The effects of physical activity interventions on stress-related psychological and physiological outcomes in children and adolescents: a systematic review and meta-analysis.

Abstract

Objective This systematic review and meta-analysis aimed to evaluate the effects of physical activity interventions on stress-related psychological and physiological outcomes in children and adolescents, including direct or subjective stress-related measures, related psychological health outcomes, and physiological indicators potentially associated with stress regulation. Methods PubMed, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were systematically searched from database inception to September 8, 2026. The Cochrane Risk of Bias 2 (RoB 2) tool was used to assess the risk of bias in randomized controlled trials, while the Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I) tool was used for non-randomized intervention studies; the certainty of evidence for the primary outcomes was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Meta-analyses were conducted using a random-effects model, with pooled effects expressed as standardized mean differences (Hedges' g) or mean differences (MDs), as appropriate for each outcome. Results A total of 35 controlled studies were included, comprising 32 randomized controlled trials and 3 non-randomized intervention studies. Primary pooled estimates favored lower perceived/general stress (Hedges' g = -0.28, 95% CI: -0.48 to -0.08, p = 0.006, I 2 = 49.9%, τ2 = 0.030) and depressive symptoms (Hedges' g = -0.53, 95% CI: -1.04 to -0.02, p = 0.041, I 2 = 94.8%, τ2 = 0.809), with statistically significant pooled differences also observed for resting systolic blood pressure, resting diastolic blood pressure, and HRV-LF/HF. No statistically significant effects were observed for the remaining psychological or physiological outcomes. Certainty was low for systolic blood pressure and very low for the other statistically significant outcomes. Depressive symptom, diastolic blood pressure, and LF/HF findings were sensitive to the inferential method. Conclusion Low-certainty evidence suggested a possible small reduction in resting systolic blood pressure; possible reductions in other outcomes were supported by very-low-certainty evidence. Overall, certainty was very low for most outcomes, and the findings should be regarded as tentative. Several findings were sensitive to analytical choices or individual studies. The non-specificity of related symptoms and resting physiological measures limits inferences about stress regulation. Further high-quality RCTs are warranted. Systematic review registration The study was prospectively registered in the PROSPERO database on September 7, 2026 (registration number: CRD420261499943).