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July 26, 2026Open Access

Comparative effectiveness of school-based physical activity interventions on moderate-to-vigorous physical activity in children and adolescents: a systematic review and network meta-analysis

QLQian LiuZhengzhou University ZXZongyin XuShandong Marine Resource and Environment Research Institute XSXiudong ShaoShandong Xiehe University

Key Points

The review aims to compare the effectiveness of various school-based physical activity interventions on moderate-to-vigorous physical activity (MVPA) in youth.
Conducted systematic searches across multiple databases until May 2026
Included randomized controlled trials and cluster-randomized controlled trials
Performed network meta-analysis, risk of bias assessment using RoB 2, and certainty assessment with CINeMA.
PE/curriculum-focused interventions showed higher MVPA (SMD = 0.21, 95% CI: 0.07 to 0.35)
Whole-school interventions also increased MVPA (SMD = 0.21, 95% CI: 0.07 to 0.34)
Additional physical activity opportunities beyond the regular curriculum had no clear effect on MVPA (SMD = 0.07, 95% CI: −0.05 to 0.18).

Abstract

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.

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