Effects of exercise intervention parameters on anxiety symptoms in adolescents: a systematic review and meta-analysis of randomized controlled trials

Abstract

Objective This meta-analysis aimed to systematically evaluate the effects of exercise interventions (including aerobic exercise, Yoga, and Tai Chi) on anxiety symptoms in adolescents and to explore the moderating roles of intervention parameters. Methods Randomized controlled trials (RCTs) examining the effects of exercise interventions on adolescent anxiety symptoms were searched in PubMed, Web of Science, CNKI, Wanfang Database, and VIP Information up to October 15, 2025. The Cochrane Risk of Bias tool was used for quality assessment. Meta-analysis, subgroup analyses, sensitivity analysis, and publication bias assessment were performed using Review Manager 5.4. Results Twelve RCTs with a total of 1,874 participants were included. The overall effect size was small but statistically significant [SMD = −0.30, 95% CI (−0.60, −0.01), P = 0.04], with substantial heterogeneity (I2 = 87%, P < 0.00001). Subgroup analyses suggested that intervention effects may vary by exercise type, session duration, weekly frequency, and total intervention duration. Exploratory findings indicated that interventions with 30-min sessions, five times per week, and longer total duration (~45 weeks) were associated with larger reductions in anxiety symptoms. However, these subgroup findings should be interpreted cautiously due to the limited number of studies per subgroup. Conclusions Exercise-based interventions may reduce anxiety symptoms in adolescents, although the effect magnitude is small and the evidence is limited by substantial heterogeneity. Exploratory subgroup analyses suggest that exercise parameters may influence intervention outcomes, but no definitive optimal prescription can be established based on the current evidence. Future research with standardized protocols and larger samples is warranted. PROSPERO Registration: CRD420251265936