Physical activity interventions to alleviate depressive symptoms in children and adolescents: A systematic review and meta-analysis

Francesco RECCHIA, Joshua D. K. BERNAL, Daniel Y. FONG, Stephen H. S. WONG, Pak-Kwong CHUNG, King Chung Derwin CHAN, Catherine Mamaid CAPIO, Clare C. W. YU, Sam W. S. WONG, Cindy H. P. SIT, Ya-Jun CHEN, Walter R. THOMPSON, Parco M. SIU

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21 Citations (Scopus)


Importance: Depression is the second most prevalent mental disorder among children and adolescents, yet only a small proportion seek or receive disorder-specific treatment. Physical activity interventions hold promise as an alternative or adjunctive approach to clinical treatment for depression. 

Objective: To determine the association of physical activity interventions with depressive symptoms in children and adolescents. 

Data Sources: PubMed, CINAHL, PsycINFO, EMBASE, and SPORTDiscus were searched from inception to February 2022 for relevant studies written in English, Chinese, or Italian. 

Study Selection: Two independent researchers selected studies that assessed the effects of physical activity interventions on depressive symptoms in children and adolescents compared with a control condition. 

Data Extraction and Synthesis: A random-effects meta-analysis using Hedges g was performed. Heterogeneity, risk of bias, and publication bias were assessed independently by multiple reviewers. Meta-regressions and sensitivity analyses were conducted to substantiate the overall results. The study followed the PRISMA reporting guideline. 

Main Outcomes and Measures: The main outcome was depressive symptoms as measured by validated depression scales at postintervention and follow-up. 

Results: Twenty-one studies involving 2441 participants (1148 [47.0%] boys; 1293 [53.0%] girls; mean [SD] age, 14 [3] years) were included. Meta-analysis of the postintervention differences revealed that physical activity interventions were associated with a reduction in depressive symptoms compared with the control condition (g = -0.29; 95% CI, -0.47 to -0.10; P = .004). Analysis of the follow-up outcomes in 4 studies revealed no differences between the physical activity and control groups (g = -0.39; 95% CI, -1.01 to 0.24; P = .14). Moderate study heterogeneity was detected (Q = 53.92; df = 20; P < .001; I2 = 62.9% [95% CI, 40.7%-76.8%]). The primary moderator analysis accounting for total physical activity volume, study design, participant health status, and allocation and/or assessment concealment did not moderate the main treatment effect. Secondary analyses demonstrated that intervention (ie, <12 weeks in duration, 3 times per week, unsupervised) and participant characteristics (ie, aged ≥13 years, with a mental illness and/or depression diagnosis) may influence the overall treatment effect. 

Conclusions and Relevance: Physical activity interventions may be used to reduce depressive symptoms in children and adolescents. Greater reductions in depressive symptoms were derived from participants older than 13 years and with a mental illness and/or depression diagnosis. The association with physical activity parameters such as frequency, duration, and supervision of the sessions remains unclear and needs further investigation. Copyright © 2023 American Medical Association. All Rights Reserved.

Original languageEnglish
Pages (from-to)132-140
JournalJAMA Pediatrics
Issue number2
Publication statusPublished - Feb 2023


Recchia, F., Bernal, J. D. K., Fong, D. Y., Wong, S. H. S., Chung, P.-K., Chan, D. K. C., . . . Siu, P. M. (2023). Physical activity interventions to alleviate depressive symptoms in children and adolescents: A systematic review and meta-analysis. JAMA Pediatrics, 177(2), 132-140. doi: 10.1001/jamapediatrics.2022.5090


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