Effects of physical exercise on body esteem among females: a meta-analysis

Abstract

In recent years, females’ body esteem has gradually declined, which has seriously affected their physical and mental health. Physical exercise has the positive impact on promoting females’ body esteem. Therefore, to better understand the relationship between physical exercise and body esteem, it is necessary to conduct a quantitative analysis of physical exercise to improve females’ body esteem. Retrieve randomized controlled trials on the effects of physical exercise on females’ body esteem from PubMed, Embase, Web of Science, Cochrane Library, and Scopus databases and the search period is from the creation of the database to June 20, 2024. The Stata 17.0 software is used for meta-analysis. Results: It is shown that physical exercise have a significant overall effect on promoting females’ body esteem (g = 0.35, P < 0.001), and physical exercise can effectively improve the PC (g = 0.66, P < 0.01) and PS (g = 0.27, P < 0. 01) of females, but there is not statistically significant in females’ PSW (g = 0.32, P > 0.05), SC (g = 0.42, P > 0.05) and BA (g = -0.20, P > 0.05). Conclusions: Although physical exercise can effectively improve body esteem of females, it mainly affects the PC and PS in body esteem of females.

Introduction

Body esteem is a specific field of global self-esteem, referring to an individual’s satisfaction or dissatisfaction with different aspects of one's body, which is closely related to social evaluation [1, 2]. When individuals value their own appearance, body image and physical ability, it will have a significant predictive effect on overall self-esteem [3]. Body esteem includes five dimensions: physical self-worth (PSW), sport competence (SC), physical condition (PC), physical strength (PS) and body attractiveness (BA) [4]. Physical self-worth (PSW) is an important part of the whole self, which is closely related to the whole self and refers to the degree to which an individual is satisfied with various aspects of his or her body, such as his or her looks, athletic ability, body size, etc. [5]. Sport competence (SC) refers to the ability of people to participate in sports and training and it is a comprehensive performance of human body form, quality, function, skills, mental ability and other factors [6]. Physical condition (PC) usually refers to the health condition of people and there are four types: health state, sub- healthy status, precursor state before the onset of disease and disease onset state. [7]. Physical strength (PS) refers to the strength, speed, endurance, sensitivity, flexibility, and other functions shown by the human body exhibits in activities [8]. Body attractiveness (BA) is defined as a dimension of psychological evaluation of the state and degree of beauty of the human body [9].

In recent years, influenced by social media and short videos, females have become increasingly demanding for their figure, leading to gradually decreased the satisfaction with body image and the level of body esteem [10–12], which seriously affects their physical and mental health. A study finds that when females compare their own figure with the perceived figure, it may lead to dissatisfaction with their body image and exacerbate body-related anxiety [13]. Additionally, some studies also shows that body dissatisfactions of females are relatively stable throughout their lives [14], and that females seem to pay more attention to the social aspects of body image than men [15], and in general, the levels of females’ body esteem are lower than those of men [16]. For example, Fredrickson et al. point out that under the influence of materialization culture, females are more likely to be troubled by body image than males, and generally exhibit lower levels of body esteem and higher levels of body dissatisfaction [17]; Luciana Zaccagni et al. also find that females athletes have lower body image satisfaction than male athletes [18]; Holland et al. report that 83% of women in the United States are dissatisfied with their bodies [19] and Guinn et al. show that female adolescents in puberty tend to focus more on physical appearance and development [20]; poor body image is common in middle-aged women, and physical changes during menopause are related to body satisfaction, which may increase the risk of declines in body esteem [21, 22]. Moreover, relevant studies also point out that individuals with higher levels of body esteem exhibit lower levels of anxiety, higher life satisfaction and greater subjective well-being [23]. Conversely, individuals with low body esteem tend to have lower sports confidence, lack confidence in their body attractiveness, have reduced personal well-being [24], and are more likely to have psychological problems such as low self-esteem, anxiety and depression [25], disordered eating behaviors, lower physical activity levels, and even more severe issues such as eating disorders and physical activity disorders [26]. For example, You et al. note that South Korean teenagers with low body satisfactions may exhibit low self-esteem and high levels of depressive symptoms [27]; Włodarczyk et al. also point out that decreased body esteem may place menopausal women at a higher risk for negative menopausal outcomes, leading to more unpleasant and stressful menopausal experiences [28]. Therefore, it is particularly important to pay closer attention to females’ body esteem and promote their physical and mental health.

In response to the above, some studies point out a relationship between lower body mass index (BMI) and higher body esteem in females [29], and a large number of studies have also confirmed that physical exercise can effectively reduce BMI, increase body satisfaction, and thereby enhance body esteem and global self-esteem. For instance, Jackson et al. indicate out that physical exercise can increase body esteem and impact positively global self-esteem by improving body image [30]; Festino et al. find that people who engage in physical exercise tend to have a more positive body image than those who do not [31]; Similarly, Tiggemann et al. also note that women who participate in physical exercise feel better about their bodies, are less likely to experience body dissatisfaction, and achieve higher levels of body esteem as a result [32]. Furthermore, when women engage in physical exercise, their emotional states will improve, and their anxiety and depression will decrease [33]. In addition, relevant studies have also found that physical exercise can enhance the body esteem of females with diverse characteristics and ages. For example, Michael et al. note that 6 weeks of circuit training significantly improves the levels of body esteem in primary schools students, with girls showing greater increases in body esteem scores compared to boys [34]; Halliwell et al. find that 4-week yoga exercise improves body esteem and positive emotions of girls aged 9 to 11 years [35]; Gao et al. report that physical exercise not only enhances body esteem in obese teenagers, but also reduces negative emotions such as tension, anger and depression while fostering a more positive self-perception [36]; Elavsky et al. find that walking and yoga effectively enhance self-esteem in middle-aged women during a 4-month randomized trial [37]; Elizabeth et al. also point out that physical exercise is effective in improving and maintaining the body esteem in the elderly individuals, as well as in boosting specific domains of self-esteem, such as physical self-worth and physical condition [38].

However, although relevant studies have confirmed that physical exercise has the significant effect on improving body esteem in females, there are still some shortcomings in existing studies. First, there is no systematic study on the effects of physical exercise on females’ body esteem. While some studies have systematically explored this relationship, they often focus on specific forms of physical exercise or sample groups [39, 40], which may limit the generalizability of the results. Additionally, most existing literatures consists of surveys or small-simple studies, lacking comprehensive, quantitative, and systematic evaluations [41, 42]. Notably, there is no systematic comparison or in-depth analysis of the specific effects of different types of physical exercise on the dimensions or the specific domains of body esteem in females with diverse characteristics. This gap leaves us without a comprehensive understanding of the mechanisms and differential effects that various forms of physical exercise may have on female body esteem. Although different types of physical exercise may influence physical self-esteem in varying ways, these differences have not been fully explored or quantified. Therefore, to better understand the relationship between physical exercise and body esteem, and narrow the gap in existing research, this study systematically and quantitatively summarizes relevant literature from recent years through meta-analysis and compares the impact of various forms of physical on females’ body esteem and its various dimensions or specific domains, so as to provide a theoretical foundation and practical insights for developing scientifically-based methods to promote body esteem and healthy development of females.

Sources and methods

This study systematically follows the guidelines and requirements of the Preferred Reporting Items for Systematic Reviews and Meta-analyses, PRISMA. And the registration number is CRD42024540111, as shown in Fig. 1 and Attach File 1.

Fig. 1.

Registration number of meta-analysis

Search strategy

This study searched PubMed, Embase, Web of Science, Cochrane Library and Scopus for articles published in English and the search years from the database creation to June 20, 2024. The search strings included “exercise*” or “sport*” or “physical exercise*” or “physical activi*” or “exercise intervention” or “fitness” or “yoga” or “Pilates” or “dance” and “female*” or “girl*” or “wom?n” and “body esteem” or “body self-esteem” or “physical self-esteem” in all fields of the Advanced Search. Additionally, to capture as many relevant studies as possible, a manual search was conducted on Google Scholar. All search results were imported into Endnote software for screening. The specific search strategy for PubMed is shown in Table 1.

Table 1.

Literature retrieval strategy in PubMed

Number	Specific search content
#1	exercise* OR sport* OR physical activit* OR physical exercise* OR exercise intervention* OR fitness OR yoga OR Pilates OR dance
#2	female* OR girl* OR wom?n
#3	body esteem OR body self-esteem OR physical self-esteem
#4	#1 AND #2 AND #3

Inclusion and exclusion criteria

This study fellows the PICOS principle for selecting literature in meta-analyses [43], and formulates the inclusion and exclusion criteria for literature. The aim of inclusion and exclusion criteria is to improve the overall credibility of the study, reduce bias as much as possible and ensure the robustness of the results.

Inclusion criteria: (1) The study design must be a randomized controlled trial (RCT) ( To ensure rigor in research design and the reliability of results, thereby improving the internal and external validity of the analysis); (2) The subjects must be females with the ability to participate in the experiment and there are no special age restrictions (To more effectively analyze the impact of physical exercise on changes in body esteem among females of different ages); (3) The intervention for the experimental group must be physical exercise; (4) The primary outcome must be body esteem or body self-esteem or physical self- esteem, and the secondary outcomes may include physical self-worth, sport competence or athlete ability, physical condition, body attractiveness or body attraction or physical attractiveness and physical strength or physical fitness to capture multiple dimensions related to body esteem; (5) The measurement of outcomes must use measurement tools with better reliability and validity to ensure the accuracy and comparableness of data; (6) The mean and standard deviation of body esteem levels in both the experimental and control groups must be directly or indirectly obtained from literature to support data integration and statistical analysis in meta-analysis.

Exclusion criteria: (1) Studies published in languages other than English; (2) Subjects have movement disorders and are unable to complete exercise intervention; (3) Review, meta-analysis, retrospective, observational and cross-sectional studies (4) Conference abstracts, dissertations, books, case reports, case studies and other descriptive studies; (5) Repeatedly published studies, withdrawn studies, studies with incomplete or inaccessible data provision, and studies with poor quality assessment; (6) Studies using measurement paradigms that do not meet the requirements of meta-analysis.

Screening and data extraction

The entire process of literature search, screening and data extraction is conducted by two researchers at the same time respectively. If the screening and data extraction are consistent after cross-checking, it will be included in the meta-analysis; if it is inconsistent, it will be discussed with the third researcher (Yu Zhang) and reach a consensus. Firstly, the selected literature was imported into Endnote software, removed the duplicates, excluded the literature that does not meet the requirements of this study, browsed the title and summary of the articles, downloaded the full-text literature that is in line with the article, read the full text carefully and include it in the study. Then data were extracted from the included literature, and the extracted content included: first author, publication time, age of the subjects, sample size, form of physical exercise, intervention period, frequency, intensity, duration of a single intervention, and outcome indicator (in the form of mean and standard deviation). Useful data were summarized through Excel sheet records for next summary generalization.

Quality assessment

Given the possible limitations of the included studies, the quality of the included studies will be evaluated in this study using the Cochrane Risk of Bias tool in Revman 5.4 software. Specifically, the evaluation content covers a series of biases in seven specific domains: 1) Random sequence generation, 2) Allocation concealment, 3) Blinding of participants and personnel, 4) Blinding of outcome assessment, 5) Incomplete outcome data, 6) Selective reporting, and 7) Other bias. Each domain can rate low risk of bias, high risk of bias, or unclear risk of bias. In the process of literature evaluation, two researchers conducted separate and respective quality ratings to prevent judging bias caused by subjective judgment. If there is a difference of opinion, a consensus will be reached after discussing with the third researcher (Yu Zhang).

Statistical analysis

The statistical analysis of the data was conducted with STATA 17. Firstly, due to the different outcome measures of the included studies, standardized mean deviation (SMD) for no sample size bias (Cohen’d) and 95% confidence intervals (CI) were calculated in the present study. Likewise, the χ² test was used to ascertain the presence of significant heterogeneity among the studies. A fixed-effect model was selected if P > 0.1 and I² < 50% indicated that there was acceptable heterogeneity between the studies; a random-effect model was selected if P < 0.1 and I² > 50% indicated that there was significant heterogeneity between the studies. Then subgroup analysis and meta-regression will be carried out to explore and discuss research question, as well as the reasons for heterogeneity between studies, if considered significant heterogeneity. This study examines the actual effectiveness of exercise intervention on mental health by subgroup analysis and meta-regressions on the moderator. Finally, the Funnel Plot and Egger’s test were used to assess publication bias, with publication bias when P < 0.05 for Egger’s test. Sensitivity analysis was performed to evaluate the stability of the results.

Results

Literature search results

A total of 2437 studies were retrieved from PubMed, Embase, Web of Science, Cochrane Library and Scopus, and 9 literatures were finally included after layer-by-layer screening. The specific operation process is shown in Fig. 2.

Fig. 2.

Flow diagram of literature selection

Basic characteristics of the included studies

The 9 studies included were all randomized controlled trials, including a total of 631 subjects. Among them, the subjects had a wide variety of characteristics, covering a range of different ages (from 9 to 65 years and over 65 years old) and health conditions, including primary school children, high school students, pre-adolescent girls, obese women, older adults and some groups with specific health or social backgrounds, such as breast cancer survivors, women of lower socioeconomic status with depressive symptoms, and women facing lockdown‐related domestic violence. Additionally, of the nine studies, two were conducted in the United States and France respectively, while the others were conducted the United Kingdom, South Korea, Sweden, Greece, and Switzerland respectively. Additionally, in nine studies, there were different physical exercise to intervene in females’ body esteem with different characteristics. And the experimental group had various forms of physical exercise intervention, including aerobic exercise, resistance exercise, dance, Taiji, and yoga; the intervention durations ranged from 4 weeks to 6 months; the frequency of physical exercise was usually 2 to 3 times/week; each time lasted between 15 and 120 min; 6 out of the 9 studies did not specify the intensity of physical exercise. Detailed information is provided in Table 2. (Since Table 2 is too wide, it is provided as an attachment).

Table 2.

Basic characteristics of studies that met the inclusion criteria

Author/Year	Country	Age (Range)/(M ± SD)	Simple Size	Type of Exercise	Duration	Frequency	Intensity
HwangBo [44]/2016	Republic of Korea	EG 18.14 ± 1.60 CG 18.88 ± 1.55	EG 8 CG 8	schroth exercise pilates exercise	12 weeks	3 times a week	/
Halliwell [35]/2018	UK	9 ~ 11 9.34 ± 0.69	EG 91 CG 96	Yoga	4 weeks	1 time a week	/
Muller-Pinget [45]/2018	Switzerland	46.91 ± 10.15	EG 27 CG 19	dance	16 weeks	/	/
Fuzhong Li [46]/2002	United States	≥ 65 EG 72.84 ± 4.65 CG 72.73 ± 5.69	EG 43 CG 41	Tai Chi	6 months	2 times a week	/
Musanti [47]/2011	United States	50.5 ± 7.5	EG1 10 EG2 9 EG3 11 CG 12	aerobic exercise resistant exercise aerobic plus resistant	12 weeks	A 3 times a week R 3 times a week A + R (A 4 ~ 5 T R 2 times a week)	A 40 ~ 85%HRmax R / A + R /
Legrand [48]/2014	France	18 ~ 35 EG 21.56 ± 3.18 CG 20.59.5 ± 2.18	EG 22 CG 22	aerobic exercise (fast walking + slow jogging + Zumba)	7 weeks	2 times a week	/
Kahlin [49]/2015	Sweden	16 ~ 19 EG 17.2 ± 0.55 CG 16.1 ± 0.34	EG 60 CG 44	/	6 months	at least 1 time a week	/
Megakli [50]/2015	Greece	18 ~ 64 EG 32.70 ± 7.27 CG 32.22 ± 8.84	EG 37 CG 35	aerobic plus resistance exercise	12 weeks	3 times a week	/
Legrand [51]/2022	France	33.4 ± 3.5	EG 12 CG1 12 CG2 12	walking or running + strength training	6 weeks	2 times a week	MPVA

Author/Year	Time/min	Outcome	Pre-EG	Post-EG	Pre-CG	Post-CG	Characteristics
HwangBo [44]/2016	60	BE	25.20±1.82	32.13±1.30	26.60±1.45	32.07±1.03	high school students
Halliwell [35]/2018	40	BE	3.55±0.99	3.59±1.01	3.62±0.89	3.92±0.90	pre-adolescent girls
Muller-Pinget [45]/2018	/	BE	28.5±6.2	30.8±6.2	28.7±5.4	29.4±6.0	obese females
Fuzhong Li [46]/2002	60	PSW PC PS BA	13.511±4.034 13.423±3.620 12.986±3.669 13.214±3.949	15.725±3.610 14.950±3.748 14.450±3.993 14.625±3.807	14.044±3.030  13.311±3.866 13.622±3.466 13.667±3.580	14.531±3.100 14.106±3.550 13.781±2.837 14.075±3.617	older adults
Musanti [47]/2011	A 15～30 R / A+R /	PSE PC PS BA	A 13.1±4.89/R 13.22±3.07/A+R 13.91±3.65 A 11.90±3.73/R 12.89±3.26/A+R 15.09±4.06 A 13.90±4.10/R 14.11±3.1/A+R 14.73±4.05 A 12±4.3/R 12.67±2.83/A+R 12.73±3.85	A 14.8±4.49/R 16.44±3.8/A+R 14.82±4.17 A 16.80±4.24/R 16.56±2.65/A+R 15.73±3.1 A 14.80±4/R 16.33±3.12/A+R 15.91±3.75 A 14.4±5.06/R 15.56±3.65/A+R 14.09±3.94	14.42±4.87 13.08±3.94 12.83±4.2 13.50±4.3	15±2.83 13.58±4.01 13.25±3.52 14.33±3.31	breast cancer survivors
Legrand [48]/2014	45～60	PSW PC SC PS BA	14.33±3.75 13.47±4.16 11.60±2.80 10.07±1.71 11.87±2.03	16.80±2.30 17.47±3.54 12.47±2.39 11.07±1.68 12.33±1.43	14.33±2.71 13.67±2.60 11.17±2.29 10.75±1.60 12.17±2.12	14.83±1.99 13.58±1.98 10.67±1.15 10.42±0.79 11.67±1.15	women of low socioeconomic status with elevated depressive symptoms
Kahlin [49]/2015	/	PSW PC SC PS BA	12.3±2.88 11.8±3.36 13.4±3.63 11.9±2.60 13.7±4.16	14.2±3.49 13.5±4.48 14.6±4.61 13.5±3.77 14.8±4.34	15.2±3.40 14.0±4.00 15.8±3.29 13.9±3.19 14.8±4.18	14.2± 3.05 13.5±2.94 15.7±3.17 13.5±3.77 14.8±3.62	primary school children
Megakli [50]/2015	/	PSW PC SC PS BA	1.63±0.76 1.52±0.57 1.56±0.69 1.90±0.85 1.57±0.61	2.00±0.81 2.18±0.86 2.13±0.80 2.29±0.91 1.82±0.75	1.62±0.69 1.63±0.54 1.58±0.61 1.99±0.75 1.60±0.63	1.79±0.73 1.70±0.58 1.67±0.56 2.02±0.73 1.70±0.64	obese females
Legrand [51]/2022	35～40	PSE PC PS BA	18.27±6.87 15.91±8.47 7.82±4.16 11.27±3.13	22.73±5.35 20.36±6.42 9.27±4.34 14.00±2.41	14.00±5.88/14.40±4.19 11.46±6.39/11.60±4.95 6.55±3.20/8.20±2.25 10.91±3.51/10.50±3.21	14.55±5.94/14.90±4.82 11.18±5.36/10.70±5.12 6.64±2.34/8.80±2.04 10.64±4.61/10.80±2.78	women facing lockdown‐related domestic violence

M Mean, SD Standard deviation, EG1, EG2, EG3, Exercise group 1, Exercise group 2, Exercise group 3; CG1, CG2, Control group 1, Control group 2, Pre Pre intervention, Post Post intervention; /,unclear; + , and, T Time or times; min, minutes, MVPA Moderate to vigorous physical activity, Fre Frequency, BE Body esteem, BES Body-esteem scale, PSPP Physical Self-perception Profile, PSW Physical self-worth, PC Physical condition, SC Sport competence, PS Physical strength, BA Body attractiveness, A Aerobic exercise, R Resistance exercise, A plus R Aerobic exercise plus resistance exercise, HRmax Maximum heart rate

Results of quality assessment

The quality of the included studies was evaluated using the Cochrane Risk of Bias Tool. The evaluation process was conducted by two researchers and if there was a difference opinion, the third researcher (Yu Zhang) would participate in the solution of the problem and reached a consensus after joint discussion. The quality evaluation of the literature showed that the 9 studies included had some biases, which was main due to the random method was not clear, the blinding method was not implemented in the experimental process and measurement process, Fig. 3.

Fig. 3.

The summary and distribution of bias risk of included studies (Based on the judgements of authors about each risk of bias item for included studies)

Meta analysis results

Results of the overall effectiveness of physical exercise on body esteem among females

The results of the meta-analysis were shown in Table 3. The overall effectiveness of physical exercise on females’ body esteem was significant (g = 0.35, P < 0.001). However, the test for heterogeneity indicated a large degree of heterogeneity between studies (I² = 55.9%, P = 0.000), therefore, subgroup analysis and meta-regression analysis would be carried out based on the included studies characteristics to explore the reasons for the heterogeneity and the factors influencing the effect of physical exercise on females’ body esteem.

Table 3.

Overall effectiveness of physical exercise on body esteem among females

	K	N	Heterogeneity analysis		Meta-analysis
			I2	P	Hedges’ g	95% CI
Body esteem	9	38	55.9%	0.000	0.35***	[0.20, 0.49]

K Number of studies, N Number of Effect Sizes

^***P < 0.001; 95% CI 95% confidence interval

Results of subgroup analysis and meta-regression

As shown in Table 4, subgroup analysis by female sample characteristics showed that the synthesis effect sizes for studies were statistically significant in obesity (g = 0.39, P < 0.001), facing family violence (g = 1.07, P < 0.01), breast cancer survivors (g = 0.38, P < 0.01), low-activity older adults (g = 0.23, P < 0.05) and low socioeconomic and depressive (g = 0.81, P < 0.001), but were not statistically significant in physically inactive high school students (g = -0.13, P > 0.05); Subgroup analysis by type of physical exercise showed that the synthesis effect sizes for studies were statistically significant in aerobic exercise (g = 0.63, P < 0.001), resistance exercise (g = 0.61, P < 0.01), aerobic and resistance exercise (g = 0.38, P < 0.001), walking and running training (g = 1.07, P < 0.01) and Tai Chi exercise (g = 0.23, P < 0.05), but were not statistically significant in other physical exercise (g = -0.11, P > 0.05); Subgroup analysis by control group showed that the synthesis effect sizes for studies were statistically significant in no Intervention (g = 0.45, P < 0.001), resistance exercise (g = 0.38, P < 0.01), daily routine activities (g = 0.23, P < 0.05), but were not statistically significant in others (g = -0.13, P > 0.05); Subgroup analysis by different dimensions of body esteem showed that the synthesis effect sizes for studies were statistically significant in PC (g = 0.66, P < 0.01), and PS (g = 0.27, P < 0.01), but were not statistically significant in BE (g = 0.18, P > 0.05), PSW (g = 0.32, P > 0.05), SC (g = 0.42, P > 0.05), and BA(g = -0.20, P > 0.05).

Table 4.

Subgroup analysis results

Subgroup	K / N	Heterogeneity		Meta-Analysis
		I2	P	SMD (g)	95% CI
Female sample characteristics
Physically inactive high school students	3 / 7	0.0%	0.618	-0.13	[-0.27, 0.02]
Obesity	2 / 6	0.0%	0.577	0.39***	[0.19, 0.58]
Facing family violence	1 / 4	58.9%	0.063	1.07**	[0.38, 1.76]
Breast cancer survivors	1 / 12	0.0%	0.760	0.38**	[0.13, 0.62]
Low-activity older adults	1 / 4	0.0%	0.923	0.23*	[0.01, 0.44]
Low socioeconomic and depressive	1 / 5	16.7%	0.308	0.81***	[0.51, 1.12]
Type of physical exercise
Aerobic exercise	2 / 9	29.6%	0.182	0.63***	[0.35, 0.91]
Resistance exercise	1 / 4	0.0%	0.782	0.61**	[0.16, 1.05]
Aerobic and resistance exercise	2 / 9	0.0%	0.590	0.38***	[0.20, 0.57]
Walking and running training	1 / 4	58.9%	0.063	1.07**	[0.38, 1.76]
Tai Chi exercise	1 / 4	0.0%	0.923	0.23*	[0.01, 0.44]
Other physical exercise	4 / 8	0.0%	0.572	-0.11	[-0.25, 0.04]
Control group
No Intervention	4 / 19	68.6%	0.000	0.45***	[0.24, 0.67]
Flexibility exercise	1 / 12	0.0%	0.760	0.38**	[0.13, 0.62]
Daily routine activities	1 / 4	0.0%	0.923	0.23*	[0.01, 0.44]
Other	3 / 3	37.3%	0.203	-0.13	[-0.52, 0.27]
Aspects of body esteem
BE/BSE/PSE	5 / 7	63.8%	0.011	0.18	[-0.26, 0.61]
PSW	4 / 4	49.1%	0.117	0.32	[-0.01, 0.65]
PC	6 / 8	65.8%	0.005	0.66**	[0.28, 1.04]
SC	3 / 3	68.0%	0.001	0.42	[-0.34, 1.17]
PS	6 / 8	0.0%	0.604	0.27**	[0.07, 0.47]
BA	6 / 8	7.4%	0.373	-0.20	[-0.01, 0.41]

K Number of Effect sizes, g Hedges’g, 95% CI 95% Confidence Interval, BE Body-esteem, BSE Body esteem, PSE Physical self-esteem, PSW Physical self-worth, PC Physical condition, SC Sport competence, PS Physical strength, BA Body attractiveness

^*P < 0.05

^**P < 0.01

^***P < 0.001

In addition, as shown in Table 5, meta-regression analysis for female sample characteristics (β = 0.21, P < 0.001) and type of physical exercise (β = 0.21, P < 0.001) were statistically significant. Therefore, female sample characteristics and type of physical exercise were the moderators influence the effect of physical exercise on females’ body esteem.

Table 5.

Results of meta-regression analysis

Moderator	β	SE	t	95% CI
Female sample characteristics	0.21***	0.03	7.19	[0.15, 0.27]
Type of physical exercise	0.21***	0.03	7.03	[0.14, 0.26]
Control Group	0.14	0.07	1.99	[-0.01, 0.28]
Aspects of body esteem	0.08	0.04	1.97	[-0.01, 0.16]

β Regression Coefficient, SE Standard Error, 95% CI 95% Confidence Interval

^**p < 0.01

Results of publication bias and sensitivity analysis

Figure 4 showed that the funnel plot was small overly asymmetric, but not serious, indicating that the reliability of this study was quite good and no significant publication bias. Sensitivity analysis was used to test whether individual studies influenced the overall study and to assess the stability of the results in the present study. Figure 5 showed that there was a considerable difference in one study, however, the meta-analysis showed no significant reduction in heterogeneity after excluding this study (I² = 50.8%, P = 0.089) compared to all studies (I² = 55.9%, P = 0.000), indicated that none of the individual significantly affected the overall, suggesting that the results of this study were stable.

Fig. 4.

Funnel plot of publication bias

Fig. 5.

Results of sensitivity analysis

Discussion

The effects of physical exercise on body esteem and its specific fields among females

The results of overall meta-analysis show that physical exercise can enhance the body esteem of females, which is consistent with previous studies [52, 53] and further corroborates the positive effects of physical exercise in improving females’ body esteem. This may be because the improvement in females’ body esteem is related to the positive changes in physical and psychological aspects brought about by physical exercise. Firstly, through physical exercise, females can reduce weight and BMI index, alleviate obesity, and shape a more toned body, thereby enhancing the sense of self-identity and body esteem of individual [54, 55]. Secondly, physical exercise not only regulates hormone levels and reduces the secretion of stress hormones, such as cortisol, but also stimulates the secretion of adrenaline and catecholamine neurotransmitters and increases the release of pleasure hormones such as endorphins [56]. These physiological changes may help to improve self-efficacy and physical self-perception, thereby enhancing body esteem and mental health. Additionally, physical exercise enables females to achieve weight loss and shape positive body images [57], allowing them to experience a sense of accomplishment and satisfaction from achieving goals and self-breakthrough, which in turn increase their physical satisfaction and body esteem [58]. Furthermore, subgroup analysis revealed that physical exercise has different effects on different specific dimensions of females’ body esteem, which is generally consistent with previous studies [59, 60]. Specifically, physical exercise effectively improves females’ PC (physical condition) and PS (physical strength). However, it shows no significant effect on females’ PSW (physical self-worth), SC (sport competence) and BA (body attractiveness), which may be because specific dimensions of body esteem are influenced by various complex factors. Firstly, the type, duration and intensity of physical exercise may affect different aspects of body esteem in distinct ways. Short-term physical exercise may be more immediate impact on improving PC (physical condition) and PS (physical strength), which can be observed in a short period. However, the improvements in PSW (physical self-worth), SC (sports competence) and BA (body attractiveness) may not be significant due to the short time. Additionally, the dimensions of PSW (physical self-worth), SC (sports competence) and BA (body attractiveness) may involve more complex psychological and social factors and may not be able to achieve significant improvement through physical exercise alone. Therefore, if participants want to improve the levels of PSW (physical self-worth), SC (sports competence) and BA (body attractiveness) through physical exercise, they may need longer persistence or more targeted training plans.

The effects of different types of physical exercise on body esteem among females

The result of subgroup analysis and meta regression showed that there were significant differences in the effect of different types of physical exercise on body esteem of females, which is consistent with previous studies [61, 62]. This study also found that aerobic exercise, resistance exercise, aerobic exercise plus resistance exercise, walking and running training, and Tai Chi all effectively improve females’ body esteem. Among these, the effects of aerobic exercise and aerobic exercise plus resistance exercise on improving body esteem of females were most significant. This may be because body image and weight are closely linked to body esteem [63]. Aerobic exercise can help achieve the pursuit of an ideal body shape by reducing weight and BMI; while aerobic exercise plus resistance exercise can meet females’ needs for reducing weight, shaping body, and strengthening muscle, thus improving the levels of body esteem. However, compared with aerobic exercise and aerobic exercise plus resistance exercise, the intensity of Tai Chi may be lower, and it may have less effect on reducing females’ weight and improving their body shape in a short time, which could affect its influence on body esteem.

The effects of physical exercise on body esteem of females with different characteristics

The result of subgroup analysis and meta regression showed that there were significant differences in the effect of physical exercise on body esteem of females with different characteristics, which is consistent with previous studies [64, 65]. Specifically, physical exercise effectively improved the females’ body esteem with obesity, facing family violence, breast cancer survivors, low-activity older adults, and low socioeconomic and depressive, and the effects of physical exercise on improving body esteem were most significant in females with obesity and low socioeconomic and depressive. However, the effects of physical exercise on improving body esteem of physically inactive high school female students were not significant. This may be because compared with healthy females, those with obesity, low socio-economic status, and depression, face more negative body image issues and the challenges to their body esteem. For example, obese females may often be troubled by negative societal evaluations of their terrible body shape and weight [66]. Physical exercise can help improve females’ self-satisfaction with their bodies by losing weight and enhancing their body shape, thus improving their body esteem. Similarly, females with low socio-economic status and depression may be accompanied by lack of resources and psychological pressure, and depression symptoms can further aggravate the decline of self-identity [67]. Physical exercise not only improves the physical health, but also enhances mental health by relieving stress, improving emotions, and boosting social support, thereby improving their body esteem. However, for inactive high school female students, the effect of physical exercise on the improvement of their body esteem was not significant. This may be because high school female students mainly focus on their studies, and the uniformly required dress and heavy academic workload reduce their attention to body image. Additionally, teenagers in this age have not yet fully entered a sensitive period for body-related anxiety and deformity aesthetics, which may also explain why the effect of physical exercise on body esteem was not significant among high school female students.

Conclusions and limitations

Conclusions

1. Physical exercise can effectively improve body esteem of females, but it mainly improves the level of PC and PS in body esteem of females.

2. Different types of physical exercise have different effects on body esteem of females, but aerobic exercise and aerobic exercise plus resistance exercise have more obvious effect on improving body esteem of females.

3. The effect of physical exercise on body esteem of females with different characteristics is different, and the effects of physical exercise on the females’ body esteem with obesity and low socioeconomic and depressive were most significant.

Limitations

While this study provides valuable insights into the effects of physical exercise on females’ body esteem, there are several limitations that need to be considered:

1. Limited Database Coverage: The literature retrieval for this meta-analysis was conducted using a limited number of databases, which may have led to the inclusion of only a small number of studies and relatively small sample sizes. This could potentially affect the overall results and the generalizability of the findings. In future research, expanding the number of databases and conducting a broader literature search could enhance the robustness and representativeness of the meta-analysis.

2. Publication Bias and Heterogeneity: We observed a certain level of publication bias and heterogeneity in the included studies. This variability could be due to several factors, such as the differences in the physical exercise interventions used in the experimental groups, variations in the control group interventions, and the diversity in the age and characteristics of participants. Additionally, the measurement tools used for assessing body esteem outcomes were not standardized across studies. These factors might have contributed to the observed heterogeneity, and future studies could benefit from adopting more uniform intervention protocols and standardized measurement tools to reduce this bias.

3. Sample Diversity and Missing Factors: Another limitation is the homogeneity of the sample population in the included studies, which primarily focused on females. There is a lack of detailed demographic information in many studies, such as ethnicity, geographical location, and cultural background, which may affect the generalizability of the results. Future research could consider a more diverse sample that includes multiple demographic factors to provide a more comprehensive understanding of how physical exercise impacts body esteem across different populations.

4. Potential Subjective Bias in Data Extraction: Although the literature screening and data extraction were independently conducted by multiple researchers to reduce bias, there is still a possibility of subjective influence, which could lead to some omissions or discrepancies. This could affect the comprehensiveness and authenticity of the evaluation results. Future studies could further improve the reliability of data extraction by implementing more rigorous protocols and cross-checking procedures.

Abbreviations

BE

Body esteem

PSW

Physical self-worth

SC

Sport competence

PC

Physical condition

PS

Physical strength

BA

Body attractiveness

BES

Body-esteem scale

PSPP

Physical Self-perception Profile

M

Mean

SD

Standard deviation

EG1, EG2, EG3

Exercise group 1, Exercise group 2, Exercise group 3

CG1, CG2

Control group 1, Control group 2

Pre

Pre intervention

Post

Post intervention

/

unclear; + 

T

time or times

min

Minutes

MVPA

Moderate to vigorous physical activity

Fre

Frequency

A

Aerobic exercise

R

Resistance exercise

A plus R

Aerobic exercise plus resistance exercise

HRmax

Maximum heart rate

K

Number of studies

N

Number of Effect Sizes

SE

Standard Error

95% CI

95% Confidence Interval

G

Hedges’g

Β

Regression Coefficient

Authors’ contributions

YZ and Z-HW: conceptualization, methodology, resources, and visualization. Z-HW, Y-BZ and G-FG: screening and data extraction. YZ: funding acquisition. YZ and Z-HW: investigation, supervision, and validation. YZ: project administration. YZ and Z-HW: software. YZ、Z-HW、Y-BZ and G-FG: writing—original draft. All authors contributed to the article and approved the submitted version. And all authors reviewed the manuscript.

Funding

Not applicable.

Data availability

The data and materials used by the study are publicly available. For more information, please contact the corresponding author for non-commercial research purposes only.

Declarations

Ethics approval and consent to participate

This study has been approved by the Biomedical Scientific Research Ethics Subcommittee of Henan University, and the ethical approval number is HUSOM2024-633. All participants voluntarily signed a written informed consent with a full understanding of the purpose and process of the research.

Consent for publication

All participants have agreed in writing to use the research results for academic publication.

Competing interests

The authors declare no competing interests.