Key points Can physical activity interventions alleviate depressive symptoms in children and adolescents? Findings This systematic review and meta-analysis included 21 studies with 2441 participants. Results indicate that physical activity interventions were associated with significant reductions in depressive symptoms compared to the control condition. Meaning Available evidence supports physical activity interventions as an alternative or complementary approach to alleviating depressive symptoms in children and adolescents, corroborating the beneficial influence of physical activity on the mental health of pediatric populations. |
Summary
Importance
Depression is the second most prevalent mental disorder among children and adolescents; However, only a small proportion seek or receive specific treatment for the disorder. Physical activity interventions show promise as an alternative or complementary approach to the clinical treatment of depression.
Aim
Determine the association of physical activity interventions with depressive symptoms in children and adolescents.
The 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 evaluated the effects of physical activity interventions on depressive symptoms in children and adolescents compared to a control condition.
Data extraction and synthesis
A random effects meta-analysis was performed using Hedges g. Multiple reviewers independently assessed heterogeneity, risk of bias, and publication bias. Meta-regressions and sensitivity analyzes were performed to corroborate the overall results. The study followed the PRISMA reporting guideline.
Main results and measures
The primary outcome was depressive symptoms measured using validated depression scales after the intervention and at follow-up.
Results
We included 21 studies with 2441 participants (1148 [47.0%] boys; 1293 [53.0%] girls; mean [SD] age, 14 [3] years). Meta-analysis of post-intervention differences revealed that physical activity interventions were associated with a reduction in depressive symptoms compared to the control condition (g = −0.29; 95% CI, −0.47 to −0.10; P = 0.004).
Analysis of follow-up results in 4 studies revealed no differences between the physical activity and control groups (g = −0.39; 95% CI, −1.01 to 0.24; P = 0.14) . Moderate heterogeneity was detected in the study ( Q = 53.92; df = 20; P < 0.001; I 2 = 62.9% [95% CI, 40.7%-76.8%]).
Primary moderator analysis taking into account total volume of physical activity, study design, health status of participants, and concealment of allocation or assessment did not moderate the main effect of treatment.
Secondary analyzes demonstrated that the intervention (i.e., <12 weeks duration, 3 times per week, unsupervised) and participant characteristics (i.e., ≥13 years of age, diagnosed with mental illness or depression) may influence the overall effect of the treatment.
Conclusions and relevance
Physical activity interventions can be used to reduce depressive symptoms in children and adolescents. The greatest reductions in depressive symptoms were derived from participants over 13 years of age and with a diagnosis of mental illness and/or depression. The association with physical activity parameters such as session frequency, duration and supervision remains unclear and needs further investigation.
Unlocking the promise of physical activity for mental health promotion
Eduardo E. Bustamante, Dr. María Enid Santiago-Rodríguez; Jared D. Ramer, PhD
Physical activity is remarkable medicine. The 2018 Physical Activity Guidelines for Americans reported 27 important physical and mental health benefits with strong research support, all of which are compelling (e.g., lower all-cause mortality). Among these benefits, 9 were noted as new for 2018. These new benefits, of course, are not new in the sense that people active in the past did not receive them; rather, they are new in the sense that sufficient evidence emerged in the meta-analyses to affirm them.
In their systematic review and meta-analysis published in this issue of JAMA Pediatrics , Recchia et al expand the evidence on the health benefits of physical activity. Their meta-analysis includes data from more than 2,400 youth who participated in more than 20 randomized clinical trials and quasi-experimental design studies. The review includes data collected by researchers in the US, China, Chile, Germany, Iran, Brazil, Thailand and the UK over the past 35 years (although most was conducted in the last 10 years). The work is timely, aligns with the rise in mental health disorders in adolescents, 3 and the methods are rigorous (e.g., random effects models, risk of bias assessment, sensitivity analyses).
