Editorial: Physical Exercise as a Treatment for Anxiety and Depression in Children and Adolescents? The Devil Is in the Details.

Few would disagree that appropriate physical exercise is good for the body and the mind. For professionals working specifically in the field of child and adolescent mental health, one important question is: "Could physical exercise be considered a treatment strategy to tackle anxiety and depression in children and adolescents?" Singh and colleagues aimed to rigorously answer this question based on the best available evidence by conducting an umbrella review, that is, a quantitative synthesis of systematic reviews and meta-analyses of randomized controlled trials (RCTs) testing the efficacy of physical activity on anxiety and depression in children and adolescents. After screening more than 6,000 potentially relevant references, the authors statistically pooled data from more than 20 systematic reviews with meta-analyses, including a total of 375 RCTs, encompassing 38,117 participants. The main findings from Singh et al. highlighted a small effect size for anxiety (standardized mean difference [SMD] = 0.39) and depression (SMD = 0.45), with confidence intervals indicating that the true effect may actually range from very small to medium (for anxiety: 95% CI = 0.17-0.61; for depression: 95% CI = 0.31-0.59). Therefore, it would seem that the largest evidence synthesis to date supports physical exercise as an effective intervention for children and adolescents with anxiety and/or depression … but the devil is in the details. After careful and critical assessment of the Singh et al. umbrella review, we conclude that additional rigorous research is needed to support the inclusion of physical activity in guidelines for the treatment of anxiety and depression in children and adolescents.