Systematic Umbrella Review and Meta-Meta Analysis: Effectiveness of Physical Activity in Improving Depression and Anxiety in Children and Adolescents.

IF 9.2 1区医学 Q1 PEDIATRICS

Journal of the American Academy of Child and Adolescent Psychiatry Pub Date : 2025-04-11 DOI:10.1016/j.jaac.2025.04.007

Ben Singh,Hunter Bennett,Aaron Miatke,Dorothea Dumuid,Rachel Curtis,Ty Ferguson,Jacinta Brinsley,Kimberley Szeto,Emily Eglitis,Mason Zhou,Catherine E M Simpson,Jasmine M Petersen,Joseph Firth,Carol A Maher

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引用次数: 0

Abstract

OBJECTIVE Depression and anxiety are prevalent and rising in children and adolescents, prompting interest in exercise as a potential therapeutic intervention. The aim of this systematic umbrella review and meta-meta-analysis was to evaluate the effects of exercise on depression and anxiety symptoms in children and adolescents and identify the most promising exercise-based approaches. METHOD This systematic umbrella review was preregistered (PROSPERO ID: CRD42024533558) and followed PRISMA and PRIOR guidelines. A search of 11 databases identified systematic reviews and meta-analyses of randomised controlled trials (RCTs) evaluating the effects of exercise (aerobic, resistance, mind-body exercise) on depression and anxiety symptoms in children and adolescents. Risk of bias was assessed using the AMSTAR-2 tool and certainty of evidence was assessed using GRADE. Meta-analyses were conducted to combine effect sizes, using random effects models. Subgroup analyses were performed to examine participant and intervention characteristics. RESULTS Twenty-one systematic reviews (n=375 RCTs, n=38,117 participants aged 5-18 years) were included. Participants had various clinical conditions including depression, psychosocial disorders, obesity, cancer, as well as healthy individuals. The pooled analysis found moderate effect sizes favouring exercise for symptoms of depression (SMD = -0.45 [95% CI, -0.59 to -0.31], I2 = 71.37%, p<0.01, 180 RCTs, n=34,490 participants) and anxiety (SMD = -0.39 [95% CI, -0.61 to -0.17], I2 = 68.1%, p<0.01, n=55 RCTs, n=24,797 participants). Mixed exercise modes and moderate-intensity exercise had the largest effects on depression, while resistance exercise was most effective for symptoms of anxiety. Interventions that were <12 weeks were more effective for depression compared with ≥12-week interventions. Benefits were generally consistent across populations. The certainty of evidence was moderate for depression and low to moderate for anxiety. CONCLUSION This meta-meta-analysis finds that exercise reduces depression and anxiety symptoms in children and adolescents. These results suggest that structured exercise programs should be considered as part of comprehensive care approaches.

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系统综述和Meta-Meta分析：体育活动改善儿童和青少年抑郁和焦虑的有效性。

抑郁症和焦虑症在儿童和青少年中普遍存在且呈上升趋势，这促使人们对运动作为一种潜在的治疗干预手段产生了兴趣。本系统综述和meta-meta分析的目的是评估运动对儿童和青少年抑郁和焦虑症状的影响，并确定最有希望的基于运动的方法。方法本系统伞式评价采用预注册（PROSPERO ID: CRD42024533558），遵循PRISMA和PRIOR指南。对11个数据库的搜索确定了随机对照试验（rct）的系统综述和荟萃分析，这些试验评估了运动（有氧运动、阻力运动、身心运动）对儿童和青少年抑郁和焦虑症状的影响。使用AMSTAR-2工具评估偏倚风险，使用GRADE评估证据的确定性。采用随机效应模型进行meta分析以结合效应大小。进行亚组分析以检查参与者和干预特征。结果共纳入21篇系统评价（n=375 rct, n= 38117名5 ~ 18岁的参与者）。参与者有各种临床状况，包括抑郁症、心理障碍、肥胖、癌症，以及健康个体。合并分析发现，运动对抑郁（SMD = -0.45 [95% CI, -0.59至-0.31],I2 = 71.37%, p<0.01, 180个随机对照试验，n=34,490名受试者）和焦虑（SMD = -0.39 [95% CI, -0.61至-0.17],I2 = 68.1%, p<0.01, n=55个随机对照试验，n=24,797名受试者）的症状有中等效应。混合运动模式和中等强度运动对抑郁症的影响最大，而阻力运动对焦虑症状最有效。与≥12周的干预相比，<12周的干预对抑郁症更有效。在不同人群中，获益总体上是一致的。对于抑郁，证据的确定性为中等，对于焦虑，证据的确定性为低至中等。结论：这项荟萃分析发现，运动可以减少儿童和青少年的抑郁和焦虑症状。这些结果表明，有组织的锻炼计划应被视为综合护理方法的一部分。

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来源期刊

Journal of the American Academy of Child and Adolescent Psychiatry 医学-精神病学

CiteScore

21.00

自引率

1.50%

发文量

1383

审稿时长

53 days

期刊介绍： The Journal of the American Academy of Child & Adolescent Psychiatry (JAACAP) is dedicated to advancing the field of child and adolescent psychiatry through the publication of original research and papers of theoretical, scientific, and clinical significance. Our primary focus is on the mental health of children, adolescents, and families. We welcome unpublished manuscripts that explore various perspectives, ranging from genetic, epidemiological, neurobiological, and psychopathological research, to cognitive, behavioral, psychodynamic, and other psychotherapeutic investigations. We also encourage submissions that delve into parent-child, interpersonal, and family research, as well as clinical and empirical studies conducted in inpatient, outpatient, consultation-liaison, and school-based settings. In addition to publishing research, we aim to promote the well-being of children and families by featuring scholarly papers on topics such as health policy, legislation, advocacy, culture, society, and service provision in relation to mental health. At JAACAP, we strive to foster collaboration and dialogue among researchers, clinicians, and policy-makers in order to enhance our understanding and approach to child and adolescent mental health.