The effect of physical activity on anxiety in children and young people: a systematic review and meta-analysis

• 22 randomised controlled trials have been undertaken that explore the effect of physical activity on anxiety symptoms compared to non-physical activity controls in children and young people. • Most of the 22 randomised controlled trials are of low methodological quality and high risk of bias. • Physical activity may be effective in improving anxiety symptoms in non-clinical samples of young people. • More studies of clinical populations of young people with longer follow ups and improved methodological quality are needed. There is emerging evidence that physical activity can have beneficial effects on anxiety. A comprehensive synthesis of the evidence of the anxiolytic effects of physical activity from randomised controlled trials (RCTs) in children and young people (CYP) is warranted. A search of 13 databases was conducted to identify RCTs testing the effects of physical activity on anxiety symptoms in children and young people (up to 25 years). Screening, data extraction and risk of bias assessment (using the Cochrane Collaboration tool for assessing risk of bias) were independently undertaken by two study authors. The primary analysis used a random effects model to compare the effect of physical activity interventions to no intervention or minimal intervention control conditions on state anxiety, assessed using validated, self-report measures. Of the 3590 articles retrieved, 22 RCTs were included, with nine included in the primary meta-analysis. The overall standardised mean difference was 0.54 (95% CI -0.796, -0.28), representing a moderate improvement in state anxiety, compared to no intervention or minimal intervention control conditions. Physical activity was also found to produce significantly superior effects on state anxiety when compared to a time and attention-controlled group. The studies are of low quality overall, and there are a limited number of studies included in the meta-analyses therefore limiting the precision of results. Physical activity may be a useful approach to addressing anxiety symptoms in children and young people, however, further trials of clinical populations are required to determine the effectiveness of physical activity as a treatment of anxiety disorders.