Objective <p>This study aims to systematically evaluate the intervention effects of long-term exercise on motor skills in children with ADHD (Attention Deficit and Hyperactivity Disorder) using a three-level meta-analysis.</p> Methods <p>A computer-based search was conducted in four databases: Embase, The Cochrane Library, PubMed, and Web of Science, for randomized controlled trials related to the effects of long-term exercise on motor skills in children with ADHD, with search dates ranging from database inception to December 3, 2024. The risk of bias in the included studies was assessed using the Rob 2.0 tool. Effect sizes were synthesized, and influence analysis, moderator analysis, and publication bias assessment were conducted using the metafor package in R software. Evidence quality was evaluated using GRADEpro.</p> Results <p>A total of 9 studies were included. The intervention effect of long-term exercise on motor skills in children with ADHD was statistically significant (g = 0.72, 95% CI = (0.31, 1.14), <i>P</i> = 0.001), with a moderate level of evidence. Diagnosis method, exercise type, duration, frequency, and motor skill type were not found to be moderating factors (<i>P</i> &gt; 0.05 for all).</p> Conclusion <p>Long-term exercise can enhance motor skills in children with ADHD; however, this finding should be interpreted with caution. Further validation through large-scale randomized controlled trial is required in future research.</p>