Schools provide important opportunities for promoting moderate-to-vigorous physical activity (MVPA) among children and adolescents. However, the comparative effectiveness of different school-based physical activity intervention strategies remains unclear. This systematic review and network meta-analysis compared the effects of different school-based physical activity interventions on MVPA in children and adolescents. A systematic search was conducted in PubMed, Embase, CENTRAL, ERIC, PsycINFO, Web of Science Core Collection, Scopus, SPORTDiscus, ClinicalTrials.gov, and WHO ICTRP from inception to 8 May 2026, with no language restrictions. Randomized controlled trials (RCTs) and cluster-randomized controlled trials (cluster-RCTs) of school-based physical activity interventions in children and adolescents were included. Risk of bias was assessed using RoB 2. Random-effects pairwise meta-analysis, network meta-analysis, and sensitivity analyses were performed. Certainty of evidence was assessed using the Confidence in Network Meta-Analysis (CINeMA) framework. A total of 41 studies were included in the systematic review, and 29 were included in the network meta-analysis. Compared with the control condition, PE/curriculum-focused interventions were associated with higher MVPA (SMD = 0.21, 95% CI: 0.07 to 0.35), as were whole-school interventions (SMD = 0.21, 95% CI: 0.07 to 0.34). Additional physical activity opportunities beyond the regular curriculum showed no clear effect on MVPA (SMD = 0.07, 95% CI: −0.05 to 0.18). Certainty of evidence was moderate for PE/curriculum-focused and whole-school interventions and low for additional physical activity opportunities. School-based physical activity interventions showed strategy-specific effects on MVPA among children and adolescents. Current evidence suggests that PE/curriculum-focused and whole-school interventions are associated with small but potentially meaningful improvements in MVPA, whereas the effects of additional PA opportunities beyond the regular curriculum remain uncertain. PROSPERO, CRD420261388278.
Liu et al. (Thu,) studied this question.