Does physical activity really improve anxiety and depression in overweight or obese children and adolescents? A systematic review and meta-analysis

TL;DR

Physical activity may slightly improve anxiety, depression, self-esteem, and self-worth in overweight or obese children and teens, but the effects are small and uncertain.

Contribution

A systematic review and meta-analysis evaluating the mental health benefits of physical activity in overweight/obese youth.

Findings

Physical activity was associated with modest improvements in depression and self-esteem.

The effects on anxiety were small and of low certainty.

Improvements varied based on age, obesity level, and race.

Abstract

To evaluate the effects of physical activity (PA) on anxiety, depression, self-esteem, and self-worth in overweight/obese children and adolescents.

A systematic search of six databases was conducted from inception to March 1, 2025. Randomized controlled trials (RCTs) examining the effects of PA on mental health outcomes in children and adolescents (aged 5–19 years) with overweight/obesity were included.

Nineteen RCTs (1,795 participants) were analyzed. PA was associated with improvements in anxiety (SMD = -0.98, 95% CI -1.90 to -0.05, P = 0.04), depression (SMD = -0.15, 95% CI -0.25 to -0.05, P = 0.005), self-esteem (SMD = 0.19, 95% CI 0.03 to 0.35, P = 0.02), and self-worth (SMD = 0.34, 95% CI 0.19 to 0.49, P = 0.0002). However, the evidence for anxiety was of low certainty, and the improvements in depression and self-esteem were modest. The effects were also modulated by age, obesity level, and race.

PA was associated with small to modest improvements in mental health outcomes among young people. While PA may reduce anxiety, the evidence is uncertain, and the observed effects on depression and self-esteem appear small and of modest clinical relevance, supporting PA as an adjunctive mental health strategy.

Not applicable.

The online version contains supplementary material available at 10.1186/s12888-025-07761-9.

Figures