Exercise type, dose and mental health outcomes in youth: Which types and doses are sufficient?

Although experimental evidence supports links between exercise and certain mental health indicators, epidemiological research has focused primarily on the dose-response effect of a single type of exercise, overlooking potential differences across exercise types in their associations with overall and specific mental health outcomes.

To examine the associations between different types of exercise and multiple mental health outcomes, including depression, anxiety, post-traumatic stress disorder, suicidal ideation, suicide attempts and nonsuicidal self-injury, and to explore their dose-response relationships in terms of exercise frequency and duration.

Data were drawn from a large-scale, cross-sectional study of 79 011 university students in Jilin Province, China, in 2021 via an online survey. Mental health outcomes were evaluated using validated scales and diagnoses. Propensity score matching was first applied to balance covariates between exercise types. Logistic regression analysis was then used to examine the associations between exercise types and mental health outcomes. Additionally, generalised additive models were employed to explore the dose-response relationships between exercise frequency/duration and mental health outcomes, adjusting for sociodemographic factors.

Among the 79 011 students reporting participation in physical exercise, team ball sports showed the strongest protective associations, followed by single anaerobic activities, two-player racket sports, single moderate-intensity aerobic sports and single low-intensity aerobic sports. U-shaped associations were observed between exercise frequency, duration and mental health outcomes. Exercising three to four times per week for 90-120 min was associated with a lower probability of reporting mental health problems, whereas excessive exercise was associated with poorer outcomes.

Participation in different types of exercise is differentially associated with mental health outcomes, with team ball sports showing the most favourable associations. Optimal levels of exercise dosage vary between exercise types, suggesting that individuals may benefit from selecting exercise patterns that best support their mental health.