Evidence Summary
There were seven studies looking at the effect of physical activity and sports participation on self-esteem.
· There is evidence from one meta-analysis (including both interventional and observational studies) that physical activity is positively associated with self-esteem and psychological wellbeing (1).
· There is evidence from two randomised controlled trials that exercise has the potential to improve self-esteem (2, 3) . The effect size was small (intervention=2.3% vs control=0.1%), and the difference was statistically significant.
· One cross-over trial, using yoga as the intervention, found a significant positive treatment effect for self-esteem in adolescents (4).
· Three longitudinal studies did not find that changes in physical activity were related to changes in global self-esteem (5, 6, 7).
2.1 There is evidence from one case control study that adolescents who participate in sport have higher self-esteem than controls (8).

Quality of Evidence
A – high quality
Strength of Recommendation
1 Strong recommendation, from a range of robust study designs including meta-analysis, RCTs, longitudinal studies
Conclusion
There is evidence from interventional studies that physical activity, sport and yoga can improve self-esteem for children and adolescents.

References
· Rodriguez-Ayllon M, Cadenas-Sanchez C, Estévez-López F,et al. Role of physical activity and sedentary behavior in the mental health of preschoolers, children and adolescents: a systematic review and meta-analysis. Sports medicine. 2019 Apr 16:1-28.
· Bonhauser M, Fernandez G, Püschel K, et al. Improving physical fitness and emotional well-being in adolescents of low socioeconomic status in Chile: results of a school-based controlled trial. Health Promotion International. 2005 Jun 1;20(2):113-22.
· Lindwall M, Lindgren EC. The effects of a 6-month exercise intervention programme on physical self-perceptions and social physique anxiety in non-physically active adolescent Swedish girls. Psychology of Sport and Exercise. 2005 Nov 1;6(6):643-58.
· Beets MW, Mitchell E. Effects of yoga on stress, depression, and health-related quality of life in a nonclinical, bi-ethnic sample of adolescents: A pilot study. Hispanic Health Care International. 2010 Apr 1;8(1):47.
· Van Dijk ML, Savelberg HH, Verboon P, et al. Decline in physical activity during adolescence is not associated with changes in mental health. BMC public health. 2016 Dec;16(1):300.
· Fløtnes IS, Nilsen TI, Augestad LB. Norwegian adolescents, physical activity and mental health: The Young-HUNT study. Norsk epidemiologi. 2011 Aug 3;20(2).
· Lindwall M, Asci H, Crocker P. The physical self in motion: within-person change and associations of change in self-esteem, physical self-concept, and physical activity in adolescent girls. Journal of Sport and Exercise Psychology. 2014 Dec 1;36(6):551-63.
· Karakaya I, Çoşkun A, Ağaoğlu B. Evaluation of depression, anxiety and self-esteem levels in swimmers. Anatolian Journal of Psychiatry. 2006;7(3):162-6.