The association between accelerometer-measured physical activity and symptoms of depression and anxiety in children and adolescents: a systematic review and meta-analysis.

backgroundPhysical activity (PA) is associated with symptoms of depression and anxiety in children and adolescents. Using accelerometers to measure PA can provide more accurate and detailed data to investigate this relationship. However, no study has systematically reviewed and pooled the effects of accelerometer-measured PA on mental health. Therefore, this meta-analysis examined the association between accelerometer-measured PA and symptoms of depression and anxiety in children and adolescents and determined whether the strength of this relationship varied by accelerometery methodology.

methodsA systematic review conducted up to May 2025 using the following databases: Medline, PsycINFO, Embase, Web of Science, and SPORTDiscus, following the PRISMA guidelines, and using terms relating to children, PA, depression/anxiety and observational design. Meta-analyses were performed separately for 12 studies with continuous outcomes (Partial r) and 7 studies with binary outcomes (Odds Ratio). Subgroup analysis tested the moderating effects of accelerometer data collection and processing methods (e.g., epoch length, wear location, valid days, valid hours).

resultsThirty studies met the inclusion criteria (n = 15 cross-sectional, n = 15 prospective) including 40,334 youth aged 5-18 years. There was a small negative association of moderate-to-vigorous physical activity (MVPA) with depression (partial r = -0.17, 95%CI [-0.28, -0.06], p < 0.001) and anxiety (partial r = -0.21, 95%CI [-0.34, -0.09], p < 0.001). Total physical activity (TPA) (OR = 0.98, 95%CI [0.96,1.00], p = 0.05) and light intensity PA (OR = 0.95, 95%CI [0.92,0.98], p < 0.001) were associated with reduced risk of depression. The association between MVPA and depression appeared to vary by epoch length (≤ 15 s partial r = -0.32, 95% [-0.49, -0.15]; > 15 s partial r = -0.08, 95% [-0.19, 0.03]; difference p = 0.02). Sensitivity and publication bias analyses supported the overall robustness and reliability of the associations between PA and depression or anxiety.

conclusionsThis review highlights that while PA was associated with reduced depression and anxiety in youth, substantial methodological heterogeneity, particularly in accelerometer protocols, may influence effect sizes. Improved and standardised accelerometry methodologies and developed innovative PA metrics are needed to better assess these relationships.

trial registrationThe protocol for the present review was registered on PROSPERO (CRD42022320410) on 23rd March 2022. KEY POINTS: • This systematic review included 30 studies involving 40,334 children and adolescents aged 5-18 years and revealed substantial variability in accelerometer data collection and processing methods across studies, including 11 different device models, 4 wear locations, 6 epoch lengths, 4 intensity thresholds units, 5 valid day definitions, and 7 non-wear criteria, as well as 17 questionnaires used to assess depression and anxiety. • Meta-analysis results showed that moderate-to-vigorous, total, and light physical activity were associated with reduced depression and anxiety in youth, while epoch length and accelerometer wear location may affect the magnitude of this relationship. The findings remained consistent across sensitivity analyses, and no evidence of publication bias was detected. • Of the 30 studies assessed for risk of bias, 2 were rated as good quality, 22 as fair quality, and 6 as poor quality. The main quality problems were the lack of sample size justification, or insufficient reporting of uniform selection criteria.