Physical Activity

What is it? Physical activity includes any interventions that improve mental health by way of also improving physical health.

Evidence? There is limited evidence demonstrating a causal link between physical activity and good student mental health in a UK context, hence the ‘weak’ evidence rating for this page. However, the international studies which do exist provide some examples of methodological strong evidence on interventions which have been tested with large samples of students. Whether these studies suggest a beneficial impact on mental health appears heavily dependent on the exact nature of the physical activity being tested. These studies should be viewed in the context of robust evidence that physical activity has been shown to have positive effects on symptoms of depression, anxiety and psychological distress in a range of adult populations outside higher education (Singh et al., 2023).

What is the intervention?

A physical activity intervention engages people in physical activity over a period of time in order to improve both their physical and mental health. This may include indoor activities such as yoga or gym sessions, or outdoor activities such as running, cycling or walking. They can be offered in groups or individually and, in some cases, without being guided by a professional. This intervention can also be delivered online via online conferencing or specialist apps that track progress and make recommendations for the individual to follow. Physical activities can be adapted to suit an individual’s needs regardless of physical ability. This type of intervention can be a good accompaniment to other therapies and is often preventative.

How effective is it?

Our evidence review suggests that physical activities tend to have a mixed or positive impact on mental health. Whether studies suggest a beneficial impact appears heavily dependent on the exact nature of the physical activity being tested.

While the studies discussed on this page have been undertaken specifically in HE contexts, it is important to note that there are many other studies which suggest a positive impact of physical activities with other adult populations. Singh et al. (2023) provide a wide-ranging and rigorous overview of 97 systematic reviews which finds physical activity is highly beneficial for improving symptoms of depression, anxiety and distress across a range of adult populations, including the general population and people with diagnosed mental health disorders. They suggest that the benefit from physical activity is comparable or bigger than that observed for some psychological therapies or the use of pharmaceutical drugs.

However, for the purpose of providing the best support to students, it’s important we examine the evidence which is most relevant to the HE context. Students are younger, on average, than the general adult population and may have specific requirements or characteristics which make physical activity interventions more, or less, effective. In the absence of a formal review which collates evidence on the impact of these approaches for students.

The evidence on physical activity interventions is split into groups of studies which look at different sorts of approaches. If we look at just those which provide causal impact evidence of a medium/high quality, the largest grouping focuses on traditional exercise practices from China and Korea. These studies do generally provide some promising evidence of impact.  The next largest grouping focuses on interventions which encourage more general aerobic exercise, in a variety of forms. It appears that exercise which is mandated and tested in a controlled laboratory setting over the short-term is unlikely to improve mental health outcomes, although there is more support for longer-term interventions which help people exercise ‘in the real world.’ Only a handful of studies fall outside these groupings.  A summary of the key evidence for each type of intervention is given below.

Traditional exercise practices from China and Korea

There are several studies which provide evidence of a positive impact of traditional exercise practices from China and Korea, some involving large numbers of students. For example, Li et al. (2022) tested the effect of Baduanjin exercise on COVID‑19‑related anxiety, psychological well‑being, and the lower back pain of college students. Baduanjin is an exercise containing eight components of mindful movements and is easy to learn (Xiao et al., 2021). Working across four Chinese universities with almost 400 participants, students were randomly allocated to either a treatment group who were instructed to participate in Baduanjin exercises five times a week, or to a control group who were instructed to learn health knowledge on the internet independently. Comparisons of surveys collected from both groups after the 12-week programme suggested improvements in anxiety, wellbeing and muscle pain. Similarly, Xiao et al. (2021) conducted a study with 100 students in a Chinese university who were identified as exhibiting problematic smartphone use via a survey. They tested whether engagement in either basketball or Baduanjin exercise sessions for 12 weeks would be beneficial for student mental health. Comparison of survey results between these students and those in a pure control group (who did not participate in either intervention) found that both treatment groups had better outcomes on anxiety, loneliness, inadequacy, and stress than the control group. They also exhibited lower rates of ‘problematic smartphone use.’ These benefits were still observed two months after the end of the programme, except for stress. The authors find that the group-based basketball intervention was observed to have a greater effect than Baduanjin, which they suggest may be due to the social activities involved. Chen et al. (2017) provide one final example of positive impact for a Baduanjin for Chinese university students; healthy college students were randomly allocated into either the treatment group or control group and participated in either an eight week programme of Baduanjin practice or progressive muscle relaxation training. The Baduanjin led to greater improvements in mood, and executive function, than the relaxation exercise, although this study only involved 40 students making it less robust than the others cited here. It should be noted there is also one example which finds no impact of Baduanjin; Li et al. (2015) ran a study with over 200 students in a Chinese university who were randomly placed in a treatment group who received a 12-week exercise training versus or a control group who received business as usual. At the end of the training, and 12 weeks after that, they found no evidence of impact on the vast majority of psychological outcomes measured, with the exception of ‘attention’ for which there was a positive impact in the short term which was not sustained over time. The authors note that, because the difference in outcomes between the two groups was smaller than expected, the sample might not have been big enough to detect whether there was a true impact of the intervention.

Two studies focus on Tai Chi/Taijiquan (a Chinese martial art practised for self-defence and health). Du et al. (2022) provide a meta-analysis on the effect of taijiquan on improving negative psychological symptoms of college students. A total of 12 articles were reviewed, covering a sample of over 1,000 students and found that this sort of intervention can significantly reduce the depression and anxiety symptoms of college students with small to medium effects. However, it should be noted that the review draws on many studies with sample sizes, some of which focus only on female students, making the results less robust and generalisable. One study which does not support the positive impact of Tai Chi is Zheng et al. (2015) which focuses on a sample of over 200 students in a Chinese university. These students were randomly placed in either a treatment group who received Tai Chi training for 12 weeks, or a treatment group who did not. The study found no effect on any psychological outcome measures at the end of the 12 weeks, at a later follow-up date. The authors suggest that the student population may be too healthy, on average, before participating to fully benefit from this sort of intervention.

Kim et al. (2013) study the effect of Kouk Sun Do – a Korean ‘mind-body exercise’ on students with anxiety symptoms. In a large USA university, they ran a small trial in which students were randomly allocated to attend three Kouk Sun Do sessions per week, for four weeks, or to a ‘waitlist’ control group who would participate later. They find a positive impact on anxiety and depression symptoms, but not stress. However, small samples (fewer than 20 students) and high rates of dropout limit the strength of these results.

General exercise – short-term

A handful of studies look at the impact of general aerobic exercise tested in laboratory settings, meaning the intervention is normally one-off and tightly controlled and the results are monitored over the short-term. These studies find mixed or no effect of exercise on mental health outcomes.

Mason et al. (2018) test the effect of different levels of aerobic exercise on mental health outcomes. A sample of Canadian college students with low levels of self-reported physical activity were allocated to participate in a moderate- or a high-intensity ten-minute exercise intervention, or to a control group. Surveys were run with all groups within 48 hours of the interventions happening and revealed an improvement in anxiety sensitivity among those who completed either form of exercise, which was bigger in the high-intensity group. However, there was no effect on the other mental health outcomes measured. Plante et al. (2003) compare the effect of aerobic exercise with a virtual reality running experience as part of a 20-minute intervention. Using survey data collected directly after the session, they found that students who took part in real exercise had higher energy levels than those who participated only virtually, but the effects on tension and calmness were mixed and not clearly in favour of the physical exercise.

Julian et al. (2012) worked with a sample of 112 USA college students with high social anxiety to test the effect of exercise combined with attention training on ‘attention bias’ which is ‘thought to result in hyperarousal and increased anxiety as well as preventing individuals from gathering disconfirming evidence for their fears.’ The study found no effect of attention training, on its own or in combination with exercise. Finally, Lindheimer et at. (2017) worked with a sample of healthy USA college students with high anxiety to test whether a short cycling intervention could improve energy, anxiety and working memory. Students were randomly allocated to different groups who received different versions of the intervention which required more or less physical exertion, but surveys administered afterwards found no difference in outcomes between the groups.

General exercise – long-term

There are a smaller number of examples of more positive findings relating to longer-term physical activity interventions. For example, Smits et al. (2018) tested the effect of two-week exercise intervention. USA college students were allocated to a group who took part in either six 20-minute exercise sessions, these sessions plus a ‘cognitive restructuring intervention’ or a waitlist group who would take part later. Mental health outcomes were measured one and three weeks after the sessions concluded. The study found that both exercise conditions led to significant improvements in anxiety sensitivity compared to the control group. Barği (2022) finds more mixed results; in a small trial in a university in Turkey, students were allocated to either an intervention which required them to be physically active every day or to a control group who received no such instructions. The intervention appears to have had a positive impact on physical activity, anxiety and some other outcomes, but not on depression. However, the small number of students (31) limits the strength of these findings.

Other studies

Other studies of note cover yoga, whole body vibration and pedometer use.

Chang et al. (2022) ran a large US-wide study on the impact of Isha Upa yoga on mental health among university students during the COVID-19 pandemic. Students from multiple universities were invited to apply, and almost 700 were randomly allocated to either the treatment group (who received four weeks of online instruction and was instructed to learn and practise the yoga for the remaining eight weeks) or a control group (who did not). Comparison of survey outcome between the treatment and control group found that practising yoga over 4 weeks significantly reduced stress and improved well-being in undergraduates.

Sharp et al. (2016) tested the effect of providing students with a pedometer, monthly tracking logs, and follow-up emails to encourage physical activity. By comparing Canadian college students who received this intervention for 12 weeks to a control group who did not, the study found that there was no effect of the intervention on physical activity or wellbeing.

Chawla et al. (2022) test effects of whole-body vibration training on depression, anxiety, stress and quality of life in students in India. Students were either allocated to whole body vibration, or to a group who participated in exercise, for the same amount of time. The results suggest that depression and stress were improved more for those who experienced the whole-body vibration, but there was no particular benefit for anxiety. However, this was a small study with only 30 students which limits its strength.

How secure is the evidence?

The evidence base for physical activity is weak because it is limited in size and coverage when it comes to studies which can tell us about impact for student populations and none of the medium/high-quality causal studies (outlined on this page) are from the UK.

It should be noted that there are a sizeable number of reasonable quality randomised controlled trials (RCTs) that have been conducted on a student population which provide causal evidence on these interventions, through comparison of a treatment group that receives the intervention and a control group that does not (or does so only after a set time period – a waitlist control). However, the majority of studies have been developed in North America or China. There is limited evidence on physical activity interventions in the UK. More research is needed in a UK context to draw reliable conclusions that are accurate for UK HE providers.

It should also be noted that the evidence is split between the various approaches outlined above so there is not a sufficiently large evidence base to start drawing strong conclusions about the efficacy of all different physical activity interventions, even in a global context.

While no studies measure student outcomes for physical interventions, some do measure physical health and social support networks. If physical activity interventions are designed and implemented with the aim of improving student outcomes, future evaluations must also measure these outcomes as it is important to understand whether interventions improve student mental health but also that they contribute to success on-course.

Where interventions have been tested in a laboratory setting (as for the ‘General exercise – short-term’ section above), the physical activity will generally have been experienced and observed in a highly controlled setting which is not similar to the real world. This, and the use of short-term outcomes, is a fundamental limitation of this sort of study.

A number of the research studies cited here recruited volunteer students through undergraduate psychology degrees, or through general call-outs to the student population. As a result, female students are likely to be over-represented and this may limit the generalisability of findings to other, or wider, student populations. The use of self-report measures is also a limitation of much of the evidence cited above, particularly as for many interventions here students will have been acutely aware of the approach being tested, leading to a strong risk of students reporting better mental health outcomes because they think they are expected to. It should also be noted that some of the studies have small samples and/or there is insufficient detail in the paper to understand if the sample is big enough for the purpose of the analysis. This, and other methodological limitations mean the existing evidence cannot be universally characterised as high-quality, even if we set aside the other issues outlined here.

How do I evaluate this intervention?

RCTs are one of the most robust ways to measure interventions as they allow comparison of two groups that have either received or haven’t received the intervention, whilst controlling for observable and unobservable differences between the two groups. These trials should take place outside of lab settings to test whether, and how, interventions translate and perform in the ‘real world’. There are many examples of RCT designs in the literature cited above, including waitlist designs (see for example Smits et al., 2018); the key benefit of this design is that the control group is still able to receive the intervention, just at a later date once outcomes have been measured in both groups. However, this approach is less appropriate if we expect that the effect of an intervention will materialise in the longer term.

Outcomes should be measured in both treatment and control groups using validated scales before and after the intervention has been received. Measuring outcomes at multiple time points (e.g. three-, six- and twelve-month follow-ups) is important, rather than only immediately after.

We also have a paucity of evidence that measures the impact of physical activity interventions on student outcomes such as attainment, retention and progression and HE providers should seek to embed these into evaluation plans.

When it comes to physical activity, many of the studies above include eligibility criteria to ensure participants are able to complete the physical activities required of them. This may be an important element of evaluating new interventions, or interventions in new populations. For example, Chang et al. (2022) assessed the feasibility and acceptability of the yoga intervention they were testing and found that over 90% of participants reported that they could complete the exercise correctly on their own, providing confirmation that it is feasible to learn these yoga practices online.

Where can I find more information and guidance?

For guidance from the Mental Health Charter, please follow the links below:

Most psychological interventions fall under the following themes:

• Support services
• Proactive interventions and a mentally healthy environment
• Social integration and belonging

Where does the evidence come from?

The evidence in the Toolkit was gathered via an evidence review undertaken as part of the Student Mental Health Project. For full details of this review, please see our Methodology document.

It is important to note that our review, and therefore this Toolkit, only relates to student mental health. The review did not cover other populations (e.g. school children, other adult populations) or non-HE settings. The review was also subject to other inclusion/exclusion criteria, outlined in the Methodology document. However, we have flagged some additional links to the wider literature where appropriate and included them under ‘other references’ below.

Please also note that this Toolkit page only includes Type 3 (causal) studies which have been rated as providing medium/high-quality evidence according to our evidence strength ratings. These studies are outlined in the page above and referenced below. A full list of studies collated via our evidence review, including Type 1/Type 2 studies, and those rated as providing weak/emerging evidence, can be found in our Evidence Review Spreadsheet. A breakdown of these studies by type and strength of evidence is available to download.

Key references

Bargi, G. (2022) Effectiveness of Physical Activity Counseling in University Students Educated by Distance Learning During COVID-19 Pandemic: A Randomized-Controlled Trial. Journal of Basic Clinical Health Science. 6, 374–384. doi:10.30621/jbachs.1027410

Chang, T.F.H., Ley, B.L., Ramburn, T.T., Srinivasan, S., Hariri, S., Purandare, P. & Subramaniam, B. (2022) Online Isha Upa Yoga for student mental health and well‐being during COVID‐19: A randomized control trial. Applied Psychology: Health and Well-Being. 14 (4), 1408–1428. doi:10.1111/aphw.12341

Chawla, G., Azharuddin, M., Ahmad, I. & Hussain, M.E. (2022) Effect of Whole-body Vibration on Depression, Anxiety, Stress, and Quality of Life in College Students: A Randomized Controlled Trial. Oman Medical Journal. 37 (4), e408–e408. doi:10.5001/omj.2022.72

Chen, T., Yue, G.H., Tian, Y. & Jiang, C. (2017) Baduanjin Mind-Body Intervention Improves the Executive Control Function. Frontiers in Psychology. 7. doi:10.3389/fpsyg.2016.02015

Du, Z., Zhang, X., Qin, H., Wang, R., Bai, Y. & Yao, X. (2022) Metaanalysis on the effect of taijiquan on improving negative psychological symptoms of college students and the optimal dose. Frontiers in Public Health. 10, 1032266. doi:10.3389/fpubh.2022.1032266

Julian, K., Beard, C., Schmidt, N.B., Powers, M.B. & Smits, J.A.J. (2012) Attention training to reduce attention bias and social stressor reactivity: An attempt to replicate and extend previous findings. Behaviour Research and Therapy. 50 (5), 350–358. doi:10.1016/j.brat.2012.02.015

Kim, J.-H., Yang, H. & Schroeppel, S. (2013) A Pilot Study Examining the Effects of Kouk Sun Do on University Students with Anxiety Symptoms: The Effects of Kouk Sun Do on Mental Health. Stress and Health. 29 (2), 99–107. doi:10.1002/smi.2431

Li, K., Walczak-Kozłowska, T., Lipowski, M., Li, J., Krokosz, D., Su, Y., Yu, H. & Fan, H. (2022) The effect of the Baduanjin exercise on COVID-19-related anxiety, psychological well-being and lower back pain of college students during the pandemic. BMC Sports Science, Medicine and Rehabilitation. 14 (1), 102. doi:10.1186/s13102-022-00493-3

Li, M., Fang, Q., Li, J., Zheng, X., Tao, J., Yan, X., Lin, Q., Lan, X., Chen, B., Zheng, G. & Chen, L. (2015) The Effect of Chinese Traditional Exercise-Baduanjin on Physical and Psychological Well-Being of College Students: A Randomized Controlled Trial M. Buchowski (ed.). PLOS ONE. 10 (7), e0130544. doi:10.1371/journal.pone.0130544

Lindheimer, J.B., O’Connor, P.J., McCully, K.K. & Dishman, R.K. (2017) The Effect of Light-Intensity Cycling on Mood and Working Memory in Response to a Randomized, Placebo-Controlled Design. Psychosomatic Medicine. 79 (2), 243–253. doi:10.1097/PSY.0000000000000381.

Mason, J.E. & Asmundson, G.J.G. (2018) A single bout of either sprint interval training or moderate intensity continuous training reduces anxiety sensitivity: A randomized controlled trial. Mental Health and Physical Activity. 14, 103–112. doi:10.1016/j.mhpa.2018.02.006

Plante, T.G., Aldridge, A., Su, D., Bogdan, R., Belo, M. & Kahn, K. (2003) Does Virtual Reality Enhance the Management of Stress When Paired With Exercise? An Exploratory Study. International Journal of Stress Management. 10 (3), 203–216. doi:10.1037/1072-5245.10.3.203

Sharp, P. & Caperchione, C. (2016) The effects of a pedometer-based intervention on first-year university students: A randomized control trial. Journal of American College Health. 64 (8), 630–638. doi:10.1080/07448481.2016.1217538

Smits, J.A.J., Berry, A.C., Rosenfield, D., Powers, M.B., Behar, E. & Otto, M.W. (2008) Reducing anxiety sensitivity with exercise. Depression and Anxiety. 25 (8), 689–699. doi:10.1002/da.20411

Xiao, T., Jiao, C., Yao, J., Yang, L., Zhang, Y., Liu, S., Grabovac, I., Yu, Q., Kong, Z., Yu, J.J. & Zhang, J. (2021) Effects of Basketball and Baduanjin Exercise Interventions on Problematic Smartphone Use and Mental Health among College Students: A Randomized Controlled Trial J. Liu (ed.). Evidence-Based Complementary and Alternative Medicine. 2021, 1–12. doi:10.1155/2021/8880716

Zheng, G., Lan, X., Li, M., Ling, K., Lin, H., Chen, L., Tao, J., Li, J., Zheng, X., Chen, B. & Fang, Q. (2015) Effectiveness of Tai Chi on Physical and Psychological Health of College Students: Results of a Randomized Controlled Trial C.M. Schooling (ed.). PLOS ONE. 10 (7), e0132605. doi:10.1371/journal.pone.0132605

Other references

Singh, B., Olds, T., Curtis, R., Dumuid, D., Virgara, R., Watson, A., Szeto, K., O’Connor, E., Ferguson, T., Eglitis, E., Miatke, A., Simpson, C.E. & Maher, C. (2023) Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews. British Journal of Sports Medicine. 57 (18), 1203–1209. doi:10.1136/bjsports-2022-106195