Adolescent mental health interventions: a narrative review of the positive effects of physical activity and implementation strategies

The review addresses the question of how physical activity can serve as an effective intervention to enhance adolescent mental health, mitigate psychological stress, and prevent mental health problems including anxiety, depression, and suicidal behaviors. It situates the problem within a global rise in adolescent mental health issues driven by academic pressure, social media, family and socioeconomic factors, and worsened by the COVID-19 pandemic. The purpose is to synthesize evidence on psychological impacts of different types of physical activity in adolescents, clarify benefits and risks, and propose implementation strategies in school and community settings. The study underscores the importance of timely, multi-sectoral interventions that leverage PA to improve psychological well-being during a critical developmental period.

The narrative synthesis highlights converging evidence that regular physical activity benefits adolescent cognition (via increased cerebral blood flow and neurotrophic factors), emotion regulation (endorphins, BDNF-related mechanisms), coping skills (stress reduction, positive coping habits), and social functioning (team sports fostering cooperation, social identity, and self-esteem). Evidence spans aerobic exercise, resistance training, team sports, and mind-body practices. The review also notes potential harms when PA is maladaptive (exercise addiction linked to perfectionism and achievement goals; contributions to eating/body image disorders; mood/fatigue with abrupt withdrawal). Studies cited include large observational cohorts, systematic reviews, and meta-analyses, generally supporting a positive association between PA (especially moderate-to-vigorous and team-based activities) and better mental health outcomes.

Databases: PubMed, PsycINFO, Web of Science, Scopus. Keywords: adolescent mental health, physical activity, psychological intervention, types of exercise, anxiety, depression, self-esteem, social skills, emotional regulation. Inclusion: peer-reviewed studies; adolescent populations (10–19) or applicable; examined PA effects on mental health; clear methods and results. Exclusion: non-PA or non-mental-health focus; conference abstracts/reviews/unpublished; insufficient data/methods; non-English. Search results: 1,246 records identified; 296 duplicates removed; 950 screened; 700 excluded by title/abstract; 250 full texts assessed; 180 excluded (did not meet criteria or insufficient data); 61 studies included. Data extraction included study design, sample characteristics, intervention type (aerobic, strength, team sports, mind-body), main findings, and methodological quality. Qualitative and quantitative syntheses compared outcomes, addressed biases/limitations, and summarized psychological effects across PA modalities.

- Sixty-one studies indicate PA is broadly beneficial for adolescent mental health. - Aerobic exercise: improves mood, cognitive functions (attention, planning, problem-solving) via increased cerebral blood flow and neurotrophic signaling; reduces anxiety/depression symptoms (e.g., evidence from mechanistic and clinical studies). - Strength training: meta-analyses show significant reductions in depressive symptoms and increased self-efficacy. - Team sports: associated with fewer mental health difficulties (e.g., data from >11,000 US youth), improved social skills, self-esteem, and sense of belonging; benefits may extend into adulthood. - Mind-body practices (yoga, tai chi, qigong): improve heart rate variability, reduce perceived stress, and alleviate anxiety/depression; may reduce cortisol. - Dose-response: Higher frequency and intensity of PA correlate with greater improvements in depressive symptoms and life satisfaction. - Risks: Exercise addiction (linked to perfectionism/achievement goals), potential exacerbation of body image/eating disorders, and depressive mood/fatigue after abrupt PA withdrawal. - Implementation strategies: Integrate PA into curricula; offer diverse options (team, individual, low-intensity); train coaches/teachers in both technique and mental health literacy; foster family/community involvement; monitor and evaluate programs using surveys, psychological assessments, and fitness measures.

Findings support the hypothesis that structured and varied physical activity can effectively improve adolescent psychological outcomes by enhancing neurocognitive function, emotion regulation, coping, and social connectedness. Team-based and moderate-to-vigorous activities show particularly strong associations with reduced internalizing symptoms and improved well-being, while mind-body practices offer stress-regulation benefits suitable for diverse abilities. Recognizing and mitigating risks (e.g., exercise dependence, harmful body image focus) is essential to ensure net benefit. Implementation within schools and communities, supported by trained personnel and family/community engagement, can increase access and adherence. The evidence base, though largely supportive, is limited by heterogeneity and nonrandomized designs, necessitating more rigorous trials to establish causality and optimal PA prescriptions (type, intensity, frequency, duration) for mental health outcomes.

This narrative review concludes that physical activity is a promising, multifaceted intervention for promoting adolescent mental health. Aerobic, resistance, team-based, and mind-body exercises each confer distinct psychological and social benefits, with stronger effects observed at higher frequencies and intensities within safe limits. The review recommends integrating PA into school curricula, offering diverse activity options, training coaches/teachers in mental health literacy, fostering family and community participation, and instituting continuous monitoring and evaluation systems. Future research should broaden sample diversity, conduct long-term follow-up, employ randomized controlled designs, explore innovative PA modalities (e.g., VR/interactive fitness), and elucidate neurobiological and psychosocial mechanisms underlying mental health benefits.

Methodological and evidence-base limitations include: (i) limited sample representativeness (geographical, cultural, socioeconomic diversity); (ii) self-selection bias among participants; (iii) difficulty controlling and precisely recording PA type, frequency, intensity, and duration; (iv) scarcity of randomized controlled trials to determine causality; (v) predominance of short-term outcomes with limited long-term follow-up; and (vi) incomplete mechanistic elucidation of how PA influences adolescent psychological states. These constraints may affect generalizability and the precision of recommended PA prescriptions.