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 & Measures: The main outcome was depressive symptoms as measured by validated depression scales at post-intervention and follow-up.
Results: 21 studies involving 2,441 participants (1148 [47.0%] boys; 1293 [53.0%] girls; mean [SD] age, 14 [3] years) were included. Meta-analysis of the post-intervention 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 = 0.004). 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 = 0.14). Moderate study heterogeneity was detected (Q = 53.92; df = 20; P < 0.001; 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× 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.