Authors: Hongpeng Zhao, Yi Wang
Categories: Systematic Review, Physical exercise, Children and adolescents, Aggressive behavior, Systematic review, Meta-Analysis
Source: BMC Public Health
Authors: Hongpeng Zhao, Yi Wang
Physical exercise is recognized as a cost-effective intervention for mitigating aggressive behavior; however, its impact on aggression in children and adolescents remains inconclusive. The aim of this study was to investigate the effects of physical exercise on aggressive behavior in this population and to perform subgroup analyses to examine potential moderating factors.
We searched five databases (PubMed, Web of Science, Scopus, EBSCOhost, and China National Knowledge Infrastructure (CNKI)) for studies published up to December 25, 2024, that tested physical activity programs for reducing aggression in children and teenagers. The methodological quality of the included studies was assessed using the Cochrane risk of bias tool. The standardized mean difference (SMD) was calculated as the outcome indicator, which was based on the mean and standard deviation (SD) of the aggression scores before and after the physical exercise intervention. The data were analyzed with RevMan 5.4 and Stata 15 software using a random effects model.
Eighteen studies involving 2,479 participants were included. The meta-analysis demonstrated a significant reduction in overall aggressive behavior following physical exercise [SMD = -0.55, 95% confidence interval (CI) (-0.89, -0.21), P < 0.01]. Significant reductions in physical aggression [SMD = -0.56, 95% CI (-0.81, -0.32)], anger [SMD = -0.45, 95% CI (-0.68, -0.22)], and hostility [SMD = -0.46, 95% CI (-0.68, -0.24)] were observed, but verbal aggression showed no significant change [SMD = -0.28, 95% CI (-0.62, 0.06)]. Subgroup analyses of exercise intervention characteristics and participant demographics revealed significantly greater reductions in aggressive behavior with ball sports [SMD = -1.04, 95% CI (-1.46, -0.61)], noncontact group-based instruction [SMD = -1.18, 95% CI (-1.64, -0.73)], exercise duration of 8–16 weeks [SMD = -1.03, 95% CI (-1.57, -0.50)], and a session length of 30–60 min [SMD = -1.03, 95% CI (-1.61, -0.45)]. Participants with higher baseline aggression levels exhibited significantly greater reductions in aggressive behavior [SMD = -0.72, 95% CI (-1.22, -0.23)].
Physical exercise significantly reduces aggressive behavior in children and adolescents. These reductions are moderated by the characteristics of the exercise interventions and participant demographics.
The study protocol was prospectively registered with PROSPERO (registration CRD420251038714).
The online version contains supplementary material available at 10.1186/s12889-025-25267-7.
Aggressive behavior refers to intentional actions aimed at causing physical injury or psychological harm to others [1, 2]; its core characteristics include four physical aggression, verbal aggression, anger, and hostility. Epidemiological data across 96 countries reveal that over 1 billion children and adolescents (aged 2–17) experience aggressive behaviors [3], with severity escalating significantly during adolescence [4]. Its persistence threatens individual development and societal well-being: longitudinal evidence confirms childhood aggression predicts risks of adolescent antisocial personality disorder, substance misuse, and adult violent crime [5, 6], while also driving academic decline and impaired social functioning [7]. Currently, there is an urgent need to explore safe and effective intervention strategies to mitigate the harm caused by aggressive behavior.
Common clinical treatments for aggressive behavior primarily include cognitive behavioral therapy and pharmacological interventions. However, these interventions often have known and unknown side effects, such as weight gain and drowsiness [8, 9], and have limited feasibility [10] and acceptability [11]. Therefore, it is crucial to explore safe and effective nonpharmacological intervention strategies.
In recent years, numerous cross-sectional studies have shown a significant negative correlation between physical exercise and aggressive behavior [12]. Physical exercise may reduce aggressive behavior in children and adolescents by optimizing neural functioning [13] (e.g., increasing prefrontal cortex activation to inhibit impulsive behavior), accumulating psychological resources [14] (e.g., emotion management, enhanced self-esteem), and promoting social behavioral norms [15] (e.g., adherence to rules and discipline in sports), thus reducing the occurrence of aggressive behavior.
Given the positive effects of physical exercise on mental and physical health [16, 17] and the improvement in social skills [18], several exercise programs have been implemented to prevent aggressive behavior. However, the impact of physical exercise on aggressive behavior remains inconsistent. Although some studies have reported reduced aggression in intervention groups compared with control groups [19, 20], others have reported no significant reduction [21, 22], and others have indicated a potential increase in aggressive behaviors following physical exercise [23].
This heterogeneity may stem (1) Participant Age and baseline aggression levels significantly moderate outcomes; (2) Characteristics of physical exercise, which include exercise type, teaching method, duration of exercise and exercise lengths. Exercise Physiological mechanisms differ across activities (e.g., team sports vs. martial arts), variably influencing aggression; teaching under the same type of exercise, variations in teaching methods—categorized by social interaction patterns (individual vs. group) and degree of physical contact (contact vs. noncontact)—may differentially impact aggression reduction. For instance, within soccer interventions, Trajković et al. [24] used contact-based confrontational exercises and reported a significant reduction in aggressive behavior, whereas Perić et al. [25] used noncontact technical exercises and reported no reduction in aggressive behavior; Duration Variations in duration of exercise and session length may trigger “time window effects” in behavioral adaptation.
Existing systematic reviews have explored the impact of physical exercise on aggressive behavioral issues in children and adolescents, focusing on the relationship between physical exercise and aggressive behavior [26] and the externalizing problems of aggressive behavior [27] (such as delinquency and other behavioral issues). Unfortunately, systematic reviews on the impact of physical exercise on aggressive behavior in children and adolescents remain lacking. Moreover, whether the heterogeneity in the effects of physical exercise on aggressive behavior can be attributed to participants’ baseline levels and characteristics of physical exercise has not been thoroughly studied.
In summary, systematic research evaluating the effects of physical activity on aggressive behaviors in children and adolescents and establishing an evidence-based foundation for targeted interventions are critically imperative. Therefore, this study has two (1) to evaluate the effects of physical exercise on overall aggressive behavior, physical aggression, verbal aggression, anger, and hostility in children and adolescents and (2) to explore the moderating effects of participant characteristics and exercise characteristics on aggressive behavior.
This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [28] and the implementing PRISMA in Exercise, Rehabilitation, Sports Medicine and Sports Science (PERSiST) guidelines [29]. The study protocol was registered with PROSPERO (registration CRD420251038714). The PRISMA checklist is provided in Supplemental Material 1.
A combination of subject terms and free terms was used to conduct a computerized search of five PubMed, Web of Science, Scopus, EBSCOhost, and CNKI. The search period spanned from the establishment of each database to December 25, 2024. The search strategy was constructed using keywords such as children, adolescents, aggressive behavior, physical exercise, and randomized controlled trials to identify experimental studies on the effects of physical exercise on aggressive behavior in children and adolescents. Additionally, a comprehensive search of the references of related meta-analyses was conducted to ensure that the inclusion of all the articles that meet the study criteria. The search strategies for and screenshots of different databases are provided in Supplemental Material 2.
The inclusion and exclusion criteria were developed using the Participants, Interventions, Comparisons, Outcomes, and Study design (PICOS) framework. The inclusion criteria were as (P) children aged 6–12 years or adolescents aged 13–18 years; (I) physical exercise as the sole intervention in this study, excluding acute interventions; (C) nonexercise control groups (e.g., waitlist control or health education) or regular physical activities; (O) the effects of physical exercise on aggressive behavior measured using validated scales; and (S) study randomized controlled trials (RCTs) or quasiexperimental studies. The exclusion criteria were as (1) intervention studies involving other health interventions (e.g., dietary or sleep interventions combined with physical exercise); (2) document conference papers; and (3) study cross-sectional (correlational) studies.
All records retrieved from the electronic databases were imported into EndNote software for deduplication. Two reviewers independently screened the titles and abstracts to exclude articles that were irrelevant to the research question. The full texts of potentially eligible studies were subsequently assessed to determine their inclusion in the systematic review. At each stage, decisions were made by consensus between the two reviewers. Any discrepancies were resolved through discussion until a consensus was reached.
Two reviewers independently extracted the data, and any discrepancies were resolved through discussion until a consensus was reached. A standardized online form was used to extract and record the following basic study details (author, publication year, country), participant characteristics (age and sample size), intervention features (type of exercise, teaching methods, duration, and session length), and additional data (control group intervention, measurement tools, and outcome indicators, including the M and SD), Given the potential ambiguities in defining physical contact, the following criteria were standardized for data Contact-based Interventions that included combative drills, simulated games, or official matches involving physical contact. Non-contact Interventions focusing on individual skill development or physical fitness training without physical opposition. In accordance with the Cochrane Handbook, we extracted the pre- and postintervention means and standard deviations for the outcome measures. For studies that did not report change scores, we used the following mean change = mean post − mean pre and SD change = SQRT [(SDpre² + SD post²) − (2 × Corr × SDpre × SDpost)]. Here, SQRT denotes the square root calculation and Corr is the correlation coefficient, which is assumed to be 0.5 [30]. If the necessary statistical data (e.g., M and SD) were not directly reported, we calculated them based on available information, such as the sample size and standard error, following guidance from the Cochrane Handbook. In cases where missing data could compromise study inclusion, the authors were contacted via email up to two times. If no response was received, the study was excluded from the analysis.
The outcome measure in this study was operationalized as aggressive behavior. Because aggressive behavior typically encompasses externalizing behavioral problems manifested in forms such as violence and criminal conduct, this investigation specifically utilized composite scores of total aggressive behavior, physical aggression, verbal aggression, anger, and hostility as outcome measures.
Two reviewers independently assessed the risk of bias in the included studies using the Cochrane risk of bias tool [31] (ROB 2.0). This tool evaluates six (1) randomization process bias, (2) deviations from intended intervention bias, (3) missing outcome data bias, (4) outcome measurement bias, (5) reported result selection bias and (6) overall bias. All assessments were conducted independently by two reviewers, and any discrepancies were resolved through discussion until a consensus was reached.
Two reviewers independently employed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of evidence. The GRADE framework classifies the certainty of evidence as “high,” “moderate,” “low,” or “very low” by assessing five key domains, including risk of bias, consistency, directness, precision, and publication bias.
All statistical analyses were performed using RevMan 5.4 and Stata 15.0. Owing to variations in the assessment tools for aggressive behavior across the included studies and the continuous nature of the outcome variables, standardized mean differences (SMDs) with 95% CIs were calculated to estimate effect sizes. A p value of < 0.05 was considered statistically significant.
According to the Cochrane Handbook, the magnitude of effect sizes was categorized as small (SMD = 0.2), moderate (SMD = 0.5), or large (SMD = 0.8) [32]. Heterogeneity among studies was assessed via the I² statistic and Cochran’s Q test. If P > 0.1 and I² ≤ 50%, heterogeneity was deemed acceptable, and a fixed effects model was applied. If P ≤ 0.1 and I² > 50%, a random effects model was used. Publication bias was assessed via funnel plot symmetry and Egger’s test. In cases of significant publication bias, the trim-and-fill method was applied to adjust the pooled estimates, thus enhancing the robustness of the results.
To identify sources of heterogeneity or explore potential moderating effects, subgroup analyses were conducted based on participant characteristics and exercise characteristics (type of exercise, teaching method, duration, and session length). Although characteristics such as low socioeconomic status (SES) and overweight status may serve as confounding factors. However, since these factors are commonly used to define “high-risk aggressive behavior” groups, we will also conduct subgroup analyses based on these variables to compare the effects of physical exercise between high-risk and healthy groups. It should be noted that due to limitations in data access, the results of this analysis should be interpreted as a descriptive comparison. Sensitivity analysis was performed using the leave-one-out method and by excluding studies deemed to have a high overall risk of bias. If the combined effect size, direction, and significance after dual sensitivity analyses were consistent with the original analysis, the results were considered stable.
A total of 6,711 relevant articles were identified through the initial literature search. Two additional studies were included from the references of previous reviews. Duplicate articles were removed using EndNote (n = 2,079), leaving 4,634 potentially eligible studies. After screening the titles and abstracts, 52 studies were selected for full-text review. Based on the inclusion and exclusion criteria, 34 studies were further excluded after full-text evaluation (Supplemental Material 3). Ultimately, 18 studies were included in the quantitative analysis. The literature selection process and results are depicted in (Fig. 1).
Fig. 1Flowchart of the screening process
A total of 18 studies [19–25, 33–43] involving 2,497 participants were included (exercise 1,335; control 1,162), with a mean age range of 7 to 18 years. Among them, 7 studies focused on 836 children and adolescents with behavioral problems, including children with aggressive tendencies [33], those diagnosed with attention deficit hyperactivity disorder (ADHD) [19, 22], those diagnosed with emotional disorders [34], those with disciplinary violations [21, 35], and those diagnosed with Down syndrome [25]. The studies originated from 13 China [19, 33, 36] (n = 3), Serbia [20, 24, 25] (n = 3), and the United States [37, 38] (n = 2), as well as Italy [39], Iran [34], Sweden [40], South Korea [41], France [23], Israel [42], the Netherlands [35], Canada [22], Australia [21], and Bangladesh [43]. All studies implemented interventions on a weekly basis, with exercise durations ranging from 2.5 weeks [37] to 48 weeks [23], exercise frequencies ranging from 1 [33, 34] to 5 days per week [38], and session lengths ranging between 20 min [38] and 90 min [21, 22, 33]. The types of exercise interventions included combat sports (n = 5) [23, 33, 37, 39, 40], ball sports (n = 8) [19, 21, 22, 24, 25, 36, 38, 42], physical fitness exercises (n = 3) [21, 35, 41], and yoga practices [34, 43]. The teaching methods for physical exercise encompass two key social interaction patterns and the degree of physical contact. The social interaction patterns in physical activity are categorized into individual-based and group-based formats. Specifically, individual-based formats were employed in 10 studies [19, 21, 23, 33, 37, 39–41, 43], whereas group-based formats were used in 8 studies [20, 22, 24, 25, 35, 36, 38, 42]. Based on the degree of physical contact involved during instruction, physical exercise was further classified into contact-based and noncontact-based formats. Contact-based physical activities were reported in 7 studies [23, 24, 33, 35, 39, 40, 42], whereas noncontact-based formats were reported in 11 studies [19–22, 25, 34, 36–38, 41, 43]. The most commonly used instruments for measuring aggressive behavior include the Buss-Perry Aggression Questionnaire (n = 7) [20, 23, 24, 36, 39, 42], followed by the Child Behavior Checklist (n = 4) [19, 22, 33, 34] and self-developed aggression scales (n = 3) [25, 37, 41]. Other tools employed included the Buss–Durkee Hostility Inventory [35], the Aggression Scale [21], the Pediatric Anger Expression Scale [38], and the Aggression Orientation Scale [43]. With respect to outcome indicators for aggressive behavior, 13 studies reported total aggression scores, 7 reported physical aggression scores, 6 reported verbal aggression scores, 6 reported anger scores, and 7 reported hostility scores. The detailed characteristics of the studies are provided in Supplemental Material 4.
Regarding the risk of bias in the included studies, the majority were judged to raise some concerns (n = 14, 77.8%), followed by low risk (n = 2, 11.1%) and high risk (n = 2, 11.1%). Most studies implemented and adequately described randomization procedures. The primary sources of bias were inadequate reporting of allocation concealment and lack of assessor blinding. Supplemental Material 5.1 presents the risk of bias ratings for individual studies. A summary of the risk of bias assessments is shown in (Fig. 2).
Fig. 2Summary of the risk in the included RCTs
The certainty of evidence was assessed via the GRADE approach, with detailed findings provided in Supplemental Material 5.2. Owing to risks of bias in the randomization process, publication bias, and substantial heterogeneity in pooled results among some included studies, the certainty of evidence for physical exercise in reducing overall aggression, verbal aggression, and anger was rated as “moderate”. However, because no downgrading factors were identified for physical aggression and hostility, the certainty of evidence regarding the effects of physical exercise on these outcomes was judged to be “high”.
As shown in Fig. 3, physical exercise had a moderate to strong effect on reducing aggressive behavior among children and adolescents, with the difference being statistically significant [SMD = −0.55, 95% CI (−0.89, −0.21), p < 0.01]. However, no significant improvement in aggressive behavior was observed in healthy children and adolescents [SMD = −0.41, 95% CI (−0.96, 0.15), P = 0.15]. The overall heterogeneity was substantial, We explored the sources of this heterogeneity through sensitivity analysis and subgroup analysis.
Fig. 3Forest plot of the impact of physical exercise on aggressive behavior
Physical exercise selectively improves subindicators of aggressive behavior in children and adolescents. Compared with the control group, physical exercise had a moderate to large effect on reducing physical aggression [SMD = −0.56, 95% CI (−0.81, −0.32), p < 0.01, I² = 70%]. It also had a small to moderate effect on reducing anger [SMD = −0.45, 95% CI (−0.68, −0.22), p < 0.01, I² = 73%] and hostility [SMD = −0.46, 95% CI (−0.68, −0.24), p < 0.01, I² = 63%]. However, no significant reduction in verbal aggression was observed [SMD = −0.28, 95% CI (−0.62, 0.06), p = 0.11, I² = 76%].
Owing to the limited number of studies reporting subindicators of aggressive behavior, most studies reported only the total aggression score. Therefore, our subgroup analysis was based on this score. The analysis revealed significant differences in the impact of various characteristics of physical exercise and participant traits on aggressive behavior, as shown in Table 1. Forest plots for subgroup analyses are presented in Supplemental Material 6.1, The forest plot for the subgroup analysis of healthy populations is provided in Supplementary Material 6.2.
Table 1Results of subgroup analysisFactorsZSMD95% CI P I^2^WeightExercise TypesBall sports4.79−1.04−1.46, −0.61< 0.0127%26%Combat sports0.17−0.03−0.43, 0.360.8672%32.5%Physical fitness exercises0.93−0.22−0.67, 0.240.3580%29.6%Yoga practice1.22−2.10−5.47, 1.260.2296%11.9%Teaching MethodsIndividual contact0.030.01−0.49, 0.510.9880%25.2%Group contact0.80−0.11−0.37, 0.150.42-9.0%Individual noncontact2.34−0.80−1.47, −0.130.0289%46.4%Group noncontact5.11−1.18−1.64, −0.73< 0.0115%19.1%Duration (Week)< 40.63−0.20−0.80, 0.410.53-7.3%8–163.80−1.03−1.57, −0.50< 0.0182%58.1%> 161.080.09−0.08, 0.260.2825%34.6%Length30–60 min3.46−1.03−1.61, −0.45< 0.0182%70.4%90 min0.30−0.06−0.45,0.330.5874%29.6%Baseline LevelsHigh2.87−0.72−1.22, −0.23< 0.0188%49.2%Low3.17−0.41−0.96, 0.150.1586%50.8%AgesChildren2.48−0.76−1.36, −0.160.0184%57%Adolescents2.11−0.54−1.04, −0.040.0386%43%“-”: indicates that this metric is derived from only one publication, precluding heterogeneity
Subgroup analysis by exercise type revealed a significant reduction in aggressive behavior with ball sports. No significant reduction in aggressive behavior was observed with combat sports (p = 0.86), physical fitness exercises (p = 0.35), or yoga (p = 0.22). This finding suggests that the type of exercise may be a source of heterogeneity.
In the subgroup of healthy children and adolescents, ball sports significantly reduced aggressive behavior (P < 0.01). No significant improvement in aggressive behavior was observed with combat sports (P = 0.13), physical fitness exercises (P = 0.10), or yoga (P = 0.40).
The subgroup analysis of teaching methods revealed that the group noncontact method (p < 0.01) was more effective in reducing aggressive behavior compared with the individual noncontact method (p = 0.02). No significant reductions in aggressive behavior with the individual-contact method (p = 0.98) or the group-contact method (p = 0.42) were observed. This finding suggests that the mode of social interaction and the degree of physical contact in exercise teaching may also be sources of heterogeneity.
In the subgroup of healthy children and adolescents, the group non-contact method significantly reduced aggressive behavior (P < 0.01). No significant improvement in aggressive behavior was observed with the individual non-contact method (P = 0.20) or the individual contact method (P = 0.05, SMD = 0.27).
The subgroup analysis of exercise duration revealed that a period of 8–16 weeks significantly reduced aggressive behavior (p < 0.01). In contrast, durations longer than 16 weeks (p = 0.28) and shorter than 4 weeks (p = 0.53) were not significantly reduced. This finding suggests that the duration of physical exercise may be a source of heterogeneity.
In the subgroup analysis of healthy children and adolescents, interventions lasting 8–16 weeks significantly reduced aggressive behaviors (p < 0.01). However, no significant intervention effects on aggression reduction were observed for durations shorter than 4 weeks (p = 0.53) or longer than 16 weeks (P = 0.05, SMD = 0.17).
The subgroup analysis of exercise duration per session indicated that sessions lasting 30–60 min significantly reduced aggressive behavior (p < 0.01). In contrast, sessions lasting 90 min (p = 0.76) resulted in no significant reduction. This finding suggests that the duration of each exercise session may be a source of heterogeneity.
In the subgroup of healthy children and adolescents, exercise lasting 30–60 min significantly reduced aggressive behavior (p = 0.03). However, exercise lasting 90 min did not result in a statistically significant improvement in aggressive behavior (p = 0.24).
Subgroup analysis based on participant characteristics revealed significantly greater improvement in aggressive behavior among participants with higher baseline aggression levels (p < 0.01). No significant reduction in aggressive behavior was observed with low baseline levels of aggressive behavior (p = 0.15). Participant characteristics may be one of the sources of heterogeneity.
Age-stratified subgroup analysis revealed statistically significant reductions in aggressive behavior following physical exercise interventions in both children (p = 0.01) and adolescents (p = 0.03), whereas no moderating effect of age was observed.
For the included studies, funnel plots for overall aggressive behavior, physical aggression, verbal aggression, anger, and hostility were constructed, and Egger’s test was performed. The combined assessment of the visual funnel plot (Supplemental Material 7.1) and Egger’s test results (Supplemental Material 7.2) indicated the presence of publication bias for total aggressive behavior (p = 0.017). The trim-and-fill method was used to account for potentially unpublished studies. The results demonstrated that no additional studies were required to balance the funnel plot, confirming robust outcome stability and a low risk of publication bias (Supplemental Material 7.3).
These results remained unchanged in terms of effect size, significance, and direction following dual sensitivity analyses (Supplemental Material 8). Specifically, the outcomes for total aggressive behavior [SMD = −0.38, 95% CI (−0.69, −0.07), p = 0.01], physical aggression [SMD = −0.64, 95% CI (−0.87, −0.41), p < 0.01], verbal aggression [SMD = −0.23, 95% CI (−0.62, 0.17), p = 0.26], anger [SMD = −0.45, 95% CI (−0.68, −0.22), p < 0.01], and hostility [SMD = −0.46, 95% CI (−0.68, −0.24), p < 0.01] were unaltered after leave-one-out analysis was performed, and studies judged to have an overall high risk of bias were excluded, indicating robust stability of the meta-analysis results.
This study systematically integrated empirical research on the effects of physical exercise on aggressive behavior and its subindicators in children and adolescents. To our knowledge, this study is the first meta-analysis to explore the impact of exercise characteristics and individual characteristics on aggressive behavior, yielding several key findings that confirm the benefits of physical exercise in addressing issues related to aggressive behavior. Specifically, (1) physical exercise can effectively address aggressive behavioral problems in children and adolescents, selectively reducing physical aggression, anger, and hostility; (2) using subgroup analysis, the study clarified the differences in the reduction in aggressive behavior based on various exercise characteristics (type of exercise, teaching method, duration, and session length) and participant characteristics. Compared with previous studies, this research confirms the effect of physical exercise on aggressive behavior in children and adolescents; quantifies the moderating effects of different exercise types, teaching methods, exercise durations, session length, and participant characteristics on aggressive behavior; and clarifies the dosage range of exercise settings and the application choices of exercise and teaching methods. This study advances the development of effective, scientific programs and provides guidance for personalized exercise prescriptions for children and adolescents.
Physical exercise effectively reduces aggressive behavior in children and adolescents, A stronger effect was observed, particularly among children and adolescents with behavioral issues, which is consistent with prior findings [27, 44]. This behavioral improvement may involve synergistic mechanisms of physiological catharsis, cognitive restructuring, and (1) Catharsis theory [45] and physiological release exercise may discharge aggressive impulses through caloric expenditure [46] and modulation of the cortisol‒testosterone balance [47, 48], thereby attenuating physical aggression. (2) Social learning theory [49] and cognitive restructuring provide positive reinforcement of cooperative behaviors (e.g., praise) and negative feedback on aggression (e.g., criticism) during exercise modify cognitive patterns; this corrects hostile attribution bias [50], enhances confidence in resolving social conflicts [51], and reduces negative societal perceptions, ultimately decreasing aggressive behavior. (3) Self-control theory [52] and emotional regulation are important. Self-control capacities (e.g., inhibiting anger impulses) rely on exhaustible psychological resources. Exercise may expand this resource capacity through prefrontal cortex enhancement [53, 54], suppressing anger-induced aggression. In summary, physical exercise can comprehensively reduce aggressive behavior through three physiological catharsis, cognitive restructuring, and neural regulation.
Ball sports effectively address aggressive behavior in children and adolescents, which is consistent with prior findings [55]. This effect likely stems from their unique exercise characteristics and sociopsychological mechanisms. The defined rule structures and team collaboration inherent in ball sports require participants to inhibit impulsive actions—directly addressing the core deficit of aggression (i.e., deficient self-control). Repeated rule-compliance practices may strengthen prefrontal cortex-mediated self-regulation [56], thereby reducing aggression. Furthermore, social learning theory [49] posits that aggression partially originates through imitation and reinforcement. Ball sports substitute aggressive competition with cooperative Participants observing prosocial teammate behaviors (e.g., cooperation, encouragement) subsequently exhibit reduced behavioral manifestations of aggression [57]. Although combat sports and physical fitness exercises may enhance self-control, the limited social interaction and rule constraints in physical fitness exercises and yoga, along with the unique training content of combat sports (such as simulated attack movements), may increase aggressive cognition through observational learning, especially in adolescents with poor impulse control, potentially leading to an increase in aggressive behavior [58].
Subgroup analysis of teaching methods revealed significant differences in the effectiveness of various physical exercise teaching methods in reducing aggressive behavior in children and adolescents, with noncontact group teaching being the most effective. This result suggests that the intervention effect of physical exercise on aggressive behavior is closely related to the mode of social interaction and the degree of physical contact in instruction. From the perspective of social interaction modes, group activities promote prosocial behavior and reduce hostile attribution bias [50] through cooperation, role division, and positive behavior modeling (such as encouragement and sharing) [59], thus reducing the occurrence of aggressive behavior. In contrast, although individual sports can alleviate short-term aggressive emotions through physiological arousal regulation (such as reducing cortisol) [60], they lack the social interaction necessary to address the cognitive roots of aggressive behavior [59]. Analyzing the dimension of physical contact, noncontact environments reduce the direct stimuli of physical conflicts, preventing aggressive, conditioned reflexes [2]. In contrast, contact sports (such as football) that allow reasonable physical collisions may be misinterpreted by children and adolescents as “aggression is acceptable” [61], thus increasing the risk of transferring aggressive tendencies. Furthermore, although a classification framework for instructional approaches was established based on the intervention content to enhance the validity of subgroup analyses, the lack of detailed descriptions of intervention protocols in some original studies may have compromised the accuracy of the categorization.
Exercise duration demonstrated a critical time window effect on aggression reduction in children and Interventions spanning 8–16 weeks yielded optimal efficacy. This result can be explained through unique neurobehavioral mechanisms and motivational theory perspectives. The limited effect of short-term interventions may be due to their brief duration, which poses limitations such as delayed neuroplasticity [62] and insufficient behavioral learning [63, 64]. Self-control is a crucial mediating variable in reducing aggressive behavior through physical exercise, and enhancement of the prefrontal cortex (the brain region associated with self-control) requires at least 4–6 weeks of continuous stimulation to induce synaptic remodeling [65]. Additionally, alternative strategies for aggressive behavior need repeated reinforcement to form automatic responses, which short-term interventions cannot achieve [66]. An optimal duration of 8–16 weeks enhances synaptic stimulation in the prefrontal cortex, improving inhibitory control and thus reducing aggressive behavior [67]. However, when the exercise duration extends to 16 weeks or longer, adaptive fatigue [68] may weaken intrinsic motivation and adherence, and confounding environmental factors [69, 70] may lead to diminished effects.
Exercise sessions lasting 30–60 min demonstrated significant efficacy in reducing aggressive behavior among children and adolescents. This aligns with arousal-performance theory [71]. Specifically, medium-duration exercise (30–60 min) achieves optimal prefrontal cortex activation [72] and thus more effectively suppresses aggressive behavior. Additionally, based on the attention resource theory, such a session length provides “optimal cognitive arousal” [13], preventing self-control depletion induced by cognitive overload during prolonged exercise [73]. This sustains inhibitory control capacity.
Conversely, excessive session length (> 60 min) triggers lactate accumulation and elevated cortisol [67]. Progressive fatigue accumulation and diminished motivation [74] may foster exercise-induced aversion [75], compromising adherence and potentially exacerbating aggression.
Physical exercise demonstrated comparable efficacy in reducing aggressive behavior across children and adolescents, with no moderating effect of age observed; this confirms the consistent therapeutic efficacy of exercise interventions in both cohorts.
The ameliorative effects of physical exercise on aggressive behaviors were particularly pronounced in children and adolescents with high baseline aggression levels, Especially among children and adolescents with behavioral issues, a stronger effect was observed, which is consistent with prior findings [44], a phenomenon closely associated with their distinctive neuropsychological profiles and environment-interaction mechanisms. Individuals with elevated baseline aggression frequently exhibit prefrontal–limbic system dysfunction, manifesting as impaired inhibitory control [76]. Furthermore, such populations are more susceptible to aggression due to social skill deficits (e.g., hostile attribution bias) [77]. Physical exercise mitigates aggressive behaviors in these individuals by enhancing inhibitory control and correcting hostile attribution bias through structured rule enforcement and prosocial behavior training. Notably, subjects with high baseline aggression demonstrate greater potential for improvement through exercise interventions [78], whereas those with low baseline levels may show limited amelioration owing to ceiling effects [79].
To reduce potential heterogeneity from special populations, such as those with ADHD or Down syndrome, we reanalyzed the effects exclusively in healthy children and adolescents. We also performed subgroup analyses based on exercise type, teaching method, intervention duration, and session length. After excluding clinical populations, the positive effects of exercise on aggression and their moderating patterns remained highly consistent with the overall analysis. These results reinforce the robustness and generalizability of our findings, demonstrating that they are not driven by special groups but are equally evident in typically developing children and adolescents. Sensitivity analyses further confirmed that the relationship between exercise and aggression is independent of specific pathological conditions, underscoring its applicability to normal development. Overall, by removing clinical confounding factors, our analyses provide a stronger and more generalizable evidence base for the benefits of exercise interventions.
Our study has several advantages. First, it compiles all the evidence on the impact of physical exercise on aggressive behavior in children and adolescents, confirming the effectiveness of physical exercise in addressing aggressive behavior. The findings of this study provide important insights for the development of future intervention programs and scientific research. Additionally, using subgroup analysis, we explored the moderating effects of exercise characteristics and population characteristics on reducing aggressive behavior. We quantified the actual effects of different exercise types, teaching methods, exercise durations, session length, and participant characteristics on the modulation of aggressive behavior. By doing so, we clarified the dosage range of exercise settings and the application choices of exercise and teaching methods, advancing the development of effective, scientific programs and providing guidance for personalized exercise prescriptions for children and adolescents. Finally, we used multiple sensitivity analyses and subgroup analyses to verify the stability of the results and identify potential sources of heterogeneity, confirming the robustness of the findings.
Nevertheless, the current systematic review has several limitations. First, the diversity of intervention programs and measurement tools in the included studies resulted in considerable heterogeneity in the findings. To increase the reliability of the results, we conducted subgroup and sensitivity analyses across multiple dimensions. Second, the number of studies included in the meta-analysis was relatively small, particularly with limited data reporting on subindicators of aggressive behavior, which restricts our ability to perform subgroup analyses on these subindicators. Future research needs to supplement high-quality evidence. An additional limitation of this study is that, for known confounders such as low socioeconomic status (SES) and overweight status, we were unable to perform pooled analyses using adjusted effect sizes across all included studies. Future research should prioritize the inclusion of original studies that report adjusted estimates or employ individual participant data meta-analysis to more accurately verify these moderation effects. Finally, some studies did not report specific methods for allocation concealment and blinding, which may lead to potential publication bias. We effectively assessed the risk of bias in the included studies using the Cochrane risk of bias tool and adjusted the results using the trim-and-fill method to ensure the robustness of the findings.
Physical exercise significantly reduces aggressive behavior in children and adolescents. These reductions are moderated by the characteristics of the exercise interventions and participant demographics.
Supplementary Material 1