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

OBJECTIVE: To evaluate the effects of physical activity (PA) on anxiety, depression, self-esteem, and self-worth in overweight/obese children and adolescents. METHODS: 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. RESULTS: 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. CONCLUSION: 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. CLINICAL TRIAL NUMBER: Not applicable.