Effects of physical activity-centered programs on mental health in adolescents experiencing social disadvantage: a systematic review with meta-analysis

Background Social disadvantage can increase adolescents’ exposure to stress while limiting support and access to care. Physical activity programs fit everyday settings, but their effects and transferability remain uncertain. We assessed physical activity-centered programs for adolescents aged 10–19 years experiencing verifiable social disadvantage. Methods Following PRISMA 2020, we searched seven databases through 1 September 2026, rerunning all seven on 8 September. Randomized and non-randomized controlled interventions were eligible. Two reviewers conducted screening, data verification, and evidence assessment. The study family was the independent weighting unit and the specific psychological construct was the synthesis unit. Comparable constructs represented by at least two families were synthesized using restricted maximum likelihood random-effects models with Hartung–Knapp inference. Risk of bias was assessed with RoB 2, cluster RoB 2, or ROBINS-I, and three important outcomes were evaluated with GRADE. Results Fourteen reports from 12 study families from 8 countries were included; 8 families were randomized, including 4 cluster trials. In randomized no-added-program comparisons, immediate depression could be pooled across only two families, with estimates pointing in opposite directions ( g = −0.256, 95% CI [−5.442, 4.930]; I 2 = 91.8%; very low certainty). General anxiety was represented by one randomized family; the estimate favored the wait-list ( g = −0.627, 95% CI [−0.955, −0.298]; low certainty). One four-school trial found a positive impact on wellbeing; however, the estimate was uncertain ( g = 0.220; df = 2; interval [−0.505, 0.944]; very low certainty). Other findings were largely family-specific, and safety reporting was incomplete. Conclusion Sparse, heterogeneous evidence does not establish mental health effects generalizable across socially disadvantaged adolescents. The roles of program content, comparators, and social context remain unresolved. Physical activity-centered programs should be evaluated further within existing care and social support, with a focus on implementation, psychosocial resources, and possible risks. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261508854 .