Effects of Physical Activity on Executive Function and Emotional Regulation in Children and Adolescents with Neurodevelopmental Disorders: A Systematic Review and Meta-Analysis

<b>Background/Objectives:</b> Children and adolescents with neurodevelopmental disorders (NDDs) often experience deficits in executive functioning and emotional regulation, which impact their academic, social, and behavioral development. While physical activity is increasingly recognized as a promising non-pharmacological intervention, the specific effects on cognitive and emotional domains remain heterogeneous. This systematic review and meta-analysis aimed to assess the efficacy of physical-motor interventions in improving executive functions and emotional regulation in youths with NDDs. <b>Methods</b>: Following PRISMA 2020 guidelines, a comprehensive search of five databases was conducted (2010-2024) to identify randomized controlled trials (RCTs) evaluating the effects of structured physical activity programs on executive and emotional outcomes in children and adolescents diagnosed with NDDs. A total of 22 RCTs were included in the qualitative synthesis, while 16 were included in the quantitative analysis. Effect sizes were calculated using a random effects model, while heterogeneity was assessed with the Q, I², Tau², and Egger's tests. <b>Results</b>: Physical activity interventions demonstrated a non-significant effect on executive functioning (g = 0.492; <i>p</i> = 0.215; 95% CI: -0.286 to 1.269). Although the point estimate suggested a small-to-moderate effect, the wide confidence interval and lack of statistical significance prevent firm conclusions. In contrast, a large and significant effect was observed on emotional regulation outcomes (g = -1.204; <i>p</i> < 0.001; 95% CI: -1.688 to -0.655), despite moderate heterogeneity (I² = 72.3%). Several studies also reported specific improvements in working memory, cognitive flexibility, and emotional control. <b>Conclusions</b>: Structured physical activity may be an effective complementary intervention for improving emotional regulation in youth with NDDs, with less consistent evidence for executive functioning. Future research should clarify optimal protocols and target populations to enhance intervention effectiveness.