Mental health outcomes and physical activity during the COVID-19 pandemic: A systematic review and meta-analysis of observational studies

The COVID-19 pandemic disrupted physical activity behaviors and worsened mental health worldwide. This study synthesized observational evidence on relationships between physical activity and depression, anxiety, and stress in adults during COVID-19. A systematic review and multilevel random-effects meta-analysis (PROSPERO CRD42023491651) of observational studies published January 2020–May 2023 included 38 studies with 140,915 adults using validated measures. Physical activity showed significant inverse associations with depression ( r  = −0.18; p  < 0.001) and stress ( r  = −0.14; p  = 0.043), but not anxiety ( p  = 0.340). Heterogeneity was substantial. Findings suggest physical activity can serve as a low-risk adjunct to mitigate depressive symptoms and perceived stress during public health crises, though interpretation should be cautious given observational design and high heterogeneity. Clinically, brief assessment and promotion of regular physical activity—tailored to context and delivered in-person or remotely—may support psychological well-being, while anxiety may require combined approaches during emergencies.