Abstract
OBJECTIVES: To evaluate the effects of different exercise interventions on depression, anxiety, and self-esteem in children and adolescents, and to determine the optimal exercise treatment approach. METHODS: A comprehensive search was conducted in the PubMed, The Cochrane Library, Embase, Scopus, and Web of Science databases for randomized controlled trials (RCTs) on the impact of exercise interventions on depression, anxiety, and self-esteem in children and adolescents. The search period spanned from the inception of each database to April 2025. Statistical analyses were performed using Stata 18 and R software. RESULTS: A total of 27 RCTs, encompassing 3059 children and adolescents, were included. Pairwise meta-analysis showed that exercise significantly improved depression (MD = -0.29, 95% CI [-0.44, -0.14]) and self-esteem (MD = 0.23, 95% CI [0.07, 0.38]), with a positive but non-significant effect on anxiety (MD = -0.12, 95% CI [-0.32, 0.09]). Network meta-analysis indicated that aerobic training significantly outperformed the control group in reducing depression, while resistance training significantly outperformed the control group in enhancing self-esteem. However, none of the exercise interventions showed significant effects on alleviating anxiety. Cumulative ranking curve (SUCRA) rankings showed that resistance training was most effective in improving depression, combined aerobic and resistance exercise was most effective in alleviating anxiety, and resistance training was most effective in enhancing self-esteem. The quality of the evidence in this network meta-analysis was rated as "low" to "moderate". CONCLUSION: Resistance training produced greater improvements in depressive symptoms and self-esteem than other exercise modalities; moreover, combined aerobic-and-resistance training may be beneficial for alleviating anxiety symptoms in children and adolescents. TRIAL REGISTRATION: The review protocol was preregistered in the PROSPERO database (Registration No. CRD42025645711).