Comparative effectiveness of school-based physical activity interventions on moderate-to-vigorous physical activity in children and adolescents: a systematic review and network meta-analysis.

BACKGROUND: Schools provide important opportunities for promoting moderate-to-vigorous physical activity (MVPA) among children and adolescents. However, the comparative effectiveness of different school-based physical activity intervention strategies remains unclear. This systematic review and network meta-analysis compared the effects of different school-based physical activity interventions on MVPA in children and adolescents. METHODS: A systematic search was conducted in PubMed, Embase, CENTRAL, ERIC, PsycINFO, Web of Science Core Collection, Scopus, SPORTDiscus, ClinicalTrials.gov, and WHO ICTRP from inception to 8 May 2026, with no language restrictions. Randomized controlled trials (RCTs) and cluster-randomized controlled trials (cluster-RCTs) of school-based physical activity interventions in children and adolescents were included. Risk of bias was assessed using RoB 2. Random-effects pairwise meta-analysis, network meta-analysis, and sensitivity analyses were performed. Certainty of evidence was assessed using the Confidence in Network Meta-Analysis (CINeMA) framework. RESULTS: A total of 41 studies were included in the systematic review, and 29 were included in the network meta-analysis. Compared with the control condition, PE/curriculum-focused interventions were associated with higher MVPA (SMD = 0.21, 95% CI: 0.07 to 0.35), as were whole-school interventions (SMD = 0.21, 95% CI: 0.07 to 0.34). Additional physical activity opportunities beyond the regular curriculum showed no clear effect on MVPA (SMD = 0.07, 95% CI: -0.05 to 0.18). Certainty of evidence was moderate for PE/curriculum-focused and whole-school interventions and low for additional physical activity opportunities. CONCLUSIONS: School-based physical activity interventions showed strategy-specific effects on MVPA among children and adolescents. Current evidence suggests that PE/curriculum-focused and whole-school interventions are associated with small but potentially meaningful improvements in MVPA, whereas the effects of additional PA opportunities beyond the regular curriculum remain uncertain. TRIAL REGISTRATION: PROSPERO, CRD420261388278.