Role of Physical Activity and Sedentary Behavior in the Mental Health of Preschoolers, Children and Adolescents: A Systematic Review and Meta-Analysis
Evidence suggests that participation in physical activity may support young people’s current and future mental health. Although previous reviews have examined the relationship between physical activity and a range of mental health outcomes in children and adolescents, due to the large increase in published studies there is a need for an update and quantitative synthesis of effects.
The objectives of this study were to determine the effect of physical activity interventions on mental health outcomes by conducting a systematic review and meta-analysis, and to systematically synthesize the observational evidence (both longitudinal and cross-sectional studies) regarding the associations between physical activity and sedentary behavior and mental health in preschoolers (2–5 years of age), children (6–11 years of age) and adolescents (12–18 years of age).
A systematic search of the PubMed and Web of Science electronic databases was performed from January 2013 to April 2018, by two independent researchers. Meta-analyses were performed to examine the effect of physical activity on mental health outcomes in randomized controlled trials (RCTs) and non-RCTs (i.e. quasi-experimental studies). A narrative synthesis of observational studies was conducted. Studies were included if they included physical activity or sedentary behavior data and at least one psychological ill-being (i.e. depression, anxiety, stress or negative affect) or psychological well-being (i.e. self-esteem, self-concept, self-efficacy, self-image, positive affect, optimism, happiness and satisfaction with life) outcome in preschoolers, children or adolescents.
A total of 114 original articles met all the eligibility criteria and were included in the review (4 RCTs, 14 non-RCTs, 28 prospective longitudinal studies and 68 cross-sectional studies). Of the 18 intervention studies, 12 (3 RCTs and 9 non-RCTs) were included in the meta-analysis. There was a small but significant overall effect of physical activity on mental health in children and adolescents aged 6–18 years (effect size 0.173, 95% confidence interval 0.106–0.239, p < 0.001, percentage of total variability attributed to between-study heterogeneity [I2] = 11.3%). When the analyses were performed separately for children and adolescents, the results were significant for adolescents but not for children. Longitudinal and cross-sectional studies demonstrated significant associations between physical activity and lower levels of psychological ill-being (i.e. depression, stress, negative affect, and total psychological distress) and greater psychological well-being (i.e. self-image, satisfaction with life and happiness, and psychological well-being). Furthermore, significant associations were found between greater amounts of sedentary behavior and both increased psychological ill-being (i.e. depression) and lower psychological well-being (i.e. satisfaction with life and happiness) in children and adolescents. Evidence on preschoolers was nearly non-existent.
Findings from the meta-analysis suggest that physical activity interventions can improve adolescents’ mental health, but additional studies are needed to confirm the effects of physical activity on children’s mental health. Findings from observational studies suggest that promoting physical activity and decreasing sedentary behavior might protect mental health in children and adolescents. PROSPERO Registration Number: CRD42017060373.
This work was part of María Rodriguez-Ayllon’s Ph.D. thesis (Biomedicine Doctoral Studies of the University of Granada, Spain).
Compliance with Ethical Standards
This review was supported by the Spanish Ministry of Economy and Competitiveness (DEP2013-47540 and DEP2016-79512-R), the European Regional Development Fund (ERDF), the European Commission (no. 667302) and the Alicia Koplowitz Foundation. In addition, this review was conducted with additional funding from the University of Granada, Plan Propio de Investigación 2016, Excellence actions: Units of Excellence; Unit of Excellence on Exercise and Health (UCEES), Junta de Andalucía, Consejería de Conocimiento, Investigación y Universidades, and the ERDF, (ref. SOMM17/6107/UGR). Cristina Cadenas-Sánchez and Fernando Estévez-López are supported by a Grant from the Spanish Ministry of Economy and Competitiveness (BES-2014-068829 and BES-2014-067612, respectively); Jose Mora-Gonzalez and Jairo H. Migueles are supported by the Spanish Ministry of Education, Culture and Sport (FPU14/06837 and FPU15/02645, respectively); and Irene Esteban-Cornejo is supported by a Grant from the Alicia Koplowitz Foundation. In addition, this work was further supported by the SAMID III network, RETICS, funded by the PN I+D+I 2017-2021 (Spain), ISCIII-Sub-Directorate General for Research Assessment and Promotion and the ERDF (ref. RD16/0022).
Conflict of interest
María Rodriguez-Ayllon, Cristina Cadenas-Sánchez, Fernando Estévez-López, Nicolas Ernesto Muñoz, Jose Mora-Gonzalez, Jairo H. Migueles, Pablo Molina-García, Hanna Henriksson, Alejandra Mena-Molina, Vicente Martínez-Vizcaíno, Andrés Catena, Marie Löf, Kirk I. Erickson, David Lubans, Francisco B. Ortega and Irene Esteban-Cornejo declare that they have no conflicts of interest relevant to the content of this review.
- 1.Murray CJL, Lopez AD, World Health Organization, World Bank, Harvard School of Public Health. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020: summary. Geneva: World Health Organization; 1996. http://www.who.int/iris/handle/10665/41864.
- 15.Lubans D, Richards J, Hillman C, Faulkner G, Beauchamp M, Nilsson M, et al. Physical activity for cognitive and mental health in youth: a systematic review of mechanisms. Pediatrics. 2016;14:114.Google Scholar
- 16.Physical Activity Guidelines for Americans. 2nd edition. 2018; Washington, DC: US Department of Health and Human Services. https://health.gov/paguidelines/second-edition/pdf/Physical_Activity_Guidelines_2nd_edition.pdf. Accessed 15 Nov 2018
- 21.Liu M, Wu L, Ming Q. How does physical activity intervention improve self-esteem and self-concept in children and adolescents? Evidence from a meta-analysis. PLoS One. 2015;10:1–17.Google Scholar
- 31.von Klitzing K, Döhnert M, Kroll M, Grube M. Mental disorders in early childhood. Dtsch Arztebl Int. 2015;112:375–86.Google Scholar
- 39.Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med. 2008;61:344–9.Google Scholar
- 40.Armijo-Olivo S, Stiles CR, Hagen NA, Biondo PD, Cummings GG. Assessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological research. J Eval Clin Pract. 2012;18(1):12–8.CrossRefPubMedGoogle Scholar
- 42.Hasanpour M, Tabatabaei M, Alavi M, Zolaktaf V. Effect of aerobics exercise on self-esteem in Iranian female adolescents covered by welfare organization. Sci World J. 2014;29(6):714–32.Google Scholar
- 43.Goldfield GS, Alberga AS, Hadjiyannakis S, Phillips P, Malcolm J, Wells GA, et al. Effects of aerobic training, resistance training, or both on psychological health in adolescents with obesity: the HEARTY randomized controlled trial. J Consult Clin Psychol. 2015;83:1123–35.CrossRefPubMedGoogle Scholar
- 47.Tubić T, Đorđić V. Exercise effects on mental health of preschool children. An Psicol. 2013;29:249–56.Google Scholar
- 49.Peng S, Qi A, Yuan F. Experimental study on the effects of exercise prescription on the mental health of left-behind school children in rural areas. Rev Argent Clin Psic. 2015;24(3):267–76.Google Scholar
- 56.Kyle TL, Mendo AH, Reigal Garrido RE, Sánchez VM. Effects of physical activity on self-concept and self-efficacy in preadolescents. RETOS. Nuevas Tendencias en Educacion Fisica Deporte y Recreacion. 2016;2041:61–5.Google Scholar
- 71.Kipp LE, Weiss MR. Physical activity and self-perceptions among children and adolescents. Routledge handbook of physical activity and mental health. New York: Routledge; 2013. p. 187–99.Google Scholar
- 72.Lubans DR, Lonsdale C, Cohen K, Eather N, Beauchamp MR, Morgan PJ, et al. Framework for the design and delivery of organized physical activity sessions for children and adolescents: Rationale and description of the “SAAFE” teaching principles. Int J Behav Nutr Phys Act. 2017;14:24.CrossRefPubMedPubMedCentralGoogle Scholar
- 83.Reigal R, Videra A, Gil J. Physical exercise, general self-efficacy and life satisfaction in adolescence. Rev Int Med Cienc Ac. 2014;14:561–76.Google Scholar
- 125.Marques R, Assis M, Maranhao Neto GA, Resende F, Palma A. Body image dissatisfaction among 14-15 year old females in Rio de Janeiro. Brazil. Int J Sport Psychol. 2014;45:39–56.Google Scholar
- 128.Wang H, Fu J, Lu Q, Tao F, Hao J. Physical activity, body mass index and mental health in Chinese adolescents: a population based study. J Phys Fit Sports Med. 2014;54:518–25.Google Scholar
- 134.Trinh L, Wong B, Faulkner GE. The independent and interactive associations of screen time and physical activity on mental health, school connectedness and academic achievement among a population-based sample of youth. J Can Acad Child Adolesc Psychiatry. 2015;24:17–24.PubMedPubMedCentralGoogle Scholar
- 138.Hyakutake A, Kamijo T, Misawa Y, Washizuka S, Inaba Y, Tsukahara T, et al. Cross-sectional observation of the relationship of depressive symptoms with lifestyles and parents’ status among Japanese junior high school students. Environ Health Prev Med. 2016;21:265–73.CrossRefPubMedPubMedCentralGoogle Scholar
- 141.Mouissi F. Physical activity and sport and their impact on mental health of Algerian adolescents. J Phys Educ Sport Health Recr. 2015;4:1807–13.Google Scholar
- 169.Padilla-Moledo C, Castro-Piñero J, Ortega FB, Pulido-Martos M, Sjöström M, Ruiz JR. Television viewing, psychological positive health, health complaints and health risk behaviors in Spanish children and adolescents. J Sports Med Phys Fit. 2015;55:675–83.Google Scholar