Structured physical activity, yoga, and music-based interventions for depressive symptoms in adolescents: a systematic review and meta-analysis of randomized controlled trials
Abstract
BackgroundDepressive symptoms are common in adolescence. Structured physical activity, yoga, and music-based interventions have been proposed as low-intensity options, but randomized evidence is limited and heterogeneous.ObjectiveTo estimate the effect of structured physical activity, yoga, and music-based interventions on post-intervention depressive symptom severity in adolescents and to rate the certainty of this evidence.MethodsThe review was registered in PROSPERO (CRD420261429956) and reported according to PRISMA 2020. CENTRAL, CINAHL, Embase, PsycINFO, PubMed, Web of Science, and Scopus were searched. Randomized controlled trials in adolescents aged approximately 12–19 years with depressive disorders, elevated depressive symptoms, or clinically relevant risk were eligible. Hedges g was pooled with a restricted maximum likelihood random-effects model; Hartung–Knapp–Sidik–Jonkman (HKSJ) small-sample intervals were also calculated. Risk of bias was assessed with RoB 2 and certainty of evidence with GRADE.ResultsOf 11,575 records, 13 studies (16 reports) were included; seven randomized comparisons (N = 345; four exercise, two music-based, one yoga) contributed to the primary meta-analysis. The pooled estimate, an average across heterogeneous interventions, populations, and comparators, favored the interventions (SMD −0.59, 95% CI − 0.97 to −0.20; HKSJ 95% CI − 1.09 to −0.08), with substantial heterogeneity (I2 = 63%) and a 95% prediction interval that included no effect (−1.75 to 0.58). No trial was at low risk of bias, mainly because participants could not be blinded and most outcomes were self-reported; four were at high risk. Estimates were smaller and imprecise for the three trials not at high risk of bias (SMD −0.38; HKSJ 95% CI − 1.16 to 0.40) and for the four exercise trials (SMD −0.26, 95% CI − 0.58 to 0.07); larger estimates came from three music-based and yoga trials at high risk of bias. The certainty of evidence was very low.ConclusionCurrent randomized evidence is insufficient to determine whether structured physical activity, yoga, or music-based interventions reduce depressive symptoms in adolescents. The pooled estimate should be regarded as hypothesis-generating; adequately powered, prospectively registered trials with blinded outcome assessment and appropriate control conditions are needed before these interventions can be recommended.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261429956, identifier CRD420261429956.
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BibTeX
@article{zeng2026structured,
title = {{Structured physical activity, yoga, and music-based interventions for depressive symptoms in adolescents: a systematic review and meta-analysis of randomized controlled trials}},
author = {Huantao Zeng and Feng Tian and Yan Jiang},
journal = {Frontiers in Public Health},
year = {2026},
month = nov,
doi = {10.3389/fpubh.2026.1922220},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1922220},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Structured physical activity, yoga, and music-based interventions for depressive symptoms in adolescents: a systematic review and meta-analysis of randomized controlled trials
AU - Huantao Zeng
AU - Feng Tian
AU - Yan Jiang
PY - 2026
DA - 2026/11/04
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1922220
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1922220
AB - BackgroundDepressive symptoms are common in adolescence. Structured physical activity, yoga, and music-based interventions have been proposed as low-intensity options, but randomized evidence is limited and heterogeneous.ObjectiveTo estimate the effect of structured physical activity, yoga, and music-based interventions on post-intervention depressive symptom severity in adolescents and to rate the certainty of this evidence.MethodsThe review was registered in PROSPERO (CRD420261429956) and reported according to PRISMA 2020. CENTRAL, CINAHL, Embase, PsycINFO, PubMed, Web of Science, and Scopus were searched. Randomized controlled trials in adolescents aged approximately 12–19 years with depressive disorders, elevated depressive symptoms, or clinically relevant risk were eligible. Hedges g was pooled with a restricted maximum likelihood random-effects model; Hartung–Knapp–Sidik–Jonkman (HKSJ) small-sample intervals were also calculated. Risk of bias was assessed with RoB 2 and certainty of evidence with GRADE.ResultsOf 11,575 records, 13 studies (16 reports) were included; seven randomized comparisons (N = 345; four exercise, two music-based, one yoga) contributed to the primary meta-analysis. The pooled estimate, an average across heterogeneous interventions, populations, and comparators, favored the interventions (SMD −0.59, 95% CI − 0.97 to −0.20; HKSJ 95% CI − 1.09 to −0.08), with substantial heterogeneity (I2 = 63%) and a 95% prediction interval that included no effect (−1.75 to 0.58). No trial was at low risk of bias, mainly because participants could not be blinded and most outcomes were self-reported; four were at high risk. Estimates were smaller and imprecise for the three trials not at high risk of bias (SMD −0.38; HKSJ 95% CI − 1.16 to 0.40) and for the four exercise trials (SMD −0.26, 95% CI − 0.58 to 0.07); larger estimates came from three music-based and yoga trials at high risk of bias. The certainty of evidence was very low.ConclusionCurrent randomized evidence is insufficient to determine whether structured physical activity, yoga, or music-based interventions reduce depressive symptoms in adolescents. The pooled estimate should be regarded as hypothesis-generating; adequately powered, prospectively registered trials with blinded outcome assessment and appropriate control conditions are needed before these interventions can be recommended.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261429956, identifier CRD420261429956.
SN - 2296-2565
ER -