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.
AçikgözAYörükSŞahanAG, et al. (2022) Relationship between loneliness, physical activity, and depressive symptoms among older adults: A cross-sectional study conducted during the fourth wave of the COVID-19 pandemic in Turkey. Turkish Journal of Geriatrics25(3): 386–395.
3.
AkçayBYilmaz GökmenGKeçeli̇OğluŞ, et al. (2021) Investigation of the effect of covid-19 outbreak on physical activity, perceived stress, physical activity awareness and exercise barriers: A national study. Türk Fizyoterapi ve Rehabilitasyon Dergisi32(3): 103–112.
4.
ArabzadehEEbrahimiSGholamiM, et al. (2023) The relationship between physical activity pre COVID-19 pandemic with mental health, depression, and anxiety in COVID-19 patients: A cross-sectional study. Sport Sciences for Health19(4): 1239–1244.
5.
AroraTGreyI (2020) Health behaviour changes during COVID-19 and the potential consequences: A mini-review. Journal of Health Psychology25(9): 1155–1163.
6.
AroraTGreyIÖstlundhL, et al. (2022) The prevalence of psychological consequences of COVID-19: A systematic review and meta-analysis of observational studies. Journal of Health Psychology27(4): 805–824.
7.
BalshemHHelfandMSchünemannHJ, et al. (2011) GRADE guidelines: 3. Rating the quality of evidence. Journal of Clinical Epidemiology64(4): 401–406.
8.
BellichaALassenPBPoitouC, et al. (2022) Effect of COVID-19 lockdowns on physical activity, eating behavior, body weight and psychological outcomes in a post-bariatric cohort. Obesity Surgery32(7): 1–9.
9.
BhattacharyaPChatterjeeSRoyD (2023) Impact of exercise on brain neurochemicals: A comprehensive review. Sport Sciences for Health19(2): 405–452.
10.
BhuiyanNKangJHPapaliaZ, et al. (2022) Assessing the stress-buffering effects of social support for exercise on physical activity, sitting time, and blood lipid profiles. Journal of American College Health70(5): 1563–1569.
11.
BohnLAbdallaPPGomideEBG, et al. (2023) Non-rigorous versus rigorous home confinement differently impacts mental health, quality of life and behaviors. Which one was better? A cross-sectional study with older Brazilian adults during covid-19 first wave. Archives of Public Health81(1): 105–114.
12.
BrownVMPriceRDombrovskiAY (2023) Anxiety as a disorder of uncertainty: Implications for understanding maladaptive anxiety, anxious avoidance, and exposure therapy. Cognitive Affective & Behavioral Neuroscience23(3): 844–868.
13.
CarraMCRomandiniPRomandiniM (2025) Risk of bias evaluation of cross-sectional studies: Adaptation of the Newcastle-Ottawa Scale. Journal of Periodontal Research. Epub ahead of print 28 April 2025. https://doi.org/10.1111/jre.13405
14.
Çerezci-DuyguSÖzdemirFKarakaşG (2023) Relationship between physical activity level and stress perception: Exploring factors during COVID-19 pandemic. Journal of Research in Health Sciences23(3): e00585.
15.
ChanADuJAndrewDPS (2023) Social media consumption and depressive symptoms during the COVID-19 lockdown: The mediating effect of physical activity. Frontiers in Psychiatry14: 1120230.
16.
CohenBHLeaRB (2004) Essentials of Statistics for the Social and Behavioral Sciences. John Wiley & Sons. Available at: https://rb.gy/ao0gri (accessed 12 July 2025).
17.
Cruz-AusejoLOsadaJRueda-TorresL, et al. (2023) Physical activity level and factors associated with perceived stress among Peruvian university professors during the COVID-19 pandemic. Heliyon9(6): e16439.
18.
da CostaTSSeffrinAde Castro FilhoJ, et al. (2022) Effects of aerobic and strength training on depression, anxiety, and health self-perception levels during the COVID-19 pandemic. European Review for Medical and Pharmacological Sciences26(15): 5601–5610.
19.
DuncanGEAveryARTsangS, et al. (2021) Changes in physical activity levels and mental health during COVID-19: Prospective findings among adult twin pairs. PLoS One16(11): e0260218.
20.
EggerMSmithGDSchneiderM, et al. (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ315(7109): 629–634.
21.
GiercMRiaziNAFaganMJ, et al. (2021) Strange days: Adult physical activity and mental health in the first two months of the COVID-19 pandemic. Frontiers in Public Health9: 567552.
22.
GuyattGHOxmanADKunzR, et al. (2011) GRADE guidelines: 7. Rating the quality of evidence—inconsistency. Journal of Clinical Epidemiology64(12): 1294–1302.
23.
HaggerMS (2025) Psychological determinants of health behavior. Annual Review of Psychology76(1): 821–850.
24.
HanS-SLiBKeYZ, et al. (2022) Chinese college students’ physical-exercise behavior, negative emotions, and their correlation during the COVID-19 outbreak. International Journal of Environmental Research and Public Health19(16): 10344.
25.
HeisselAHeinenDBrokmeierLL, et al. (2023) Exercise as medicine for depressive symptoms? A systematic review and meta-analysis with meta-regression. British Journal of Sports Medicine57(16): 1049–1057.
26.
HollingdaleKFirebaughCMMorganSM (2022) A brief report relating physical activity and depressive symptoms in women during the COVID-19 pandemic. Human Movement24(1): 100–103.
27.
HungWTBellVWongKK-Y (2025) The impact of COVID-19 on physical activity and mental health: A mixed-methods approach. Journal of Health Psychology30(4): 808–822.
28.
Ibáñez RománJEEkholmOAlgrenMH, et al. (2023) Mental wellbeing and physical activity levels: A prospective cohort study. Mental Health and Physical Activity24: 100498.
29.
JuYJKimWLeeSY (2023) Is COVID-19 induced reductions in the level of physical activity associated with increased depressive symptoms in patients with hypertension?Journal of Psychosomatic Research166: 111160.
30.
KarpovMVBartholmaeMMLevyBL, et al. (2023) Exploring the influence of behavioral factors on depression and anxiety scores during the COVID-19 pandemic: Insights from the Virginia statewide COVIDsmart longitudinal study. BMC Public Health23(1): 1749.
31.
Koziel LyNKMohamudLVilleneuvePJ, et al. (2022) Protective effects of physical activity on mental health outcomes during the COVID-19 pandemic. PLoS One17(12): e0279468.
32.
LageACarrapatosoSSampaio de Queiroz NetoE, et al. (2021) Associations between depressive symptoms and physical activity intensity in an older adult population during COVID-19 lockdown. Frontiers in Psychology12: 644106.
33.
LardierDTZuhlMNHolladayKR, et al. (2023) A latent class analysis of mental health severity and alcohol consumption: Associations with COVID-19-related quarantining, isolation, suicidal ideations, and physical activity. International Journal of Mental Health and Addiction21(4): 2285–2308.
34.
LiuP (2025) Stress buffering effects of physical activity in adolescents: The moderating role of physical activity attitudes. BMC Public Health25(1): 463.
35.
LuLShenHTanL, et al. (2023) Prevalence and factors associated with anxiety and depression among community-dwelling older adults in Hunan, China: A cross-sectional study. BMC Psychiatry23(1): 107.
36.
Martín-RodríguezAGostian-RopotinLABeltrán-VelascoAI, et al. (2024) Sporting mind: The Interplay of physical activity and psychological health. Sports12(1): 37.
37.
MatthayECHaganEGottliebLM, et al. (2021) Powering population health research: Considerations for plausible and actionable effect sizes. SSM–Population Health14: 100789.
38.
McElroyEPatalayPMoltrechtB, et al. (2020) Demographic and health factors associated with pandemic anxiety in the context of COVID-19. British Journal of Health Psychology25(4): 934–944.
39.
MorseKFFinePAFriedlanderKJ (2021) Creativity and leisure during COVID-19: Examining the relationship between leisure activities, motivations, and psychological well-being. Frontiers in Psychology12: 609967.
40.
MuFZLiuJLouH, et al. (2024) How breaking a sweat affects mood: The mediating role of self-efficacy between physical exercise and emotion regulation ability. PLoS One19(6): e0303694.
41.
Odriozola-GonzálezPPlanchuelo-GómezÁIrurtiaMJ, et al. (2022) Psychological symptoms of the outbreak of the COVID-19 confinement in Spain. Journal of Health Psychology27(4): 825–835.
42.
PageMJMcKenzieJEBossuytPM, et al. (2021) The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ74: 790–799.
43.
PearceMGarciaLAbbasA, et al. (2022) Association between physical activity and risk of depression: A systematic review and meta-analysis. JAMA Psychiatry79(6): 550–559.
44.
RicciPPallocciMTregliaM, et al. (2023) The effect of physical exercise during COVID-19 lockdown. Healthcare11(11): 1618.
45.
RodriguesLRAzevedoMJDCostaGP, et al. (2023) Associação entre prática de atividade física com a saúde mental e a percepção da qualidade de vida em profissionais de enfermagem de Ribeirão Preto e região durante a pandemia da covid-19. Medicinar56(2): e-197591.
46.
SamsudinNBaileyRPRiesF, et al. (2024) Assessing the impact of physical activity on reducing depressive symptoms: A rapid review. BMC Sports Science Medicine and Rehabilitation16(1): 107.
47.
SantanaEESNevesLMSouzaKC, et al. (2023) Physically inactive undergraduate students exhibit more symptoms of anxiety, depression, and poor quality of life than physically active students. International Journal of Environmental Research and Public Health20(5): 4494.
48.
SchuchFBVancampfortDFirthJ, et al. (2018) Physical activity and incident depression: A meta-analysis of prospective cohort studies. American Journal of Psychiatry175(7): 631–648.
49.
SchünemannHJMustafaRABrozekJ, et al. (2020) GRADE guidelines: 21 part 2. Test accuracy: Inconsistency, imprecision, publication bias, and other domains for rating the certainty of evidence and presenting it in evidence profiles and summary of findings tables. Journal of Clinical Epidemiology122: 142–152.
50.
ShannonSShevlinMBrickN, et al. (2023) Frequency, intensity and duration of muscle strengthening activity and associations with mental health. Journal of Affective Disorders325: 41–47.
51.
SinghBOldsTCurtisR, et al. (2023) Effectiveness of physical activity interventions for improving depression, anxiety and distress: An overview of systematic reviews. British Journal of Sports Medicine57: 1203–1209. https://doi.org/10.1136/bjsports-2022-106195
52.
StevensMLieschkeJCruwysT, et al. (2021) Better together: How group-based physical activity protects against depression. Social Science & Medicine286: 114337.
53.
TsekouraMFousekisKRoukounakiM, et al. (2023) Investigation of physical activity levels and associated factors of Greek older adults during COVID-19 pandemic: A community-based cross-sectional study. In: VlamosP. (eds). Advances in Experimental Medicine and Biology. Springer International Publishing, pp.353–358. https://doi.org/10.1007/978-3-031-31986-0_34
54.
VallyZHelmyM (2021) The association between depressive symptomology, psychological burden related to COVID-19, and engagement in physical exercise among college students. Frontiers in Psychiatry12: 741964.
55.
VancampfortDFirthJStubbsB, et al. (2025) The efficacy, mechanisms and implementation of physical activity as an adjunctive treatment in mental disorders: A meta-review of outcomes, neurobiology and key determinants. World Psychiatry24(2): 227–239.
56.
VellaSAAidmanETeychenneM, et al. (2023)Optimising the effects of physical activity on mentalhealth and wellbeing: A joint consensus statement from Sports Medicine Australia and the Australian Psychological Society. Journal of Science and Medicine in Sport26(2): 132–139.
57.
ViechtbauerW (2010) Conducting meta-analyses in R with the metafor Package. Journal of Statistical Software36: 1–48.
58.
Vuelvas-OlmosCRSánchez-VidañaDICortés-álvarezNY (2023) Gender-based analysis of the association between mental health, sleep quality, aggression, and physical activity among university students during the COVID-19 outbreak. Psychological Reports126(5): 2212–2236.
59.
WangXFengZ (2022) A narrative review of empirical literature of behavioral activation treatment for depression. Frontiers in Psychiatry13: 845138.
60.
WangYSunJZhangY, et al. (2025) Association of reallocating time between physical activity and sedentary behavior on the risk of depression: A systematic review and meta-analysis. Frontiers in Psychology16: 1505061.
61.
WanjauMNMöllerHHaighF, et al. (2023) Physical activity and depression and anxiety disorders: A systematic review of reviews and assessment of causality. AJPM Focus2(2): 100074.
62.
WhiteRLVellaSBiddleS, et al. (2024) Physical activity and mental health: A systematic review and best-evidence synthesis of mediation and moderation studies. International Journal of Behavioral Nutrition and Physical Activity21(1): 134.
63.
WilkialisLRodriguesNBChaDS, et al. (2021) Social isolation, loneliness and generalized anxiety: Implications and associations during the COVID-19 quarantine. Brain Sciences11(12): 1620.
64.
WutT-MLeeSWXuJB (2023) Mental health of working adults during the COVID-19 pandemic: Does physical activity level matter?International Journal of Environmental Research and Public Health20(4): 2961.
65.
YasunobeYAkasakaHYamamotoK, et al. (2023) The relationship between changes in exercise habits and psychosomatic activities in older hypertensive patients during the COVID-19 pandemic. Hypertension Research46(1): 208–213.
66.
ZhangKHuangBDivigalpitiyaP (2025) Identifying Community-Built Environment’s Effect onPhysical Activity and Depressive Symptoms Trajectories Among Middle-aged and Older Adults: Chinese National Longitudinal Study. JMIR Public Health and Surveillance11(1): e64564.
67.
ZhuWXuDLiH, et al. (2022) Impact of long-term home quarantine on mental health and physical activity of people in Shanghai during the COVID-19 pandemic. Frontiers in Psychiatry12: 782753.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
