Physical activity is associated with better mental health in adolescents, particularly among those with lower activity levels, with dose-response relationships showing the strongest associations at lower physical activity levels.
Key Findings
Results
Higher physical activity was significantly associated with lower stress perception among adolescents.
Multivariable linear regression showed B = -0.13, p < 0.001 for the association between physical activity and stress perception
At lower physical activity levels, the RCS slope for stress perception was -5.65 (p < 0.001)
At higher physical activity levels, the association was substantially attenuated
Cross-sectional survey conducted in September 2024 among 2,270 students aged 12-15 years from 4 middle schools in Shanghai, China
Models adjusted for demographic and academic covariates
Results
Higher physical activity was significantly associated with greater psychological resilience among adolescents.
Multivariable linear regression showed B = 0.33, p < 0.001 for the association between physical activity and psychological resilience
At lower physical activity levels, the RCS slope for psychological resilience was 8.59 (p < 0.001)
At higher physical activity levels, the association was substantially attenuated
Restricted cubic spline (RCS) models were used to examine dose-response relationships
Results
Higher physical activity was significantly associated with greater self-efficacy among adolescents.
Multivariable linear regression showed B = 0.25, p < 0.001 for the association between physical activity and self-efficacy
At lower physical activity levels, the RCS slope for self-efficacy was 12.10 (p < 0.001), the largest slope among the three outcomes
At higher physical activity levels, the association was substantially attenuated
Self-efficacy showed the steepest initial dose-response slope of the three mental health outcomes examined
Results
Dose-response relationships between physical activity and all three mental health outcomes were non-linear, with stronger associations at lower physical activity levels.
Restricted cubic spline analyses revealed dose-response relationships for stress perception, psychological resilience, and self-efficacy
Slopes at lower physical activity levels were -5.65, 8.59, and 12.10 for stress perception, psychological resilience, and self-efficacy respectively (all p < 0.001)
Associations were substantially attenuated at higher physical activity levels
The pattern suggests diminishing returns of physical activity on mental health outcomes at higher activity levels
Results
Gender-stratified analyses indicated stronger associations between physical activity and mental health outcomes in males than in females.
Gender-stratified analyses were conducted for all three mental health outcomes: stress perception, psychological resilience, and self-efficacy
Males showed stronger associations between physical activity and mental health outcomes compared to females
The sample consisted of students aged 12-15 years from 4 middle schools in Shanghai, China
The cross-sectional design limits causal inference about gender differences
Conclusions
The study findings highlight the importance of targeting less active adolescents in school-based physical activity interventions.
The dose-response pattern suggests that the greatest mental health gains from increased physical activity occur among adolescents who are currently least active
Sample consisted of 2,270 students aged 12-15 years from 4 middle schools in Shanghai
The cross-sectional design does not permit causal conclusions
Authors recommend focusing school-based interventions on less active adolescents based on the observed dose-response pattern
What This Means
This research suggests that being more physically active is linked to better mental health in teenagers, specifically lower perceived stress, greater psychological resilience, and higher self-efficacy (belief in one's ability to succeed). The study surveyed 2,270 middle school students aged 12 to 15 in Shanghai, China, and used statistical methods to examine not just whether physical activity matters, but how much activity is needed to see benefits.
One of the most important findings is that the mental health benefits of physical activity are not equal across all activity levels — the gains are steepest for teenagers who go from doing very little physical activity to doing moderate amounts. For students who are already quite active, additional activity showed much smaller additional mental health benefits. The study also found that these associations were stronger in male students than in female students, though both groups showed positive associations.
This research suggests that school-based programs aimed at improving teenage mental health through physical activity may get the most impact by focusing on the least active students, since they stand to gain the most from even modest increases in activity. Because this was a cross-sectional study (a snapshot in time), it cannot prove that physical activity directly causes better mental health — it is possible other factors contribute to both. Nevertheless, the findings add to growing evidence that regular physical activity is connected to adolescent mental wellbeing.
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Bai Y, Liang D, Lu Y, Zhang W, Huang J, Wu Y. (2026). Dose-response relationship between physical activity and mental health outcomes in adolescents.. Frontiers in public health. https://doi.org/10.3389/fpubh.2026.1780794