
neural specificity in older adults. Front Hum Neurosci. 2017;11:123 https:// 81. McMorris T, Collard K, Corbett J, Dicks M, Swain JP. A test of the
doi.org/10.3389/fnhum.2017.00123. catecholamines hypothesis for an acute exercise-cognition interaction.
61. Koch ED, Tost H, Braun U, Gan G, Giurgiu M, Reinhard I, et al. Mood Pharmacol Biochem Behav. 2008;89(1):106–15 https://doi.org/10.1016/j.pbb.
dimensions show distinct within-subject associations with non-exercise 2007.11.007.
activity in adolescents: an ambulatory assessment study. Front Psychol. 82. McMorris T, Hale BJ. Differential effects of differing intensities of acute
2018;9:268. https://doi.org/10.3389/fpsyg.2018.00268. exercise on speed and accuracy of cognition: a meta-analytical
62. Krause-Utz A, Winter D, Niedtfeld I, Schmahl C. The latest neuroimaging investigation. Brain Cogn. 2012;80(3):338–51 https://doi.org/10.1016/j.bandc.
findings in borderline personality disorder. Curr Psychiatry Rep. 2014;16(3): 2012.09.001.
438 https://doi.org/10.1007/s11920-014-0438-z. 83. Medina JA, Netto TLB, Muszkat M, Medina AC, Botter D, Orbetelli R, et al.
63. Kuja-Halkola R, Lind Juto K, Skoglund C, Ruck C, Mataix-Cols D, Perez-Vigil A, Exercise impact on sustained attention of ADHD children, methylphenidate
et al. Do borderline personality disorder and attention-deficit/hyperactivity effects. Atten Defic Hyperact Disord. 2010;2(1):49–58 https://doi.org/10.1007/
disorder co-aggregate in families? A population-based study of 2 million s12402-009-0018-y.
swedes. Mol Psychiatry. 2018; https://doi.org/10.1038/s41380-018-0248-5. 84. Meeusen R, De Meirleir K. Exercise and brain neurotransmission. Sports Med.
64. Lee R, Kermani P, Teng KK, Hempstead BL. Regulation of cell survival by 1995;20(3):160–88.
secreted proneurotrophins. Science. 2001;294(5548):1945–8 https://doi.org/ 85. Meeusen R, Piacentini MF, De Meirleir K. Brain microdialysis in exercise
10.1126/science.1065057. research. Sports Med. 2001;31(14):965–83.
65. Lee SK, Lee CM, Park JH. Effects of combined exercise on physical fitness 86. Mehren A, Özyurt J, Lam AP, Brandes M, Müller HHO, Thiel CM, Philipsen A.
and neurotransmitters in children with ADHD: a pilot randomized Acute effects of aerobic exercise on executive function and attention in
controlled study. J Phys Ther Sci. 2015;27(9):2915–9 https://doi.org/10.1589/ adult patients with ADHD. Front Psychiatry. 2019;10(132) https://doi.org/10.
jpts.27.2915. 3389/fpsyt.2019.00132.
66. Liao Y, Shonkoff ET, Dunton GF. The acute relationships between affect, 87. Mehta MA, Owen AM, Sahakian BJ, Mavaddat N, Pickard JD, Robbins TW.
physical feeling states, and physical activity in daily life: a review of current Methylphenidate enhances working memory by modulating discrete frontal
evidence. Front Psychol. 2015;6:1975. https://doi.org/10.3389/fpsyg.2015. and parietal lobe regions in the human brain. J Neurosci. 2000;20(6):RC65.
01975. 88. Memarmoghaddam M, Torbati HT, Sohrabi M, Mashhadi A, Kashi A. Effects
67. Lieb K, Zanarini MC, Schmahl C, Linehan MM, Bohus M. Borderline of a selected exercise programon executive function of children with
personality disorder. Lancet. 2004;364(9432):453–61 https://doi.org/10.1016/ attention deficit hyperactivity disorder. J Med Life. 2016;9(4):373–9.
S0140-6736(04)16770-6. 89. Mitchelmore C, Gede L. Brain derived Neurotrophic factor: epigenetic
68. Ligeza TS, Kalamala P, Tarnawczyk O, Maciejczyk M, Wyczesany M. Frequent regulation in psychiatric disorders. Brain Res. 2014;1586:162–72 https://doi.
physical exercise is associated with better ability to regulate negative org/10.1016/j.brainres.2014.06.037.
emotions in adult women: the electrophysiological evidence. Ment Health 90. Mousavi Gilani SR, Dashipour A. The effects of physical activity on self-
Phys Act. 2019;7. https://doi.org/10.1016/j.mhpa.2019.100294. esteem: a comparative study. Int J High Risk Behav Addict. 2016;6(1):1–6.
69. Lista I, Sorrentino G. Biological mechanisms of physical activity in https://doi.org/10.5812/ijhrba.35955.
preventing cognitive decline. Cell Mol Neurobiol. 2010;30(4):493–503 91. Nater UM, Bohus M, Abbruzzese E, Ditzen B, Gaab J, Kleindienst N, et al.
https://doi.org/10.1007/s10571-009-9488-x. Increased psychological and attenuated cortisol and alpha-amylase
70. Liu DY, Shen XM, Yuan FF, Guo OY, Zhong Y, Chen JG, et al. The physiology responses to acute psychosocial stress in female patients with borderline
of BDNF and its relationship with ADHD. Mol Neurobiol. 2015;52(3):1467–76 personality disorder. Psychoneuroendocrinology. 2010;35(10):1565–72
https://doi.org/10.1007/s12035-014-8956-6. https://doi.org/10.1016/j.psyneuen.2010.06.002.
Mehren et al. Borderline Personality Disorder and Emotion Dysregulation (2020) 7:1 Page 10 of 11

92. Nemoda Z, Lyons-Ruth K, Szekely A, Bertha E, Faludi G, Sasvari-Szekely M. 111. Ridderinkhof KR, van den Wildenberg WP, Segalowitz SJ, Carter CS.
Association between dopaminergic polymorphisms and borderline Neurocognitive mechanisms of cognitive control: the role of prefrontal
personality traits among at-risk young adults and psychiatric inpatients. cortex in action selection, response inhibition, performance monitoring, and
Behav Brain Funct. 2010;6:4 https://doi.org/10.1186/1744-9081-6-4. reward-based learning. Brain Cogn. 2004b;56(2):129–40. https://doi.org/10.
93. Neudecker C, Mewes N, Reimers AK, Woll A. Exercise interventions in 1016/j.bandc.2004.09.016.
children and adolescents with ADHD: A Systematic Review. J Atten Disord. 112. Robinson AM, Hopkins ME, Bucci DJ. Effects of physical exercise on ADHD-
2015; https://doi.org/10.1177/1087054715584053. like behavior in male and female adolescent spontaneously hypertensive
94. Neumark-Sztainer D, Goeden C, Story M, Wall M. Associations between rats. Dev Psychobiol. 2011;53(4):383–90 https://doi.org/10.1002/dev.20530.
body satisfaction and physical activity in adolescents: implications for 113. Rubia K, Alegria AA, Cubillo AI, Smith AB, Brammer MJ, Radua J. Effects of
programs aimed at preventing a broad spectrum of weight-related stimulants on brain function in attention-deficit/hyperactivity disorder: a
disorders. Eat Disord. 2004;12(2):125–37. https://doi.org/10.1080/ systematic review and meta-analysis. Biol Psychiatry. 2014;76(8):616–28
10640260490444989. https://doi.org/10.1016/j.biopsych.2013.10.016.
95. Ni X, Sicard T, Bulgin N, Bismil R, Chan K, McMain S, Kennedy JL. 114. Ruocco AC. The neuropsychology of borderline personality disorder: a
Monoamine oxidase a gene is associated with borderline personality meta-analysis and review. Psychiatry Res. 2005;137(3):191–202. https://doi.
disorder. Psychiatr Genet. 2007;17(3):153–7 https://doi.org/10.1097/YPG. org/10.1016/j.psychres.2005.07.004.
0b013e328016831c. 115. Ruocco AC, Amirthavasagam S, Zakzanis KK. Amygdala and hippocampal
96. Nystoriak MA, Bhatnagar A. Cardiovascular effects and benefits of exercise. volume reductions as candidate endophenotypes for borderline personality
Front Cardiovasc Med. 2018;5(September):1–11. https://doi.org/10.3389/ disorder: a meta-analysis of magnetic resonance imaging studies. Psychiatry
fcvm.2018.00135. Res. 2012;201(3):245–52. https://doi.org/10.1016/j.pscychresns.2012.02.012.
97. Pajonk FG, Wobrock T, Gruber O, Scherk H, Berner D, Kaizl I, et al. 116. Salmon P. Effects of physical exercise on anxiety, depression, and sensitivity
Hippocampal plasticity in response to exercise in schizophrenia. Arch Gen to stress: a unifying theory. Clin Psychol Rev. 2001;21(1):33–61. https://doi.
Psychiatry. 2010;67(2):133–43 https://doi.org/10.1001/archgenpsychiatry. org/10.1016/S0272-7358(99)00032-X.
2009.193. 117. Sansone RA, Chu JW, Wiederman MW. Body image and borderline
98. Pan CY, Chang YK, Tsai CL, Chu CH, Cheng YW, Sung MC. Effects of physical personality disorder among psychiatric inpatients. Compr Psychiatry. 2010;
activity intervention on motor proficiency and physical fitness in children 51(6):579–84 https://doi.org/10.1016/j.comppsych.2010.04.001.
with ADHD: an exploratory study. J Atten Disord. 2017;21(9):783–95 https:// 118. Schachter HM, Pham B, King J, Langford S, Moher D. How efficacious and
doi.org/10.1177/1087054714533192. safe is short-acting methylphenidate for the treatment of attention-deficit
99. Pan CY, Tsai CL, Chu CH, Sung MC, Huang CY, Ma WY. Effects of physical disorder in children and adolescents? A meta-analysis. CMAJ. 2001;165(11):
exercise intervention on motor skills and executive functions in children 1475–88.
with ADHD: A Pilot Study. J Atten Disord. 2015; https://doi.org/10.1177/ 119. Schmahl C, Berne K, Krause A, Kleindienst N, Valerius G, Vermetten E, et al.
1087054715569282. Hippocampus and amygdala volumes in patients with borderline
100. Perroud N, Salzmann A, Prada P, Nicastro R, Hoeppli ME, Furrer S, et al. personality disorder with or without posttraumatic stress disorder. J
Response to psychotherapy in borderline personality disorder and Psychiatry Neurosci. 2009;34(4):289–95.
methylation status of the BDNF gene. Transl Psychiatry. 2013;3:e207 https:// 120. Sebastian A, Jung P, Krause-Utz A, Lieb K, Schmahl C, Tüscher O. Frontal
doi.org/10.1038/tp.2012.140. dysfunctions of impulse control - a systematic review in borderline
101. Philipsen A, Limberger MF, Lieb K, Feige B, Kleindienst N, Ebner-Priemer U, personality disorder and attention-deficit/hyperactivity disorder. Front Hum
et al. Attention-deficit hyperactivity disorder as a potentially aggravating Neurosci. 2014;8:698 https://doi.org/10.3389/fnhum.2014.00698.
factor in borderline personality disorder. Br J Psychiatry. 2008;192(2):118–23 121. Seidman LJ, Valera EM, Makris N. Structural brain imaging of attention-
https://doi.org/10.1192/bjp.bp.107.035782. deficit/hyperactivity disorder. Biol Psychiatry. 2005;57(11):1263–72 https://
102. Piepmeier AT, Shih C-H, Whedon M, Williams LM, Davis ME, Henning DA, et doi.org/10.1016/j.biopsych.2004.11.019.
al. The effect of acute exercise on cognitive performance in children with 122. Selzler AM, Rodgers WM, Berry TR, Stickland MK. The importance of exercise
and without ADHD. J Sport Health Sci. 2015;4(1):97–104 https://doi.org/10. self-efficacy for clinical outcomes in pulmonary rehabilitation. Rehabil
1016/j.jshs.2014.11.004. Psychol. 2016;61(4):380–8. https://doi.org/10.1037/rep0000106.
103. Pliszka SR. The neuropsychopharmacology of attention-deficit/hyperactivity 123. Shephard RJ. Physical activity and the healthy mind. Can Med Assoc J. 1983;
disorder. Biol Psychiatry. 2005;57(11):1385–90 https://doi.org/10.1016/j. 128(5):525–30.
biopsych.2004.08.026. 124. Smith AL, Hoza B, Linnea K, McQuade JD, Tomb M, Vaughn AJ, et al. Pilot physical
104. Polich J. Updating P300: an integrative theory of P3a and P3b. Clin activity intervention reduces severity of ADHD symptoms in young children. J
Neurophysiol. 2007;118(10):2128–48 https://doi.org/10.1016/j.clinph.2007.04. Atten Disord. 2013;17(1):70–82 https://doi.org/10.1177/1087054711417395.
019. 125. Southwick SM, Axelrod SR, Wang S, Yehuda R, Morgan CA 3rd, Charney D,
105. Pontifex MB, Saliba BJ, Raine LB, Picchietti DL, Hillman CH. Exercise improves et al. Twenty-four-hour urine cortisol in combat veterans with PTSD and
behavioral, neurocognitive, and scholastic performance in children with comorbid borderline personality disorder. J Nerv Ment Dis. 2003;191(4):261–
attention-deficit/hyperactivity disorder. J Pediatr. 2013;162(3):543–51 https:// 2. https://doi.org/10.1097/01.NMD.0000061140.93952.28.
doi.org/10.1016/j.jpeds.2012.08.036. 126. Sylvia LG, Chang WC, Szuhany KL, Hearing CM, Nierenberg AA, Deckersbach
106. Powell AL, Thelen MH. Emotions and cognitions associated with bingeing T. Physical exercise for treatment of mood disorders: a critical review. Curr
and weight control behavior in bulimia. J Psychosom Res. 1996;40(3):317– Behav Neurosci Rep. 2016. https://doi.org/10.1007/s40473-016-0089-y.
28. 127. Szuhany KL, Bugatti M, Otto MW. A meta-analytic review of the effects of
107. Prince J. Catecholamine dysfunction in attention-deficit/hyperactivity exercise on brain-derived neurotrophic factor. J Psychiatr Res. 2015;60:56–64
disorder: an update. J Clin Psychopharmacol. 2008;28(3 Suppl 2):S39–45 https://doi.org/10.1016/j.jpsychires.2014.10.003.
https://doi.org/10.1097/JCP.0b013e318174f92a. 128. Tantillo M, Kesick CM, Hynd GW, Dishman RK. The effects of exercise on
108. Reichert M, Kapteinat I, Lauvai I, Hennig O, Reinhard I, Braun U, et al. Tiny children with attention-deficit hyperactivity disorder. Med Sci Sports Exerc.
steps towards smartphone based exercise interventions in everyday life? 2002;34(2):203–12.
Pilot testing the effects of an exercise intervention on depressed people’s 129. Thayer RE, Newman JR, McClain TM. Self-regulation of mood: strategies for
everyday life mood. Z Sportpsychol. 2018;25(4):156–63. https://doi.org/10. changing a bad mood, raising energy, and reducing tension. J Pers Soc
1026/1612-5010/a000243. Psychol. 1994;67(5):910–25.
109. Reichert M, Tost H, Reinhard I, Schlotz W, Zipf A, Salize HJ, et al. Exercise 130. Tsai SJ. Attention-deficit hyperactivity disorder may be associated with
versus nonexercise activity: e-diaries unravel distinct effects on mood. Med decreased central brain-derived neurotrophic factor activity: clinical and
Sci Sports Exerc. 2017;49(4):763–73. https://doi.org/10.1249/MSS. therapeutic implications. Med Hypotheses. 2007;68(4):896–9 https://doi.org/
0000000000001149. 10.1016/j.mehy.2006.06.025.
110. Ridderinkhof KR, Ullsperger M, Crone EA, Nieuwenhuis S. The role of the 131. Tsatsoulis A, Fountoulakis S. The protective role of exercise on stress system
medial frontal cortex in cognitive control. Science. 2004a;306(5695):443–7. dysregulation and comorbidities. Ann N Y Acad Sci. 2006;1083:196–213
https://doi.org/10.1126/science.1100301. https://doi.org/10.1196/annals.1367.020.
Mehren et al. Borderline Personality Disorder and Emotion Dysregulation (2020) 7:1 Page 11 of 11

132. Unoka Z, Richman MJ. Neuropsychological deficits in BPD patients and the
moderator effects of co-occurring mental disorders: a meta-analysis. Clin
Psychol Rev. 2016;44:1–12. https://doi.org/10.1016/j.cpr.2015.11.009.
133. Vaidya CJ, Austin G, Kirkorian G, Ridlehuber HW, Desmond JE, Glover GH,
Gabrieli JD. Selective effects of methylphenidate in attention deficit
hyperactivity disorder: a functional magnetic resonance study. Proc Natl
Acad Sci U S A. 1998;95(24):14494–9.
134. Vaidya CJ, Stollstorff M. Cognitive neuroscience of attention deficit
hyperactivity disorder: current status and working hypotheses. Dev Disabil
Res Rev. 2008;14(4):261–7 https://doi.org/10.1002/ddrr.40.
135. Vaynman S, Ying Z, Gomez-Pinilla F. Hippocampal BDNF mediates the
efficacy of exercise on synaptic plasticity and cognition. Eur J Neurosci.
2004;20(10):2580–90 https://doi.org/10.1111/j.1460-9568.2004.03720.x.
136. Verret C, Guay MC, Berthiaume C, Gardiner P, Beliveau L. A physical activity
program improves behavior and cognitive functions in children with ADHD:
an exploratory study. J Atten Disord. 2012;16(1):71–80 https://doi.org/10.
1177/1087054710379735.
137. Voss MW, Prakash RS, Erickson KI, Basak C, Chaddock L, Kim JS, et al.
Plasticity of brain networks in a randomized intervention trial of exercise
training in older adults. Front Aging Neurosci. 2010;2:17 https://doi.org/10.
3389/fnagi.2010.00032.
138. Wagner S, Baskaya O, Lieb K, Dahmen N, Tadic A. The 5-HTTLPR
polymorphism modulates the association of serious life events (SLE) and
impulsivity in patients with borderline personality disorder. J Psychiatr Res.
2009;43(13):1067–72 https://doi.org/10.1016/j.jpsychires.2009.03.004.
139. Walter WG, Cooper R, Aldridge VJ, McCallum WC, Winter AL. Contingent
negative variation: an electric sign of sensorimotor association and
expectancy in the human brain. Nature. 1964;203:380–4 https://doi.org/10.
1038/203380a0.
140. Wang GJ, Volkow ND, Fowler JS, Franceschi D, Logan J, Pappas NR, et al.
PET studies of the effects of aerobic exercise on human striatal dopamine
release. J Nucl Med. 2000;41(8):1352–6.
141. Wigal SB, Emmerson N, Gehricke J-G, Galassetti P. Exercise: applications to
childhood ADHD. J Atten Disord. 2013;17(4):279–90 https://doi.org/10.1177/
1087054712454192.
142. Wigal SB, Nemet D, Swanson JM, Regino R, Trampush J, Ziegler MG, Cooper
DM. Catecholamine response to exercise in children with attention deficit
hyperactivity disorder. Pediatr Res. 2003;53(5):756–61 https://doi.org/10.
1203/01.PDR.0000061750.71168.23.
143. Wiklund P. The role of physical activity and exercise in obesity and weight
management: time for critical appraisal. J Sport Health Sci. 2016;5(2):151–4.
https://doi.org/10.1016/j.jshs.2016.04.001.
144. Wingenfeld K, Driessen M, Adam B, Hill A. Overnight urinary cortisol release
in women with borderline personality disorder depends on comorbid PTSD
and depressive psychopathology. Eur Psychiatry. 2007;22(5):309–12. https://
doi.org/10.1016/j.eurpsy.2006.09.002.
145. Wingenfeld K, Wolf OT. Stress, memory, and the hippocampus. Front Neurol
Neurosci. 2014;34:109–20. https://doi.org/10.1159/000356423.
146. Winsper C, Marwaha S, Lereya ST, Thompson A, Eyden J, Singh SP. A
systematic review of the neurobiological underpinnings of borderline
personality disorder (BPD) in childhood and adolescence. Rev Neurosci.
2016;27(8):827–47 https://doi.org/10.1515/revneuro-2016-0026.
147. Zamani Sani SH, Fathirezaie Z, Brand S, Pühse U, Holsboer-Trachsler E,
Gerber M, et al. Physical activity and self-esteem: testing direct and indirect
relationships associated with psychological and physical mechanisms.
Neuropsychiatr Dis Treat. 2016;12:2617–25. https://doi.org/10.2147/NDT.
S116811.
148. Ziereis S, Jansen P. Effects of physical activity on executive function and
motor performance in children with ADHD. Res Dev Disabil. 2015;38:181–91
https://doi.org/10.1016/j.ridd.2014.12.005.
149. Zouhal H, Jacob C, Delamarche P, Gratas-Delamarche A. Catecholamines
and the effects of exercise, training and gender. Sports Med. 2008;38(5):
401–23 https://doi.org/10.2165/00007256-200838050-00004.

Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affiliations.