Andermo Susanne, Hallgren Mats, Nguyen Thi-Thuy-Dung, Jonsson Sofie, Petersen Solveig, Friberg Marita, Romqvist Anja, Stubbs Brendon, Elinder Liselotte Schäfer
Community Nutrition and Physical Activity, Department of Global Public Health, Karolinska Institutet, Solnavaegen 1E, 104 65, Stockholm, Sweden.
Epidemiology of Psychiatric Conditions, Substance Use and Social Environment, Department of Global Public Health, Karolinska Institutet, Solnavaegen 1E, 10465, Stockholm, Sweden.
Sports Med Open. 2020 Jun 16;6(1):25. doi: 10.1186/s40798-020-00254-x.
Low levels of physical activity, sedentary behaviour and mental health problems are issues that have received considerable attention in the last decade. The aim of this systematic review and meta-analysis was to investigate effects of interventions targeting school-related physical activity or sedentary behaviour on mental health in children and adolescents and to identify the features of effective interventions.
Scientific articles published between January 2009 and October 2019 fulfilling the following criteria were included: general populations of children and adolescents between age 4 and 19, all types of school-related efforts to promote physical activity or reduce sedentary behaviour. Study selection, data extraction and quality assessment were done by at least two authors independently of each other. Data were analysed with a random effects meta-analysis and by narrative moderator analyses.
The literature search resulted in 10265 unique articles. Thirty-one articles, describing 30 interventions, were finally included. Eleven relevant outcomes were identified: health-related quality of life, well-being, self-esteem and self-worth, resilience, positive effect, positive mental health, anxiety, depression, emotional problems, negative effect and internalising mental health problems. There was a significant beneficial effect of school-related physical activity interventions on resilience (Hedges' g = 0.748, 95% CI = 0.326; 1.170, p = 0.001), positive mental health (Hedges' g = 0.405, 95% CI = 0.208; 0.603, p = < 0.001), well-being (Hedges' g = 0.877, 95% CI = 0.356; 1.398, p = < 0.001) and anxiety (Hedges' g = 0.347, 95% CI = 0.072; 0.623, p = 0.013). Heterogeneity was moderate to high (I = 59-98%) between studies for all outcomes except positive effect, where heterogeneity was low (I = 2%). The narrative moderator analyses of outcomes based on 10 or more studies showed that age of the children moderated the effect of the intervention on internalising mental health problems. Interventions in younger children showed a significantly negative or no effect on internalising mental health problems while those in older children showed a significant positive or no effect. Moreover, studies with a high implementation reach showed a significant negative or no effect while those with a low level of implementation showed no or a positive effect. No signs of effect moderation were found for self-esteem, well-being or positive mental health. Risk of publication bias was evident for several outcomes, but adjustment did not change the results.
School-related physical activity interventions may reduce anxiety, increase resilience, improve well-being and increase positive mental health in children and adolescents. Considering the positive effects of physical activity on health in general, these findings may reinforce school-based initiatives to increase physical activity. However, the studies show considerable heterogeneity. The results should therefore be interpreted with caution. Future studies should report on implementation factors and more clearly describe the activities of the control group and whether the activity is added to or replacing ordinary physical education lessons in order to aid interpretation of results.
PROSPERO, CRD42018086757.
身体活动水平低、久坐行为和心理健康问题是过去十年中受到广泛关注的问题。本系统评价和荟萃分析的目的是研究针对学校相关身体活动或久坐行为的干预措施对儿童和青少年心理健康的影响，并确定有效干预措施的特征。
纳入2009年1月至2019年10月发表的符合以下标准的科学文章：4至19岁儿童和青少年的一般人群，以及所有与学校相关的促进身体活动或减少久坐行为的努力。研究选择、数据提取和质量评估由至少两名作者独立进行。采用随机效应荟萃分析和叙述性调节分析对数据进行分析。
文献检索共得到10265篇独特的文章。最终纳入31篇文章，描述了30项干预措施。确定了11个相关结果：与健康相关的生活质量、幸福感、自尊和自我价值感、恢复力、积极影响、积极心理健康、焦虑、抑郁、情绪问题、负面影响和内化心理健康问题。学校相关身体活动干预对恢复力（Hedges' g = 0.748，95% CI = 0.326；1.170，p = 0.001）、积极心理健康（Hedges' g = 0.405，95% CI = 0.208；0.603，p = <0.001）、幸福感（Hedges' g = 0.877，95% CI = 0.356；1.398，p = <0.001）和焦虑（Hedges' g = 0.347，95% CI = 0.072；0.623，p = 0.013）有显著的有益影响。除积极影响（异质性低，I = 2%）外，所有结果在研究之间的异质性为中度至高度（I = 59 - 98%）。基于10项或更多研究的结果叙述性调节分析表明，儿童年龄调节了干预对内化心理健康问题的影响。对年幼儿童的干预对内化心理健康问题显示出显著的负面影响或无影响，而对年长儿童的干预则显示出显著的积极影响或无影响。此外，实施范围高的研究显示出显著的负面影响或无影响，而实施水平低的研究则显示无影响或积极影响。在自尊、幸福感或积极心理健康方面未发现效应调节的迹象。几个结果存在明显的发表偏倚风险，但调整并未改变结果。
与学校相关的身体活动干预可能会降低儿童和青少年的焦虑、增强恢复力、改善幸福感并提高积极心理健康水平。考虑到身体活动总体上对健康的积极影响，这些发现可能会加强以学校为基础的增加身体活动的倡议。然而，研究显示出相当大的异质性。因此，对结果的解释应谨慎。未来的研究应报告实施因素，并更清楚地描述对照组的活动，以及该活动是添加到普通体育课还是取代普通体育课，以便于结果的解释。
PROSPERO，CRD42018086757。
