Introduction
Method
Search strategy
Eligibility criteria
Study selection
Quality assessment
Data extraction
Evidence synthesis
Meta-analysis
Results
Study selection
Overview of studies
Author, year, country, study design | Age (mean age/age range); Sample size (male/female) | Physical activity measurement tool and reporting source (SR/PR) | Mental health outcome and measurement tool | Main findings | Quality of evidence |
---|---|---|---|---|---|
Alves, et al., USA, Cross-sectional [56] | 9–15 years; 64 (24/40) | CQ (SR) | Positive affect, Anxiety, Negative affect; STAIC, Positive and Negative Affect Schedule for Children | MVPA was associated with reduced anxiety levels in children with overweight/obesity (r = − 0.52, p < 0.05) | Medium |
Alves, et al., USA, Cross-sectional [57] | 9–15 years; 65 (25/40) | CQ (SR) | Anxiety; STAIC | Children who engaged in VPA had lower mean anxiety (β = − 2.8, p = 0.01); Children who reported more time spent in MVPA also had lower anxiety (β = − 0.2, p = 0.01) | Medium |
Awais, et al., Pakistan, Cross-sectional [58] | 17.9 ± 1.22 years; 225 (107/118) | GLTEQ (SR) | Distress; Kessler-10 | A moderate negative correlation of PA (r = − 0.340, p < 0.001) was found with psychological distress levels | Medium |
Bosselmann, et al., Germany, Cross-sectional [59] | 15.83 ± 1.73 years; 122 (53/69) | GSLTPAQ (SR) | Boredom, COVID-19 Fear; FOC-19, Multidimensional State Boredom Scale | COVID-19 Fear significantly correlated with total PA (r = − 0.214, p = 0.017), quantity of strenuous PA (r = − 0.325, p < 0.01), and boredom (r = − 0.211, p < 0.05) | Medium |
Breidokiene, et al., Lithuania, Cross-sectional [60] | 9.65 ± 1.94 years; 306 (144/162) | CQ (PR) | General well-being; CQ | There was no significant correlation between PA and a Child’s emotional well-being/behavior | Low |
Chi, et al., CHN, Cross-sectional [61] | 15.26 ± 0.47 years; 1794 (1,077/787) | IPAQ-SF (SR) | Anxiety, Depression, Insomnia; YSIS; PHQ-9; GAD | Moderately active physically was significantly associated with a lower level of depressive symptoms (β = − 0.16, p = 0.002) and anxiety symptoms (β = − 0.16, p = 0.005), while highly active physically was associated with a lower level of insomnia symptoms (β = − 0.05, p = 0.020), depressive symptoms (β = − 0.17, p < 0.001) and anxiety symptoms (β = − 0.15, p = 0.004) | Medium |
Constantini, et al., Israel, Cross-sectional [62] | 17.4 ± 0.8 years; 473 (302/171) | CQ (SR) | Resilience; CD-RISC | PA was important factor associated with resilience (β = 0.008, p < 0.001) | Medium |
Cosma, et al., Czekh, Cross-sectional [63] | 13.45 ± 1.62 years; 3438 (1574/1866) | CQ (SR) | General well-being, Life satisfaction; WHO-5, Cantril ladder | Sports and PA components were positively associated with WHO-5 (β = 0.158, p < 0.001) and Life Satisfaction (β = 0.110, p < 0.001) | Medium |
Deng, et al., CHN, Cross-sectional [64] | 18–22 years; 1607 (1041/566) | CQ (SR) | Anxiety, Depression, Stress; DASS-21 | Lower DASS-21 scores were significantly correlated with regular exercise, maintaining exercise habits during the outbreak of COVID-19, exercising more than 1 to 2 times a week, exercise duration > 1 h, and > 2000 pedometer steps (all p < 0.05) | Medium |
Ellis, et al., CAN, Cross-sectional [65] | 16.68 ± 0.78 years; 1054(231/805) (18 people who chose the “other”) | GLTEQ (SR) | Depression, Loneliness, COVID-19 Stress; CQ, Brief Symptom Inventory, UCLA Loneliness Scale | PA significantly correlated with Loneliness (r = − 0.12, p < 0.01) and depression (r = − 0.08, p < 0.05). More PA (β = − 0.09, p < 0.001) was significant predictor of less loneliness | Medium |
Fang, et al., CHN, Cross-sectional [66] | 20.17 ± 0.47 years; 1011 (328/683) | The five-item scale was developed by Boothby, Tungatt, and Townsend (SR) | General well-being; The eight-item scale developed by Campbell, The 28-item scale developed by Burckhardt and Anderson | Participation in sports was positively related to general well-being (r = 0.02, p < 0.01). The linear regression analysis of how participation in sports influences well-being (β = 0.25, p < 0.001) revealed a significant amount of explained variance | Medium |
Ghorbani, et al., Iran, Cross-sectional [67] | 16.28 ± 0.97 years; 136 (60/76) | The accelerometer ActiGraph wGT3X-BT | Anxiety, Depression, Stress; DASS-21 | The analyses showed that MVPA per day was negatively associated with all of the mental health indicators; depression (β = − 0.290, p = 0.001), anxiety (β = − 0.404, p < 0.001), and stress (β = − 0.298, p < 0.001) | Medium |
Gilbert, et al., USA, Cross-sectional [68] | 8.01 ± 1.75 years; 144 (80/64) | CQ (PR) | General well-being; Child Mood and Feelings Questionnaire, | Children with a decrease in total PA, outside play and organized sports programs had lower general well-being (p < 0.05) | Medium |
Huang, et al., CHN, Cross-sectional [69] | NR, Middle school students; 1493 (778/715) | CQ (SR) | Negative affect, Feelings of loss of control; CQ | There were significant differences among students with low, medium, and high PA in terms of their self-perceived feelings of loss of control (p < 0.01, effect size = 0.274) and negative affect (p < 0.01, effect size = 0.257) | Medium |
Kang, et al., CHN, Cross-sectional [70] | 16.3 ± 1.3 years; 4898 (2359/2539) | IPAQ (SR) | Vigor, Self-esteem, Tension, Depression, Anger, Fatigue, Confusion; Chinese Profile of Mood States | Higher levels of PA were significantly associated with lower levels of total mood disturbance in this population (High PA group according to IPAQ: B = − 3.22, SE = 0.40, p < 0.001; Moderate: B = − 1.47, SE = 0.37, p < 0.001, compared to Low PA group) | Medium |
Khan, et al., Bengladesh, Cross-sectional [71] | NR, college and university students; 505 (317/188) | CQ (SR) | Anxiety, Depression, Stress, Event-specific distress; DASS-21, Impact of Event Scale | Physical exercise was significantly associated in lowering scores of DASS depression subscale (B = − 2.10, p < 0.05) | Medium |
Lai, et al., CHN, Cross-sectional [72] | NR, University Students; 124 (45/79) | CQ (SR) | Resilience, Anxiety, Depression, insomnia; Stress; PSS-10, PHQ-4, The seven-item Insomnia Severity Scale, CD-RISC | Exercise was significantly related to anxiety and depression (r = − 0.194, p < 0.05) | Medium |
Lee, Korea, Cross-sectional [73] | 14–19 years; 1,046 (521/525) | Model of sports participation developed by Snyder | COVID-19 Stress; COVID-19 Stress Scale | PA was significantly related to COVID-19 stress (r = − 0.162, p < 0.001) | Medium |
Lee, et al., Korea, Cross-sectional [74] | 14–16 years; 333 (153/180) | Ware’s “Health Perception” Scales (SR) | Mental health importance, Mental health performance; Ware’s “Health Perception” Scales | PA performance was significantly related to mental health importance (r = 0.533, p < 0.001), mental health performance (r = 0.520, p < 0.001) | Medium |
Li, et al., CHN, Cross-sectional [75] | 5.21 ± 1.40 years; 21,526 (11,281/10,245) | CQ (PR) | Mental health problems; SDQ | PA < 1 h/day (OR: 1.21, p < 0.001) was associated with increased risks for child mental health problems | Medium |
Lindoso, et al., Brazil, Cross-sectional [76] | 10–18 years; 355 (140, 215) | CQ (SR) | Mental health problems; SDQ | There was a negative correlation between the mental health problems score and PA per week (r = -0.222, p < 0.001) | Medium |
Lu, et al., CHN, Cross-sectional [77] | 15.26 ± 0.46 years; 965 (556, 409) | IPAQ-SF (SR) | Anxiety, Depression, COVID-19 Fear, Insomnia; YSIS, PHQ-9, GAD, FOC-19 | People with high PA were less likely to experience insomnia (OR = 0.71, p < 0.05) and depression (OR = 0.71, p < 0.05) compared to those with low PA | Medium |
Lukacs, Hungary, Cross-sectional [78] | 24.52 ± 7.15 years; 2162 (599/1552) (11 people who chose the “other”) | CQ (SR) | General well-being, Perceived health; CES-D | The test indicated students with reduced MVPA had lower general well-being and perceived health status scores than students who were unchanged (p < 0.001) or increased their activities (p < 0.001) | Medium |
Masse, et al., CAN, Cross-sectional [79] | 13 ± 0.1 years; 254 (117/ 137) | CQ (SR) | General well-being, Anxiety; CQ | Children's general well-being had a significant impact on PA (β = 0.286, 95% CI 0.138–0.424, p < 0.05) | Medium |
Maximova, et al., CAN, Cross-sectional [80] | 9-12 years; 1095 (538/557) | CQ (SR) | General well-being, Positive outlook, Internalizing and functioning problems, Tiredness, Loneliness, Boredom; CQ | Girls who were more physically active during than before the lockdown were less likely to experience ‘internalizing and functioning problems, tiredness and loneliness’ and more likely to have a ‘positive outlook on future and time during lockdown’ relative to those who were less physically active. Boys who were physically active during the lockdown were more likely to have a ‘positive outlook on future and time during the lockdown’ | Medium |
McArthur, et al., CAN, Cross-sectional [81] | 9–11 years; 846 (447/398) | CQ (SR) | Happiness, Anxiety, Depression; CQ | PA was significantly related to anxiety (r = − 0.11, p < 0.05) and happiness (r = 0.15, p < 0.05) | Medium |
McGuine, et al., USA, Cross-sectional [82] | 15.7 ± 1.2 years; 559 (313/244) | The Hospital for Special Surgery Pediatric Functional Activity Brief Scale (SR) | Health-related quality of life, Anxiety, Depression; GAD-7, PHQ-9, Pediatric Quality of Life Inventory 4.0 | The did not play (DNP) group had a higher (ie., worse) GAD-7 score than the did play (PLY) group (p < 0.001) as well as a higher (ie., worse) PHQ-9 score than the PLY group (p < 0.001). the PLY group had a higher Pediatric Quality of Life Inventory total scores (p < 0.001) | Medium |
Mitra, et al., CAN, Cross-sectional [83] | 9–15 years; 800 (377/423) | CQ (SR) | General well-being ; CQ | Lower general well-being was related to less PA (OR = 1.54, p = 0.028) | Medium |
Moriarty, et al., USA, Cross-sectional [84] | 21.3 ± 3.8 years; 550 (135/408) | IPAQ-SF (SR) | Stress; PSS-4 | Stress was negatively associated with exercise during COVID-19 (r = − 0.162, p < 0.001) | Medium |
Morres, et al., Greece, Cross-sectional [85] | 14.41 ± 1.63 years; 950 (518/432) | IPAQ-SF (SR) | Positive energy, Relaxation, General well-being, Negative arousal, Tiredness; The 4-Dimensional Mood Scale, WHO-5 | Total PA was significantly related to general well-being (r = 0.35, p < 0.01), positive energy (r = 0.36, p < 0.01), relaxation (r = 0.12, p < 0.01), and negative arousal (r = − 0.10, p < 0.01) | Medium |
Oliva, et al., Italy, Cross-sectional [86] | 1-18 years; 9688 (5066/4622) | CQ (PR) | Anxiety, Depression, Emotional and behavioral problems; The Pediatric Symptom Checklist, CES-D, The Screen for Child Anxiety Related Disorders | Emotional and behavioral problems (Estimate = − 5.7980, p < 0.001), anxiety (Estimate = − 4.3827, p < 0.001), and depression (Estimate = − 3.0091, p < 0.001) were negatively correlated with PA | Medium |
Pigaiani, et al., Italy, Cross-sectional [87] | 18.1 ± 0.9 years; 306 (223/83) | CQ (SR) | General well-being; CQ | PA was significantly related to general well-being (OR = 2.609, p = 0.007) | Medium |
Qi, et al., CHN, Cross-sectional [88] | 11–20 years; 9554 (4557/4997) | CQ (SR) | Depression; CES-D | Duration of PA > 60 min/day (OR = 0.686, p < 0.001) and 30–60 min/day (OR = 0.636, p < 0.001) were significantly associated with lower risk of depression | Medium |
Qin, et al., CHN, Cross-sectional [89] | 13–16 years; 248 (114/134) | CQ (SR) | Anxiety; Mental Health Test | Exercising for ≥ 1 h per day (OR = 0.23, p < 0.01) was a protective factor for anxiety | Medium |
Qin, et al., CHN, Cross-sectional [90] | 12.04 ± 3.01 years; 1,199,320 (619,144/580,176) | CQ (SR) | Distress; GHQ-12 | Students who spent less than 0.5 h exercising had increased odds of self-reported psychological distress compared with students who spent more than 1 h exercising (OR = 1.64, p < 0.001) | High |
Ren, et al., CHN, Cross-sectional [91] | 13.14 ± 1.55 years; 1487 (727/760) | CQ (SR) | Depression; CES-D | PA time (β = − 0.07, p < 0.001) was negatively associated with depressive symptoms | Medium |
Sikorska, et al., Poland, Cross-sectional [92] | 15.38 ± 2.10 years; 455 (121/243) (2 non-binary people and 4 people who chose the “other”) | CQ (SR) | Resilience, General well-being, Anxiety, Depression, Stress; CD-RISC, DASS | Physical exercise was significantly associated resilience (r = 0.183, p < 0.01), emotional well-being (r = 0.153, p < 0.01), psychological well-being (r = 0.191, p < 0.01), Social well-being (r = 0.126, p < 0.05) | Medium |
Song, et al., Korea, Cross-sectional [93] | NR, middle school and high school students; 836 (412/424) | Social Aspect of Sport (SR) | Optimism, Pessimism, COVID-19 Stress; A scale with Verified Reliability and Validity as Reported by Chang, The scales Used by Gaumer Erickson, The COVID Stress Scale | Sports participation exerted a positive effect on optimism (β = 0.659, p < 0.001). Sports participation exerted a negative effect on pessimism (β = − 0.156, p = 0.037) and COVID Stress (β = − 0.656, p < 0.001) | Medium |
Swansburg, et al., CAN, Cross-sectional [94] | 10.14 ± 3.06 years; 587 (166/412) (9 people who chose the “other”) | A daily activities table with the same activity categories as the United Kingdom Co-SPACE study (SR) | Anxiety, Depression, Hyperactive impulsive, Inattention; PHQ-9, GAD, The Swanson, Nolan, and Pelham 26-question scale | Exercising < 1 h/day correlated positively with the PHQ-9 (r = 0.110, p < 0.01) but negatively with the hyperactive/impulsive (r = − 0.086, p < 0.05) score | Medium |
Szwarcwald, et al., Brazil, Cross-sectional [95] | 12-17 years; 9470 (4716/4754) | The National School Health Survey (SR) | Insomnia, Irritability, Sadness; World Health Survey | PA for 60 min or over at least twice a week was inversely correlated with the problem (At least two problems from frequent sadness, frequent irritability, and sleep problems) (OR = 0.82, p < 0.001) | Medium |
Tandon, et al., USA, Cross-sectional [96] | 10.8 ± 3.5 years; 1000 (517/467) | CQ (SR) | Mental health problems; SDQ | For younger children (6–10 years), engaging in the recommended 7 day/week of PA was associated with mental health problems (β = − 2.4, p = 0.04). For older children (11–17 years), engaging in 1–6 (β = − 3.5, p < 0.01), and 7 day/week (β = − 3.6, p < 0.01) of PA was significantly associated with mental health problems | Medium |
Thomas, et al., United Kingdom, Longitudinal [97] | 16–24 years; 64 (34/30) | CQ (SR) | Self-esteem, General well-being; The Short Warwick-Edinburgh Mental Wellbeing Scale | Changes in general well-being were positively associated with changes in moderate PA (r = 0.24, p < 0.05), and total PA (r = 0.28, p < 0.05) | Medium |
Wang, et al., CHN, Cross-sectional [98] | NA, primary scholar; 6017 (3287/2730) | CQ (PR) | Emotional and behavioral problems; SDQ | Exercise duration of 30 min/day could reduce the risk of Emotional and behavioral problems | Medium |
Wang, et al., CHN, Cross-sectional [99] | 6–16 years; 12,186 (6357/5829) | CQ (SR) | Psychosocial and behavioral problems; The Child Behavior Checklist Score | PA time per day was a significant risk factor associated with mood and behavior problems: outside Wuhan (OR = 0.510, p < 0.001), within Wuhan (OR = 0.416, p < 0.01) | Medium |
Wang, et al., USA, Longitudinal [100] | 13–18 years; 349 (140/209) | GLTEQ (SR) | Positive Affect, Stress; The Multicultural Events Schedule for Adolescents, The Positive and Negative Affect Scale for Children | Daily exercise was significantly associated Stress (r = − 0.05, p < 0.001) and positive affect (r = 0.23, p < 0.001) | Low |
Wright, et al., United Kingdom, Cross-sectional [101] | 15.9 ± 1.48 years; 165 (65/100) | CQ (SR) | Vigor, Anxiety, Depression, Fatigue, Stress; PSS-10, The Hospital Anxiety and Depression Scale, The 20-item Multidimensional Fatigue Inventory, The Subjective Vitality Scale | Higher levels of PA were associated with lower levels of stress (r = -0.26, p < 0.01), depression (r = − 0.31, p < 0.01), fatigue (r = − 0.38, p < 0.01), as well as higher levels of vigor (r = 0.34, p < 0.01) | Medium |
Wunsch, et al., Germany, Cross-sectional [102] | 10.36 ± 4.04 years; 1711 (750/961) | The Momo Physical Activity Questionnaire (SR) | Health-related quality of life, The KIDSCREEN-10 Index | PA within-COVID-19 was positively predicted by pre-COVID-19 health-related quality of life (standardized estimate = 0.07; p = 0.003) | Medium |
Xu, et al., CHN, Cross-sectional [103] | NA, college and university students; 11,254 (4054/7200) | CQ (SR) | Anxiety, Depression, Insomnia, Posttraumatic stress disorder (PTSD); PHQ-9, GAD-7, ISI, Posttraumatic Stress Disorder Checklist for DSM-5 | Participants who engaged in regular exercise during the pandemic reported a lower risk of symptoms of depression (OR = 0.86, p = 0.01), and insomnia (OR = 0.82, p < 0.01) | Medium |
Zhang, et al., CHN, Cross-sectional [104] | NA, college and university students; 2270 (877/1393) | CQ (SR) | Anxiety, Depression; The Self-Rating Anxiety Scale, The Self-Rating Depression Scale | Exercise during the epidemic outbreak (OR = 0.456, p < 0.001) was protective factors for anxiety and depression | Medium |
Zhang, et al., CHN, Cross-sectional [105] | 11.63 ± 1.23 years; 9979 (5131/4848) | IPAQ-SF (SR) | Self-esteem, Vigor, Anger, Confusion, Depression, Fatigue, Tension; Chinese Profile of Mood States | Moderate PA (β = − 3.031, p < 0.001) and High PA (β = − 1.309, p = 0.047) were significantly correlated with mood states in children and adolescents | Medium |
Zhang, et al., CHN, Cross-sectional [106] | 20.51 ± 1.88 years; 11,787 (5056/6731) | CQ (SR) | Depression; PHQ-9 | Compared with PA ≥ 3 day/week, PA < 3 day/week was positively associated with depression symptoms (β = 0.01, 95% CI 0.008–0.012) | Medium |
Zhang, et al., CHN, Longitudinal [107] | 20.70 ± 2.11 years; 66 (25/41) | IPAQ (SR) | Aggressiveness, Anxiety, Depression, Stress; DASS-21, The Buss-Perry Aggressive Questionnaire | Each 100-unit increase in METs of total PA corresponded to a change of (Point Estimate = − 0.12, p < 0.05) in the global DASS score. PA also significantly alleviated depression (Point Estimate = − 0.04, p < 0.05) | Medium |
Zhou, et al., CHN, Cross-sectional [108] | 11–18 years; 4805 (0/4805) | CQ (SR) | Depression; CES-D | Compared with physical exercise duration/day of > 30 min, duration/day of < 30 min (OR = 1.641, p < 0.001) was a risk factor for depression | Medium |
Zhu, et al., CHN, Cross-sectional [109] | 12.6 ± 1.3 years; 2860 (1346/1502) (12 people missing) | The Mental Health Lifestyle Scale (SR) | Being more stressed, Feeling more horrified, Feeling more apprehensive, Feeling more helpless, Having larger study pressure, Perceived vulnerability; CQ, The adapted Perceived Risk of the HIV Scale | Those who perceived more vulnerability were more likely than others to spend more time to exercise (OR = 1.28, p < 0.001) | Medium |
Country, study design | Age (mean age/age range); Sample size (male/female), Participants Characteristics (types of disorders or diseases), Grouping | Condition for the control, Condition for the intervention, Intensity, frequency, duration | Mental health outcome and measurement tool | Main findings | Quality of evidence |
---|---|---|---|---|---|
Chen, et al., CHN, Randomized controlled trials [110] | 14.4 ± 1.0 years; 69, patients with moderate and severe anxiety symptoms (anxiety Scale ≥ 61), experiment group (35) and the control group (34) | The control group was given routine health education support the experiment group was given both routine health education support and the integration model for intervention (mindfulness meditation training, aerobics exercise course). 30 min (mindfulness meditation training); 45 min, medium intensity (aerobics exercise course); 5 times a week (mindfulness meditation training); 3 times a week (aerobics exercise course); 8 weeks (mindfulness meditation training); 10 weeks (aerobics exercise course) | Positive Affect, General well-being, Life satisfaction, Anxiety, Negative Affect; Self-rating Anxiety Scale, Positive and Negative Affect Scale, Psychological Well-Being Scale | After intervention, a significant difference between groups was obtained in anxiety scores, negative affect scores, positive affect scores (all p < 0.01), and overall well-being index (p = 0.04) | Medium |
De Candia, et al., Italy, Randomized controlled trials [111] | 16.13 ± 0.74 years; 50, NA, information regarding nutritional education (EG; n = 25) or a waitlist control group (CG; n = 25) | Do nothing. Receive 12 weeks of aerobic exercises characterized by fun elements associated with theoretical lessons 90 min (physical activities, such as joint mobility exercises, low-to-moderate intensity aerobic exercise, team-building activities, exercise stations, cardio workout) 2 times a week; 12 weeks | Exercise Dependence, Stress; Exercise Dependence Scale, PSS-10 | The post-hoc analysis revealed a significant improvement in the score for exercise dependence (p < 0.001, d = 2.05, large effect size) and stress (p < 0.001, d = 2.17, large effect size) in the intervention group | Medium |
Hamed, et al., Saudi Arabia, Randomized controlled trials [112] | 20.77 ± 1.16 years; 54, mild to moderate anxiety and depression, participants were divided into: group A (GA) and Group B (GB) | Group B (GB) students received an online CBT (1.5 h each session) for 8 weeks (once per week). Group A (GA) were encouraged to increase their aerobic training of moderate to vigorous exercises such as jumping, running, swimming, or dancing, 5 days/week for one h daily.80 min, 70–90% of their maximum heart rate; 5 times a week; 8 weeks (tread mill running, high pace stationary cycling or weight bearing aerobic exercises) | Anxiety, Depression, Stress; DASS-21 | A significant improvement of DASS scores after treatment in both groups (p ≤ 0.001). IPAQ scores showed a significant improvement in GA and GB with non-significance in vigorous activities; category. GA showed a significant reduction of anxiety more than GB with a non-significant difference in stress and depression (p ≥ 0.05) | High |
Zheng, et al., CHN, Randomized controlled trials [113] | 13.5 ± 0.5 years; 954(499/455), NA, intervention (n = 485, 6 schools) and control (n = 469, 6 schools) groups | (1) An outline was provided on the recommended 20-20-20 rule during study and viewing of on-screen content; (2) During recess (15 min for each recess; 4 times per day), participants in the control group received SMS text message prompts (≤ 50 characters) to participate in broadcast exercise programs at home, eye relaxation, or to stretch for 10 min. Students had access to at-home workout videos developed by exercise physiologists. Students in the intervention group received the identical health information session, online curriculum, workout videos, and breaks as described above. Additionally, at the beginning of the study, students in the intervention group were asked to log on and download a peer-to-peer live-streaming app (the Recess and Exercise Advocacy Program [REAP]). REAP is a live-streaming platform that allows users to capture short videos and photographs with their smartphones related to their physical exercise or eye relaxation activities (eg., looking outdoors through the window).15 mins for each recess, 4 times per day; 2 weeks | Anxiety, Insomnia; The 45-item Chinese version of the Spence Children’s Anxiety Scale, The 4-item Patient-Reported Outcomes Measurement Information System | Anxiety score fell by − 0.23 in the intervention group and rose (worsened) by 0.12 in the controls by the end of the study. The change in anxiety score was significantly greater in the intervention group compared to the controls (− 0.36, p = 0.02) | High |
Quality assessment
Data syntheses
Changes in physical activity and mental health of children and youth during COVID-19
The relationship between physical activity and mental health among children and youth during COVID-19
Overall findings
Overall | 6–12 years group | 13–18 years group | 19–24 years group | Disability | ||||
---|---|---|---|---|---|---|---|---|
Positive relationship | Negative relationship | No relationship | Assoc (% studies) | |||||
Negative psychological responses | ||||||||
Depression | − – 21/23 (91.3%) | − – 5/7 (83.3%) | − – 17/18 (94.4%) | − – 11/11 (100%) | − – 6/6 (100%) | |||
Anxiety | − – 14/21 (66.7%) | − – 4/6 (66.7%) | − – 12/17 (70.6%) | ?? 5/9 (55.6%) | − – 6/7 (85.7%) | |||
Stress | − – 7/11 (63.6%) | 0 0/1 (0%) | − – 6/8 (75%) | ?? 4/7 (57.1%) | − 1/1 (100%) | |||
Insomnia | − – 4/6 (66.7%) | − 1/1 (100%) | − – 4/6 (66.7%) | ? 1/2 (50%) | ||||
COVID-19 Stress | [65]b | − 2/3 (66.7%) | − 2/3 (66.7%) | − 1/1 (100%) | ||||
Fatigue | − – 3/3 (100%) | − 1/1 (100%) | − – 3/3 (100%) | − 1/1 (100%) | ||||
Mental health problems | − – 3/3 (100%) | − – 3/3 (100%) | − 2/2 (100%) | − 1/1 (100%) | ||||
Negative affect | [56]ab | − 2/3 (66.7%) | 0 0/1 (0%) | − 2/3 (66.7%) | − 1/1 (100%) | |||
Anger | − 2/2 (100%) | − 1/1 (100%) | − 2/2 (100%) | |||||
Boredom | [59]bc | [80]a | ? 1/2 (50%) | 0 0/1 (0%) | − 1/1 (100%) | − 1/1 (100%) | ||
Confusion | − 2/2 (100%) | − 1/1 (100%) | − 2/2 (100%) | |||||
Distress | − 2/2 (100%) | − 2/2 (100%) | − 2/2 (100%) | |||||
Emotional and behavioral problems | − 2/2 (100%) | − 2/2 (100%) | − 1/1 (100%) | − 2/2 (100%) | ||||
Loneliness | [65]b | [80]a | ? 1/2 (50%) | 0 0/1 (0%) | − 1/1 (100%) | |||
Tension | 0 0/2 (0%) | 0 0/1 (0%) | 0 0/2 (0%) | |||||
Tiredness | 0 0/2 (0%) | 0 0/2 (0%) | 0 0/1 (0%) | |||||
Aggressiveness | [107]c | 0 0/1 (0%) | 0 0/1 (0%) | |||||
Being more stressed | [109]ab | 0 0/1 (0%) | 0 0/1 (0%) | 0 0/1 (0%) | ||||
COVID-19 Fear | [59]bc | − 1/1 (100%) | − 1/1 (100%) | − 1/1 (100%) | ||||
Event-specific distress | [71]c | 0 0/1 (0%) | 0 0/1 (0%) | |||||
Exercise dependence | [111]b | − 1/1 (100%) | − 1/1 (100%) | |||||
Feeling more horrified | [109]ab | 0 0/1 (0%) | 0 0/1 (0%) | 0 0/1 (0%) | ||||
Feeling more apprehensive | [109]ab | 0 0/1 (0%) | 0 0/1 (0%) | 0 0/1 (0%) | ||||
Feeling more helpless | [109]ab | 0 0/1 (0%) | 0 0/1 (0%) | 0 0/1 (0%) | ||||
Feelings of loss of control | [69]b | − 1/1 (100%) | − 1/1 (100%) | |||||
Having larger study pressure | [109]ab | 0 0/1 (0%) | 0 0/1 (0%) | 0 0/1 (0%) | ||||
Hyperactive/impulsive | [94]abd | + 1/1 (100%) | + 1/1 (100%) | + 1/1 (100%) | + 1/1 (100%) | |||
Irritability | [95]ab | − 1/1 (100%) | − 1/1 (100%) | − 1/1 (100%) | ||||
Inattention | [94]abd | 0 0/1 (0%) | 0 0/1 (0%) | 0 0/1 (0%) | 0 0/1 (0%) | |||
Internalizing and functioning problems | [80]a | 0 0/1 (0%) | 0 0/1 (0%) | |||||
Negative arousal | [85]ab | − 1/1 (100%) | − 1/1 (100%) | − 1/1 (100%) | ||||
Pessimism | [93]b | − 1/1 (100%) | − 1/1 (100%) | |||||
Perceived vulnerability | [109]ab | + 1/1 (100%) | + 1/1 (100%) | + 1/1 (100%) | ||||
Psychosocial and behavioral problems | [99]ab | − 1/1 (100%) | − 1/1 (100%) | − 1/1 (100%) | ||||
PTSD | [103]bc | 0 0/1 (0%) | 0 0/1 (0%) | 0 0/1 (0%) | ||||
Sadness | [95]ab | − 1/1 (100%) | − 1/1 (100%) | − 1/1 (100%) | ||||
Positive psychological responses | ||||||||
General well-being | + + 11/13 (84.6%) | + + 5/7 (71.4%) | + + 9/10 (90%) | + + 4/4 (100%) | + 1/1 (100%) | |||
Positive affect | [56]ab | + 2/3 (66.7%) | 0 0/1 (0%) | + 2/3 (66.7%) | + 1/1 (100%) | |||
Self-esteem | [97]bc | + 2/3 (66.7%) | + 1/1 (100%) | + 2/3 (66.7%) | 0 0/1 (0%) | |||
Vigor | + + 3/3 (100%) | + 1/1 (100%) | + + 3/3 (100%) | + 1/1 (100%) | ||||
Health-related quality of life | + 2/2 (100%) | + 1/1 (100%) | + 2/2 (100%) | + 1/1 (100%) | ||||
Life satisfaction | + 2/2 (100%) | + 1/1 (100%) | + 2/2 (100%) | + 1/1 (100%) | ||||
Resilience | + 2/2 (100%) | + 1/1 (100%) | + 2/2 (100%) | |||||
Happiness | [81]a | + 1/1 (100%) | + 1/1 (100%) | |||||
Mental health performance | [74]b | + 1/1 (100%) | + 1/1 (100%) | |||||
Mental health importance | [73]b | + 1/1 (100%) | + 1/1 (100%) | |||||
Optimism | [93]b | + 1/1 (100%) | + 1/1 (100%) | |||||
Positive energy | [85]ab | + 1/1 (100%) | + 1/1 (100%) | + 1/1 (100%) | ||||
Positive outlook | [80]a | + 1/1 (100%) | + 1/1 (100%) | |||||
Prosocial behavior | [98]ad | + 1/1 (100%) | + 1/1 (100%) | + 1/1 (100%) | ||||
Perceived health | [78]c | + 1/1 (100%) | + 1/1 (100%) | |||||
Relaxation | [85]ab | + 1/1 (100%) | + 1/1 (100%) | + 1/1 (100%) |
Findings across age ranges
Findings among children and youth with disabilities or chronic conditions (DCC)
Meta-analytic results
The relationship between physical activity and negative psychological responses
Studies on negative psychological responses | β | t | P | 95% CI | |
---|---|---|---|---|---|
Agea | − 0.010 | − 6.52 | 0.001 | − 0.013 | − 0.007 |
Total PA | − 0.171 | − 3.77 | 0.001 | − 0.263 | − 0.079 |
PA duration | − 0.219 | − 4.51 | 0.001 | − 0.319 | − 0.121 |
PA frequency | − 0.050 | − 0.50 | 0.622 | − 0.253 | 0.153 |
PA intensity | − 0.326 | − 5.49 | 0.001 | − 0.446 | − 0.206 |
Quality | − 0.172 | − 7.04 | 0.001 | − 0.222 | − 0.123 |
Disability | − 0.147 | − 1.99 | 0.053 | − 0.296 | − 0.002 |
Studies on positive psychological responses | β | t | P | 95% CI | |
---|---|---|---|---|---|
Agea | 0.012 | 4.02 | 0.002 | 0.005 | 0.019 |
Total PA | 0.165 | 2.54 | 0.028 | 0.022 | 0.308 |
PA duration | 0.090 | 0.40 | 0.697 | − 0.407 | 0.588 |
PA frequency | 0.202 | 1.78 | 0.103 | − 0.048 | 0.452 |
PA intensity | 0.350 | 1.71 | 0.115 | − 0.100 | 0.799 |
Quality | 0.159 | 3.20 | 0.008 | 0.050 | 0.268 |
Disability | 0.288 | 1.18 | 0.263 | − 0.249 | 0.824 |