Comparative effects of various exercise interventions on anxiety and depression symptoms in children and adolescents: a network meta-analysis of randomized controlled trials.

backgroundAnxiety and depression affect about 6.5% and 2.6% of young people and often occur together, worsening over time. Exercise increases mood-boosting chemicals like dopamine and endorphins, and research shows it can relieve these symptoms. However, most studies focus on ages 6-18 and test only one type of exercise, overlooking older adolescents (up to 24) and comparisons among different activities. This study addresses these gaps by examining 10-24-year-olds and using a network meta-analysis to compare various exercise programs-such as aerobic, resistance, mind-body, and mixed routines-to determine which best reduces anxiety and depression in this age group.

methodsA comprehensive search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library to identify randomized controlled trials assessing the impact of exercise interventions on children with anxiety and depression. The search spanned all available records from the inception of each database up to May 2024. Literature screening, data extraction, and quality evaluation were independently managed by two reviewers. Subsequently, Stata version 15.1 was utilized to perform a network meta-analysis.

resultsWe included 26 randomized controlled trials and conducted a network meta-analysis to compare the effects of different exercise interventions on anxiety and depression symptoms in children and adolescents. For depressive symptoms, both aerobic exercise (SMD = - 3.66, 95% CI [- 6.62, - 0.69]) and medium-low intensity training (SMD = - 3.61, 95% CI [- 6.10, - 1.13]) were significantly more effective than no intervention. Resistance training showed the highest effect size (SMD = - 4.14, 95% CI [- 9.08, 0.79]), although this result did not reach statistical significance. According to SUCRA rankings, the interventions were ordered as follows in terms of efficacy for reducing depressive symptoms: resistance training (78.2%) > medium low intensity training (77.4%)= aerobic exercise (77.4%) > mind body exercise (55.7%) > group training (27.0%) > cognitive behavioral therapy (20.2%) > no intervention (14.7%). Regarding anxiety symptoms, none of the exercise interventions showed a statistically significant advantage compared to no intervention. However, aerobic exercise had the largest effect size (SMD = 3.10, 95% CI [- 0.85, 7.05]), followed by medium-low intensity training (SMD = 2.37, 95% CI [- 0.21, 4.95]) and mind-body exercise (SMD = 1.75, 95% CI [- 1.75, 5.25]), all of which showed favorable trends. Based on SUCRA rankings, the interventions were ordered as follows for reducing anxiety: aerobic exercise (79.2%) > mind body exercise (72.8%) > medium low intensity training (60.2%) > cognitive behavioral therapy (51.0%) > no intervention (26.5%) > group training (10.4%). LIMITATIONS: Results should be interpreted with caution because the included trials were heterogeneous, only English-language studies were analyzed, outcome scales varied, and long-term follow-up data-especially for resistance training-were scarce.

conclusionsExercise interventions may help alleviate anxiety and depressive symptoms in children and adolescents. Resistance training ranked relatively high for depression, while aerobic exercise showed favorable effects for anxiety. However, the current evidence remains limited, and further high-quality studies are needed to confirm these conclusions.