Physical activity can boost child mental health, but it’s complex

Physical activity offers a range of benefits for children, including mental health (Mountjoy et al., 2011). Researchers are constantly seeking a better understanding of this relationship, including why and how it exists. Studies seem to show that the relationship between physical activity and mental health is more complex than was first thought.

The current study

The study involved an updated analysis of review papers, exploring the association between physical activity and mental health in children and adolescents (Biddle & Asare, 2011; Biddle, Ciaccioni, Thomas, & Vergeer, 2019). It also investigated whether physical activity can be considered ‘causal’ in producing any effects on mental health.

The updated review considered four mental health outcomes:

• Depression
• Anxiety
• Self-esteem
• Cognitive functioning.

This short article will focus on self-esteem and cognitive functioning.

Searches for new systematic reviews from November 2010 to the end of 2017 were conducted. Only research addressing regular involvement in physical activity, rather than mental health effects of single exercise sessions, was considered.

This review explored multiple research questions to judge causality (see Hill, 1965), such as:

• How strong is the association between physical activity and the mental health outcome of interest?
• Does physical activity precede the change in the mental health outcome (i.e. ‘temporal sequencing’)?
• Does greater physical activity produce stronger mental health effects (i.e. a ‘dose-response association’)?
• Is there experimental evidence?

Findings

Self-esteem

The review papers concerning self-esteem tended to include healthy samples, with ages ranging from pre-school (i.e.<5 years) to late adolescence (i.e. 16-18 years). Physical activity was defined quite broadly and included:

• leisure-time physical activity
• recreational (but not elite) sports
• yoga
• recreational dance; and
• muscle strengthening exercise.

Overall, the reviews suggested positive associations between physical activity and self-esteem. While evidence from experimental designs suggested that physical activity might even have a causal role in enhancing self-esteem in children and young people, when considered alongside other criteria for causality a causal relationship was not supported. The authors concluded that the association was not causal for the following reasons:

• The strength of the association was mixed. For example, intervention effects ranged from small to large and observational studies showed only small effect sizes in favour of physical activity and higher self-esteem.
• There was no support for physical activity preceding, rather than following, self-esteem (‘temporal sequencing’).
• There was no support for greater physical activity producing higher levels of self-esteem (a ‘dose-response’ relationship).

One reason for the mixed findings above might be the predominant use of global self-esteem as the main outcome of interest. Self-esteem can be viewed as having different elements – one of which is that of the physical self. One might expect stronger associations between physical activity and perceptions of physical self-worth – rather than the global assessment of self-esteem. A meta-analysis has demonstrated that physical activity is associated with physical self-concept/self-worth (Babic et al., 2014). This is something that requires continued investigation. Logically, one might expect stronger links between physical activity and perceptions of physical self-worth – rather than between physical activity and global self-esteem.
Moreover, different types and contexts of physical activity may have different ‘effects’ on self-esteem/physical self-worth for different people.

Cognitive functioning

The study also investigated whether physical activity was associated with enhanced cognitive functioning in children and youth. This field is also complex and can include outcomes such as performance on cognitive tasks undertaken in a lab setting (e.g. complex reaction time) and markers of academic achievement (Donnelly et al., 2016).

Cautious support for a causal relationship was found. A moderate association between physical activity and cognitive functioning was shown and there was partial support for physical activity preceding a change in cognitive functioning.

The cognitive benefits of physical activity have strong implications for the promotion of physical activity in schools. Advocates suggest that this should not be restricted to curriculum physical activity (i.e. PE classes), but broadened out to include less sedentary and more active classrooms (Szabo-Reed et al., 2019; Vazou, 2019).

Conclusions

Research concerning physical activity and mental health in young people is moving rapidly. With poor mental health a significant societal concern, alongside the need to address sedentary lifestyles across all segments of the population, it is a good time to enhance awareness of physical activity as an important element of positive, resilient, and healthy lifestyles. This study shows that:

• an association between physical activity and positive mental health is evident, but the field is complex
• there appears to be a causal link between physical activity and cognitive functioning in youth
• an association between physical activity and self-esteem does exist, but this may be stronger and more consistent when assessing physical self-worth as an important element of self-esteem
• there are many forms of physical activity and these hold different levels of appeal to different children. This, alongside the quality of the physical activity experience, will also determine the effects on mental health
• positive mental health outcomes from physical activity might also act as reinforcement for continued participation.

Mental health professionals and policy makers should be aware of such findings and seek ways to encourage physical activity for mental as well as physical health gains. Physical activity could prove to be a highly cost-effective mental health strategy.

Finally, physical activity is not just for children. Parents, carers, and families should seek opportunities to be active together, thus boosting social connections and relatedness. Adult role-modelling (e.g. actively commuting to work) is also beneficial.

References

Babic, M. J., Morgan, P. J., Plotnikoff, R. C., Lonsdale, C., White, R. L., & Lubans, D. R. (2014). Physical activity and physical self-concept in youth: systematic review and meta-analysis. Sports Medicine, 44(11), 1589-1601. doi:10.1007/s40279-014-0229-z

Biddle, S. J. H., & Asare, M. (2011). Physical activity and mental health in children and adolescents: A review of reviews. British Journal of Sports Medicine, 45, 886-895. doi:10.1136/bjsports-2011-090185

Biddle, S. J. H., Ciaccioni, S., Thomas, G., & Vergeer, I. (2019). Physical activity and mental health in children and adolescents: An updated review of reviews and an analysis of causality. Psychology of Sport and Exercise, 42, 146–155. doi:10.1016/j.psychsport.2018.08.011

Donnelly, J. E., Hillman, C. H., Castelli, D., Etnier, J. L., Lee, S., Tomporowski, P., … Szabo-Reed, A. N. (2016). Physical activity, fitness, cognitive function, and academic achievement in children: a systematic review. Medicine and Science in Sports and Exercise, 48(6), 1197-1222. doi:10.1249/MSS.0000000000000901

Hill, A. B. (1965). The environment and disease: Association or causation? Proceedings of the Royal Society of Medicine, 58(5), 295-300.

Mountjoy, M., Andersen, L. B., Armstrong, N., Biddle, S., Boreham, C., Bedenbeck, H.-P. B., … van Mechelen, W. (2011). International Olympic Committee consensus statement on the health and fitness of young people through physical activity and sport. British Journal of Sports Medicine, 45(11), 839-848. doi:10.1136/bjsports-2011-090228

Szabo-Reed, A. N., Willis, E. A., Lee, J., Hillman, C. H., Washburn, R. A., & Donnelly, J. E. (2019). The influence of classroom physical activity participation and time on task on academic achievement. Translational Journal of the American College of Sports Medicine, 4(12), 84-95. doi:10.1249/tjx.0000000000000087

Vazou, S. (2019). From “Sit Still and Listen” to “Get Up and Move,” the leap may be one of educational paradigms but no longer one of faith. Translational Journal of the American College of Sports Medicine, 4(17), 127-128. doi:10.1249/tjx.0000000000000096