School physical activity and mental health in school-aged Brazilian adolescents: a systematic review

Solidade, Vanessa Teixeira da; Nascimento, Victor Matheus Santos do; Oliveira, Davi Pereira Monte; Ribas, Michele Caroline de Souza; Sampaio, Ricardo Aurélio Carvalho; Silva, Roberto Jerônimo dos Santos

doi:10.1590/1980-0037.2021v23e82866

Review Article • Rev. bras. cineantropom. desempenho hum. 23 • 2021 • https://doi.org/10.1590/1980-0037.2021v23e82866 linkcopy

School physical activity and mental health in school-aged Brazilian adolescents: a systematic review

Atividade física e saúde mental em adolescentes brasileiros escolarizados: uma revisão sistemática

Authorship SCIMAGO INSTITUTIONS RANKINGS

The aim of this study was to identify evidence regarding associations between School Physical Activity (PA) and Mental Health (MH) in Brazilian school-aged adolescents. This is a systematic review study. Studies were selected in Portuguese and English and identified by a systematic search in six electronic databases: PubMed, Web of Science, SPORTDiscus / Ebsco, ScIELO, ERIC, and LILACS, which comprised publications until 2019. Inclusion criteria were: studies with cohort, descriptive, cross-sectional or qualitative design; performed with children and adolescents; studies that analyzed the relationship between PA and MH; studies that investigated adolescents who practiced PA in schools; studies carried out in Brazil; and studies that reached minimum of 60% of methodological quality criteria according to STROBE. Physical education, as curricular activity in basic education, has protective effect on MH in the school setting. In addition, more than 300 min/week of PA was positively associated with MH; while associations between PA and excessive TV time; social isolation; and body weight dissatisfaction were negatively associated. School PA is positively associated with MH as it promotes physical and psychological well-being, impacting on the reduction of insomnia rates, attenuating loneliness and improving physical appearance.

Key words:
Physical activity; Mental health; Adolescents; School; Brazil

Authors	Year of publication	Region where the study was carried out	Type of study	Sample size (n)	Population of interest	Study quality analysis score (STROBE)
Straatmann et al.¹⁸	2016	Southeastern	Cohort/ Longitudinal	526	Elementary school. Children and Adolescents (Age at start: 10 - 15 years) and a high school cohort (Age at start: 13.5 to 19 -years).	71.87%
Silva et al.¹⁹	2014	Southeastern	Qualitative	96	Elementary school	80%
Levandoski and Luiz Cardoso¹⁷	2013	Southern	Descriptive of exploratory character	337	Elementary school 6^th grade Adolescents aged 13-19 years	65.62%
Matias et al.⁸	2010	Southern	Descriptive of exploratory character	316	13 - 19 years.	62.06%
Werneck et al.⁷	2019	Northern, Northeastern, Midwestern, Southeastern and Southern	Cross-sectional	100.839	Elementary school 9^th grade	81.25%
Gonzaga et al.¹² *	2021	Southern	Cross-sectional	938	Adolescents and young people aged 15-19 years	72%
Cruzeiro et al.¹⁴	2008	Southern	Cross-sectional	1.145	11-15 years.	65.62%
Santos et al.¹⁶	2015	Northeastern	Cross-sectional	4.207	High school 14-19 years	65.62%
Triaca et al.¹⁵	2019	Northern, Northeastern, Midwestern, Southeastern and Southern	Cross-sectional	102.301	Elementary school 9^th grade 13-17 years.	71.87%
de Almeida Silva and Menezes¹³	2018	Northeastern	Cross-sectional	3.992	High school 14-19 years	65.62%

Authors	Diagnostic/Main prevalence variables	Prevalence	Instrument/Diagnostic criterion	Other variables	Main results
Straatmann et al.¹⁸	Physical activity	70.90%	10.4% IPAQ, psychological domain by KIDSCREEN 27	Screen time with daily time spent in front of the TV	Significant inverse association between “psychological well-being” and screen minutes per day at T2 (r(2) = 0.049/β = -3.81 (95% CI -7.0, -0.9)), association between psychological well-being and onset of screen time recommended in categorical analyses (crude RR: 1.3; 95% CI 1, 1, 1.7; Adjusted RR: 1.3; 95% CI 1.0, 1.6). For males, association between psychological well-being and insufficient onset of activity 2 years later (crude RR: 1.3; 95% CI 1.2, 1.4; Adjusted RR: 1.2; 95% CI 1.1, 1.4)
	Sedentary behavior	42.70%
	Psychological well-being
		10.40%
Silva et al.¹⁹	Body image	Not informed	Pre-established script containing topics that supported the debate	Physical exercise practice	The influence of the media on body image showed the difficulty of achieving the perfect body and is viewed with suspicion in the face of beauty transmission standards; the importance of a healthy body was noted as standards of beauty and good appearance were closely linked to good physical condition and result from having healthy body; the relationship between the standard of beauty and prejudice, as people who are not considered attractive, with minor physical imperfections, are discriminated against and can be rejected or even excluded from society
Levandoski and Luiz Cardoso¹⁷	Bullying,	28.30%	Study of violence among peers, sociometric examination, body image perception scale and social status scale at school		The incidence was 28.3% of students involved in bullying, with 14.1, 4.3 and 9.8% being victims (V), aggressors/victims (AV) and aggressors (A)
	Body image	65.40%
	Social status	Not informed
Matias et al.⁸	Physical activity, Body weight satisfaction	64.50%	Habitual physical activities (QAFH), behavioral change stages questionnaire for physical activity (EMCAF)	Self-assessment of lifestyle and self-efficacy	Physical activity is associated with body satisfaction, in this case, active adolescents seem to be more satisfied. The opposite is true and there is a tendency for sedentary adolescents to be dissatisfied with their bodies, especially girls. It was concluded that the practice of physical activity in adolescence is an important mediator in the formation of positive concepts about the body
Matias et al.⁸	Physical activity, Body weight satisfaction	45.60%		Self-assessment of lifestyle and self-efficacy
Werneck et al.⁷	Social isolation Physical activity	Not informed	Cross-sectional analyses of PeNSE 2015	Chronological age, race and type of city (capital or other)	Longer sitting time was associated with greater probability of social isolation, and it was low (<1 h / d) [boys: OR: 1.54 (95% CI: 1.33-1.77); girls: OR: 1.31 (95% CI: 1.17 to 1.48] and long TV time (≥8 h / d) [boys: OR: 1.75 (95% CI: 1.47 to 2.09)]; girls: OR: 1.58 (95% CI: 1.37 to 1.82)]. More than 300 min/week of physical activity was enough to eliminate the association of excessive TV time and sitting time with social isolation markers in boys
Werneck et al.⁷	Sedentary behavior	Not informed	Cross-sectional analyses of PeNSE 2015	Chronological age, race and type of city (capital or other)
Gonzaga et al.¹²	Body image	30.70%	Body Dissatisfaction Scale for Adolescents- EEICA	Demographics, body image, physical activity, teasing, and perceived social support	There was no difference in body image dissatisfaction between adolescents who practiced and did not practice physical activity, but among the former, those who had been provoked had greater body dissatisfaction. In addition, adolescents who had a relative or friend to talk to, in addition to giving and receiving affection, were more likely to have lower body image dissatisfaction. Stratifying the sample by sex, the results were similar in females, but not significant in males
	Physical activity	73.10%
	Teasing	72.90%
	Social support	27.30%
Cruzeiro et al.¹⁴	Conduct disorder	29.20%	Mini International Neuropsychiatric Interview (MINI)	Behavioral factors, Socioeconomic level; use of alcoholic beverages; use/abuse of illicit drugs; bullying; sedentary lifestyle.	It is estimated that 29.2% of adolescents have conduct disorder. In males, the chance of having conduct disorder increased by 2.04. Suffering bullying remained associated with 2.02, lower socioeconomic class 1.65, drug use in the last month increased by 3 times the chance of conduct disorder 2.28, sedentary lifestyle 1.44, alcoholic beverage 2.64, that is, all these factors were associated with greater number of behaviors related to conduct disorder
Santos et al.¹⁶	Social isolation (feeling loneliness and having few friends)	17.60%	Global School-based Student Health Survey (GSHS) Questionnaire	Social isolation (feeling loneliness and having few friends)	Regarding the social isolation indicator, it is estimated that 15.8% of participants reported feeling loneliness and 19.5% reported having few friends. The female gender was highlighted, as both the feeling of loneliness and having few friends were significantly higher (p=0.001). Participation in physical education classes was identified as a factor associated with 24% lower chance of having few friends
Triaca et al.¹⁵	. Loneliness	Not informed	Loneliness, sleep problems, physical activity	Physical activity	Results showed that school physical education has negative effect, reducing the probability of reporting insomnia and loneliness problems among students who attend the discipline. Physical education offered in the basic education curriculum has protective effect on the mental health of school-aged children.
Triaca et al.¹⁵	Sleep problems	Not informed	Loneliness, sleep problems, physical activity	Physical activity
de Almeida Silva and Menezes¹³	Stress perception	20.10%	Self-applied questionnaire	Sedentary behavior; Physical activity; consumption of fruits and vegetables, soft drinks, alcohol and drugs; smoking	High prevalence of sedentary behavior; sedentary behavior positively associated with low levels of physical activity, soft drink consumption, negative stress perception, feeling of loneliness and difficulty sleeping, alcohol consumption inversely associated with sedentary behavior
	Feeling of loneliness Difficulty sleeping	-
		50.30%
		45.70%

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The Study by Gonzaga et al.¹² was originally published in the E-Pub on November 11, 2019, however, the version in the journal was released in 2021, with a new bibliographic indication.