Child - 2022 - Hale - Physical Activity Interventions For The Mental Health of Children A Systematic Review

Received: 2 February 2021 Revised: 8 August 2022 Accepted: 14 August 2022
DOI: 10.1111/cch.13048
REVIEW ARTICLE
Physical activity interventions for the mental health of

children: A systematic review
Gabrielle E. Hale | Luke Colquhoun | Deborah Lancastle | Nicky Lewis |

Philip J. Tyson
School of Psychology and Therapeutic Studies,

University of South Wales, Pontypridd, UK Abstract
Objective: This systematic review explored the effectiveness of using physical activ-
Correspondence
Gabrielle E. Hale, School of Psychology and ity (PA) interventions to enhance psychological well-being and reduce psychological
Therapeutic Studies, University of South
ill-being (e.g., anxiety and depression) in children aged six to 11 years old from the
Wales, Pontypridd CF37 1DL, UK.
Email: [email protected] general population.
Methods: Electronic databases were searched for studies published between January
2005 and June 2020: Web of Science, ProQuest Psychology Journals, PsycINFO,
Pub Med, ASSIA, CINHAL PLUS, SPORTDiscus, EMBASE and Wiley Online Library.
Search terms included ‘physical activity intervention’, ‘psychological well-being’ and
‘child*’. After removing duplicates, 11 390 studies were independently screened by
two authors based on inclusion/exclusion criteria and assessed for risk of bias.
Results: A total of 23 studies were narratively synthesized and categorized into four
domains: Quality of Life (QOL), body image, self-esteem and psychological ill-being.
Evidence was provided for the impact of PA interventions in improving QOL, body
image and self-esteem. Despite the positive effect on psychological well-being, evi-
dence for a reduction in the frequency and severity of symptoms associated with
psychological ill-being in children is less clear.
Conclusions: Reviewed studies support the use of PA interventions in enhancing the
psychological well-being of children in school and community settings. More research
is warranted to understand the impact of PA interventions on reducing psychological
ill-being in children from the general population.
KEYWORDS
children, mental health, physical activity intervention, well-being, young people
1 | I N T RO DU CT I O N mechanisms, including changes to the structural composition of the

brain, opportunities for social interaction and increases in confidence
The World Health Organisation (WHO, 2020) recommends that chil- (Lubans et al., 2016). Despite these benefits, a recent pooled analy-
dren aged 5 to 17 should participate in an average of 60 min moder- sis across 146 low to high-income countries estimated that more
ate to vigorous intensity physical activity (PA) each week, and the than 80% of young people under 17 do not meet WHO PA recom-
positive psychological impact has been well documented. Children mendations (Guthold et al., 2020), and evidence suggests that PA
who are more physically active demonstrate greater self-esteem and declines begin as early as 5 years old (Cooper et al., 2015; Farooq
lower levels of anxiety and depression (Ahn & Fedewa, 2011; Biddle et al., 2018; Kwon et al., 2015). Adding to this, recent trends
et al., 2019; Lubans et al., 2016) due to underlying biopsychosocial indicate a rise in psychological ill-being in children, with symptoms
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212 HALE ET AL.
associated with anxiety and depression increasing from 12.0% in

2011 to 15.7% in 2017 (Tkacz & Brady, 2019).
Key Messages
Many factors can prevent PA participation during childhood,
• Rates of PA are declining, and symptoms associated with
including preferences for electronic media, time devoted to aca-
psychological ill-being (e.g., anxiety and depression) are
demic activities, poor health (e.g., weight issues), lack of parental
increasing in children as early as 5 years old.
support, bullying and peer judgments (Hesketh et al., 2017; Kemp
• Interventions that target both PA and psychological well-
et al., 2020). There is an urgent need to address these barriers, as
being and ill-being could be used to address these
children who continue to lead increasingly sedentary lifestyles are at
concerns.
greater risk of psychological ill-being due to the absence of the posi-
• This review supports the use of PA-only and multicompo-
tive influence of the biopsychosocial factors outlined above (Lubans
nent PA interventions in improving body image dissatis-
et al., 2016). Psychological ill-being during childhood can have life-
faction and self-esteem in children (aged 6 to 11) from
long adverse consequences, affecting emotional and social develop-
the general population.
ment, educational attainment and later employment (Copeland
• The impact of PA interventions in reducing psychological
et al., 2015; Merikangas et al., 2010), as well as leading to an
ill-being is unclear, and further research is warranted.
increased risk of diagnosis of a psychological disorder in adulthood
(Mulraney et al., 2021). To reduce the likelihood of ill-being develop-
ing, it is critical to identify PA barriers at an early stage when reme-
dial action can be instigated (Lavigne et al., 2016). Moreover, the
recent Lancet Commission on global mental health advocated the relationships, body image, Quality of Life (QOL) and resilience
importance of developing new, innovative interventions to promote (Currie et al., 2009; Tennant et al., 2007). Although two recent
children's psychological well-being (Patel et al., 2018). Taken meta-analyses included broader outcomes of interest (e.g., QOL,
together, it is reasonable to suggest that interventions that target resilience), inclusion criteria were restricted to PA-only (Rodriguez-
both PA and psychological health could be used to address con- Ayllon et al., 2019) or school-based (Andermo et al., 2020) interven-
cerns, by encouraging children to take part in PA whilst enhancing tions. Hence, the overall picture of all types of PA interventions on
psychological well-being and preventing the onset of ill-being in a comprehensive range of factors that contribute to children's psy-
later life. chological well-being remains unknown. Reviewing the impact of
Existing PA interventions can be delivered alone or within a both multicomponent and PA-only interventions is important, as the
multicomponent framework (Spruit et al., 2016), whereby PA is WHO (2009) maintains that interventions that combine PA and
combined with additional sessions to educate participants on health health education (e.g., sedentary behaviour and diet) are more
(e.g., nutrition), behaviour (e.g., goal setting) or psychological topics effective in modifying children's lifestyle factors and can be
(e.g., stress). As evidence for the impact of PA interventions on expected to have similar impact on psychological well-being. More-
young people's psychological well-being continues to grow, there is over, to determine the vital components of PA interventions for
a need to collate the evidence and a recent umbrella review found children, it has been recommended that future reviews should con-
26 reviews covering 150 individual studies (Dale et al., 2019). How- sider community level initiatives delivered outside of school settings
ever, many identified reviews focussed on cross-sectional research (Messing et al., 2019).
(e.g., Dennison et al., 2016), adolescents (e.g., Spruit et al., 2016) or Another limitation of previous research is the small number of
specific sub-components of PA (e.g., Eime et al., 2013). Most find- interventions that have focused specifically on children in compari-
ings gathered from reviews that broadly focused on PA interventions son to adolescents. Less than a third of studies identified by Brown
for children from the general population have been positive (Brown et al. (2013) and Liu et al. (2015) included children (M age ≤
et al., 2013; Liu et al., 2015; Rodriguez-Ayllon et al., 2019), yet 11 years) and effect sizes were not reported separately. Rodriguez-
inconsistent conclusions warrant more research to determine the Ayllon et al. (2019) also found that most PA-only interventions were
vital components that are necessary for promoting psychological delivered to adolescents (aged 12 to 18; N = 10/18) and whilst
well-being. Brown et al. (2013) identified small, significant effects overall effects were small but statistically significant for this age
(Hedges' g = 0.26) on depression and subgroup analyses revealed group, the effect for children (aged 6 to 11) was not (ES = 0.209,
that multicomponent interventions contributed to greater declines p = 0.141). Adding to this, Andermo et al. (2020) found that school-
than PA-only, whereas Liu et al. (2015) found positive effects on based interventions for children (≤ 12 years; N = 14) often demon-
self-esteem following PA-only but not interventions that included strated significant negative effects on psychological ill-being,
additional components. whereas significant positive effects were found for adolescents
Earlier reviews have also tended to focus on anxiety, depres- (>12 years; N = 16). Evidently, the smaller proportion of child inter-
sion and self-esteem (Brown et al., 2013; Dale et al., 2019; Liu ventions and weaker support in comparison to those targeted at
et al., 2015) and a range of outcomes that can contribute to chil- adolescents suggest that more research is warranted to better
dren's psychological well-being have been overlooked. For example, understand the impact of PA interventions on children's psychologi-
it is unclear whether existing PA interventions can enhance peer cal well-being and ill-being.
HALE ET AL. 213
Thus, taking previous research into account, the aim of the delivered in combination with psychological treatment and
current review was to (1) provide an update on the literature of PA (d) exergaming or wilderness interventions. Samples that screened
interventions for children under 11 years old, (2) identify any gaps in positive for anxiety or depression were eligible for inclusion, as many
knowledge and research in this area, (3) summarize the key children can experience symptoms without receiving a clinical diagno-
intervention components (e.g., PA type and education) and discuss sis (Bitsko et al., 2018; Merikangas et al., 2010). Thus, it was antici-
effectiveness in enhancing the psychological well-being and ill-being pated that several studies would include children presenting with mild
of children. or moderate symptoms.
2 | METHODS 2.4 | Risk of bias analysis
2.1 | Protocol registration Risk of bias was assessed using the Cochrane Collaboration tool
(Higgins et al., 2011) by reporting high, low or unclear risk for four
Review protocol was registered with the International Database domains: selection bias, attrition bias, reporting bias and detection
for Prospective Register of Systematic Reviews PROSPERO bias. Due to the nature of PA interventions and use of self-report
(No. CRD42018105356) and conducted in line with recommendations measures, performance bias (i.e., blinding of participants) was not
from the Preferred Reporting Items for Systematic Reviews and considered a high risk for the current review or included in the
Meta-Analyses (PRISMA) guidelines (Page et al., 2021). assessment. Pre-post designs were not assessed as they have
unquestionable bias by not using a comparator (Higgins
et al., 2011).
2.2 | Literature search strategy
Nine databases were searched in June 2020 to identify any PA 2.5 | Quality assessment
interventions for children under 11 years old that had been evalu-
ated for psychological impact. Databases included Web of Science, Methodological quality of all studies were assessed using the National
ProQuest Psychology Journals, PsycINFO, Pub Med, ASSIA, CIN- Heart Lung and Blood Institute (NHBLI, 2014) Quality Assessment
HAL PLUS, SPORTDiscus, EMBASE and Wiley Online Library. The Tool for Before-After (Pre-Post) Studies with No Control Group as
search comprised of three components: intervention (PA-based), pre-post designs were eligible and at greatest risk of bias (Higgins &
population (children) and outcome (psychological health). Screening, Green, 2011). Authors assessed quality (good and fair) for 12 items
data extraction, risk of bias and quality assessment were indepen- focused on eligibility criteria, intervention description, outcome
dently performed by two authors (GH and LC), and any disagree- assessment and incomplete data (see Table S1).
ments were resolved through discussion or with a third author (PT,
DL or NL) if necessary. Thirty studies were randomly selected at
full-text review and a Kappa statistic of 0.802 (95% CI 0.592–1.00, 2.6 | Narrative synthesis
p = .000) indicated substantial inter-rater consistency (Viera &
Garrett, 2005). Meta-analysis was not appropriate due to considerable heterogeneity
(I2 > 75%) across studies (Higgins & Green, 2011). Instead, a narrative
synthesis was employed by organizing interventions into four
2.3 | Eligibility criteria domains: (a) QOL; (b) body image; (c) self-esteem and (d) psychological
ill-being. Effect size (d) was calculated to support findings where
Studies had to meet the following criteria: (a) quantitative peer- possible (Sullivan & Feinn, 2012) using Cohen's (1992) original
reviewed published in English or easily translated; (b) PA must be the lassification of small (d = 0.2), medium (d = 0.5) and large effect
main intervention component (≥50% of the delivery) and (c) the mean (d = 0.8).
age of participants was under 11 years. There were no comparator
restrictions, as withholding PA can be considered unethical and can
lead to schools and other sectors being unwilling to cooperate (Annesi 3 | RE SU LT S
et al., 2009; von Hippel et al., 2007). Hence, it was anticipated that
several relevant studies would not include a control group or would After removing studies that did not meet inclusion criteria, 23
implement another form of PA for comparison. Studies published in interventions were included in the review. Included studies measured
any country were eligible for inclusion. multiple outcomes of interest; 10 studies measured QOL, 8 measured
Exclusion criteria were (a) samples with physical health problems body image, 10 measured self-esteem and 6 measured psychological
(excluding obesity); (b) samples with developmental or psychological ill-being (e.g., depression and anxiety). See Figure 1 for PRISMA
disorders (e.g., autism spectrum disorder [ASD]); (c) interventions flow chart.
214 HALE ET AL.
FIGURE 1 PRISMA flow-chart
3.1 | Participant characteristics ethnicity, six samples were predominantly White (e.g., Duncan
et al., 2009), four were predominantly African American (Annesi
Sample size ranged from 20 (Seabra et al., 2014) to 1392 (Adab et al., 2008, 2017; Centeio et al., 2017; Williams et al., 2019),
et al., 2018) participants (M = 314; SD = 395.3). Mean age of children two were Asian (Chen et al., 2015; Yu et al., 2020) and two were
ranged from 6.31 (Adab et al., 2018) to 10.8 years (Faude of Latin American origin (Bohnert & Ward, 2013; Wong et al.,
et al., 2010). No studies including participants younger than 6 years 2016). Fifteen studies recruited children from schools (e.g., Centeio
old were identified. Eighteen interventions included mixed sex et al., 2017), five recruited from community settings (Annesi et al.,
samples (e.g., Yu et al., 2020), three used female-only (Bohnert & 2008, 2009, 2017; DeBate et al., 2009; Sacher et al., 2010)
Ward, 2013; DeBate et al., 2009; Gabriel et al., 2011) and two used and two recruited from primary care clinics (Chen et al., 2015;
male-only samples (Seabra et al., 2014, 2016). Of studies reporting Seabra et al., 2016). One study recruited participants via
HALE ET AL. 215
advertisements (Perez-Sousa et al., 2020). Eight interventions reinforce the key intervention messages (e.g., how to reduce
included overweight/obese samples (i.e., BMI > 85th percentile for screen time) (Chen et al., 2015). See Table S2 for all intervention
age and sex) (e.g., Williams et al., 2019) and one selected participants characteristics.
that demonstrated anxiety using the Screen for Child Anxiety Related
Emotional Disorders (SCARED; Birmaher et al., 1999) scale (Bazzano
et al., 2018). Eight studies excluded participants that acquired a physi- 3.2.1 | Theory
cal disease, disability or medication that would inhibit PA (e.g., Faude
et al., 2010). Three studies required insufficient PA for eligibility, for Four interventions were underpinned by Social Cognitive Theory
example, less than 60 min PA per week (Seabra et al., 2014, 2016; (SCT), which suggests that motivation to change PA behaviour is pro-
Williams et al., 2019). moted through knowledge, expectations, self-efficacy, facilitators and
goals (Bandura, 2004). Multicomponent intervention Girls in the Game
(GIG) covers different sport and health topics over 10 weeks and
3.2 | Intervention characteristics incorporates SCT principles by using role models to increase health
literacy and encourage children to become more active (Bohnert &
Eleven studies were randomized controlled trials (RCT) (e.g., Kriemler Ward, 2013). Three interventions were underpinned by Self-Efficacy
et al., 2010), seven were non-randomized (e.g., Wong et al., 2016) Theory (Bandura, 1977) and focused on productive self-talk and goal
and four were single-group pre-post designs (Annesi et al., 2008; setting (Annesi et al., 2009). Three interventions were conducted in
Centeio et al., 2017; Chen et al., 2015; DeBate et al., 2009). One line with Socio-Ecological approaches (McLeroy et al., 1988) and tar-
follow-up study explored the effect of an RCT 3 years after imple- geted individual and social factors of school PA (Kriemler et al., 2010).
mentation (Meyer et al., 2014). Of the studies that implemented a The Girls on the Run intervention was influenced by developmental-
control group, seven used usual Physical Education (PE) sessions in focused youth sport (DYS) programmes, which combine sport and life
schools (e.g., Resaland et al., 2019), three used unstructured PA as skills to enhance development (Petitpas et al., 2005). DYS pro-
part of usual after-school care (Annesi et al., 2008, 2017; Faude grammes traditionally focus on boys, yet Girls on the Run addressed
et al., 2010), three used control groups that took part in sedentary gender-specific topics that contribute to female development and PA
activities (e.g., arts and crafts) (Seabra et al., 2016; Williams participation, including inner beauty and the negative consequences
et al., 2019; Wong et al., 2016), three used control groups that did of gossiping (Gabriel et al., 2011). One intervention was underpinned
not take part in any intervention (Bohnert & Ward, 2013; Gabriel by the Developmental Theory of Embodiment (Piran & Teall, 2012),
et al., 2011; Perez-Sousa et al., 2020), two used wait-list control which aims to connect the mind and body to prevent disordered
groups (Sacher et al., 2010; Yu et al., 2020) and one used treatment eating. Yoga was chosen for the intervention as it combines mind and
as usual (i.e., counselling and other activities led by school social body practices and can be easily integrated into schools (Halliwell
worker) (Bazzano et al., 2018). Interventions were predominantly et al., 2018).
delivered in schools. Eight were delivered as an after-school pro-
gramme (e.g., Annesi et al., 2017), five were delivered during school
hours as additional sessions (Adab et al., 2018; Kriemler et al., 2010; 3.2.2 | Facilitators and training
Meyer et al., 2014; Resaland et al., 2019; Yu et al., 2020) and three
replaced regular PE (Centeio et al., 2017; Duncan et al., 2009; Ten interventions were delivered by teachers and the training offered
Halliwell et al., 2018). Six studies were delivered in community set- varied, for example, professional development days (Bazzano et al.,
tings (e.g., Chen et al., 2015), and one was delivered in a health set- 2018), workshops (Adab et al., 2018), online resources (Resaland
ting (Perez-Sousa et al., 2020). et al., 2019) and research team support (Seabra et al., 2016). Three
Most interventions delivered more than one type of interventions were delivered by after-school counsellors (Annesi
PA. Seventeen included cardiovascular/aerobic exercise (e.g., Annesi et al., 2008, 2009, 2017), and two were delivered by yoga instructors
et al., 2017), five included team sports (Adab et al., 2018; Bohnert & (Centeio et al., 2017; Halliwell et al., 2018). Other facilitators included
Ward, 2013; Faude et al., 2010; Seabra et al., 2014, 2016), three community staff (Chen et al., 2015), an exercise physiologist (Duncan
included yoga (Bazzano et al., 2018; Centeio et al., 2017; Halliwell et al., 2009) and a strength and conditioning technician (Perez-Sousa
et al., 2018), two included age-appropriate resistance training (Annesi et al., 2020). Four interventions were delivered by staff that receive
et al., 2008, 2009) and two included water-based activities (Sacher regular training to deliver existing initiatives such as Healthy Kids
et al., 2010; Wong et al., 2016). Fifteen of the interventions were Houston (Bohnert & Ward, 2013; DeBate et al., 2009; Gabriel
multicomponent and provided educational sessions on health et al., 2011; Wong et al., 2016). Three multicomponent interventions
(e.g., nutrition) (Adab et al., 2018), behaviour (e.g., team performance) were delivered by a team of experts, including dieticians and peadia-
(DeBate et al., 2009) or psychological topics (e.g., body image) tricians (Chen et al., 2015; Sacher et al., 2010; Seabra et al., 2016).
(Bohnert & Ward, 2013). Education sessions were delivered using One intervention was delivered in collaboration with local schools and
workshops, information booklets and/or discussion groups. Six English Premier League football club Aston Villa (AVFC) (Adab
interventions offered workshops and/or newsletters to parents to et al., 2018).
216 HALE ET AL.
3.2.3 | Length et al., 2018; Kriemler et al., 2010; Resaland et al., 2019). The Kinder-
Sportstudie (KISS) included two additional PE sessions per week, daily
Six interventions were delivered for less than 12 weeks (Bazzano activity breaks and PA homework. Despite the increase in activity, no
et al., 2018; Centeio et al., 2017; Chen et al., 2015; Duncan significant differences were found between groups post-intervention
et al., 2009; Sacher et al., 2010) with the shortest lasting 4 weeks (Kriemler et al., 2010) or at 3-year follow-up (Meyer et al., 2014).
(Halliwell et al., 2018). Four interventions were delivered for Similarly, the Active Smarter Kids (ASK) intervention (Resaland
12 weeks (Annesi et al., 2008, 2009; DeBate et al., 2009; Gabriel et al., 2019) included an additional 165 min of school PA, and no sig-
et al., 2011). The remaining 13 interventions ranged from 18 (Wong nificant intervention effects occurred. KISS and ASK were conducted
et al., 2016) to 52 weeks (Adab et al., 2018) in total. One intervention in European schools that require a minimum of 135 min of weekly PE
was delivered for 20 weeks (Seabra et al., 2014), one was delivered (Kriemler et al., 2010; Resaland et al., 2019), which may suggest that
for 24 weeks (Annesi et al., 2017), two were delivered for 26 weeks additional PA does not have a positive effect on children already
(Faude et al., 2010; Perez-Sousa et al., 2020), three were delivered for participating in considerable levels.
30 weeks (Bohnert & Ward, 2013; Resaland et al., 2019; Seabra
et al., 2016), two were delivered for 35 weeks (Williams et al., 2019;
Yu et al., 2020) and two were delivered for 39 weeks (Kriemler 3.4.2 | Body image
et al., 2010; Meyer et al., 2014). Due to variations in length and num-
ber of weekly sessions, the amount of time spent engaging in PA ran- Improvements were identified in both healthy and overweight sam-
ged from 40 (Bazzano et al., 2018) to 360 minutes (Seabra ples, with most interventions observing significant increases in posi-
et al., 2014) per week across interventions. tive body image (e.g., esteem) (Bohnert & Ward, 2013; DeBate
et al., 2009; Duncan et al., 2009; Gabriel et al., 2011) and significant
reductions in negative body image (e.g., dissatisfaction) (Seabra
3.3 | Risk of bias et al., 2014, 2016) (see Table 2). One 6-week circuit training interven-
tion (Duncan et al., 2009) found a significant increase in Body Esteem
The highest risk for the 19 studies assessed was selection bias. Six Scale for Children (BES-C; Mendelson & White, 1993) scores com-
studies were judged high risk for not using an adequate sequence pared to PE as usual. However, improvements were not maintained at
generation to assign participants to the intervention or control group 6-week follow-up. Girls on the Run involved preparing for a 5 km run-
(Annesi et al., 2008; Duncan et al., 2009; Gabriel et al., 2011; Perez- ning event, and significant increases in Schematic Figural Scale (SFS;
Sousa et al., 2020; Seabra et al., 2014, 2016). Five studies were Collins, 1991) scores were identified following a pre-post (DeBate
judged high risk for allocation concealment (Annesi et al., 2008; et al., 2009) and non-randomized study that compared impact to
Bohnert & Ward, 2013; Duncan et al., 2009; Gabriel et al., 2011; females that had not taken part (Gabriel et al., 2011). Greater
Seabra et al., 2016). Other domains were judged as ‘low’ risk improvements were also found in females newly exposed to the inter-
or ‘unclear’ due to insufficient information being provided (see vention compared to those that had been exposed previously (Gabriel
Table S3). et al., 2011).
One study found larger improvements in participants that were
assigned to the control group that took part in PE as usual in
3.4 | Effect of interventions comparison to those assigned to the 4-week yoga intervention
(Halliwell et al., 2018). The West Midlands ActiVe lifestyle and healthy
3.4.1 | Quality of life Eating in School children (WAVES) (Adab et al., 2018) intervention
also found no improvements compared to the control group that took
Overweight/obese children (Chen et al., 2015; Faude et al., 2010; part in PE as usual. The multicomponent PA and health education
Perez-Sousa et al., 2020; Seabra et al., 2016) and those experiencing intervention was implemented across 53 schools, and teachers were
anxiety (Bazzano et al., 2018) demonstrated the greatest QOL given the opportunity to select two types of PA sessions to deliver
improvements (see Table 1). One study that compared a soccer (e.g., aerobics to music, games and activities) (Adab et al., 2018).
intervention to a standard exercise programme found a significant
group x time effect for the KINDL-R School (Ravens-Sieberer &
Bullinger, 1998) subscale in favour of soccer (Faude et al., 2010). 3.4.3 | Self-esteem
Increase in QOL of overweight children following team sports was
also evident during Seabra et al.'s (2016) evaluation. Pediatric Quality Most studies identified improvements using measures of both self-
of Life Inventory (PedsQL; Varni et al., 1999) scores significantly esteem (Gabriel et al., 2011; Seabra et al., 2016) and self-perception
improved for both soccer and traditional PA, yet the sedentary control (Annesi et al., 2008; Sacher et al., 2010; Wong et al., 2016). Girls on
group did not demonstrate any changes. the Run (DeBate et al., 2009; Gabriel et al., 2011) led to significant
Most studies that did not identify a change in QOL used commu- increases in Rosenberg Self-Esteem (RSE; Rosenberg, 1965) scores,
nity samples and compared interventions to PE as usual (Adab and comparable findings were also identified during two male-only
TABLE 1 Effect of PA interventions on quality of life (QOL)
Reference Participants(N, mean age, %

(citation, design) male, population) Intervention Comparator Measure ES 95% CI Other main findings
HALE ET AL.
Adab et al. (2018); I: N = 660, West Midlands PE as usual PedsQL - - Mixed linear regression model revealed that
Cluster RCT Age 6.31, ActiVe lifestyle PedsQL did not significantly differ
49.2% male & healthy between groups at any time-point
C: N = 732,age 6.31, Eating in School (baseline, 3, 18 & 27-month follow-up).
52.7% male, children However, all scores increased in the
Community. (WAVES) expected direction for both groups.
Average 53% attendance of PA sessions.
Bazzano et al. I: N = 20, Yoga Ed Treatment as usual PedsQL: 0.35 0.2162 to Significant improvement in emotional
(2018); Age 8–9, (counselling & other Overall, 0.16 0.909 PedsQL subscale in intervention group. No
RCT 50.0% male activities led by school Physical, 0.44 0.4045 to other significant differences were found,
C: N = 32, social worker) Psychosocial, 0.77 0.7145 although scores were higher for
Age 8–9, Emotional, 0.18 0.1251 to intervention.
53.1% male,clinical. Social, 0.27 1.005
School 0.10 0.1966–
BMSLSS-PTPB 1.353
0.3838 to
0.7356
0.2894 to
0.8329
0.4984 to
0.6192
Chen et al. N = 70, iStart Smart N/A PedsQL: 0.31 0.0214 to Significant improvement in all scores at
(2015); Age 9.5, Physical, 0.23 0.6452 6-month follow-up. Average 90%
Single-group 80.0% male, Psychosocial 0.1025 to attendance.
pre-post Overweight/obese. 0.5622
Faude et al. I: N = 11, Soccer Standard exercise KINDL-R: 0.75 0.1106 to RM-ANOVA found significant group x effect
(2010); Age 10.8, programme Total, 0.37 1.6193 for school QOL in favour of intervention.
RCT 54.5% male Physical, 0.29 0.4734 to No other significant differences.
C: N = 11, Emotional, 0.91 1.2123 Intervention average 65% attendance.
Age 10.8, Self-esteem, 0.02 0.5543 to Control average 72% attendance.
72.7% male, Family, 0.89 1.1257
Overweight/obese. Friends, 0.83 0.0361–
School 1.7928
0.858 to
0.8135
0.0129–
1.765
0.0447 to
1.6965
Kriemler et al. I: N = 131, age 6.9, Kinder- PE as usual CHQ: 0.03 0.2034 to Linear mixed model (LMM) found no
(2010); 51.2% male Sportstudie Physical, 0.04 0.1526 significant differences in CHQ scores
Cluster-RCT C: N = 91,age 6.9, (KISS) Psychological 0.1382 to between groups at post-intervention.
45.1% male, 0.2178
217
Community.
(Continues)
TABLE 1 (Continued)
218

Meyer et al. I: N = 108, age 10.6, KISS PE as usual CHQ: 0.18 0.1335 to No significant difference between groups at
(2014); 52.8% male Physical, 0.17 0.4939 3-year follow-up. 58% compliance of
3-year follow-up C: N = 65,age 10.6, Psychological 0.1449 to participants who took part in original
44.6%, 0.4824 intervention.
Community.
Perez-Sousa et al. I: N = 121, Sport and Fitness No intervention PedsQL: 0.5 0.1–0.8 Standardized Cohen differences showed
(2020); Age 9.4 Exercise Physical, 0.1 0.2 to 0.3 trivial ES for emotional functioning, small
NRS Gender split NR Programme Emotional, 0.3 0.0 to 0.6 for social and school functioning and
C: N = 47, Social, 0.2 0.0 to 0.6 moderate for physical, psychosocial and
Age 8.9, School, 0.5 0.2–0.9 Total. Mediator analyses found that
Overweight/obese. Psychosocial, 0.6 0.3–0.9 health-related physical fitness components
Total (i.e. cardiorespiratory fitness, body
strength, movement, agility) were
mediators of intervention effect.
Resaland et al. I: N = 596, Active Smarter PE as usual Kidscreen-27: 0.02 0.1009 to LMM found no significant intervention
(2019); 10.2, Kids (ASK) Physical, 0.02 0.1328 effect on any subscale.
Cluster-RCT 52.7% male Psychological, 0.03 0.0924 to
C: N = 533, Autonomy/ 0.01 0.1413
10.2, parents, 0.10 0.0908 to
51.4% male, community. Social support/ 0.1429
peers, 0.1039 to
School 0.1298
0.0103 to
0.2235
Seabra et al. 1: N = 29, 1: Soccer Sedentary control PedsQL:Overall 0.47 0.0189 to Single pairwise comparison of overall effect
(2016); Age 10.5, 2: Traditional PA (nutrition education) 0.9111 (d) of two interventions versus control.
3-group NRS 100% male RM-ANOVA found both interventions
2: N = 29, significantly improved, no significant
Age 10.7 change in control. Average >85%
C: N = 30,age 10.0, attendance for both Soccer & Traditional
Overweight/obese. PA.
Williams I: N = 90, SMART Sedentary control PedsQL:Overall 0.05 .3456 to LMM found that both groups improved in all
et al. (2019); Age 9.6, (homework, 0.2474 outcomes post-intervention. No group x
RCT 33.3% male art & crafts) time interaction was detected. Average
C: N = 85,age 9.7, 59% attendance.
44.7% male,
Overweight/obese.
Abbreviations: BMSLSS-PTPB, Brief Multidimensional Students' Life Satisfaction Scale-Peabody Treatment Progress Battery (Huebner et al., 2004); C, control; CHQ, Child Health Questionnaire (Landgraf
et al., 1998); I, intervention; N/A, not applicable; NR, not reported; PedsQL, Pediatric Quality of Life Inventory (Varni et al., 1999); RCT, randomised controlled trial; SCARED, Screen for Child Anxiety Related
Emotional Disorders (Birmaher et al., 1999).
HALE ET AL.
TABLE 2 Effect of PA interventions on body image

HALE ET AL.
Adab et al. (2018); I: N = 660, WAVES PE as usual CBIS - - CBIS did not significantly differ between
Cluster RCT Age 6.31 (5–6), groups at any time-point (baseline, 3, 18 &
49.2% maleC: N = 732,age 6.31 27-month follow-up). However, all scores
(5–6), increased in the expected direction for
52.7% male, both groups.
Community.
Bohnert and I: N = 52, Girls in the No intervention SFRS:Ideal 1.26 0.7341– RM-ANOVA (time x group) found significant
Ward (2013); Age 9.02, Game (GIG) image, 0.30 1.7808 effect for ideal image. Intervention group
RCT 0% male Perceived image 0.7858 to chose significantly less emaciated image &
C: N = 24, 0.1862 were significantly less dissatisfied with
Age 9.38, current image compared to control.
Community. Average 73.6% attendance.
DeBate et al. N = 1034, Girls on the Run N/A SFS: 0.32 0.402 to Dependent t-test identified significant
(2009); Age 10.5, Satisfaction 0.2285 improvement in body satisfaction post-
Single-group 0% male, intervention.
pre-post Community.
Duncan et al. I: N = 33,age 10–11,50.0% male Circuit training PE as usual BES-C 0.23 0.2477 to RM-ANOVA (time x group) revealed that
(2009); C: N = 35,age 10–11, 0.7061 intervention significantly improved post-
RCT 50.0% male, intervention compared to control.
Community. Improvements were not sustained at
6-week follow-up. Participants attended
at least 83% of sessions.
Gabriel et al. 1: N = 131, Girls on the Run Never exposed SFS - - RM- ANOVA (time x group) found
(2011); Age 9.4,0% male 1: Newly significant improvement in 1 (newly
3-group NRS 2: N = 156,age 9.9 exposed exposed) post-intervention. Significant
C: N = 590, 2: Previously improvement in control at 5-month
Age 9.8, exposed follow-up. No other differences were
Community. observed.
Halliwell et al. I: N = 190, Yoga PE as usual BES-C 0.30 0.5162 to Mixed-design ANOVA (time x group x
(2018); Age 9.34, OBCS 0.23 0.0888 gender) found significant improvements in
Cluster RCT 52.0% male BAS-2 0.08 0.4432 to body image outcomes in both groups at
C: N = 154, 0.0168 post-intervention & 6-week follow-up.
Age 9.34, 0.1299 to
38.0% male, 0.2953
Community.
Seabra et al. I: N = 12, Soccer PE as usual SFS:Body 1.89 2.9633 to RM-ANOVA (group x time) found that
(2014); Age 10.3,100% male dissatisfaction 0.8236 intervention significantly improved
NRS C: N = 8, compared to control. Average 85%
Age 10.6, attendance.
Overweight/obese.
(Continues)
219
220 HALE ET AL.
soccer interventions (Seabra et al., 2014, 2016) (see Table 3). Several
Abbreviations: BAS-2, Body Appreciation Scale-2 for Children (Halliwell et al., 2017); BES-C, Body Esteem Scale for Children (Mendelson & White, 1993); CBIS, Child's Body Image Scale (Truby & Paxton, 2002);
multicomponent interventions that incorporated PA with education
significantly improved, no significant

also found improvement (Annesi et al., 2008; Sacher et al., 2010;
Wong et al., 2016). The Youth Fit for Life (YF4L) intervention pro-
ANOVA found both interventions

vided games, resistance training and health education (Annesi
et al., 2008), and small-to-medium effects for Self-Description
Questionnaire-I (SDQ-I; Marsh, 1990) subscales were found com-
Other main findings
change in control.
pared to the control group that took part in unstructured PA. Mind,
OBCS, Objectified Body Consciousness Scale-Youth (Lindberg et al., 2006); SFS, Schematic Figural Rating Scale (Collins, 1991); SRFS, Stunkard Figure Rating Scale (Stunkard, 1983).
Exercise, Nutrition, Do It (MEND) (Sacher et al., 2010) and Healthy
Kids Houston (Wong et al., 2016) incorporated PA and nutrition edu-
cation and found significant improvements and small-to-medium
effects in Self-Perception Profile for Children (SPPC; Harter, 2012)
scores between baseline and follow-up in comparison to a wait-list
control and after-school care as usual.
0.4841 to
0.3975
After-school GIG intervention (Bohnert & Ward, 2013) involved

95% CI
less weekly PA in comparison to interventions that did identify a

change (i.e., 90 vs. 180–360 min), and it was found that RSE scores
did not significantly increase post-intervention. Moreover, improve-
0.04
ments in self-perception were not observed whilst comparing the

ES
SMART intervention to a sedentary control group (Williams

dissatisfaction
et al., 2019). Both SMART and the control group received homework
support and a prize system, whereby intervention participants earned
Measure
points for achieving a heart rate >150 beats per minute or for good
Body
SFS:
behaviour during the control group. Lack of intervention effect might

suggest that similar variables across conditions (e.g., structured
routine and adult support) can enhance self-esteem irrespective of
Sedentary control (nutrition
the presence of PA.

education)
3.4.4 | Psychological ill-being

Comparator
Three studies measured low mood (Annesi et al., 2008, 2017; Halliwell
et al., 2018), two measured depression (Williams et al., 2019; Yu
et al., 2020), one measured stress (Centeio et al., 2017) and one
2: Traditional
Intervention
measured anxiety and poor well-being (Yu et al., 2020) (see Table 4).
1: Soccer
Significant improvements in Profile of Mood States Short Form

PA
(POMS-SF; Shacham, 1983) scores were found for children that took
part in YF4L compared to after-school care as usual (Annesi
et al., 2008, 2017). However, the impact of yoga interventions is
unclear. One study (Halliwell et al., 2018) found that Positive and
Participants(N, mean age, %
Negative Affect Scale (PANAS; Laurent et al., 1999) scores improved

more during PE as usual in comparison to the yoga intervention.
C: N = 30,age 10.0,
Overweight/obese.
male, population)
Improvements in stress following yoga were also not found during the
Daniaelle Karmanos' Work It Out (DKWIO) intervention, where
100% male
1: N = 29,
2: N = 29,
Age 10.5,
participants took part in one 60-minute yoga session per week

Age 10.7
(Centeio et al., 2017).

(Continued)
Studies that measured depression and anxiety presented a mixed

picture. The SMART intervention (Williams et al., 2019) did not reveal
(citation, design)
a significant difference, with Children's Depression Inventory (CDI;

et al. (2016);
3-group NRS
Kovacs, 1985) scores reducing regardless of group allocation. More

Reference
TABLE 2
positive findings were identified during a PA and nutrition education

Seabra
intervention (Yu et al., 2020), which found reductions in Depression

Self-Rating Scale for Children (DSRSC; Birleson et al., 1987) scores for
TABLE 3 Effect of PA interventions on self-esteem
HALE ET AL.

Annesi et al. I: N = 146,age 10.6, Youth Fit for Life (YF4L) After-school care as SDQ-I: .37 0.1289– Dependent t tests revealed significant
(2008); 41.0% maleC: N = 123age usual (unstructured General self, .57 0.6128 within-group changes for intervention
NRS 10.6, voluntary PA) Physical appearance, .34 0.3221– group on all SDQ-I subscales.
41.0% male, Physical self-concept 0.8113 Independent t-tests found significantly
Community. 0.1023– greater changes for intervention
0.5856 compared to control.
Annesi et al. N = 43, YF4L N/A SDQ-I: .10 0.337 to Dependent t-test revealed no significant
(2009); Age 9.0, General self 0.5121 changes, although SDQ-1 improved in
Single-group 48.8% male, expected direction.
pre-post Community.
Bohnert and I: N = 52, GIG No intervention RSE 0.00 0.4352 to RM-ANOVA (time x group) found no
Ward (2013); Age 9.02, 0.5323 significant effects for self-esteem.
RCT 0% male
C: N = 24,age 9.38,
Community.
DeBate et al. N = 1034, Girls on the Run N/A RSE 0.26 0.1765– Dependent t-test identified significant
(2009); Age 10.5, 0.3496 improvement in self-esteem post-
Single-group 0% male, intervention.
pre-post Community.
Gabriel et al. 1: N = 131, Girls on the Run Never exposed RSE - - 2 (previously exposed) reported
(2011); Age 9.4,0% male 1: Newly exposed significantly higher RSE scores at post
3-group NRS 2: N = 156,age 9.9 2: Previously exposed & 5-month follow-up compared to
C: N = 590, control. No other significant
Age 9.8, differences were observed.
Community.
Sacher et al. I: N = 60,age 10.3, Mind, Exercise, Wait-list control SPPC:Global self-esteem 0.43 0.0602– Linear regression identified a significant
(2010); 37.0% male Nutrition, Do it 0.7969 difference in SPPC between groups
RCT C: N = 56, (MEND) Programme post-intervention. A significant
Age 10.2, increase in SPPC from baseline to
55.0% male, 12-month follow-up was found in the
Overweight/obese. intervention group. Average 86%
attendance.
Seabra et al. I: N = 12, Soccer PE as usual RSE 1.41 0.414– RM-ANOVA (group x time) found that
(2014); Age 10.3,100% male 2.4051 intervention significantly improved
NRS C: N = 8, compared to control.
Age 10.6,
Overweight/obese.
(Continues)
221
222
TABLE 3 (Continued)

Seabra et al. 1: N = 29, 1: Soccer Sedentary control RSE 1.27 0.7914– ANOVA found both interventions
(2016); Age 10.5, 2: Traditional PA (nutrition education) 1.7495 significantly improved, no significant
3-group NRS 100% male change in control.
2: N = 29,
Age 10.7
C: N = 30,age 10.0,
Overweight/obese.
Williams et al. I: N = 90, SMART Sedentary control SPPC:Global self-worth 0.17 0.1256 to Both groups improved post-intervention.
(2019); Age 9.6, (homework, art & 0.4683 LMM found no group x time
RCT 33.3% male crafts) interaction for SPPC.
C: N = 85,age 9.7,
44.7% male,
Overweight/obese.
Wong et al. I: N = 288, Healthy Kids Houston After-school care as SPPC:Scholastic 0.93 0.7423– Intervention improved significantly in all
(2016); Age 10.3, usual (homework, arts competence, 1.33 1.1292 subscales at 6-week mid-point
NRS 49.4% male & crafts) Athletic competence, 2.33 1.1307– compared to control. Scores remained
C: N = 187, Social acceptance, 2.95 1.536 elevated, but there were no further
Age 10.2, Physical appearance, 3.37 2.0969– significant improvements at later time-
55.8% male, Behavioural 3.67 2.5698 points (12-weeks & post-intervention).
Community. conduct,global self- 2.6846–
worth 3.2099
3.0916–
3.657
3.3696–
3.9637
Abbreviations: RSE, Rosenberg Self-Esteem Scale (Rosenberg, 1965); SDQ-I, Self-Description Questionnaire-I (Marsh, 1990); SPPC, Self-Perception Profile for Children (Harter, 2012).
HALE ET AL.
TABLE 4 Effect of PA interventions on psychological ill-being

HALE ET AL.
Annesi et al. I: N = 146,age 10.6, YF4L After-school care as POMS- 0.74 0.489– Significant within-group changes for
(2008); 41.0% maleC: N = 123age 10.6, usual (unstructured SF: 0.56 0.9846 intervention group for both POMS-SF
NRS 41.0% male, voluntary PA) Tension, 0.316– subscales. Independent t-tests also
Community. Vigour 0.8051 revealed significantly greater changes for
intervention compared to control.
Annesi et al. I: N = 86,age 10.0,55.0% male YF4L After-school care as POMS- 0.11 0.4479 to RM-ANOVA found significant time x group
(2017); C: N = 55,age 10.0, usual (unstructured SF: 0.2294 interaction, improvements from baseline
Cluster-RCT 55.0% male, voluntary PA) Total to mid & post-intervention were
Community. significantly greater for intervention
group.
Centeio et al. N = 93,age 9.78, Daniaelle Karmanos' Work It N/A SiC 0.10 0.3357 to RM-ANOVA (time x gender) revealed
(2017); Gender split NR, Out (DKWIO) 0.2081 significant reduction in stress scores in
Single-group pre- Community. male participants but not females.
post Average 81% attendance.
Halliwell et al. I: N = 190, Yoga PE as usual PANAS: 0.03 0.1871 to Mixed-design ANOVA (time x group x
(2018); Age 9.34, Positive, 0.11 0.238 gender) found significant improvements
Cluster RCT 52.0% male Negative 0.0988 to in body image outcomes in both groups
C: N = 154, 0.3265 at post-intervention & 6-week follow-up.
Age 9.34, Negative ESs indicates control improved
38.0% male, more in negative mood.
Community.
Williams et al. I: N = 90, SMART Sedentary control CDI 0.10 0.3928 to LMM found that both groups improved
(2019); Age 9.6, (homework, art & 0.2005 post-intervention. However, CDI in males
RCT 33.3% male crafts) improved more in control group
C: N = 85,age 9.7, compared to intervention at post-test &
44.7% male, 12-month follow-up.
Overweight/obese.
Yu et al. (2020); I: N = 99, Nutrition education & PA Wait-list control SASC 0.0 0.3036 to Mann–Whitney U test found no significant
NRS Age 9.9, WHO-5 0.0 0.3036 differences between groups post-
83% male DSRSC 0.18 0.3036 to intervention in any outcome. However,
C: N = 72, 0.3036 WHO-5 (p = 0.001) and DSRSC
Age 9.7, 0.1275 to (p = 0.064) decreased from baseline to
75% male, 0.4808 post-intervention in intervention group.
Overweight/obese. Generalized estimating equation (GEE)
model demonstrated marginally
significant improvement in poor well-
being (WHO-5, p = 0.051) and decreased
SASC (p = 0.029) using group*time
interaction.
Abbreviations: CDI, Children's Depression Inventory (Kovacs, 1985); DSRSC, Depression Self-Rating Scale for Children (Birleson et al., 1987); PANAS, Positive and Negative Affect Scale (Laurent et al., 1999);
POMS-SF, Profile of Mood States-Short Form (Shacham, 1983); SASC, Social Anxiety Scale for Children (Sanna et al., 2009); SiC, Stress in Children scale (Osika et al., 2007); WHO-5 = World Health
223
Organisation-5 Well-Being Index (Allgaier et al., 2012).
224 HALE ET AL.
overweight/obese children. Evidence for a reduction in Social Anxiety 4.2 | Body image
Scale for Children (SASC-R; Sanna et al., 2009) and World Health
Organisation-5 Well-Being Index (WHO-5; Allgaier et al., 2012) scores This is the first review of PA interventions on children's psychologi-
were also found, although meaningful effect sizes were not apparent. cal well-being that has incorporated outcomes indicative of body
image. Improvements were seen across all populations, and the
limited studies that did not observe a difference suggest that
4 | DISCUSSION intensity and type of PA can moderate intervention effect (Adab
et al., 2018; Halliwell et al., 2018). WAVES participants were also
This systematic review reports findings from 23 PA-only and multi- younger than children involved in interventions that found improve-
component PA interventions and synthesizes their effectiveness in ments (6.31 vs. ≥9.02 years), and the evidence that suggests body
enhancing the psychological well-being and reducing the psychologi- image concerns intensify with age (Paxton & Damiano, 2017) might
cal ill-being of children aged six to 11 years old. The work comple- explain the lack of impact. Although existing reviews have explored
ments existing research (Andermo et al., 2020; Liu et al., 2015; the association between PA and body image (Sabiston et al., 2019),
Rodriguez-Ayllon et al., 2019) and offers further insight into the effec- a disproportional amount of support has been found for adults in
tiveness of PA interventions in improving outcomes associated with comparison to younger age groups. Thus, this review highlights the
psychological well-being that have previously been overlooked. potential use of PA interventions in enhancing body image in
Reviewed studies present the widespread use of PA-only and multi- children and preventing the development of negative perceptions
component PA interventions in both school and community settings during later life.
and suggests that various intervention types can enhance areas of
psychological well-being, including QOL, body image and self-esteem.
Despite the positive impact on well-being, reduction in psychological 4.3 | Self-esteem
ill-being in children from the general population is less clear. More
research is needed to explore the effect of PA interventions in reduc- Findings add to the existing literature and provide confidence in the
ing symptoms associated with psychological ill-being in children. use of PA interventions in enhancing self-esteem, with most studies
observing improvements across community, same-sex and over-
weight/obese samples, as well as PA-only and multicomponent types
4.1 | Quality of life (Annesi et al., 2008; Gabriel et al., 2011; Sacher et al., 2010). How-
ever, definitions of self-esteem and self-perception are often used
To our knowledge, this is the first systematic review to look at the interchangeably (King, 1997), and this ambiguity is apparent in the
effect of various PA interventions in school and community settings current review. Hence, there is a need for more homogeneity across
on the QOL of children from the general population. Marker et al. measures to provide a clearer overview in the future.
(2018) identified small, positive effects of PA interventions on QOL,
yet most studies (78.9%) focussed on children with chronic diseases
and interventions using healthy samples were limited. Whilst Wu 4.4 | Psychological ill-being
et al. (2017) reviewed the association between PA and QOL in the
general population, only two child interventions were identified, Only a small number of identified studies evaluated outcomes asso-
and improvements were not shown. Andermo et al. (2020) did not ciated with psychological ill-being, and the evidence was unclear.
identify significant changes across 11 school-based PA interven- Although links between PA and mood have been documented in
tions, yet the effects of the five child studies (M age < 11 years) cross-sectional research (Biddle, 2016) limited reviews have
were not reported separately to those for adolescents. included mood outcomes—other than anxiety and depression—to
The current review adds weight to the existing literature and date. Findings obtained from the current review were mixed, and
advocates the importance of population, as of the 10 interventions stronger evidence for alleviating low mood was apparent following
identified, QOL changes were larger in children who were overweight aerobic intervention in comparison to yoga (Annesi et al., 2017;
(e.g., Seabra et al., 2016) or experiencing anxiety (Bazzano et al., 2018) Halliwell et al., 2018). Engaging in PA can also reduce feelings of
compared to healthy, community samples (e.g., Adab et al., 2018). stress, anxiety and depression (Biddle et al., 2019; Martikainen
Arguably, this difference in impact might be due to lower PA levels et al., 2013), and previous reviews have supported the role of PA
and QOL of these populations at baseline. With reference to interven- interventions in reducing psychological ill-being in children from
tions that did not identify change, there is a need for more studies to marginal populations (Cerrillo-Urbina et al., 2015). The current work
utilize wait-list controls to determine the level of PA required to advocates the need for more research using community samples, as
enhance QOL whilst reducing ethical concerns that can be associated heterogeneity in outcome measures made it difficult to draw clear
with withholding PA from control groups (Annesi et al., 2009). comparisons.
HALE ET AL. 225
4.5 | Limitations and future directions interventions for children to promote psychological well-being, and
the current review highlights the effectiveness of using both PA-only
An extensive search across nine databases was conducted, and non- and multicomponent PA interventions as a convenient pathway to
English studies were translated where possible; however, only pub- enhancing body image and self-esteem in children aged 6 to 11.
lished interventions were included. There is a risk that papers have Improvements in QOL were also found in overweight children and
not been published due to non-significant outcomes and not including those with clinical anxiety, yet more research is needed to determine
grey literature may have led to an overestimation of intervention impact on the general population. Despite evidence for changes in
effects. Due to the aim of gaining a broad overview of PA intervention psychological well-being, the effect of PA interventions on reducing
impact, there was notable heterogeneity of intervention components outcomes associated with psychological ill-being remains unclear,
and multiple measures of QOL, body image, self-esteem and psycho- and more research using children from the general population is
logical ill-being were used. This heterogeneity limited the conclusions warranted.
drawn within and across studies and made a meta-analysis not feasi-
ble. As additional research using homogenous outcome measures are CONFLIC T OF INT ER E ST
published, an updated review needs to be conducted to provide a The authors have no conflict of interest to disclose.
clearer overview of the impact of PA interventions on children's
psychological well-being and ill-being. Moreover, it is worthwhile to IMPLICAT IONS AND CONTRI BUTIONS
consider the level of PA required to facilitate change, as larger This paper provides an overview of the psychological impact of physi-
improvements were seen during some studies where frequency was cal activity interventions for children (aged 6 to 11) from the general
greater (Bohnert & Ward, 2013; Halliwell et al., 2018; Seabra population, including quality of life, body image, self-esteem and psy-
et al., 2016). It is recommended to increase the use of wait-list chological ill-being (e.g., anxiety and depression). Findings support the
controls to determine the level of PA required to significantly impact use of interventions in enhancing children's psychological well-being,
psychological health, eliminate ethical concerns with withholding PA yet there is a need for more research to better understand how exist-
and reduce the higher risk of selection bias associated with non- ing interventions can be used to reduce or prevent symptoms associ-
randomized and pre-post interventions. ated with psychological ill-being.
Limited studies measuring psychological ill-being might be due to
several exclusion criteria, for example, samples presenting with a diag-
OR CID
nosis of a psychological disorder. Research has found that symptoms
Gabrielle E. Hale https://orcid.org/0000-0003-4838-7999
associated with anxiety and depression have an age of onset as early
as 4 years old (Kessler et al., 2007; Kieling et al., 2011) and can
RE FE RE NCE S
develop in all children, regardless of the presence of comorbid disor-
Adab, P., Barrett, T., Bhopal, R., Cade, J., Canaway, A., Cheng, K., Clarke, J.,
ders, chronic disease or weight-related problems (Bitsko et al., 2018; Daley, A., Deeks, J., Duda, J., Ekelund, U., Frew, E., Gill, P., Griffin, T.,
Lindberg et al., 2020; Nazari et al., 2017). Hence, utilizing early inter- Hemming, K., Hurley, K., Lancashire, E. R., Martin, J., McGee, E., …
ventions during childhood can help to reduce, prevent or delay the Passmore, S. (2018). The west midlands ActiVe lifestyle and healthy
eating in school children (WAVES) study: A cluster randomised con-
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trolled trial testing the clinical effectiveness and cost-effectiveness of
uals that are at risk. Therefore, a major consideration for future a multifaceted obesity prevention intervention programme targeted at
research would be to better understand how existing PA interventions children aged 6–7 years. Health Technology Assessment, 22(8), 1–608.
can be used to reduce or prevent psychological ill-being in children https://doi.org/10.3310/hta22080
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from the general population. Identified interventions were also evalu-
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offered to children in pre-school settings (Hacke et al., 2019), evalua- Allgaier, A. K., Pietsch, K., Frühe, B., Prast, E., Sigl-Glöckner, J., & Schulte-
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Received: 2 February 2021 Revised: 8 August 2022 Accepted: 14 August 2022

Physical activity interventions for the mental health of

Gabrielle E. Hale | Luke Colquhoun | Deborah Lancastle | Nicky Lewis |

School of Psychology and Therapeutic Studies,

1 | I N T RO DU CT I O N mechanisms, including changes to the structural composition of the

associated with anxiety and depression increasing from 12.0% in

2 | METHODS 2.4 | Risk of bias analysis

FIGURE 1 PRISMA flow-chart

Reference Participants(N, mean age, %

Reference Participants(N, mean age, %

Reference Participants(N, mean age, %

significantly improved, no significant

ANOVA found both interventions

After-school GIG intervention (Bohnert & Ward, 2013) involved

less weekly PA in comparison to interventions that did identify a

ments in self-perception were not observed whilst comparing the

SMART intervention to a sedentary control group (Williams

behaviour during the control group. Lack of intervention effect might

the presence of PA.

3.4.4 | Psychological ill-being

Significant improvements in Profile of Mood States Short Form

Negative Affect Scale (PANAS; Laurent et al., 1999) scores improved

participants took part in one 60-minute yoga session per week

(Centeio et al., 2017).

Studies that measured depression and anxiety presented a mixed

a significant difference, with Children's Depression Inventory (CDI;

Kovacs, 1985) scores reducing regardless of group allocation. More

positive findings were identified during a PA and nutrition education

intervention (Yu et al., 2020), which found reductions in Depression

Reference Participants(N, mean age, %

Reference Participants(N, mean age, %

Reference Participants(N, mean age, %

Organisation-5 Well-Being Index (Allgaier et al., 2012).

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