The effects of physical activity on the mental health of typically developing children and adolescents: a systematic review and meta-analysis

Abstract

Background

Physical activity has gained attention in recent years as a promising intervention for improving the mental health of children and adolescents. However, evidence supporting the effectiveness of physical activity interventions for the mental health of typically developing children and adolescents remains limited.

Methods

This study conducted a comprehensive search across five electronic databases up to July 2024. Studies were eligible for inclusion if they involved an intervention with a control group that examined the effects of physical activity on the mental health of typically developing children and adolescents. Articles focusing on participants with developmental, behavioral, or psychiatric disorders were excluded. A random-effects meta-analysis was conducted using Stata 18.0. The quality of evidence and risk of bias were assessed using the GRADE framework and the PEDro scale.

Results

The initial search yielded 27,527 articles, of which 30 met the inclusion criteria. Meta-regression analysis indicated that country and intervention frequency were significant sources of heterogeneity. Physical activity interventions were significantly more effective than the control group in improving mental health (SMD = 0.37, 95% CI: 0.20 to 0.53). These interventions showed particularly strong effects on stress reduction (SMD = 0.86, 95% CI: 0.15 to 1.56) and social competence enhancement (SMD = 0.56, 95% CI: 0.07 to 1.06). Moreover, physical activity interventions were notably more effective for male adolescents (SMD = 1.11, 95% CI: 0.34 to 1.88) and those at the secondary school level (SMD = 0.45, 95% CI: 0.23 to 1.69).

Conclusions

Physical activity is beneficial in improving various aspects of mental health, including anxiety, depression, stress, self-esteem, and social competence in typically developing children and adolescents. However, the quality of evidence in this study is low due to methodological limitations of the studies included in this review. More high-quality randomized controlled trials are needed to validate these findings. Teachers and community workers can leverage physical activity as a preventive strategy to promote the mental health of children and adolescents. Future research should also investigate how factors like socioeconomic status and the sporting environment impact the effectiveness of these interventions.

Trial registration

PROSPERO, CRD42024567153.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-025-22690-8.

Introduction

In recent years, the mental health of children and adolescents aged 5–18 years has become a significant societal concern. According to the World Health Organization (WHO), approximately one in seven adolescents experience mental health issues, accounting for 13% of the global disease burden within this age group [1]. In Asia, mental health problems among children and adolescents have shown a marked increase, with anxiety and depressive disorders becoming particularly prevalent, peaking between the ages of 10 and 14 [2]. Since the onset of the COVID-19 pandemic, 22.6% of children have reported experiencing symptoms of depression, while 18.9% have reported symptoms of anxiety [3]. Similarly, in Western Europe, anxiety and depression rank among the top four causes of disease burden among young people [4]. Research from the American Psychological Association indicates that adolescents report higher stress levels than they perceive as healthy, with these levels exceeding those of adults, leading to heightened anxiety and depression [5]. These trends underscore the urgent need for effective prevention, diagnosis, and intervention strategies to address the mental health challenges faced by adolescents.

There is no universally accepted definition of mental health, which is sometimes referred to as mental well-being. It is often conceptualized through two primary perspectives: negative orientation and positive orientation [6]. Negative orientation refers to the presence of psychiatric symptoms, including internalizing disorders, behavioral dysfunction, and other mental health conditions, with anxiety, depression, and stress being among the most common manifestations [7]. In contrast, positive orientation reflects a state of well-being, where individuals can actively engage in daily activities while maintaining a balance between positive and negative emotions, with key elements including social competence and self-esteem [8–10]. Social competence refers to the ability to navigate social interactions effectively, including building and maintaining close relationships, and responding adaptively in various social contexts [11]. It encompasses social adjustment, performance, and skills [12]. Social competence is a key factor in mental health development and plays an essential role in enhancing adolescents’ well-being by supporting their emotional, cognitive, and social growth [13, 14]. Research has shown that higher social competence in adolescence is linked to lower levels of internalizing symptoms, such as anxiety and depression, in young people [10]. Similarly, self-esteem, a key indicator of mental health, reflects emotional stability and subjective well-being and is often emphasized in educational programs for youth [15]. In this study, we adopt a comprehensive orientation that integrates these two perspectives, considering mental health as a holistic state encompassing both negative and positive dimensions.

In recent years, physical activity has garnered significant attention as an intervention for mental health. Physical activity is defined as any movement that results in energy expenditure above resting levels [16]. Numerous meta-analyses and systematic reviews have highlighted the mental health benefits of physical activity, including reductions in anxiety [17, 18], depression [19–21], and stress [22, 23], as well as improvements in self-esteem [6, 24, 25] and overall mental health [7, 26, 27]. However, research on the impact of physical activity on social competence remains limited. Social competence plays a crucial role in children’s mental health, influencing both emotional and cognitive development. Research has shown that physical activity plays a key role in predicting social competence in adolescents [28]. Participation in sports exposes individuals to diverse social interactions, thereby broadening their social networks [29]. Furthermore, physical activity enhances both behavioral and cognitive aspects of social competence, contributing to overall improvements in health [30]. These findings highlight the importance of consolidating existing research to better understand the effects of physical activity on social competence. Additionally, much of the current research has focused on clinical populations, where the high costs and logistical barriers of treatment often limit accessibility [31]. This emphasizes the importance of early prevention and treatment strategies, with physical activity standing out as a practical, cost-effective, and widely accessible solution.

The present study aimed to investigate the effects of physical activity on the mental health of typically developing children and adolescents, with a particular focus on its impact on social competence. In this study, “typically developing children and adolescents” refers to healthy individuals aged 5 to 18 who do not have any diagnosed developmental, behavioral, or mental health disorders. Additionally, this research extends prior studies by examining how key subgroups such as age group and intervention format influence the effectiveness of physical activity interventions, providing a more comprehensive understanding of their potential benefits.

Materials and methods

Protocol and registration

This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [32], with a detailed checklist provided in Supplementary Material 1. It has been registered with the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42024567153 and the registration protocol is available in Supplementary Material 2.

Search strategy and selection criteria

A comprehensive systematic search was conducted across five databases: CNKI, EBSCOhost, PubMed, Scopus, and Web of Science. The search covered articles published from January 1, 2000, to July 1, 2024. Following the Cochrane Systematic Review Manual [33], a combination of keywords based on the PICOS framework (population, intervention, control, outcomes, study design) were used. Additionally, recent relevant reviews and reference lists were manually searched to identify studies meeting the inclusion criteria. The search was limited to English-language studies, with the full search strategy outlined in Supplementary Material 3. The search was conducted independently by two researchers, with a third researcher consulted in the event of disagreements.

The inclusion criteria based on PICOS are as follows: (1) Population: typically developing children and adolescents. (2) Interventions: various forms of physical activity, including aerobic exercise, anaerobic exercise and fitness training. (3) Control: participants from the same population who have not engaged in structured physical exercise, including those in a regular physical education group, a waitlist control group, or a group with no physical activity intervention. (4) Outcomes: studies reporting positive mental health (e.g. self-esteem, self-efficacy, social adjustment, social performance, social skills) and negative mental health (e.g. depression, anxiety, stress) as primary or secondary outcomes both at baseline and after the intervention. (5) Study design: studies with a control group intervention were included, encompassing both randomized controlled trials and non-randomized controlled trials.

This study excluded: (1) Non-English publications, unpublished works, duplicate literature, abstracts, dissertations, and grey literature. (2) Studies focusing on adults or individuals with developmental, behavioral, or mental health disorders (e.g., disabilities, mental illness, obesity). (3) Studies that did not involve physical activity interventions. (4) Studies with unclear results, incomplete data, or data that could not be reliably extracted.

Study selection

All references for the studies selected for this review were managed using EndNote X9. After duplicates were removed, the screening process was carried out independently by two researchers LLH and LQE). The researchers initially assessed the eligibility of the remaining studies by reviewing titles and abstracts. Subsequently, full-text reports were reviewed (LLH and LQE) to determine their suitability for inclusion in the systematic review. At each stage, agreement between the two researchers was required, and any disagreements were resolved through consensus with a third researcher (WJY).

Data extraction

Data extraction was performed independently by two researchers (LLH and LQE). The extracted data from all included studies were then compared, with any discrepancies resolved by a third reviewer (WJY). The data extracted included the authors’ names, year of publication, basic demographic information about the study population (sample size, age, gender, country), characteristics of the intervention (length, frequency, duration, type, and form of intervention), outcome indicators, and measurement tools. The Compendium of Physical Activities was used for assessing the intensity of the interventions, considering the duration of each intervention to make informed judgments. The intervention forms were primarily classified into physical education classes and after-school physical activities.

Assessment of quality (risk of bias) of individual studies

This review assessed the included literature using the Physiotherapy Evidence Database (PEDro) scale, a credit rating scale developed by the Australian Centre for Evidence-Based Practice [34]. The scale comprises 10 items, including randomized allocation (2 items), blinding (3 items), data reporting (3 items), data analysis (1 item), and follow-up (1 item). Each item was scored 1 if the criteria were met and 0 if they were not met or were unclear. The total score ranged from 0 to 10, with a score of ≥ 5 indicating high study quality and < 5 indicating poor quality. To ensure objectivity, two evaluators (LLH and LQE) independently assessed the studies, with discrepancies resolved by a third evaluator (WJY).

Data preparation

Prior to meta-analysis, scales and instruments included in the literature were pre-processed. If some scales increased with the severity of the disease and others decreased, the mean of a group of studies was multiplied by -1 to ensure that all scales were pointing in the same direction. If multiple mental health outcomes were assessed in a study, each outcome was analyzed separately. When a study compared multiple intervention and control groups, pooled means and standard deviations for the intervention group were calculated before determining effect sizes [35]. Similarly, if outcomes were reported separately for boys and girls, combined means and standard deviations were calculated. In cases where two related scales were used to measure different aspects of the same outcome, pooled means and standard deviations were computed, provided the scale indicators were consistent [35]. Selection of relevant outcomes from each study was achieved through consensus among three authors (LLH, WJY, and LQE), based on theoretical considerations.

Meta-analysis

Meta-analysis was performed using Stata 18.0, a programmable statistical package with comprehensive commands for meta-analysis of different types of studies and data [36]. In addition, Stata allows for complex model estimation and excellent graphical output capabilities [36]. Due to the large sample size, overlapping images in Stata were supplemented using R Studio. Study heterogeneity was assessed using the I² statistic. A fixed-effects model was applied if I² ≤50%, while a random-effects model was used for I² >50% [37]. To account for variations in outcomes and measurement scales across studies, standardized mean differences (SMD) and 95% confidence intervals (CI) were employed to combine effect sizes statistically [38]. Meta-regression was utilized to investigate the impact of covariates on inter-study heterogeneity. Additionally, subgroup analyses were conducted based on categorical variables, including participant characteristics (gender, age group), intervention details (length, frequency, duration, intensity, type, and format), and outcome measures [39]. This aimed to identify which subgroups showed the most significant improvements in mental health outcomes.

Quality of evidence and publication bias

The quality of the evidence was evaluated using the GRADE framework [40]. To assess publication bias, funnel plot analysis was conducted, with Begg’s and Egger’s tests used to further detect any potential biases in the included studies [41].

Results

Literature screening process and results

The initial search identified 27,521 records from the electronic database. After removing duplicates using EndNote, 21,291 records remained. These were screened based on titles and abstracts, resulting in 51 articles. Following a full-text review, 24 studies were included in the meta-analysis. Additionally, six relevant articles were identified through citation searches, bringing the total to 30 articles that met the inclusion criteria. The search process is detailed in Fig. 1, with a table of excluded studies and their corresponding reasons provided in Supplementary Material 4.

Fig. 1.

PRISMA flow diagram

Study characteristics

Table 1 presents the characteristics of the included studies. Sample sizes ranged from 19 participants [58] to 662 participants [61], with mean ages spanning 5 to 17 years. The proportion of female participants varied from 0 to 100%. Six studies involved participants from low socioeconomic backgrounds [44, 47, 51, 53, 57, 64], one study included participants from a medium socioeconomic background [61], and the remaining studies did not specify the socioeconomic status of their participants. The studies were conducted across 10 countries: 11 in the United States [42, 43, 45, 47, 51, 53, 55, 58–60, 64], five in the United Kingdom [44, 48, 50, 62, 69], four in India [53, 63, 65, 67], three in Australia [52, 61, 66], two in Mexico [49, 57], and one each in China [70], Greece [68], Poland [56], South Korea [71], and Turkey [46]. In all studies, the experimental groups participated in various exercise interventions, while the control groups either received no intervention or engaged in traditional programs.

Table 1.

Characteristics of included studies

			Participants	Intervention
Author	Study design	Country	Experiment/Control group; Female percentage; Mean age(years)	Length(week) / Frequency (times / week) / Duration(min)	Intervention intensity	Intervention type	Intervention form	Outcome	Measure tools
Annesi et al. (2005) [42]	RCT	USA	50/42; 50%; 10.7	12 / 3 / 45	High	Aerobic and resistance	ASPE	Self-esteem	SDQ-I-GS
Ardic et al. (2017) [43]	ES	USA	33/33; 50.57%; 12.83	12 / 1 / 15	Low	Aerobic	PE	Depression; Anxiety	BYI-II
Barton et al. (2015) [44]	ES	UK	26/26; 50%; 8.84	1 / 1 / 55	High	Aerobic and resistance	ASPE	Self-esteem	PSDQ
Bazzano et al. (2022) [45]	RCT	USA	42/44; 46.3%; 12.5	8 / 1 / 45	Low	Aerobic	PE	Anxiety	SCARED
Biber et al. (2016) [46]	ES	Turkey	20/20; 50%; 5.5	8 / 4 / 60	Moderate	Aerobic	PE	Social competence	SASS
Bohnert et al. (2013) [47]	RCT	USA	52/24; 100%; 9.13	30 / 1 / 90	Moderate	Aerobic	ASPE	Self-esteem	SED
Burgess et al. (2006) [48]	RCT	UK	50/50; 100%; 13.5	6 / 2 / 50	Moderate	Aerobic	PE	Self-esteem	CY-PSP
Cocca et al. (2020) [49]	ES	Mexico	102/127; 45.41%; 10.2	24 / 2 / 45	Moderate	Aerobic	PE	Self-esteem	SCQ
Cowley et al. (2021) [50]	RCT	UK	22/20; 100%; 14.2	6 / 3 / 30	Low	Aerobic	ASPE	Self-esteem	PSDQ
Crews et al. (2004) [51]	RCT	USA	34/32; 50%; 9–10	6 / 3 / 20	High	Aerobic	PE	Anxiety	TAIC
Eather et al. (2016) [52]	RCT	Australia	51/45; 51.5%; 15.4	8 / 2 / 60	High	Aerobic and resistance	PE	Self-esteem	PSDQ
Gaurav et al. (2013) [53]	RCT	India	44/43; 68.5%; 14.20	16 / 1 / 60	Low	Aerobic	ASPE	Anxiety	SAS-A
Jelalian et al. (2011) [54]	RCT	USA	30/30; 0%; 16–17	6 / 10 / 60	Moderate	Aerobic	ASPE	Stress; Anxiety; Depression	SEAS and BADSS
Khalsa et al. (2011) [55]	RCT	USA	72/39; 42.14%; 16.8	11 / 2 / 30	Low	Aerobic	PE	Stress	PSS
Koszałka et al. (2021) [56]	ES	Poland	40/30; 0%; 15.75	12 / 1 / 90	Moderate	Aerobic	PE	Self-esteem; Social competence	SCQ and RSES
Lobo et al. (2006) [57]	RCT	Mexico	19/21; 49%; 5.2	8 / 2 / 35	Moderate	Aerobic	PE	Social competence	SCBE
Melnyk et al. (2009) [58]	RCT	USA	12/7; 72.6%; 15.42	9 / 2 / 50	High	Aerobic	PE	Depression; Anxiety	BYI-II
Melnyk et al. (2013) [59]	RCT	USA	286/341; 53.05%; 14.75	12 / 1 / 15–20	Moderate	Aerobic	PE	Depression; Anxiety	BYI-II
Noggle et al. (2012) [60]	RCT	USA	36/15; 54.02%; 17.2	10 / 2 / 30–40	Low	Aerobic	PE	Depression; Anxiety; Stress	PSS
Olive et al. (2019) [61]	RCT	Australia	355/307; 49.45%; 8	208 / 2 / 50	High	Aerobic and resistance	PE	Depression	CDI-2
Ozyurek et al. (2015) [62]	ES	UK	21/21; 50%; 5	14 / 2 / 30–50	Moderate	Aerobic	PE	Social competence	PSSRS
Pradhan et al. (2024) [63]	IS	India	15/15; 0%; 15.5	12 / 6 / 45	Low	Aerobic	ASPE	Stress; Anxiety	PSS and DAQ
Quach et al. (2016) [64]	IS	USA	65/53; 58.47%; 12–17	4 / 2 / 45	Low	Aerobic	PE	Stress; Anxiety	PPS-10 and SCARED
Sharma et al. (2010) [65]	RCT	India	60/60; 50%; 13–16	12 / 5 / 45	Low	Aerobic	PE	Stress	ASS
Smith et al. (2018) [66]	RCT	Australia	296/212; 49.6%; 14.1	10 / 1 / 90	High	Aerobic and resistance	PE	Self-esteem	RSES
Telles et al. (2013) [67]	RCT	India	49/49; 38.78%; 10.5	12 / 5 / 45	Low	Aerobic	PE	Self-esteem	ISEQ
Tersi et al. (2020) [68]	ES	Greece	20/20; 35%; 5.5	4 / 1 / 30	Moderate	Aerobic	PE	Social competence	SSRS
Wassenaar et al. (2021) [69]	RCT	UK	52/52; 22.67%; 12.5	40 / 2 / 60	High	Aerobic and resistance	PE	Self-esteem	PSDQ
Xueming et al. (2015) [70]	LD	China	73/69; 40.62%; 14.74	52 / 5 / 60	Low	Aerobic	PE	Self-esteem	The 80-item PHCSCS
Young et al. (2015) [71]	LD	South Korea	23/23; 46.65%; 10.98	8 / 1 / 40	High	Aerobic and resistance	ASPE	Self-esteem	RSES

ES: Experimental design; IS: Interventional study; RCT: Randomized controlled trials; LD: Longitudinal design; ASPE: After-school physical activity; PE: Physical education; SDQ-I-GS: The Self-description Questionnaire-I General Self sub- scale; BYI-II: The Beck Depression Inventory and The Beck anxiety inventory; RSES: Rosenberg Self-Esteem Scale; SCARED: The Screen for Child Anxiety and Related Emotional Disorders; SASS: The Social adjustment and skills scale; SED: Social-emotional development; CY-PSP: Children and Youth Physical Self-Perception Scale; SCQ: the 12-item Adolescent Self-Esteem Questionnaire and Social Competence Questionnaire; PSDQ: Physical Self-Description Questionnaire; TAIC: Trait Anxiety Inventory for Children; SEAS: Student examination anxiety scale; BADSS: Bhatnagar Anxiety, depression and stress scale; SAS-A: the Social Anxiety Scale for Adolescents; PSS: The Perceived Stress Scale; SCQ: Social Competence Questionnaire; SCBE: Social Competence and Behavior Evaluation: Preschool Edition; CDI-2: Children’s Depression Inventory-2; PSSRS: the Preschool Social Skills Rating Scale; Ducklow’s anxiety questionnaire; DAQ: Ducklow’s anxiety questionnaire; PPS-10:Perceived Stress Scale 10; ASS: the Academic Stress Scale; ISEQ: the Indian adaptation of Battle’s self-esteem questionnaire; SSRS: Social Skills Rating System; The 80-item PHCSCS: The 80-item Piers-Harris Children’s Self-Concept Scale: A Self-Report Measure;

The interventions varied widely, encompassing general school physical education classes, sports, games, yoga, and broader programs such as COPE. The intervention cycles ranged from 1 week to 4 years, with durations spanning from 10 to 90 min per session, and frequencies ranging from 1 to 10 sessions. Intervention intensities varied from low to high. Most interventions were primarily aerobic or a combination of aerobic and anaerobic activities. Additionally, the majority of studies involved physical education classroom interventions conducted within school settings.

Results of study quality (risk of bias) assessment

Among the 30 included studies, 15 were classified as high quality, while the remaining studies were categorized as low quality, as detailed in Table 2. It is noteworthy that most of the randomized controlled trials included did not employ a double-blind experimental protocol. This lack of blinding is likely attributable to the inherent nature of physical activity interventions. The quality assessment revealed the following details: 16 studies specified eligibility criteria, and 18 studies used random allocation. However, only one study mentioned allocation concealment. Regarding baseline assessments, 16 studies confirmed that the groups were similar at the start. Although 24 studies blinded participants, only two studies blinded the therapists administering the interventions, and just four studies reported blinding of the final evaluators. Follow-up data was reported in seven studies, and all 30 studies provided at least one statistical comparison of key outcomes between groups.

Table 2.

Quality assessment of included studies

Author (Year)	Eligibility Criteria	Random Allocation	Concealed Allocation	Groups Similar at Baseline	Participants Blinded	Provider Blinded	Evaluator Blinded	Follow-Up	Intention-to-Treat Analysis	Between- Group Comparison	Total Score
Annesi et al. (2005)	0	0	0	0	0	0	0	0	1	1	2
Ardic et al. (2017)	0	0	0	1	0	0	0	1	1	1	4
Barton et al. (2014)	1	1	0	1	0	0	0	0	1	1	5
Bazzano et al. (2022)	1	1	0	1	0	0	0	0	1	1	5
Biber et al. (2016)	0	0	0	0	0	0	0	0	1	1	2
Bohnert et al. (2013)	1	1	0	0	1	0	0	1	1	1	6
Burgess et al. (2005)	0	0	0	1	0	0	0	0	1	1	3
Cocca et al. (2020)	1	0	1	0	1	0	0	0	1	1	5
Cowley et al. (2021)	1	1	0	1	0	0	0	0	1	1	5
Crews et al. (2004)	0	1	0	0	0	0	0	0	1	1	3
Eather et al. (2016)	1	1	0	1	0	0	1	1	1	1	7
Gaurav et al. (2013)	1	0	0	0	1	0	0	0	1	1	4
Jelalian et al. (2011)	1	0	0	0	0	0	0	1	1	1	4
Khalsa et al. (2011)	1	1	0	1	0	0	1	1	1	1	7
Koszałka et al. (2021)	0	0	0	1	0	0	0	0	1	1	3
Lobo et al. (2006)	1	1	0	0	1	1	1	0	1	1	7
Melnyk et al. (2009)	1	1	0	1	0	0	0	0	1	1	5
Melnyk et al. (2013)	1	1	0	0	1	0	0	0	1	1	5
Noggle et al. (2012)	1	1	0	1	0	0	0	0	1	1	5
Olive et al. (2019)	0	1	0	1	0	1	0	1	1	1	6
Ozyurek et al. (2015)	0	1	0	0	0	0	0	0	1	1	3
Pradhan et al. (2024)	0	0	0	1	0	0	0	0	1	1	3
Quach et al. (2015)	1	1	0	0	0	0	0	0	1	1	4
Sharma et al. (2010)	0	1	0	0	0	0	0	0	1	1	3
Smith et al. (2018)	1	1	0	1	0	0	0	0	1	1	5
Telles et al. (2013)	1	1	0	1	0	0	1	1	1	1	7
Tersi et al. (2020)	0	0	0	1	0	0	0	0	1	1	3
Wassenaar et al. (2021)	0	1	0	1	1	0	0	0	1	1	5
Xueming et al. (2015)	0	0	0	0	0	0	0	1	1	1	3
Young et al. (2015)	0	0	0	0	0	0	0	0	1	1	2

Meta-analysis results

Thirty studies investigating the impact of physical activity on the mental health of typically developing children and adolescents [42–71]. Heterogeneity analysis revealed significant variability among these studies (I² = 81.2%, p < 0.01), leading us to apply a random effects model for the meta-analysis. As illustrated in the Fig. 2, the physical activity participation group showed a significant improvement over the control group (SMD = 0.37, 95% CI: 0.20 to 0.53, p < 0.01), indicating that physical activity significantly enhances mental health in children. Meta-regression was conducted to identify the sources of heterogeneity in the results. Regression models were developed with the combined effect size as the dependent variable and publication year, sample size, intervention frequency, intervention duration, intervention length, age, gender, intervention type, intervention intensity, and country as covariates. The results, shown in the Table 3, indicated that intervention frequency (p < 0.01) and country (p < 0.05) were the primary sources of heterogeneity.

Fig. 2.

Forest plot of a meta-analysis on the effects of physical activity interventions on mental health

Table 3.

Meta-regression analysis of the effect of different factors on inter-study heterogeneity

Covariable	Coefficient	Standard Error	t-value	P-value	95% CI
					Lower Limit	upper Limit
year	0.000	0.015	-0.02	0.985	-0.031	0.03
Sample size	0.000	0.001	-0.27	0.789	-0.002	0.001
frequency	0.212	0.04	5.33	0.000	0.131	0.293
period	-0.002	0.003	-0.79	0.437	-0.008	0.003
duration	0.000	0.004	-0.05	0.958	-0.008	0.007
years	-0.045	0.026	-1.74	0.090	-0.097	0.007
gender	0.017	0.013	1.32	0.194	-0.009	0.044
type	-0.377	0.234	-1.61	0.106	-0.852	0.098
intensity	-0.113	0.124	-0.91	0.369	-0.365	0.139
country	-0.051	0.023	-2.24	0.031	-0.097	-0.005

Subgroup analysis

To gain a comprehensive understanding of the impact of physical activity interventions on the mental health of typically developing children and adolescents, we conducted subgroup analyses based on participant characteristics (gender, age group) and intervention characteristics (length, frequency, duration, intensity, type, and form), as well as outcomes. For additional details, please refer to Supplementary Material 5.

Participant characteristics

A meta-analysis using a random effects model was performed to explore the effects of physical activity on mental health across different genders and age groups. This analysis included a total of 30 studies [42–71]. The results, detailed in Table 4, indicated that physical activity significantly improved mental health across both genders, with the intervention group outperforming the control group. Notably, physical activity was more effective for male children and adolescents (SMD = 1.11, 95% CI: 0.34 to 1.88, p < 0.01) compared to females (SMD = 0.22, 95% CI: 0.08 to 0.36, p > 0.05), and it was particularly beneficial at the secondary school level (SMD = 0.45, 95% CI: 0.23 to 1.69, p < 0.01).

Table 4.

Subgroup analysis of different participant characteristics

Measure	No. of studies	Value	df	p-value	I2	Effect	95% CI
Female	3	1.79	3	0.618	0.00%	0.22	0.08;0.36
Male	3	56.59	6	0.00	89.40%	1.11	0.34;1.88
Mixed gender	24	167.59	34	0.00	79.70%	0.28	0.10;0.47
Preschool	4	6.11	3	0.106	50.90%	0.96	0.23;1.69
Elementary	8	49.07	13	0.00	73.50%	0.13	-0.11;0.37
Secondary school	9	166.84	27	0.00	83.80%	0.45	0.23;1.69

Intervention characteristics

A meta-analysis using a random-effects model was conducted, encompassing 30 studies [42–71]. The results, detailed in Table 5, showed that exercise interventions significantly improved mental health in typically developing children and adolescents compared to control groups. However, the effectiveness varied based on specific characteristics of the interventions. In terms of intervention length, interventions lasting less than 10 weeks were the most beneficial (SMD = 0.49, 95% CI: 0.28 to 0.70, p < 0.01), with the positive effects diminishing as the duration increased. Interventions extending beyond 20 weeks had notably weaker effects (SMD = 0.05, 95% CI: -0.1 to 0.19, p > 0.05). Regarding frequency, interventions conducted more than three times per week were the most effective, with increased session frequency leading to greater benefits (SMD = 1.63, 95% CI: 1.03 to 2.22, p < 0.01). When examining session length, sessions lasting 15–45 min (SMD = 0.40, 95% CI: 0.17 to 0.63, p < 0.01) were more effective than those lasting more than 45 min (SMD = 0.30, 95% CI: 0.05 to 0.50, p < 0.01), with effectiveness decreasing as the duration of each session increased. For intensity, moderate-intensity exercises yielded the best results (SMD = 0.79, 95% CI: 0.44 to 1.15, p < 0.05), while both lower (SMD = 0.08, 95% CI: -0.16 to 0.27, p < 0.01) and higher intensities (SMD = 0.13, 95% CI: -0.06 to 0.31, p < 0.01) were less effective. For type, aerobic, resistance and mixed exercises all have a positive impact on mental health, with aerobic exercises having the best results (SMD = 0.56, 95% CI: 0.34 to 0.77, p < 0.01). Additionally, both after-school physical activity interventions and physical education class interventions positively impacted mental health, but after-school physical activity interventions (SMD = 0.34, 95% CI: 0.17 to 0.50, p < 0.01) were more effective than traditional physical education class interventions (SMD = 0.49, 95% CI: 0.03 to 0.94, p < 0.01).

Table 5.

Subgroup analysis of different intervention characteristics

Subgroups	Variable	No. of studies	Value	df	p-value	I²	Effect	95% CI
Length	<10	15	124.35	13	0.000	89.50%	0.49	0.28; 0.70
	11–20	10	103.44	23	0.000	77.80%	0.33	-0.13; 0.79
	>20	5	2.79	8	0.947	0.00%	0.05	-0.1; 0.19
Frequency	1	10	25.12	13	0.022	48.30%	0.06	-0.12; 0.24
	2	12	18.43	17	0.362	7.80%	0.15	0.05;0.26
	3	3	28.58	5	0.000	82.50%	0.26	0.26;0.78
	≥ 3	5	38.17	7	0.000	81.70%	1.63	1.03;2.22
Duration	≤ 45	17	139.951	28	0.000	80.00%	0.40	0.17;0.63
	> 45	13	89.27	16	0.000	82.10%	0.30	0.05;0.50
Type	Aerobic	20	187.74	33	0.000	82.40%	0.56	0.34;0.77
	Resistance	3	12.26	3	0.007	75.50%	0.19	-0.62;0.24
	Mixed exercise	7	11.23	7	0.129	37.60%	0.01	-0.20;0.22
Intensity	Low-Intensity	12	117.77	18	0.000	84.70%	0.08	-0.16;0.27
	Moderate-Intensity	10	26.47	13	0.015	50.90%	0.79	0.44;1.15
	High-Intensity	8	43.93	13	0.000	70.40%	0.13	-0.06;0.31
Form	Physical education	22	139.77	32	0.000	77.10%	0.34	0.17;0.50
	After-school	8	98.48	12	0.000	87.80%	0.49	0.03;0.94

Outcome measures

A meta-analysis using a random effects model was conducted, including a total of 30 studies [42–71]. The results, illustrated in Fig. 3, demonstrate that exercise interventions were significantly effective in improving various aspects of mental health in typically developing children and adolescents, with the intervention group outperforming the control group. For depression, eight studies reported a significant impact of exercise, with a SMD of 0.46 (95% CI: 0.01 to 0.92, p < 0.01). Similarly, eleven studies found a significant reduction in anxiety, with an SMD of 0.29 (95% CI: 0.03 to 0.62, p < 0.01). Regarding self-esteem, fourteen studies demonstrated a significant positive effect, yielding an SMD of 0.10 (95% CI: 0.09 to 0.28, p < 0.01). Social competence was also significantly enhanced, as indicated by six studies, with an SMD of 0.56 (95% CI: 0.07 to 1.06, p < 0.05). Lastly, seven studies revealed that exercise was particularly effective in reducing stress, showing an SMD of 0.86 (95% CI: 0.15 to 1.56, p < 0.01). Overall, these results highlight the effectiveness of physical activity interventions in enhancing mental health, particularly in reducing stress and improving social competence.

Fig. 3.

Subgroups of the effects of physical activity interventions on different types of mental health

Quality of evidence and publication bias

The GRADE system assessed the overall certainty of the evidence in this meta-analysis as low, primarily due to the inclusion of non-randomized controlled trials and the associated risk of bias. Detailed information on the quality assessment of the evidence is provided in the Supplementary Material 6.

To assess publication bias, we examined the included studies using a funnel plot, as shown in Fig. 4. The plot displayed asymmetry on the right side, which may indicate potential publication bias. However, funnel plots are subject to subjective interpretation and can be prone to errors. To further evaluate this, we conducted Egger’s and Begg’s tests, both of which yielded p-values greater than 0.05, suggesting no significant publication bias in the literature.

Fig. 4.

Funnel plot

Sensitivity analysis

To further explore sources of heterogeneity, sensitivity analyses were conducted by systematically excluding each individual study [42–71]. The results of these analyses, shown in Fig. 5, demonstrated that excluding individual studies had minimal impact on the overall results. This indicates that the combined effect values are stable, confirming the reliability of the meta-analysis findings.

Fig. 5.

Sensitivity analysis

Discussion

Statement of principal findings

This study conducted a meta-analysis to evaluate the impact of physical activity interventions on the mental health of typically developing children and adolescents. The analysis revealed that participants in the physical activity intervention group experienced significantly better outcomes compared to the control group. To explore the sources of heterogeneity, meta-regression identified intervention frequency and country as the primary contributors. Subgroup analyses were performed to investigate the effects of various participant and intervention characteristics on mental health outcomes, including gender, age group, intervention length, frequency, duration, intensity, type, form and outcome. The findings indicated that physical activity interventions significantly improved multiple dimensions of mental health, including anxiety, depression, stress, self-esteem, and social competence. The study further found that physical activity interventions were particularly effective for males and secondary school-aged adolescents. Among the different intervention types, moderate-intensity aerobic exercise in the form of after-school physical activity, with sessions occurring three or more times per week, each lasting 15–60 min, and spanning 1–10 weeks, proved to be the most beneficial for improving mental health in children and adolescents.

Meta-regression analysis revealed that intervention frequency and country were the main sources of heterogeneity. Intervention frequency (p < 0.01) was the most significant factor contributing to study variation. This suggests that the effectiveness of physical activity on the mental health of typically developing children and adolescents may depend on how often the interventions are implemented. Research indicates that interventions involving physical activity three or more times per week typically lead to the greatest mental health benefits [72, 73]. However, overly frequent interventions may result in irritability and aggression, which could worsen negative emotions and reduce their overall effectiveness [73, 74]. Additionally, country (p < 0.05) was another important source of heterogeneity. Physical activity patterns varied across countries due to factors such as infrastructure, cultural attitudes, and access to recreational facilities [75, 76]. These differences likely account for the variation in study outcomes. Children and adolescents in countries with well-developed infrastructure and supportive cultural attitudes toward physical activity may experience more significant mental health improvements. This highlights the importance of considering country-specific factors when designing and evaluating physical activity interventions.

The first set of results showed significant improvements in mental health among typically developing children and adolescents following physical activity interventions compared to control groups. Notably, physical activity interventions significantly affected various types of mental health (anxiety, depression, stress, self-esteem, and social competence). These findings are consistent with previous systematic reviews, such as those by Biddle and Panza, which reported that physical activity interventions can reduce anxiety and depression while improving overall positive mental health in children and adolescents [77, 78]. Li’s research also supports these results, indicating that physical activity can alleviate negative emotions like anxiety, depression, and stress in children [42]. Furthermore, Hale’s meta-analysis highlighted that different forms of physical activity interventions contribute to improvements in mental health outcomes, including quality of life, body image, and self-esteem [79]. However, research focusing on social competence in children and adolescents remains limited. This study addressed this gap by incorporating social competence into the evaluation of mental health outcomes. The results indicated that physical activity significantly improved children’s social competence (SMD = 0.56, 95% CI: 0.07 to 1.06), with a stronger effect compared to its impact on anxiety (SMD = 0.29, 95% CI: -0.03 to 0.62) and depression (SMD = 0.46, 95% CI: -0.01 to 0.92). Physical activity often involves peer interaction, which plays a crucial role in the development of children’s social skills [80]. For adolescents, engaging in activities with peers provides opportunities to practice social skills, develop empathy, and learn to understand others’ perspectives, fostering social competence [28, 81]. In contrast, while physical activity alone was effective in reducing anxiety and depression, it lacked the cognitive components required to treat psychological function, leading to smaller, in some cases, statistically insignificant effects [82–84].

The second set of results highlights that physical activity significantly improves the mental health of typically developing children and adolescents across different genders and age groups. Specifically, interventions were found to be most effective for male adolescents, a result consistent with the work of Herring et al. [85] and Brown et al. [86], who reported that male participants showed the greatest benefits from sports aimed at reducing depression. Common mental health issues among children and adolescents include attention deficit hyperactivity disorder, conduct disorder, anxiety disorders, and depression [87]. Anxiety disorders typically emerge around age 11 [88], and depression often begins between the ages of 11 and 13, though these issues can also affect preschool-aged children [89]. Similarly, the impact of physical activity on mental health varies depending on developmental stage, making it crucial to examine its effects across different age groups. Our research found that physical activity had the most significant impact on the mental health of secondary school students. Adolescence, which typically overlaps with secondary school, is marked by substantial physical, psychological, and social changes [90]. During this time, adolescents face increased psychological stress and a heightened risk of anxiety and depression [90]. Our study confirms that physical activity can serve as an effective preventive measure to improve mental health during adolescence and reduce the risk of mental illness. In addition, we observed an effect size of 0.96 for physical activity on the mental health of preschoolers, though this result did not reach statistical significance (p = 0.106). Nonetheless, it suggests that physical activity may have a positive impact on preschoolers’ mental health. This finding is supported by Barry et al., who identified positive associations between mental health and younger age groups [91]. Preschool is a critical period for cognitive, emotional, and character development, and physical activity plays a vital role in these areas [92]. Our study addresses the previous lack of age-specific research and provides evidence of the beneficial effects of physical activity interventions on the mental health of children and adolescents across various developmental stages.

The third set of results indicates that physical activity interventions lasting 15–45 min, performed three or more times per week for up to 10 weeks, had the greatest impact on improving mental health among typically developing children and adolescents. This conclusion is supported by the meta-analysis conducted by Li et al., which found that a 10-week exercise intervention of 20–45 min was particularly effective in enhancing mood in children [41]. Similarly, Carneiro et al. reported that engaging in more than four exercise sessions per week, each lasting less than 45 min, was notably effective in reducing depressive symptoms [72]. Some studies highlight that intervention period, frequency, and duration are key moderators of effectiveness [73]. Specifically, an inverted U-shaped relationship was observed between the duration of the intervention and the reduction of mental health symptoms in adolescents, where maintaining regular exercise for 6–10 weeks significantly reduced negative affect, but extending the program further did not yield additional benefits [93, 94]. Overall, there is a positive dose-response relationship between exercise duration and frequency and the alleviation of depressive symptoms [95]. Clinical guidelines recommend moderate-intensity exercise for at least 45 min, three times per week, as beneficial for improving mental health in children [96]. A longitudinal study also found that even brief 15-minute exercise sessions were associated with a reduced risk of depression [97]. However, it is worth noting that excessive exercise may lead to increased irritability and aggression, potentially exacerbating negative mood [74]. Our findings reinforce the effectiveness of moderate-duration physical activity (15–45 min) performed three or more times a week for up to 10 weeks in enhancing the mental health of children and adolescents.

The fourth finding reveals that moderate-intensity aerobic exercise is the most effective form of intervention for improving the mental health of typically developing children and adolescents, with after-school physical activity proving particularly beneficial. Numerous studies support the idea that aerobic exercise is more effective than other types in treating depression and anxiety [87, 98, 99]. These studies primarily focus on cardiorespiratory conditioning programs that utilize aerobic exercises to assess the effects of physical activity on mental health. However, aerobic exercise may not be the only effective approach [100]. Some research has shown that resistance training, or a combination of resistance and aerobic exercises, may be even more effective than aerobic exercise alone [99, 101–103]. Resistance training, for instance, can enhance strength [104], which is positively associated with self-efficacy [105]. This can improve deficits in inhibition and pleasure by fostering positive psychological feedback and counteracting negative emotions [73]. As a result, there is still controversy about what type of exercise is more effective in influencing mental health. Physical education classes have also been shown to have a significant positive effect on the mental health of children and adolescents [106]. Specifically, implementing physical education two or more times per week has been linked to lower levels of stress and anxiety in both boys and girls [84]. These classes can boost self-esteem in girls and help prevent low self-esteem in boys [107]. Moreover, after-school physical activities also offer opportunities for children and adolescents to develop social and cognitive skills. Participation in organized after-school activities has been shown to protect healthy behaviors, as well as cognitive, social, and emotional well-being [108]. Such involvement improves self-esteem and pro-social behaviors, which positively influence mental health [109]. Our study further confirms the effectiveness of moderate-intensity aerobic exercise interventions on the mental health of typically developing children and adolescents. It also addresses the previously overlooked role of intervention types and shows that after-school physical activity is especially beneficial in enhancing mental health in this age group.

Practical implications

These findings highlight the importance of integrating regular physical activity into the daily routines of adolescents as an effective preventive strategy for enhancing mental health. Given that adolescents spend a significant portion of their time at school, which already has the necessary infrastructure for such programs, teachers are well-positioned to incorporate physical activity into school schedules and classroom activities. This would provide students with valuable opportunities to reduce stress, enhance social skills, and manage negative emotions. Furthermore, outside of school, community organizations can support adolescents’ mental well-being by offering physical activity programs, such as after-school activities and local sports leagues, further promoting mental health in everyday life. For effective prevention, physical activity sessions lasting 15 to 45 min, conducted three times per week over a period of up to 10 weeks, are recommended as an effective strategy for improving mental health in this population.

Strengths and limitations

This meta-analysis offers several key advantages. First, it adheres to established research standards through the pre-registration of study protocols in the PROSPERO database, ensuring transparency. Second, the scientific rigor and reliability of the findings were strengthened by following a comprehensive systematic review process in line with PRISMA guidelines. In addition, data extraction, search processes, and quality assessments were carried out independently by two researchers, minimizing bias and enhancing the validity of the results. Lastly, sensitivity analysis and meta-regression were used to explore potential sources of heterogeneity.

This meta-analysis has several limitations. First, the decision to include only published articles in English may have limited the comprehensiveness of the search. Second, the overall quality of the evidence was low due to the methodological constraints of the included studies. Specifically, many of the studies were non-randomized, and few employed double-blinding, which led to a downgrade in the quality of evidence. Additionally, there is a lack of investigation into adolescents’ adherence to physical activity interventions, which is important in today’s digital age when adolescents are increasingly dependent on electronic devices. Future research should assess adherence to physical activity interventions in order to synthesize the effects on mental health. Finally, some subgroups had limited studies and small sample sizes, which could affect the robustness of the pooled results. Given these limitations, caution is advised when interpreting the findings.

Future directions

Future research should focus on exploring how factors such as socioeconomic status and exercise environment influence the effectiveness of physical activity interventions. In addition, longer follow-up periods to further assess the long-term mental health benefits of physical activity are essential. Finally, there is an absolute need for high quality randomized controlled trials to validate and refine these results.

Conclusion

This study indicates that physical activity has a significant positive impact on the mental health of typically developing children and adolescents. The interventions were shown to effectively reduce anxiety, depression, and stress while also improving self-esteem and social competence. Among these benefits, the most notable improvements were observed in stress reduction and the development of social competence. The study further reveals that adolescents in secondary school particularly benefited from these interventions. In addition, moderate-intensity aerobic exercises, especially those incorporated into after-school programs, demonstrated the greatest impact on enhancing mental health. However, the quality of evidence in this study was considered low, and high-quality randomized controlled trials are needed to validate these findings.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Author contributions

FG: Conceptualization, Funding acquisition, Supervision, Writing– review & editing. LLH: Conceptualization, Funding acquisition, Data curation, Formal analysis, Methodology, Writing– original draft. LQE: Methodology, Formal analysis, Data curation, Writing– original draft. WJY: Methodology, Formal analysis, Writing– original draft.

Funding

This work was supported by the [China Association for Science and Technology Graduate Student Science Popularization Ability Improvement Project#1] under Grant [number KXYJS2024007], [Beijing Municipal University Great Wall Scholar Training Program Project#2] under Grant [number CIT&TCD20180335] and [Emerging Interdisciplinary Platform for Medicine and Engineering in Sports (EIPMES)#3].

Data availability

Data is provided within the manuscript or supplementary information files.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.