Effects of aerobic exercise on body self-esteem among Chinese college students: A meta-analysis

Junwen Shu; Tianci Lu; Baole Tao; Hanwen Chen; Haoran Sui; Lingzhi Wang; Ye Zhang; Jun Yan

doi:10.1371/journal.pone.0291045

. 2023 Sep 8;18(9):e0291045. doi: 10.1371/journal.pone.0291045

Effects of aerobic exercise on body self-esteem among Chinese college students: A meta-analysis

Junwen Shu ¹, Tianci Lu ¹, Baole Tao ¹, Hanwen Chen ¹, Haoran Sui ¹, Lingzhi Wang ¹, Ye Zhang ¹, Jun Yan ^1,^*

Editor: Ru Zhang²

PMCID: PMC10490958 PMID: 37682892

Abstract

Objective

To investigate the effect of aerobic exercise on five dimensions of physical self-worth, exercise capacity, physical condition, physical attractiveness, and physical quality in body self-esteem of Chinese college students.

Methods

By searching PubMed, Web of Science, Cochrane Library, CNIK database, VIP database, WANFANG database platform, we searched for the subject terms or keywords "body self-esteem", "Chinese college students", "Systematic evaluation", "Aerobic exercise", "Exercise intervention", “Meta-Analysis”. The search method was a combination of subject terms and keywords and title, and the search period was from database creation to The search was conducted from database creation to May 2022. A total of 3221 articles were searched, and 9 articles were included in the study through repeated screening. Risk of bias was assessed with Cochrane and the quality of studies in the literature was assessed using Grade pro software. The outcome indicators of the included literature were analysed using review manager 5.4 software and StataMP 17.0 software.

Results

Nine papers including 1613 subjects were included. results of Meta-analysis showed that aerobic exercise was effective in improving physical self-worth (WMD = 1.46, 95% CI: 1.08–1.83, p<0.001), improving exercise capacity (WMD = 1.62, 95% CI: 1.23–2.01, p<0.001), improving physical attractiveness (WMD = 1.32, 95% CI: 0.98–1.67, p<0.001), improved physical condition (WMD = 1.32, 95% CI: 0.98–1.67, P<0.001), improved physical fitness (WMD = 1.51, 95% CI: 1.07–1.95, P<0.001). The differences were all statistically significant.

Conclusion

Aerobic exercise can effectively improve the body self-esteem of Chinese college students. In exercise, male students pursue is athletic ability and physical fitness, and female students pursue is the sense of physical self-worth and physical attractiveness. Aerobic exercise has a greater increase in body self-esteem for obese or Obese college students. Aerobics and physical dance are the most cost-effective for improving body self-esteem. Medium-intensity relative to low-intensity exercise was effective for body self-esteem intervention. A single exercise session of 90 minutes was more effective than a single 30-minute session in boosting body self-esteem, and the overall intervention duration of 16 weeks was more effective than 10 weeks.

1. Introduction

With the increasing number of college students graduating today, the rapid social and economic development, the accelerated pace of life, and the normalization of the global new crown epidemic, the employment situation is becoming increasingly challenging, and for many Chinese college students, going to college is a stressful time [1]. In addition to dealing with academic pressure, they also have to deal with their own relationships with teachers, classmates, roommates and lovers, and some college students also have to deal with a series of pressures such as separation from their families of origin and competition for employment, which can have a negative impact on mental health [1–3]. Therefore, solving the mental health problems of Chinese university students and promoting the overall development of their physical and mental health have become the top priorities of Chinese universities [4].

Self-esteem is considered by psychologists to be the variable that best predicts changes in mood and personality [5]. Body self-esteem refers to an individual’s emotional feelings about different aspects of their body, either positive or negative, based on their own evaluations. It is a specific area under overall self-esteem and is an important component of self-esteem and mental health [6]. Among them, body self-esteem includes five dimensions: physical self-worth, athletic ability, physical condition, physical attractiveness, and physical qualities [7]. Body self-worth is an important part of the self. Body self-worth is closely linked to the whole self, plays an integrating role in the whole self, and refers to the degree to which individuals are satisfied with various aspects of their bodies such as their looks, athletic ability, body size [8] (Chen et al.,2004). Athletic ability refers to the ability of people to participate in sports and training, is a comprehensive performance of human body form, quality, function, skills and mental ability and other factors, from the biochemical point of view of analysis, athletic ability depends mainly on the supply, transfer and utilization of energy in the process of exercise [9] (Patel et al.,2021). There are four types of physical conditions, namely: healthy state, subhealthy state, precursor state before the onset of disease, and disease onset state [10] (Rivera et al.,2019). Physical attractiveness is defined as a dimension of psychological evaluation of the state and degree of beauty of the human body [11] (Durkee et al.,2019). Physical fitness refers to the strength, speed, endurance, agility, flexibility and other functions that the human body exhibits in its activities, physical quality is the external expression of a person’s physical strength [12] (Hancox et al.,2018).

College students are in the final stage of moving from school to society, and the personality development and psychological development of college students during this period are extremely important for their future life and social development [13] (Hadler et al.,2021). If students can develop good and stable body self-esteem, it will not only improve overall self-esteem, but also have a positive impact on the individual’s mental health [6] (Franzoi et al.,1984). College students’ evaluation and perception of their body self-esteem is related to their future physical activity awareness and physical life habits [14] (Deng et al.,2009).Aerobic exercise was advocated by Dr. Kenneth H. Cooper in 1968. Aerobic exercise is an exercise in which the energy consumed by the body during exercise is mainly supplied by the process of aerobic oxidation, usually lasting more than 30 minutes [15, 16] (Chen et al.,2011;Hung et al.,2021). Aerobic exercise can make the body release beta-endorphin, which can regulate the activity of the human brain nervous system, and it helps to relieve and eliminate depression, irritability, sadness, anger and other bad moods [17–19] (Li et al.,2003). A large number of studies have shown that different types of aerobic exercise can improve the mental health of college students and promote the formation of good mental qualities [4, 20–23] (Li et al.,2022;Kim et al.,2021;Zhang et al.,2022;Tang et al.,2022;Margulis et al.,2021). It has also been shown that aerobic exercise can increase the level of body self-esteem of college students [24–26] (He et al.,2002;He et al.,2003;Zhang et al.,2019 [18]). The effect of different aerobic exercises on improving the five dimensions of body self-esteem in college students varies, and different aerobic exercise on improving the five dimensions of body self-esteem among college students with different physical conditions and different genders are different, and there is a lack of quantitative systematic evaluation and research reports. Therefore, this study uses Meta-analysis to quantitatively summarize the recent literature and compare the effects of various aerobic exercises on the five dimensions of body self-esteem of college students of different genders and physical conditions, so as to provide reference for college physical education practice teaching and college students’ exercise selection, and to improve the quality of college physical education and promote college students’ mental health and exercise motivation.

2. Sources and methods

The process and steps of this study were conducted according to the regulations and process requirements of the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) [27]. The purpose of the PRISMA reputation is to help authors improve the writing and reporting of systematic reviews/meta-analyses(registration number CRD42023417686) (Table 1).

Table 1. Reporting quality of included systematic reviews assessed using the PRISMA checklist.

Section and Topic	Item #	Checklist item	Location where item is reported
TITLE
Title	1	Identify the report as a systematic review.	1
ABSTRACT
Abstract	2	See the PRISMA 2020 for Abstracts checklist.	12–37
INTRODUCTION
Rationale	3	Describe the rationale for the review in the context of existing knowledge.	39–83
Objectives	4	Provide an explicit statement of the objective(s) or question(s) the review addresses.	84–93
METHODS
Eligibility criteria	5	Specify the inclusion and exclusion criteria for the review and how studies were grouped for the syntheses.	117–125
Information sources	6	Specify all databases, registers, websites, organisations, reference lists and other sources searched or consulted to identify studies. Specify the date when each source was last searched or consulted.	107–115
Search strategy	7	Present the full search strategies for all databases, registers and websites, including any filters and limits used.	109–115
Selection process	8	Specify the methods used to decide whether a study met the inclusion criteria of the review, including how many reviewers screened each record and each report retrieved, whether they worked independently, and if applicable, details of automation tools used in the process.	123–125
Data collection process	9	Specify the methods used to collect data from reports, including how many reviewers collected data from each report, whether they worked independently, any processes for obtaining or confirming data from study investigators, and if applicable, details of automation tools used in the process.	15–23
Data items	10a	List and define all outcomes for which data were sought. Specify whether all results that were compatible with each outcome domain in each study were sought (e.g. for all measures, time points, analyses), and if not, the methods used to decide which results to collect.	49–67
Data items	10b	List and define all other variables for which data were sought (e.g. participant and intervention characteristics, funding sources). Describe any assumptions made about any missing or unclear information.	131–137
Study risk of bias assessment	11	Specify the methods used to assess risk of bias in the included studies, including details of the tool(s) used, how many reviewers assessed each study and whether they worked independently, and if applicable, details of automation tools used in the process.	139–147
Effect measures	12	Specify for each outcome the effect measure(s) (e.g. risk ratio, mean difference) used in the synthesis or presentation of results.	149–155
Synthesis methods	13a	Describe the processes used to decide which studies were eligible for each synthesis (e.g. tabulating the study intervention characteristics and comparing against the planned groups for each synthesis (item #5)).	161–164
	13b	Describe any methods required to prepare the data for presentation or synthesis, such as handling of missing summary statistics, or data conversions.	166–170
	13c	Describe any methods used to tabulate or visually display results of individual studies and syntheses.	145–151
	13d	Describe any methods used to synthesize results and provide a rationale for the choice(s). If meta-analysis was performed, describe the model(s), method(s) to identify the presence and extent of statistical heterogeneity, and software package(s) used.	149–155
	13e	Describe any methods used to explore possible causes of heterogeneity among study results (e.g. subgroup analysis, meta-regression).	187–192 201–205 214–218 227–231 240–244
	13f	Describe any sensitivity analyses conducted to assess robustness of the synthesized results.	145–151
Reporting bias assessment	14	Describe any methods used to assess risk of bias due to missing results in a synthesis (arising from reporting biases).	193–197 206–210 219–223 232–236 245–249
Certainty assessment	15	Describe any methods used to assess certainty (or confidence) in the body of evidence for an outcome.	139–147
RESULTS
Study selection	16a	Describe the results of the search and selection process, from the number of records identified in the search to the number of studies included in the review, ideally using a flow diagram.	126–129
Study selection	16b	Cite studies that might appear to meet the inclusion criteria, but which were excluded, and explain why they were excluded.	123–125
Study characteristics	17	Cite each included study and present its characteristics.	160–171
Risk of bias in studies	18	Present assessments of risk of bias for each included study.	173–176
Results of individual studies	19	For all outcomes, present, for each study: (a) summary statistics for each group (where appropriate) and (b) an effect estimate and its precision (e.g. confidence/credible interval), ideally using structured tables or plots.	160–164 187–192 201–205 214–218 227–231 240–244
Results of syntheses	20a	For each synthesis, briefly summarise the characteristics and risk of bias among contributing studies.	364–374
	20b	Present results of all statistical syntheses conducted. If meta-analysis was done, present for each the summary estimate and its precision (e.g. confidence/credible interval) and measures of statistical heterogeneity. If comparing groups, describe the direction of the effect.	176–188 197–201 210–214 223–227 236–240
	20c	Present results of all investigations of possible causes of heterogeneity among study results.	187–192 201–205 214–218 227–231 240–244
	20d	Present results of all sensitivity analyses conducted to assess the robustness of the synthesized results.	134–152
Reporting biases	21	Present assessments of risk of bias due to missing results (arising from reporting biases) for each synthesis assessed.	359–360
Certainty of evidence	22	Present assessments of certainty (or confidence) in the body of evidence for each outcome assessed.	135–143
DISCUSSION
Discussion	23a	Provide a general interpretation of the results in the context of other evidence.	250–357
	23b	Discuss any limitations of the evidence included in the review.	358–366
	23c	Discuss any limitations of the review processes used.	N/A
	23d	Discuss implications of the results for practice, policy, and future research.	367–378
OTHER INFORMATION
Registration and protocol	24a	Provide registration information for the review, including register name and registration number, or state that the review was not registered.	98
	24b	Indicate where the review protocol can be accessed, or state that a protocol was not prepared.	N/A
	24c	Describe and explain any amendments to information provided at registration or in the protocol.	N/A
Support	25	Describe sources of financial or non-financial support for the review, and the role of the funders or sponsors in the review.	379–381
Competing interests	26	Declare any competing interests of review authors.	376–378
Availability of data, code and other materials	27	Report which of the following are publicly available and where they can be found: template data collection forms; data extracted from included studies; data used for all analyses; analytic code; any other materials used in the review.	382–383

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2.1 Information retrieval strategy

The literature was collected through PubMed, Web of Science, Cochrane Library, CNIK (Chinese National Knowledge Infrastructure), VIP Chinese Journal Service Platform, and WANFANG Data Knowledge Service Platform search platforms. The search terms were "aerobic exercise", "exercise intervention", "physical exercise", "university students", "Chinese university students", and "Chinese university students". "Meta-analysis," "body self-esteem," "Chinese college students," "physical exercise," "aerobic exercise," "exercise intervention," trying to retrieve each synonym and adjusting it to the specific database, the search time was built until May 2022, and the search method was a combination of subject terms, keywords The search method was a combination of subject terms, keywords, and article names.

2.2 Literature inclusion criteria

(1) The language of the included studies was English or Chinese, but the subjects were Chinese university students; (2) The intervention for the experimental group was a specific aerobic exercise program, while the experimental group must have a pre-test, the intervention duration was not less than 8 weeks, and the duration of each exercise session was at least 30 minutes (including 30 minutes); the control group took non-exercise exercise or a different exercise mode than the experimental group; (3) The body self-esteem measures were all developed using the Fox and the revised Physical Self-Esteem Scale (PSPP) for college students by Xu Xia and Yao Jiaxin [7] (Xu et al.,2001); (4) The outcome indicators must include five dimensions in physical self-esteem: physical self-worth, athletic ability, physical condition, physical attractiveness, and physical quality.(5) The included studies were experimental studies of exercise interventions.

2.3 Literature exclusion criteria

(1) experimental subjects were not Chinese university students, (2) incomplete outcome indicators, (3) review literature, (4) measurement tools did not meet the requirements (5) low quality literature and suspicious results (Fig 1).

2.4 Literature screening and data extraction

This literature exercise software EndNote X9 was used to help literature screening. The main contents of the extraction were: the first author of the collected literature, time of publication, experimental subjects, sample size, number of each gender, form of exercise, intervention period, frequency, single intervention time, and outcome evaluation index (some of the papers extracted in this study lacked control group data, so all the control group data were replaced with experimental group pre-test) [28]. The data included in the article are published and no unpublished data were included in the article.

2.5 Quality evaluation criteria

Quality evaluation was conducted independently by two researchers. Grade pro software was used to evaluate the quality of the outcome indicators in the literature. The evaluation included (1) study limitations-assessing whether the studies had limitations in design or execution serious enough to reduce the quality of evidence for that outcome; (2) inconsistency-assessing whether the results were consistent across studies and whether any inconsistencies were serious enough to reduce the quality of evidence for that outcome; (3) Imprecision-assessing whether the results are sufficiently precise and whether any imprecision in the results is serious enough to reduce the quality of evidence for that result. Systematic review authors and guideline panels define imprecision differently; (4) Indirectness-Assess whether the evidence directly answers the question posed, and whether the indirectness of the available evidence is serious enough to reduce the quality of the evidence for that outcome; (5) Publication bias-assesses whether publication bias is likely to exist and whether reporting bias is serious enough to reduce the quality of evidence for that outcome. Each outcome was categorised as "no", "serious" or "very serious".

2.6 Risk of literature bias assessment

The included literature was evaluated for risk of bias using Cochrane in Review Manager 5.4 software [29] (Higgins et al.,2011), and the quality of the included studies was evaluated for seven indicators: random sequence generation (selection bias), Allocation concealment (selection bias), Blinding of participants and personnel (performance bias), Blinding of outcome assessment (detection bias), Incomplete outcome data (attrition bias). Selgative reporting (reporting blas), Other bias, Evaluation results include low risk, uncertainty, and high risk. All evaluation indicators were satisfied as grade A, with the lowest possibility of bias; partially satisfied as grade B, with low possibility of bias; and completely unsatisfied as grade C, with high possibility of bias. The quality assessment was carried out independently by 2 sports psychologists.

2.7 Data processing

Excel software was used to organize and summarize the data, Review Manager 5.4 software was used to assess the risk of bias in the nine papers, StataMP17.0 software was used to test for heterogeneity, merge the data, and draw funnel plots and forest plots, and Random-effects Model (REM) was used for Meta-analysis. All nine papers included in this study had continuous variables and consistent units, so Weighted mean difference (WMD) was used as the effect indicator. Each effect size was expressed as 95% CI (confidence interval), and the consistency coefficient Q and I² values were used for heterogeneity analysis.

3. Results

3.1 Literature search results

The initial literature search of 3221 articles was conducted, and a total of 9 articles were finally included in the Meta-analysis after screening.

3.2 Basic characteristics of the included studies

As shown in Table 2, of the nine included papers [30–38] (Zhu et al.,2005;Zhu et al.,2006;Wang.,2016;Yuan.,2021;Wang et al.,2012;Li.,2007;Cao et al.,2016;Xu et al.,2020;Sun et al.,2018), the subjects included 1613 individuals.

Table 2. Summary of studies that met the inclusion criteria.

First Author	Publish time		Male / Female	Exercise Program	Exercise frequency	Movement time/min	Heart rate	Duration of intervention
Xu Hengzheng	2020	30	Not explicitly stated	Ba duan jin	3 times/week	40~60	100~130	10 weeks
Wenshu Sun	2018	500	291/209	Wushu+Aerobics+Physical Dance+Badminton+Table tennis+Tennis+Football+Basketball	1 time/week	90	120~140	One academic year
Beijuan Cao	2016	184	0/184	Aerobics+Yoga+Sports Dance+Artistic Gymnastics	1 time/week	90	110~140	One semester
Li Lingyun	2007	255	137/118	Taijiquan	1 time/week	90	100~120	16 weeks
Wang Aijing	2012	186	112/74	Aerobic running + sports games + light equipment strength training	3 times/week	90	100~140	15 weeks
Yuan Yuxin	2021	60	0/60	Physical Dance	2 times/week	90	120~150	16 weeks
Wang Yajun	2016	195	88/107	Jogging+self weight training	3 times/week	50	110~150	12 weeks
Zhu Fengshu	2006	87	0/87	small-intensity aerobics+ medium-intensity aerobics	3 times/week	30	90~150	10 weeks
Zhu Fengshu	2005	116	57/59	Small to medium intensity basketball and aerobics	3 times/week	30	90~150	10 weeks

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In the nine papers, some researchers used different exercise programs to intervene in the body self-esteem of college students with different characteristics, so all the experimental groups of the intervention of exercise programs for college students with different characteristics in the nine included papers were extracted, and a total of 28 experimental groups were extracted for Meta-analysis, as shown in Table 3.

Table 3. The 28 experimental groups included in the meta-analysis.

Experimental groups	Number of persons
Xu Hengzheng 2020 (Baduanjin)	30
Sun Wenshu 2018 (Wushu)	78
Sun Wenshu 2018 (Aerobics)	41
Sun Wenshu 2018 (Sports Dance)	39
Sun Wenshu 2018 (Table Tennis)	87
Sun Wenshu 2018 (Badminton)	70
Sun Wenshu 2018 (Tennis)	37
Sun Wenshu 2018 (Basketball)	73
Sun Wenshu 2018 (Soccer)	75
Beijuan Cao 2016 (Aerobics)	23
Beijuan Cao 2016 (Yoga)	23
Beijuan Cao 2016 (Sports Dance)	23
Beijuan Cao 2016 (Artistic Gymnastics)	23
Li Lingyun 2007 (Taijiquan)	255
Wang Aijing 2012 (Aerobic exercise) Low body mass male	31
Wang Aijing 2012 (aerobic exercise) low body mass female	21
Wang Aijing 2012 (Aerobic exercise) Super fit male	52
Wang Aijing 2012 (aerobic exercise) super fit female	36
Wang Aijing 2012 (Aerobic Exercise) Obesity Male	28
Wang Aijing 2012 (aerobic exercise) obese female	18
Yuan Yuxin 2021 (physical dance)	30
Wang Yajun 2016 (jogging + self weight training)	99
Zhu Fengshu 2006 (small-intensity aerobics)	28
Zhu Fengshu 2006 (medium-intensity aerobics)	29
Zhu Fengshu 2005 (small intensity basketball) Male	28
Zhu Fengshu 2005 (medium-intensity basketball) Male	29
Zhu Fengshu 2005 (small-intensity aerobics) female	29
Zhu Fengshu 2005 (medium-intensity aerobics) female	30

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3.3 Risk of bias evaluation

Nine included papers were evaluated for quality and risk of bias according to the Cochrane Risk of Bias Assessment Tool, of which one was of low quality and high risk, and the remaining eight were of moderate quality(Fig 2).

3.4 GRADE system recommended grading

The evidence obtained on the effects of aerobic exercise on the physical self-esteem of Chinese university students was graded according to the GRADE system, and their quality of evidence was low, respectively (Table 4).

Table 4. GRADE system recommended grading results.

Aerobic Exercise for [Body Self-Esteem] in [Chinese College Students]
Patient or population: Settings: Intervention: Chinese College Students Comparison:
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
Outcomes	Assumed risk	Corresponding risk	Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
		Chinese College Students
physical self-worth		The mean physical self-worth in the intervention groups was 1.46 higher (1.08 to 1.83 higher)		2730 (9 studies)	⊕⊕⊝⊝ low¹^,²
exercise capacity		The mean exercise capacity in the intervention groups was 1.62 higher (1.23 to 2.01 higher)		2730 (9 studies)	⊕⊕⊝⊝ low¹^,²
physical condition		The mean physical condition in the intervention groups was 1.32 lower (0.96 to 1.67 higher)		2730 (9 studies)	⊕⊕⊝⊝ low¹^,²
physical attractiveness		The mean physical attractiveness in the intervention groups was 1.32 higher (0.99 to 1.65 higher)		2730 (9 studies)	⊕⊕⊝⊝ low¹^,²
physical fitness		The mean physical fitness in the intervention groups was 1.51 higher (1.07 to 1.95 higher)		2730 (9 studies)	⊕⊕⊝⊝ low¹^,²
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval;
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.

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¹ Inclusion of studies biased in terms of blinding

² Heterogeneity exists

3.5 Meta-analysis results

3.5.1 Heterogeneity test and publication bias analysis of the effect of aerobic exercise workout on physical self-worth of college students

3.5.1.1 Heterogeneity and combined effect value test. Forest plots in Meta-analysis are graphs based on statistical effect sizes and confidence intervals, using the results of numerical operations included in the literature, and thus plotted [39, 40] (Dettori et al.,2021). Bias in the literature is also called systematic error, which refers to the process by which the results or inferences of the final study deviate from the true value or lead to the phenomenon of such deviation. It is any tendency that can lead to the final conclusion systematically differing from the true value, generally during the process of collecting information, analyzing data, or publishing [41–43]. The numerical results yielded high heterogeneity among the studies: Q = 89.94,df = 27 (p<0.01), I² = 70%, and according to the criteria for classifying heterogeneity in the literature [44] (Hatala et al.,2002), a random effects model was used to test for heterogeneity and combined effect values for 28 groups, (see Fig 1). (WMD = 1.46, 95% CI: 1.08 to 1.83, p < 0.001), which was statistically significant. It indicates that aerobic exercise can effectively improve the physical self-worth of Chinese university students. (Fig 3). Subgroup analyses were conducted by gender for each study, with statistically significant differences between subgroups (p < 0.05, I² > 50%), and meta-analyses were conducted using a random-effects model. The results showed that the sense of physical self-worth of each study was higher than the preexperimental measure (p < 0.05). As shown in Table 5.

Table 5. Results of sub group analysis of body self-worth.

Subgroup (Male/Female)	Number of studies	MD (95%CI)	P	Z	I ² %
Male	8	-2.09 [-3.18, -1.00]	P = 0.0002	3.77	86%
Female	8	-1.58 [-2.36, -0.80]	P<0.0001	3.98	59%

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3.5.1.2 Bias analysis of the research literature. As shown in Fig 4, the 28 experimental groups were distributed on both sides of the funnel plot, with most of them within the two dashed 95% CI lines and four groups outside the 95% CI line, which may have heterogeneity. The overall quality of the study literature was moderate, and there was no significant bias among the literature (Fig 4).

3.5.2 Heterogeneity test and publication bias analysis of the effect of aerobic exercise workout on college students’ Athletic ability

3.5.2.1 Tests for heterogeneity and combined effect values. The results of numerical operations yielded a high heterogeneity among studies: Q = 74.99, df = 27 (p<0.01), I² = 64%, and a random effects model was used to test for heterogeneity and combined effect values for the 28 experimental groups. (WMD = 1.62, 95% CI: 1.23 to 2.01, p<0.001), which was statistically significant. It showed that aerobic exercise was effective in improving the Athletic ability of Chinese college students, and there was no significant bias in the literature, (Fig 5). The studies were analysed in subgroups by gender, with greater heterogeneity occurring within aerobic exercise intervention females (I² > 50%), and meta-analysis was performed using a random effects model. There was little heterogeneity in aerobic exercise interventions in women (p < 0.00001, I² = 2%), and exercise capacity was higher than preexperimental measurements in all studies (p < 0.05). As shown in Table 6.

Table 6. Results of subgroup analysis of exercise capacity.

Subgroup (Male/Female)	Number of studies	MD (95%CI)	P	Z	I ² %
Male	8	-1.40 [-1.80, -1.01]	P<0.00001	6.99	2%
Female	8	-1.52 [-2.35, -0.70]	P = 0.0003	3.63	68%

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3.5.2.2 Analysis of bias in the research literature. As shown in (Fig 6), the 28 experimental groups were distributed on both sides of the funnel plot, and most of them were within the two dashed 95% CI lines, with three groups outside the 95% CI line, which may have heterogeneity. The overall quality of the study literature was moderate, and there was no significant bias among the literature.

3.5.3 Heterogeneity test and publication bias analysis of the effect of aerobic exercise workouts on college students’ physical status

3.5.3.1 Tests for heterogeneity and combined effect values. The results of numerical operations yielded high heterogeneity among studies: Q = 58.22, df = 27 (p<0.01), I² = 53.6%, and a random effects model was used to test for heterogeneity and combined effect values for the 28 experimental groups. (WMD = 1.32, 95% CI: 0.98 to 1.67, p<0.001), which was statistically significant. It showed that aerobic exercise was effective in improving the physical status of Chinese college students and there was no significant bias in the literature, (Fig 7). The studies were analysed in subgroups by gender, with statistically significant and low heterogeneity of differences in each subgroup (I² < 50%, p < 0.05), and meta-analysis was performed using a fixed-effects model. The results showed that the physical condition of each study participant was higher than the preexperimental measurements (p < 0.05). As shown in Table 7.

Table 7. Results of subgroup analysis of physical condition.

Subgroup (Male/Female)	Number of studies	MD (95%CI)	P	Z	I ² %
Male	8	-0.83 [-1.25, -0.42]	P<0.0001	4.19	13%
Female	8	-0.99 [-1.43, -0.54]	P<0.0001	4.36	0%

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3.5.3.2 Analysis of bias in the research literature. The 28 experimental groups were distributed on both sides of the funnel plot, and most of them were within the two dashed 95% CI lines, with five groups outside the 95% CI line, which may have heterogeneity. The overall quality of the study literature was moderate, and there was no significant bias among the literature, as shown in (Fig 8).

3.5.4 Heterogeneity test and publication bias analysis of the effect of aerobic exercise workout on physical attractiveness of college students

3.5.4.1 Tests for heterogeneity and combined effect values. The results of numerical operations yielded high heterogeneity among studies: Q = 62.23, df = 27 (p<0.01), I² = 56.6%, and a random effects model was used to test for heterogeneity and combined effect values for the 28 experimental groups. (WMD = 1.32, 95% CI: 0.99 to 1.65, p<0.001), which was statistically significant. It showed that aerobic exercise was effective in improving the physical attractiveness of Chinese college students, and there was no significant bias in the literature, (Fig 9). The study was divided into gender subgroups, with statistically significant differences and low heterogeneity among subgroups (I2 < 50%, p < 0.05). A fixed effect model was used for meta-analysis. The results showed that the physical attractiveness of female study participants was higher than that measured before the experiment (p < 0.05), and the physical attractiveness of male study participants was not significantly improved (P = 0.21). As shown in Table 8.

Table 8. Results of subgroup analysis of physical attractiveness.

Subgroup (Male/Female)	Number of studies	MD (95%CI)	P	Z	I ² %
Male	8	-0.33 [-0.86, 0.19]	P = 0.21	1.24	41%
Female	8	-1.02 [-1.42, -0.62]	P<0.00001	5.01	0%

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3.5.4.2 Analysis of bias in the research literature. The 28 experimental groups were distributed on both sides of the funnel plot, and most of them were within the two dashed 95% CI lines, with four groups outside the 95% CI line, which may have heterogeneity. The overall quality of the study literature was moderate, and there was no significant bias among the literature, as shown in (Fig 10).

3.5.5 Heterogeneity test and publication bias analysis of the effect of aerobic exercise workouts on college students’ physical fitness

3.5.5.1 Tests for heterogeneity and combined effect values. The results of numerical operations yielded a high heterogeneity among studies: Q = 92.85, df = 27 (p<0.01), I² = 70.9%, and a random effects model was used to test for heterogeneity and combined effect values for the 28 experimental groups. (WMD = 1.51, 95% CI: 1.07 to 1.95, p<0.001), which was statistically significant. It indicates that aerobic exercise can effectively improve the physical fitness of Chinese college students, and there is no significant bias in the literature, (Fig 11). The study was subgroup analyzed by sex, with greater heterogeneity among men (I² > 50%) with aerobic exercise intervention, and a random effects model was used for meta-analysis. There was little heterogeneity in aerobic exercise interventions in women (p < 0.0001, I² = 48%), and exercise capacity was higher in all studies than in pre-experimental measurements (p < 0.05). As shown in Table 9.

Table 9. Results of subgroup analysis of physical fitness.

Subgroup (Male/Female)	Number of studies	MD (95%CI)	P	Z	I ² %
Male	8	-0.64 [-0.96, -0.31]	P = 0.0001	3.87	81%
Female	8	-0.45 [-0.67, -0.23]	P<0.0001	4.00	48%

Open in a new tab

3.5.5.2 Analysis of bias in the research literature. The 28 experimental groups were distributed on both sides of the funnel plot, and most of them were within the two dashed 95% CI lines, with five groups outside the 95% CI line, which may have heterogeneity. The overall quality of the study literature was moderate, and there was no significant bias among the literature, as shown in (Fig 12).

4. Analysis and discussion

4.1 The effect of aerobic exercise on body self-esteem intervention of college students of different genders

The results of the subgroup analyses showed that male university students had higher levels of body self-esteem and higher dimensions of body self-esteem than female university students in both the pre- and post-experiment periods. This may be because Chinese female college students are pursuing unhealthy beauty, such as "chopstick legs", "A4 waist", "right-angle shoulders", and evaluating their beauty by thinness and whiteness, while exercise will lead to the development of human muscles, and if they choose to be outdoors, it is inevitable that their skin will become darker, so the level of body self-awareness is low, resulting in a lower level of body self-esteem. In contrast, Chinese male college students exercise more frequently compared to female college students, and the ratio of men to women in college sports fields and gyms is basically greater for men than for women, while Chinese male college students do not pursue as much as Chinese female college students in terms of body perception [45] (Zhao et al.,2022), so the level of body self-esteem before the experiment is higher than that of female students. The intervention effects of physical attractiveness and physical self-worth were most significant for female college students after the experiment, followed by athletic ability, and finally physical condition and physical quality; the intervention effects of athletic ability were most significant for male college students, followed by general physical self-worth and physical quality, again physical attractiveness, and finally physical condition. This shows that the body self-esteem pursued by male and female students is different. Boys pursue is athletic ability, girls pursue is the sense of physical self-worth and physical attractiveness, which shows that boys and girls in sports exercise different exercise motivation and different exercise goals.

4.2 Effects of aerobic exercise workouts on body self-esteem interventions among college students with different physical fitness levels

In the nine included papers, the exercise interventions were targeted at college students with specific body types, including: overweight (BMI of 24–27.9), obese (BMI ≥ 28), low body type (BMI < 18.5), and "weak" college students. From the data included in the literature, comparing the level of body self-esteem of this group of university students with special physique before the experiment with the other groups, the physical self-worth (mean of special physique group: 12.24; mean of other groups: 13.57), athletic ability (mean of special physique group: 12.55; mean of other groups: 13.39), physical condition (mean of special physique group: 13.76. Other group mean: 14.95), physical attractiveness (special physique group mean: 13.05; other group mean: 13.76), and physical fitness (special physique group mean: 11.65; other group mean: 14.11). It can be seen that body self-esteem of college students with obese or thin bodies is significantly lower than other groups. In particular, the difference between physical quality and physical self-worth is the most obvious, but the level of body self-esteem of "weak" college students and low-physique college students is a little higher than that of obese and super-physique college students before the experiment, and related studies also show that there are obvious problems in the mental health of obese college students [46, 47] (Qiao.,2008;Wu.,2011), and the main psychological problems are low self-esteem, lack of self-confidence, loneliness and depression. lack of self-confidence, loneliness and depression. After the intervention, the changes in body self-esteem were more pronounced in the hyperthymic and obese groups than in the low-body mass group and the "weak" college students. This may be due to the fact that the accumulation of body fat in the overweight and obese groups has led to the decrease of their own athletic ability and physical quality. "inflexible", "unhealthy", etc. However, in real life, there is no obvious difference in the athletic ability of low fitness group and "weak" college students compared with normal students, and there is no big difference in the flexibility and reaction speed of these students compared with normal students, so the level of body self-perception is higher. Most Chinese college students think of body beauty as thinness, so the level of body perception is higher among low-fit college students and "weak" college students than obese and super-fit students. The experimental exercise intervention is aerobic exercise, which effectively burns fat and promotes weight loss, and effectively targets obese and super-fit college students, but not low-fit and "weak" college students, so on the contrary, perhaps strength and anaerobic training can improve low-fit and "weak" college students’ body self-esteem. In contrast, perhaps strength and anaerobic training can improve the body self-esteem level of low and "weak" college students.

4.3 Effects of different aerobic exercise intensities on body self-esteem interventions for college students

Moderate intensity aerobic exercise promotes the level of body self-esteem of Chinese college students better than low intensity aerobic exercise, probably because moderate intensity aerobic exercise can better stimulate muscle growth and fat burning, build a beautiful body, improve athletic ability and physical fitness, and thus improve body self-esteem compared to low intensity aerobic exercise. However, the difference between moderate and low intensity aerobic exercise on body self-esteem intervention in some literature is not significant, and even some data show that low intensity aerobic exercise is significantly more effective than moderate intensity aerobic exercise in intervening body self-worth and body condition, but the difference between the values of body self-worth and body condition after the two intensity interventions is less than 1, and the size of the difference is not significant, which may be because the difference between moderate intensity However, the difference between the two intensities was less than 1, and the size of the difference was not significant, which may be because the difference between medium intensity and small intensity was not obvious, and should be included in the comparison of large intensity exercise.

4.4 Effects of aerobic exercise of different types of sports on body self-esteem intervention of college students

All the exercise types included in the literature have a good promotion effect on Chinese college students’ body self-esteem after the intervention, among which aerobics, physical dance, artistic gymnastics, and yoga have a good effect on college students’ "athletic ability", "body self-worth", "physical condition", and "body self-esteem". The four dimensions of "physical condition" and "physical attractiveness" were improved more significantly. Perhaps because gymnastic exercises are accompanied by music, the movements are beautiful and rich, rich in rhythm, so that the exerciser can transfer the tiredness brought by exercise, which invariably increases the consumption of exercise, improves the athletic ability and physical quality, while expressing their own emotions, improving aesthetic ability, and improving self-confidence when performing in front of others, gymnastic exercises are relatively more concerned with themselves, less competitive, and the cooperation, understanding, and help of the group. Collective cooperation, understanding, help and coordination are more important and can promote interpersonal relationships, so these four dimensions of improving body self-esteem are highly targeted and have a significant effect on improving.

In terms of improving "physical quality", basketball and soccer are more effective, probably because basketball and soccer require physical confrontation in sports, and they are more effective in improving physical quality because of the high exertion, long duration, and high stimulation of the body, while soccer and basketball also have better effects on the other 4 dimensions. Jogging plus self-weight training also has a better and very good effect on the 5 dimensions of body self-esteem, but not as good as gymnastic sports and basketball and soccer. Probably because jogging plus self weight training can also play a role in muscle building while effectively slimming down, the combination of the two consumes a lot, the practitioner focuses more on himself and improves the training effect. Taijiquan and Baduanjin are less effective in improving the various dimensions of body self-esteem than the previous exercises. These two exercises are low in intensity and have a slower and softer rhythm, which is less suitable for college students who are in their vigorous years, and therefore may affect the enthusiasm of the exercise, and the stimulation and energy consumption of the body is relatively small, so the effect of improving body self-esteem is limited.

4.5 Effects of aerobic exercise of different durations on body self-esteem intervention for college students

The latter has a better effect on improving body self-esteem compared with one workout per week of 90 minutes each, probably because it is aerobic exercise and each 30 minutes is not sufficiently stimulating, but each 90 minutes is a little more stimulating to the body and the exertion is increased. In terms of the overall duration of the intervention, one semester and one year of intervention are more effective than 16 and 10 weeks of intervention, but there may also be effects from different exercise programs and populations, and this needs to be demonstrated in later experiments.

4.6 Limitations of this study

(1) There is different publication bias and heterogeneity in the included data, probably due to the different duration of the intervention. (2) The collected literature spans a large range (3) There is no uniform requirement for the process at the time of measurement.(4)The included literature has limitations in the study population and lacks detailed information that may influence the findings, such as ethnic, geographical, and cultural factors.(5)Extraction of information is carried out independently by multiple researchers, but there may still be omissions due to subjective factors, affecting the comprehensiveness and authenticity of the evaluation results.(6) Fewer studies included in the literature, smaller sample sizes, and lack of stronger evidence for the results.

5. Conclusions

(1) Aerobic exercise can effectively improve the physical self-esteem of college students. (2) Male students pursue athletic ability and physical quality, while female students pursue a sense of physical self-worth and physical attractiveness. (3) The increase in exercise intensity also improves body self-esteem. When aerobic exercise is performed, the intensity of exercise can be increased, but not the greater the intensity, but currently it can be proved that moderate intensity is good for body self-esteem intervention compared to small intensity exercise. (4) Aerobic exercise has a greater increase in body self-esteem for obese or super-fit college students. (5) Exercise class exercises are the most cost-effective for improving body self-esteem, and Taijiquan and Baduanjin are the least cost-effective. (6) An exercise session of 90 minutes was more effective than one session of 30 minutes in raising body self-esteem, and the overall intervention duration of 16 weeks was more effective than 10 weeks.

Supporting information

S1 Checklist. PRISMA 2020 checklist.

(DOCX)

Click here for additional data file.^{(32.2KB, docx)}

S1 Data

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Click here for additional data file.^{(18.7KB, zip)}

Data Availability

All relevant data are within the paper and its Supporting Information files.

Funding Statement

The author(s) received no specific funding for this work.

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PONE-D-23-08546Effects of Aerobic Exercise on Body Self-Esteem among Chinese College Students:A Meta-AnalysisPLOS ONE

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1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

**********

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: No

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The study topic is worthy of investigation; however, this study has some problems that must be fixed before acceptance. Please find below some major points to consider.

1. Lines 51-52. You mentioned that psychologists consider body self-esteem the variable that best predicts changes in mood and personality. Please provide references to support it.

2. Line 99. You mentioned that your study followed the PRISMA statement. However, several sections in the checklist are missing, such as the selection process, synthesis method, results of synthesis, and registration. Please describe those missed sections in your manuscript and update the checklist.

3. Line 112. What kind of study design is eligible for your meta-analysis? Please describe the criteria in this section. Additionally, do you have any limitations on the language of included studies? Please describe it.

4. Lines 130-132. You mentioned using the pre-test data of the experimental group to replace the lacked data of the control group. Do you have any references to support this method?

5. If you followed the PRISMA statement. Please evaluate the certainty of each body of evidence, like using the GRADE approach.

6. I found that you include football and basketball in your meta-analysis. However, these two exercises cannot strictly be classified as aerobic exercises because they require both aerobic and anaerobic energy systems. Please consider excluding them from the analyses.

7. The heterogeneity (I square) of the results of all your meta-analysis is high. I am afraid that selection of the model (whether it is a fixed effect or a random effects model) has nothing to do with the statistical heterogeneity but with the underlying assumption. Please use appropriate methods to explain the high heterogeneity.

8. Lines 249-250. I did not find any subgroup analysis to compare different sexes in the results section. Please explain how did you get this conclusion.

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Reviewer #1: No

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PLoS One. 2023 Sep 8;18(9):e0291045. doi: 10.1371/journal.pone.0291045.r002

Author response to Decision Letter 0

9 Aug 2023

Dear Editors and Reviewers:

Thank you for your letter and for the reviewers’ comments concerning our manuscript entitled “Effects of Aerobic Exercise on Body Self-Esteem among Chinese College Students: A Meta-Analysis”. Those comments are allvaluable and very helpful for revising and improving our paper, as well as theimportant guiding significance to our researches. We have studied comments carefullyand have made correction which we hope meet with approval. Revised portion aremarked in red in the paper. Some of your questions were answered below.

� 1.The reviewer’s comment: Lines 51-52. You mentioned that psychologists consider body self-esteem the variable that best predicts changes in mood and personality. Please provide references to support it.

The authors’ Answer: Thank you for your suggestion.With regard to lines 51-52, the meaning of the passage is "self-esteem" rather than " body self-esteem". Self-esteem is considered by psychologists to be the variable that best predicts changes in mood and personality. I have amended it and cited the relevant references.We apologise for this oversight!

� 2.The reviewer’s comment: Line 99. You mentioned that your study followed the PRISMA statement. However, several sections in the checklist are missing, such as the selection process, synthesis method, results of synthesis, and registration. Please describe those missed sections in your manuscript and update the checklist.

The authors’ Answer: Thank you for your suggestion.Errors in understanding the content of the PRISMA list at the time of writing led to the omission of several parts of the PRISMA list, which I have now re-added and updated.

� 3.The reviewer’s comment: Line 112. What kind of study design is eligible for your meta-analysis? Please describe the criteria in this section. Additionally, do you have any limitations on the language of included studies? Please describe it.

The authors’ Answer : Thank you for your suggestion.The included studies are experimental exercise intervention studies in English or Chinese, but the subjects must be Chinese university students. Revised "2.2 Literature inclusion criteria".

� 4.The reviewer’s comment: Lines 130-132. You mentioned using the pre-test data of the experimental group to replace the lacked data of the control group. Do you have any references to support this method?

The authors’ Answer : Thank you for your suggestion.We queried for studies with approaches to dealing with missing data from Meta-analyses, and a study published in Research Synthesis Methods (IF 9.8) illustrates the feasibility of this approach. Similar studies using this approach were also found. References have been included in the article.

� 5.The reviewer’s comment: If you followed the PRISMA statement. Please evaluate the certainty of each body of evidence, like using the GRADE approach.

The authors’ Answer : Thank you for your suggestion.In accordance with your request, the results of the GRADE system grading are now presented in Table 4, in rows 188 - 191, which I think is necessary.

� 6.The reviewer’s comment: I found that you include football and basketball in your meta-analysis. However, these two exercises cannot strictly be classified as aerobic exercises because they require both aerobic and anaerobic energy systems. Please consider excluding them from the analyses.

The authors’ Answer : Thank you for your suggestion.Aerobic exercise is exercise that is low in intensity but long and rhythmic. Its main characteristics are low intensity, rhythmic, uninterrupted and long duration, while keeping the heart rate below 150 beats per minute. Both football and basketball were selected for our study where heart rate was controlled and both lasted longer than 30min, so they can be classified as aerobic exercise. However this suggestion made us realise that we did not express the number of heart rates per minute in the paper. This is now presented in "Table 2 Summary of studies that met the inclusion criteria".

� 7.The reviewer’s comment: The heterogeneity (I square) of the results of all your meta-analysis is high. I am afraid that selection of the model (whether it is a fixed effect or a random effects model) has nothing to do with the statistical heterogeneity but with the underlying assumption. Please use appropriate methods to explain the high heterogeneity.

The authors’ Answer : Thank you for your suggestion.In my opinion, there are the following problems with heterogeneity: 1. Different genders have different pursuit of the five dimensions of body self-esteem. 2. The duration of various aerobic exercise interventions is different, and the frequency of intervention is different. 3. Multiple types of aerobic exercise, resulting in results that are not consistent.

� 8.The reviewer’s comment: Lines 249-250. I did not find any subgroup analysis to compare different sexes in the results section. Please explain how did you get this conclusion.

The authors’ Answer : Thank you for your suggestion.I came to this conclusion because I divided the various studies into groups, where these groups included different genders, and I came to this conclusion by comparing the different genders. However, I decided to take the advice you gave me because I thought it was not rigorous enough and the advice you gave was better. I have added a subgroup analysis of gender to my analysis of each result. Presented in tables 4 to 8.

Attachment

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PLoS One. doi: 10.1371/journal.pone.0291045.r003

Decision Letter 1

Ru Zhang

22 Aug 2023

Effects of Aerobic Exercise on Body Self-Esteem among Chinese College Students: A Meta-Analysis

PONE-D-23-08546R1

Dear Dr. Yan,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Ru Zhang

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

Reviewer #1: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

Reviewer #1: Yes

**********

6. Review Comments to the Author

Reviewer #1: The authors have addressed all the comments raised by me. I'm satisfied with the response. The manuscript now is now ready for publication.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

**********

PLoS One. doi: 10.1371/journal.pone.0291045.r004

Acceptance letter

Ru Zhang

29 Aug 2023

PONE-D-23-08546R1

Effects of Aerobic Exercise on Body Self-Esteem among Chinese College Students: A Meta-Analysis

Dear Dr. Yan:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

If we can help with anything else, please email us at plosone@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Ru Zhang

Academic Editor

PLOS ONE

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

S1 Checklist. PRISMA 2020 checklist.

(DOCX)

Click here for additional data file.^{(32.2KB, docx)}

S1 Data

(ZIP)

Click here for additional data file.^{(18.7KB, zip)}

Attachment

Submitted filename: Responses to reviewers.docx

Click here for additional data file.^{(25.2KB, docx)}

Data Availability Statement

All relevant data are within the paper and its Supporting Information files.

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PERMALINK

Effects of aerobic exercise on body self-esteem among Chinese college students: A meta-analysis

Junwen Shu

Tianci Lu

Baole Tao

Hanwen Chen

Haoran Sui

Lingzhi Wang

Ye Zhang

Jun Yan

Roles

Abstract

Objective

Methods

Results

Conclusion

1. Introduction

2. Sources and methods

Table 1. Reporting quality of included systematic reviews assessed using the PRISMA checklist.

2.1 Information retrieval strategy

2.2 Literature inclusion criteria

2.3 Literature exclusion criteria

Fig 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.

2.4 Literature screening and data extraction

2.5 Quality evaluation criteria

2.6 Risk of literature bias assessment

2.7 Data processing

3. Results

3.1 Literature search results

3.2 Basic characteristics of the included studies

Table 2. Summary of studies that met the inclusion criteria.

Table 3. The 28 experimental groups included in the meta-analysis.

3.3 Risk of bias evaluation

Fig 2. Risk of bias summary: Review authors’ judgements about each risk of bias item for each included study.

3.4 GRADE system recommended grading

Table 4. GRADE system recommended grading results.

3.5 Meta-analysis results

3.5.1 Heterogeneity test and publication bias analysis of the effect of aerobic exercise workout on physical self-worth of college students

Fig 3. Effect of aerobic exercise workout on physical self-worth of college students.

Table 5. Results of sub group analysis of body self-worth.

Fig 4. Body self-worth funnel diagram.

3.5.2 Heterogeneity test and publication bias analysis of the effect of aerobic exercise workout on college students’ Athletic ability

Fig 5. Effect of aerobic exercise workout on exercise capacity of college students.

Table 6. Results of subgroup analysis of exercise capacity.

Fig 6. Athletic ability funnel diagram.

3.5.3 Heterogeneity test and publication bias analysis of the effect of aerobic exercise workouts on college students’ physical status

Fig 7. Effect of aerobic exercise workout on the physical condition of college students.

Table 7. Results of subgroup analysis of physical condition.

Fig 8. Physical condition funnel chart.

3.5.4 Heterogeneity test and publication bias analysis of the effect of aerobic exercise workout on physical attractiveness of college students

Fig 9. Effect of aerobic exercise workout on physical attractiveness of college students.

Table 8. Results of subgroup analysis of physical attractiveness.

Fig 10. Funnel diagram.

3.5.5 Heterogeneity test and publication bias analysis of the effect of aerobic exercise workouts on college students’ physical fitness

Fig 11. Effect of aerobic exercise workout on physical fitness of college students.

Table 9. Results of subgroup analysis of physical fitness.

Fig 12. Physical fitness funnel.

4. Analysis and discussion

4.1 The effect of aerobic exercise on body self-esteem intervention of college students of different genders

4.2 Effects of aerobic exercise workouts on body self-esteem interventions among college students with different physical fitness levels

4.3 Effects of different aerobic exercise intensities on body self-esteem interventions for college students

4.4 Effects of aerobic exercise of different types of sports on body self-esteem intervention of college students

4.5 Effects of aerobic exercise of different durations on body self-esteem intervention for college students

4.6 Limitations of this study

5. Conclusions

Supporting information

Data Availability

Funding Statement

References

Decision Letter 0

Ru Zhang

Roles

Author response to Decision Letter 0

Decision Letter 1

Ru Zhang

Roles

Acceptance letter

Ru Zhang

Roles

Associated Data