Comparative effects of exercise type and dose on mental ill-health in children and adolescents: a systematic review and network meta-analysis

Mental ill-health among children and adolescents is increasing worldwide. Physical exercise has been suggested as a potentially beneficial approach for supporting mental health in this population. This study aimed to compare the relative effectiveness of different types of exercise and to examine the dose–response relationship between exercise dose and mental ill-health outcomes in children and adolescents. Randomized controlled trials were included in this study. Eight databases (Cochrane Library, CNKI, Embase, PubMed, Scopus, VIP, Wanfang, and Web of Science) were systematically searched from database inception to May 2026. Risk of bias was assessed using the Revised Cochrane Risk of Bias tool (RoB 2). A random-effects network meta-analysis and a Bayesian dose–response network meta-analysis were conducted. The certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. A total of 62 studies involving 10,779 participants were included. Of the 62 included studies, 20 were judged to be at low overall risk of bias, 39 raised some concerns, and 3 were considered to have a high risk of bias. Mind-body exercise was associated with a relatively larger reduction in mental ill-health in adolescents than the other exercise types (SMD = − 1.16; 95% CI: −1.70 to − 0.62), followed by aerobic exercise (SMD = − 0.85; 95% CI: −1.28 to − 0.41), combined exercise (SMD = − 0.85; 95% CI: −1.41 to − 0.29), traditional martial arts (SMD = − 0.71; 95% CI: −1.63 to 0.21), and resistance training (SMD = − 0.38; 95% CI: −1.35 to 0.6). A potential nonlinear relationship was observed between exercise dose and mental ill-health, with variations in effect estimates across dose levels. Dose-related patterns appeared to differ across exercise types, with approximate ranges observed for different intervention types. Mind-body exercise appears to be associated with greater reductions in mental ill-health compared with other exercise types in children and adolescents. However, substantial between-study heterogeneity and wide confidence/credible intervals indicate considerable uncertainty around these estimates. Therefore, these findings should be interpreted with caution. Further high-quality randomized controlled trials with improved reporting and reduced heterogeneity are needed to strengthen the evidence base. CRD420251039979.