Physical activity and mental health in children and youth during COVID-19: a systematic review and meta-analysis

Li, Bowen; Ng, Kwok; Tong, Xiuhong; Zhou, Xiao; Ye, Jiangchuan; Yu, Jane Jie

doi:10.1186/s13034-023-00629-4

Child and Adolescent Psychiatry and Mental Health

Table 3 Summary of the relationships between PA and MH outcomes

From: Physical activity and mental health in children and youth during COVID-19: a systematic review and meta-analysis

	Overall				6–12 years group	13–18 years group	19–24 years group	Disability
	Positive relationship	Negative relationship	No relationship	Assoc (% studies)	6–12 years group	13–18 years group	19–24 years group	Disability
Negative psychological responses
Depression		[61]^b, [64]^bc, [65]^b, [67]^b, [70]^b, [71]^c, [72]^bc, [77]^b, [82]^bc, [86]^abd, [88]^bcd, [91]^ab, [94]^abd, [101]^bc, [103]^bc, [104]^cd, [105]^ab, [106]^c, [107]^c, [108]^abd, [121]^bcd	[81]^a, [92]^ab	− – 21/23 (91.3%)	− – 5/7 (83.3%)	− – 17/18 (94.4%)	− – 11/11 (100%)	− – 6/6 (100%)
Anxiety		[56]^abd, [57]^abd, [61]^b, [64]^bc, [67]^b, [72]^bc, [81]^a, [82]^bc, [86]^abd, [89]^b, [104]^cd, [110]^bd, [112]^bcd, [113]^b	[71]^c, [77]^b, [92]^ab, [94]^abd, [101]^bc, [103]^bc, [107]^c,	− – 14/21 (66.7%)	− – 4/6 (66.7%)	− – 12/17 (70.6%)	?? 5/9 (55.6%)	− – 6/7 (85.7%)
Stress		[64]^bc, [67]^b, [84]^c, [98]^b, [101]^bc, [111]^b, [112]^bcd	[71]^c, [72]^bc, [92]^ab, [107]^c	− – 7/11 (63.6%)	0 0/1 (0%)	− – 6/8 (75%)	?? 4/7 (57.1%)	− 1/1 (100%)
Insomnia		[61]^b, [77]^b, [95]^ab, [103]^bc	[72]^bc, [113]^b	− – 4/6 (66.7%)	− 1/1 (100%)	− – 4/6 (66.7%)	? 1/2 (50%)
COVID-19 Stress		[73]^bc, [93]^b	[65]^b	− 2/3 (66.7%)		− 2/3 (66.7%)	− 1/1 (100%)
Fatigue		[70]^b, [101]^bc, [105]^ab		− – 3/3 (100%)	− 1/1 (100%)	− – 3/3 (100%)	− 1/1 (100%)
Mental health problems		[75]^a, [76]^abd, [96]^ab		− – 3/3 (100%)	− – 3/3 (100%)	− 2/2 (100%)		− 1/1 (100%)
Negative affect		[69]^b, [110]^bd,	[56]^ab	− 2/3 (66.7%)	0 0/1 (0%)	− 2/3 (66.7%)		− 1/1 (100%)
Anger		[70]^b, [105]^ab		− 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		[70]^b, [105]^ab		− 2/2 (100%)	− 1/1 (100%)	− 2/2 (100%)
Distress		[58]^bc, [90]^bc		− 2/2 (100%)		− 2/2 (100%)	− 2/2 (100%)
Emotional and behavioral problems		[86]^abd, [98]^ad		− 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			[70]^b, [105]^ab	0 0/2 (0%)	0 0/1 (0%)	0 0/2 (0%)
Tiredness			[80]^a, [85]^ab,	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	[63]^ab, [66]^bc, [68]^a, [78]^c, [79]^b, [83]^ab, [85]^ab, [87]^bc, [92]^ab, [97]^bc, [110]^bd		[60]^ab, [80]^a	+ + 11/13 (84.6%)	+ + 5/7 (71.4%)	+ + 9/10 (90%)	+ + 4/4 (100%)	+ 1/1 (100%)
Positive affect	[100]^b, [110]^bd		[56]^ab	+ 2/3 (66.7%)	0 0/1 (0%)	+ 2/3 (66.7%)		+ 1/1 (100%)
Self-esteem	[70]^b, [105]^ab		[97]^bc	+ 2/3 (66.7%)	+ 1/1 (100%)	+ 2/3 (66.7%)	0 0/1 (0%)
Vigor	[70]^b, [101]^bc, [105]^ab			+ + 3/3 (100%)	+ 1/1 (100%)	+ + 3/3 (100%)	+ 1/1 (100%)
Health-related quality of life	[82]^bc, [102]^ab			+ 2/2 (100%)	+ 1/1 (100%)	+ 2/2 (100%)	+ 1/1 (100%)
Life satisfaction	[63]^ab, [110]^bd			+ 2/2 (100%)	+ 1/1 (100%)	+ 2/2 (100%)		+ 1/1 (100%)
Resilience	[62]^b, [92]^ab			+ 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%)

In the association column, the strength of evidence was summarized and classified according to the percentage of studies supporting an association: 0–33% coded as “0” indicating no association, 34–59% coded as “?” indicating inconsistent association, 60–100% coded as “ + ” or “ − ” indicating positive or negative association. “00”, “??”, “ + + ”, “– –” were coded when there were three or more studies supporting an association
MH mental health, PA physical activity, PTSD post-traumatic stress disorder
^aIncludes 6–12 years group
^bIncludes 13–18 years group
^cIncludes 19–24 years group
^dIncludes people with disabilities and chronic conditions

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ISSN: 1753-2000

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