Editorial: Physical Exercise as a Treatment for Anxiety and Depression in Children and Adolescents?

Few would disagree that appropriate physical exercise is good for the body and the mind. For professionals working specifically in the field of child and adolescent mental health, one important question is: "Could physical exercise be considered a treatment strategy to tackle anxiety and depression in children and adolescents?" Singh and colleagues¹ aimed to rigorously answer this question based on the best available evidence by conducting an umbrella review (UR), that is, a quantitative synthesis of systematic reviews and meta-analyses of randomized controlled trials (RCTs) testing the efficacy of physical activity on anxiety and depression in children and adolescents. After screening more than 6,000 potentially relevant references, the authors statistically pooled data from more than 20 systematic reviews with meta-analyses, including a total of 375 RCTs, encompassing 38,117 participants. Singh et al.¹ should be congratulated for this huge effort, which provides the most comprehensive evidence synthesis to date on the topic. This UR complements findings from other URs, such as a previous one² analyzing the effect of physical activity on "psychological symptoms" in general in youths, or another one³ focusing mainly on depressive symptoms. The main findings from Singh et al.¹ highlighted a small effect size for anxiety (standardized mean difference [SMD] = 0.39) and depression (SMD = 0.45), with confidence intervals indicating that the true effect may actually range from very small to medium (for anxiety: 95% CI = 0.17-0.61; for depression: 95% CI = 0.31-0.59). Additional analyses focusing on the type of physical exercise showed that mixed exercise modes and moderate-intensity exercise had the greatest impact on reducing depression, while resistance training was the most effective for alleviating anxiety symptoms. Therefore, it would seem that the largest evidence synthesis to date supports physical exercise as an effective intervention for children and adolescents with anxiety and/or depression … but the devil is in the details.