College students represent a unique group undergoing a critical transition from adolescence to early adulthood, which is often considered one of the most stressful periods of life.1 During this period, they may face significant stressors, such as academic pressure, financial strain, social challenges, and career-related concerns.2,3 These additional stressors can increase the risk of stress-related mental health issues, such as depression and anxiety.4,5 According to the National Healthy Minds Study, the prevalence of one or more mental health problems increased by 49.7% among students at 373 universities in the United States between 2013 and 2021.6 For example, the prevalence of depression and anxiety symptoms increased by 134.6% and 109.5%, respectively. Additionally, data from the 2021–2022 academic year showed approximately 190,907 unique college students from 180 universities sought mental health treatment and clinical services.7 Therefore, addressing the mental health challenges faced by college students and promoting their well-being have become primary concerns for both the college community and public health professionals.8
Self-esteem is widely recognized as a crucial moderator between stress and mental health illnesses.9,10 High self-esteem is linked to better mental health outcomes, while low self-esteem is associated with various mental disorders (eg, anxiety and depression).11 Physical self-perception, which refers to an individual’s perception of the self in physical contexts,12 is a key psychological construct that significantly influences self-esteem and mental health.13,14 According to the Physical Self-Perception Profile developed by Fox and Corbin,15 physical self-perception has subdomains of its own, which demonstrates physical self-worth is 1 domain that affects the global self-esteem of an individual, and an individual’s physical self-worth is built up by 4 types of physical self-perception: perceived sport competence, perceived body attractiveness, perceived physical strength, and perceived physical condition. Numerous studies have documented that poor physical self-perception is strongly associated with poor mental health,16 higher level of anxiety,17 and depression symptoms.18 These findings underscore the importance of enhancing individuals’ physical self-perception to improve their mental health.
In recent years, researchers have established a close relationship between physical activity and physical self-perception.19,20 Several cross-sectional studies have demonstrated that physical activity has positive direct effects on college students’ physical self-perception, which has also been identified as the most powerful mediating variable in relation to various mental health problems.19,20 Meanwhile, some researchers began to examine the effects of physical activity interventions on physical self-perception using experimental design.21–23 For instance, Kim and Ahn22 found that a 6-week aerobic exercise significantly improved physical self-perception among college students. Similarly, Liu reported positive effects on physical self-perception in college students following a 12-week sports participation.23 However, the impact of physical activity interventions on college students’ physical self-perception remains uncertain, as several studies have indicated no significant changes in physical self-perception among college students following an 8- to 16-week aerobic exercise program.24–26 Thus, summarizing the evidence regarding the effects of physical activity interventions on physical self-perception in this group is crucial.
To date, a few systematic reviews and meta-analyses have been conducted to examine the effects of physical activity interventions on physical self-perception.19,27–30 However, it is worth noting that prior reviews have predominantly focused on children and adolescents28,29,31 or investigated specific forms of physical activity like Taekwondo or aerobic exercise,27,30 potentially limiting the generalizability of their findings. As an extension of the above reviews, the present review therefore aimed to systematically summarize RCTs and non-RCTs that examine the effects of physical activity interventions on physical self-perception in college students. Findings of this review can provide more evidence-based exercise intervention programs for college students’ mental health.
Materials and Methods
Study Design
Systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement32 and Cochrane Handbook for Systematic Reviews of Interventions Version 6.4.33 This study was registered with International PROSPERO (CRD42023458092).
Search Strategy
Nine electronic databases, including Web of Science, PubMed, Cochrane Library, EBSCOhost, Embase, Scopus, CNKI, WanFang, and Chinese Technical Periodicals were searched from their inception to August 2023, with an updated search in April 2024. The following combinations of search terms were adopted: (physical self-esteem OR body-esteem OR physical self-perception OR body self-perception OR physical self-concept OR physical self-worth OR perceived sport competence OR perceived physical strength OR perceived physical condition OR perceived body attractiveness OR body self-concept OR physical self-efficacy OR body image OR body satisfaction OR physical appearance OR physical self OR physical fitness) AND (university student OR undergraduate OR college student) AND (sports OR athletics OR exercise OR athletic OR sports activities OR physical activities OR physical exercise OR physical training OR physical education). Additionally, reference lists of the included studies were screened for eligible research. Any disagreements in the retrieval process were negotiated by 2 researchers (Z.L. Yang and Z.Y. Yang) or consulted by the third researcher (Huang). Detailed search strategies are provided in Table S1 (see Supplementary Material [available online]).
Eligibility Criteria
The inclusion criteria were as follows: (1) participants were college students, (2) study design was RCT or non-RCT, (3) experimental group adopted exercise-based or physical activity interventions, (4) control group did not receive any forms of physical activity, (5) the outcome should include at least one physical self-perception (eg, physical self-worth and perceived sport competence), and (6) English and Chinese language studies.
The exclusion criteria were as follows: (1) participants were not college students; (2) cross-sectional studies; (3) experimental group did not adopt any physical activity interventions; (4) meeting abstracts, reports, or reviews; (5) did not report outcomes of physical self-perception or incomplete data; (6) irrelevant topic of this review; and (7) not written in English or Chinese language.
Study Selection and Data Extraction
All search records were imported into Endnote 20 (EndNote, Clarivate Analytics). After removing duplicates, 2 researchers (Z.L. Yang and Z.Y. Yang) independently screened studies based on title and abstract. Full texts were reviewed to select eligible studies further. The following data were independently extracted by 2 researchers (Z.L. Yang and Z.Y. Yang): bibliographic details (first author, publication year, and country), study design, participant characteristics (sample size, gender, and age), intervention characteristics (type, time, frequency, duration, and intensity), and outcome measure (eg, physical self-worth, perceived sport competence, and perceived physical strength). Any discrepancies in the study selection and data extraction processes were resolved through consultation with a third researcher (Huang).
Following the steps taken in prior meta-analyses,28,31 to facilitate data synthesis, the results from various questionnaires measuring similar constructs, but labeled differently, were merged. Thus, “physical self-concept” was considered as the “physical self-perception,” and “physical self-esteem” and “body esteem” were categorized as the “physical self-worth.” Besides, “perceived body attractiveness,” “physical appearance,” “body image,” and “perceived appearance” were aggregated. Furthermore, constructs like “physical ability” and “physical self-efficacy” were included within “perceived sport competence.”
Risk of Bias Assessment
Two researchers (Z.L. Yang and Z.Y. Yang) independently assessed the methodological quality of included studies using Cochrane’s revised risk of bias tools. For RCTs, the ROB 2.0 tool evaluated 5 domains: randomization process, deviations from interventions, missing outcome data, outcome measurement, and selection of results. Each domain was rated as “low,” “some concerns,” “high,” or “no information.” Studies with low bias across all domains were categorized as having a “low risk”; those with high bias in at least one domain were classified as “high risk”; those with “some concerns” followed similar rules as “high risk”; and those without details to assess the risk of bias were indicated as “no information.”34 Non-RCTs were assessed using Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) across 7 domains: confounding, selection of participants, interventions classification, deviations from interventions, missing data, outcomes measurement, and selection of results. Each domain was rated as “low,” “moderate,” “serious,” “critical,” or “no information.”35 A study comparable to a well-performed randomized trial is considered “low risk.” Nonrandomized studies providing sound evidence are classified as “moderate risk.” Studies with significant problems across all domains are categorized as “serious risk.” Those too problematic to provide useful evidence are classified as “critical risk.” “No information” indicates a lack of details to assess the risk of bias. Finally, the web application Robvis was used to summarize the risk of bias results for all included studies.36 If any disagreements occur during this process, a third researcher (Huang) was consulted.
Data Analysis and Synthesis
We performed a meta-analysis to examine the effects of physical activity interventions on physical self-perception. Due to the use of different instruments to measure outcome indicators, the effect size in each study was combined using standardized mean difference (SMD) with 95% CIs between groups. The magnitude of effect size was interpreted by Cohen d values: small (0.20–0.49), moderate (0.50–0.79), or large (≥0.8).37 Heterogeneity in effect sizes across studies was measured using the I2 statistic.38 The degree of heterogeneity was divided into low (≤25%), medium (50%), and high (≥75%) heterogeneity.39 When I2 > 50%, the random-effect model was adopted to pool the effect sizes; otherwise, the fixed effect model was used. To explore heterogeneity sources, sensitivity analysis by sequentially eliminating each study was used to assess the stability of the results. Subgroup moderator analyses were conducted through the following potential moderators: (1) study design (RCT and non-RCT), (2) intervention type (aerobic exercise, resistance training, and combined exercise [a training modality that involves different physical capacities in the same session]), (3) minutes of intervention per session (<90 min and ≥90 min), (4) frequency of intervention per week (<3 times/wk and ≥3 times/wk), and (5) duration of intervention (<12 wk, 12 wk, and > 12 wk). Publication bias was assessed via funnel plots when the number of included studies was ≥ 10.40 All data analyses were conducted using Review Manger software (version 5.4, Cochrane Collaboration).
Results
Study Selection
A total of 5801 studies were initially retrieved from 9 electronic databases, and 810 duplicate studies were removed. The remaining 4991 studies were screened by reading titles and abstracts, and 4221 studies were excluded. The remaining 770 full texts were screened further. Finally, 40 studies met the criteria and were included in this systematic review and meta-analysis (Figure 1).
—Flow diagram of the study selection.
Citation: Journal of Physical Activity and Health 21, 10; 10.1123/jpah.2024-0055
Study Characteristics
The basic characteristics of the included studies are shown in Table 1. A total of 40 studies (17 RCTs and 23 non-RCTs) included in this systematic review were published between 1993 and 2023. Most of them were conducted in China (n = 30), followed by Turkey (n = 4), the United States (n = 2), Australia (n = 1), Jordan (n = 1), Nigeria (n = 1), and Singapore (n = 1).
Characteristics of Included Studies (n = 40)
| First author, year (country) | Study design | Participants | Intervention | Outcomes (measure) | ||
|---|---|---|---|---|---|---|
| Sample size (gender) | Age (M [SD]; range) | Type | Time/frequency/duration/intensity | |||
| Alsaleh,41 2023 (Jordan) | RCT | EG: 68 (33 F/35 M) CG: 63 (29 F/34 M) Total: 131 (62 F/69 M) | EG: 21.30 (2.40) CG: 21.20 (2.30) Total: NR | EG: Brisk walking CG: No intervention | 30 min; 5 times/wk; 24 wk; moderate | Perceived sport competence (ESES) |
| Asci,42 2003 (Turkey) | RCT | EG: 20 (20 F) CG: 20 (20 F) Total: 40 (40 F) | EG: 21.35 (0.88) CG: 21.20 (1.67) Total: 19–25 | EG: Aerobic exercise, 2 step dance CG: No intervention | 50 min; 3 times/wk; 8 wk; moderate (60%–80% HRR) | Perceived sport competence, perceived physical strength (PSDQ) |
| Asci,43 2009 (Turkey) | RCT | EG: 70 (37 F/33 M) CG: 68 (36 F/32 M) Total: 138 (73 F/65 M) | EG: 22.16 (1.86) CG: 22.24 (1.66) Total: 18–27 | EG: Step dance CG: No intervention | 50 min; 3 times/wk; 10 weeks; moderate (60%–80% HRR) | Physical self-worth (TSCS) |
| Aşçi et al,24 1998 (Turkey) | RCT | EG: 30 (30 F) CG:15 (15 F) Total: 45 (45 F) | EG: NR CG: NR Total: 19–28 | EG: Aerobic and step training programs CG: No intervention | 45 min; 3 times/wk; 10 wk; moderate (60%–70% HRR) | Physical self-worth, perceived sport competence, perceived physical strength, perceived physical condition, perceived body attractiveness (PSPP) |
| Cai et al,44 2019 (China) | RCT | EG: 233 (233 F) CG: 246 (246 F) Total: 479 (479 F) | EG: 20.46 (1.52) CG: 20.62 (1.65) Total: NR | EG: Aerobics dance, running CG: No intervention | 50–60 min; 3 times/wk; 16 wk; moderate | Physical self-worth, perceived sport competence, perceived physical strength, perceived physical condition, perceived body attractiveness (PSPP) |
| Cai et al,45 2022 (China) | RCT | EG: 104 (53 F/51 M) CG: 104 (53 F/51 M) Total: 208 (106 F/102 M) | EG: 21.12 (2.12) CG: 21.22 (2.13) Total: NR | EG: Aerobic exercise, anaerobic exercise CG: No intervention | 50 min; 3 times/wk; 12 wk; moderate | Physical self-worth, perceived sport competence, perceived physical strength, perceived physical condition, perceived body attractiveness (PSPP) |
| Chen,46 2009 (China) | Non-RCT | EG: 240 (240 M) CG: 240 (240 M) Total: 480 (480 M) | NR | EG: Basketball CG: No intervention | 90 min; 1 time/wk; 18 wk; NR | Physical self-worth, perceived sport competence, perceived physical strength, perceived physical condition, perceived body attractiveness (PSPP) |
| Gao,47 2019 (China) | RCT | EG: 31 (16 F/15 M) CG: 31 (16 F/15 M) Total: 62 (32 F/30 M) | EG: 22.71 (1.22) CG: 21.75 (1.12) Total: 20–24 | EG: Resistance strength, aerobic exercise CG: No intervention | 90 min; 3 times/wk; 14 wk; moderate (60%–70% MHR) | Physical self-worth, perceived sport competence, perceived physical strength, perceived physical condition, perceived body attractiveness (PSPP) |
| Guo,48 2020 (China) | Non-RCT | EG: 40 (20 F/20 M) CG: 40 (20 F/20 M) Total: 80 (40 F/40 M) | EG: 19.25 (0.98) CG: 19.13 (0.97) Total: NR | EG: Aerobics dance CG: No intervention | 90 min; 3 times/wk; 16 wk; moderate | Physical self-worth, perceived sport competence, perceived physical strength, perceived physical condition, perceived body attractiveness (PSPP) |
| Hu,49 2007 (China) | Non-RCT | EG: 50 (30 F/20 M) CG: 25 (15 F/10 M) Total: 75 (45 F/30 M) | NR | EG: Badminton, aerobics dance CG: No intervention | 80 min; 2 times/wk; 19 wk; moderate | Physical self-worth, perceived sport competence, perceived physical strength, perceived physical condition, perceived body attractiveness (PSPP) |
| Huang,50 2022 (China) | Non-RCT | EG: 66 (66 F) CG: 66 (66 F) Total: 132 (132 F) | NR | EG: Aerobics dance CG: No intervention | 90 min; 1 time/wk; 12 wk; moderate to vigorous | Physical self-worth, perceived sport competence, perceived physical strength, perceived physical condition, perceived body attractiveness (PSPP) |
| John et al,51 2023 (Nigeria) | Non-RCT | EG: 45 (34 F/11 M) CG: 45 (37 F/8 M) Total: 90 (71 F/19 M) | EG: 21.36 (4.14) CG: 21.40 (3.12) Total: NR | EG: Resistance and Aerobic training CG: No intervention | 40 min; 3 times/wk; 6 wk; moderate (50%–70% HRR) | Perceived body attractiveness (COPS) |
| Kang,52 2018 (China) | Non-RCT | EG: 60 (60 F) CG: 30 (30 F) Total: 90 (90 F) | EG: 19.32 (0.89) CG: 20.13 (1.04) Total: NR | EG: Aerobics dance CG: No intervention | 90 min; 1 time/wk; 12 wk; moderate | Physical self-worth, perceived sport competence, perceived physical strength, perceived physical condition, perceived body attractiveness (PSPP) |
| Li,53 2009 (China) | RCT | EG: 60 (60 F) CG: 20 (20 F) Total: 80 (80 F) | NR | EG: Hip hop, basketball, calisthenics CG: No intervention | 60 min; 3 times/wk; 12 wk; moderate | Physical self-worth, perceived sport competence, perceived physical strength, perceived physical condition, perceived body attractiveness (PSPP) |
| Li,54 2011 (China) | Non-RCT | EG: 40 (40 F) CG: 40 (40 F) Total: 80 (80 F) | NR | EG: Hip hop CG: No intervention | 60 min; 3 times/wk; 12 wk; moderate | Physical self-worth, perceived sport competence, perceived physical strength, perceived physical condition, perceived body attractiveness (PSPP) |
| Li,55 2020 (China) | Non-RCT | EG: 32 (32 F) CG: 30 (30 F) Total: 62 (62 F) | EG: 20 CG: 21 Total: NR | EG: Aerobics dance CG: No intervention | 90 min; 1 time/wk; 16 wk; moderate | Physical self-worth, perceived sport competence, perceived physical strength, perceived physical condition, perceived body attractiveness (PSPP) |
| Liu,56 2010 (China) | Non-RCT | EG: 87 (87 F) CG: 30 (30 F) Total: 117 (117 F) | NR | EG: Kwando aerobics CG: No intervention | 40–80 min; 2–3 times/wk; 10 wk; moderate | Physical self-worth, perceived sport competence, perceived physical strength, perceived physical condition, perceived body attractiveness (PSPP) |
| Liu,23 2022 (China) | RCT | EG: 74 (NR) CG: 36 (NR) Total: 110 (48 F/62 M) | NR | EG: Physical exercise CG: No intervention | 40 min; 3 times/wk; 12 wk; moderate (50%–80% MHR) | Perceived physical condition, perceived body attractiveness (SES) |
| Ma,57 2013 (China) | Non-RCT | EG: 300 (132 F/168 M) CG: 100 (50 F/50 M) Total: 400 (182 F/218 M) | EG: NR CG: NR Total: 17–22 | EG: Jogging CG: No intervention | 40–60 min; 4 times/wk; 48 wk; moderate | Physical self-worth, perceived sport competence, perceived physical strength, perceived physical condition, perceived body attractiveness (PSPP) |
| Mailey et al,58 2010 (The United States) | RCT | EG: 23 (NR) CG: 24 (NR) Total: 47 (32 F/15 M) | EG: NR CG: NR Total: 18–22 | EG: Jogging CG: No intervention | 40 min; 5 times/wk; 10 wk; moderate | Perceived sport competence (ESES) |
| McInman et al,59 1993 (Australia) | Non-RCT | EG: 75 (75 F) CG: 42 (42 F) Total: 117 (117 F) | EG: 23.09 (5.19) CG: 20.39 (2.50) Total: NR | EG: Strengthening and aerobic exercises CG: No intervention | 60 min; 1 time/wk; NR; moderate | Perceived sport competence, perceived body attractiveness (SDQ) |
| Özdemir et al,60 2010 (Turkey) | RCT | EG: 36 (36 M) CG: 12 (12 M) Total: 48 (48 M) | EG: NR CG: NR Total: 21.84 (1.87) | EG: Swim, cycle, run CG: No intervention | 40 min; 3 times/wk; 12 wk; moderate (60%–70% HRR) | Physical self-worth, perceived sport competence, perceived physical strength, perceived physical condition, perceived body attractiveness (PSPP) |
| Pan,61 2011 (China) | Non-RCT | EG: 72 (72 F) CG: 36 (36 F) Total: 108 (108 F) | NR | EG: Yoga CG: No intervention | 90 min; 2 times/wk; 14 wk; moderate | Physical self-worth, perceived sport competence, perceived physical strength, perceived physical condition, perceived body attractiveness (PSPP) |
| Pan,62 2021 (China) | Non-RCT | EG: 60 (60 F) CG: 60 (60 F) Total: 120 (120 F) | NR | EG: Aerobics dance CG: No intervention | 90 min; 1 time/wk; 16 wk; moderate | Physical self-worth, perceived sport competence, perceived physical strength, perceived physical condition, perceived body attractiveness (PSPP) |
| Qin et al,63 2019 (China) | RCT | EG: 140 (72 F/68 M) CG: 140 (69 F/71 M) Total: 280 (141 F/139 M) | EG: 21.54 (0.87) CG: 21.60 (0.96) Total: NR | EG: Strength training, aerobic exercise CG: No intervention | 45–50 min; 3 times/ wk; 16 wk; moderate | Physical self-worth, perceived sport competence, perceived physical strength, perceived physical condition, perceived body attractiveness (PSPP) |
| Qiu et al,64 2008 (China) | RCT | EG: 34 (34 F) CG: 12 (12 F) Total: 46 (46 F) | EG: NR CG: NR Total: 19.45 (0.94) | EG: Aerobics dance CG: No intervention | 40 min; 3 times/wk; 10 wk; small or moderate | Physical self-worth, perceived sport competence, perceived physical strength, perceived physical condition, perceived body attractiveness (PSPP) |
| Qiu,65 2019 (China) | RCT | EG: 60 (30 F/30 M) CG: 30 (15 F/15 M) Total: 90 (45 F/45 M) | EG: 18.69 (0.43 CG: 18.74 (0.41) Total: NR | EG: Aerobics dance CG: No intervention | 120 min; 3 times/wk; 12 wk; moderate (54%–65% MHR) | Physical self-worth, perceived sport competence, perceived physical strength, perceived physical condition, perceived body attractiveness (PSPP) |
| Shen,66 2022 (China) | Non-RCT | EG: 57 (57 F) CG: 57 (57 F) Total: 114 (114 F) | NR | EG: Cheerleading CG: No intervention | 90 min; 3 times/wk; 16 wk; NR | Physical self-worth, perceived sport competence, perceived physical strength, perceived physical condition, perceived body attractiveness (PSPP) |
| Wang et al,67 2015 (Singapore) | Non-RCT | EG: 55 (NR) CG: 7 (NR) Total: 62 (NR) | EG: NR CG: NR Total: 22.30 (1.51) | EG: Aerobic exercise CG: No intervention | 60–180 min; 1 time/wk; 8 wk; NR | Perceived sport competence (IMI) |
| Wang,68 2013 (China) | Non-RCT | EG: 15 (15 M) CG: 15 (15 M) Total: 30 (30 M) | EG: NR CG: NR Total: 19. 68 (0.73) | EG: Strength training CG: No intervention | 90 min; 2 times/wk; 15 wk; NR | Physical self-worth, perceived sport competence, perceived physical strength, perceived physical condition, perceived body attractiveness (PSPP) |
| Wang,69 2016 (China) | RCT | EG: 99 (53 F/46 M) CG: 96 (54 F/42 M) Total: 195 (107 F/88 M) | EG: 21.32 (2.13) CG: 21.42 (2.33) Total: NR | EG: Aerobic exercise, strength training CG: No intervention | 50 min; 3 times/wk; 12 wk; moderate | Physical self-worth, perceived sport competence, perceived physical strength, perceived physical condition, perceived body attractiveness (PSPP) |
| Williams et al,70 2001 (The United States) | Non-RCT | EG: 39 (27 F/12 M) CG: 39 (27 F/12 M) Total: 78 (54 F/24 M) | EG: 21.70 (3.80) CG: 21.50 (3.90) Total: NR | EG: Circuit weight training CG: No intervention | 180 min; 1 time/wk; 6 wk; NR | Perceived sport competence (PSEC) |
| Xu et al,71 2020 (China) | Non-RCT | EG: 30 (NR) CG: 26 (NR) Total: 56 (NR) | NR | EG: Baduanjin exercise CG: No intervention | 40–60 min; 3 times/ wk; 10 wk; moderate (60%–80% MHR) | Physical self-worth, perceived sport competence, perceived physical strength, perceived physical condition, perceived body attractiveness (PSPP) |
| Xu,72 2021 (China) | RCT | EG: 29 (17 F/12 M) CG: 30 (16 F/14 M) Total: 59 (33 F/26 M) | EG: 21.38 (0.47) CG: 21.26 (0.41) Total: 20–23 | EG: Rope skipping CG: No intervention | 60 min; 3 times/wk; 12 wk; moderate | Physical self-worth, perceived sport competence, perceived physical strength, perceived physical condition, perceived body attractiveness (PSPP) |
| Yin et al,73 2012 (China) | RCT | EG: 40 (20 F/20 M) CG: 20 (10 F/10 M) Total: 60 (30 F/30 M) | NR | EG: Tennis, aerobics dance CG: No intervention | 50–60 min; 3 times/ wk; 8 wk; moderate | Physical self-worth, perceived sport competence, perceived physical strength, perceived physical condition, perceived body attractiveness (PSPP) |
| Yuan,74 2021 (China) | Non-RCT | EG: 30 (30 F) CG: 30 (30 F) Total: 60 (60 F) | EG: 19.60 (0.68) CG: 19.57 (0.63) Total: NR | EG: Aerobics dance CG: No intervention | 90 min; 2 times/wk; 16 wk; moderate | Physical self-worth, perceived sport competence, perceived physical strength, perceived physical condition, perceived body attractiveness (PSPP) |
| Zhao,75 2011 (China) | Non-RCT | EG: 30 (30 F) CG: 30 (30 F) Total: 60 (60 F) | NR | EG: Aerobics dance CG: No intervention | 60 min; 3 times/wk; 10 wk; NR | Physical self-worth, perceived sport competence, perceived physical strength, perceived physical condition, perceived body attractiveness (PSPP) |
| Zhou,76 2014 (China) | Non-RCT | EG: 60 (20 F/40 M) CG: 60 (20 F/40 M) Total: 120 (40 F/80 M) | NR | EG: Aerobics dance CG: No intervention | 90 min; 1 time/wk; 18 wk; moderate | Physical self-worth, perceived sport competence, perceived physical strength, perceived physical condition, perceived body attractiveness (PSPP) |
| Zhu,77 2005 (China) | Non-RCT | EG: 116 (59 F/57 M) CG: 60 (30 F/30 M) Total: 176 (89 F/87 M) | NR | EG: Aerobics dance, basketball CG: No intervention | 30 min; 3 times/wk; 10 wk; small or moderate | Physical self-worth, perceived sport competence, perceived physical strength, perceived physical condition, perceived body attractiveness (PSPP) |
| Zhu,78 2018 (China) | Non-RCT | EG: 65(NR) CG: 65 (NR) Total: 130 (NR) | NR | EG: Aerobics dance CG: No intervention | 45–90 min; 2 times/ wk; 12 wk; moderate | Physical self-worth, perceived sport competence, perceived physical strength, perceived physical condition, perceived body attractiveness (PSPP) |
Note: CG, control group; COPS, the Cosmetic Procedures Screening Questionnaire; EG, experimental group; ESES, the Exercise Self-Efficacy Scale; F, female; HRR, heart rate reserve; IMI, Intrinsic Motivation Inventory; M, male; MHR, maximum heart rate; NR, no report; PSDQ, Physical Self-Description Questionnaire; PSFC, the Physical Self-Efficacy Scale; PSPP, Physical Self-Perception Profile; RCT, randomized controlled trial; SDQ, the Self-Description Questionnaire; SES, Self-Esteem Scale; TSCS, Tennessee Self-Concept Scale.
Regarding the participant characteristics, all included studies focused on college students, totaling 4955 participants. Of these, 2815 participants were assigned to experimental groups, and 2140 formed the control groups. There were more females (n = 2980) than males (n = 1730) across the 37 studies that reported participants’ gender. Notably, 16 studies exclusively enrolled female students, while 3 studies exclusively enrolled male students. Only 24 studies reported the age of participants between 17 and 28 years, and the remainder did not.
As for intervention characteristics, the included intervention types were aerobic exercise, resistance training, combined exercise, and mind-body exercise, with aerobic exercise (eg, aerobic dance, basketball, and jogging) being the most common (n = 30). The intervention time ranged from 30 to 180 minutes, with the 90 minutes being the most frequently adopted (n = 12). The intervention frequency varied from 1 to 5 times per week, with the 3 times being the most frequently employed (n = 22). The intervention duration ranged from 8 to 48 weeks, and 12 weeks was the most frequently used (n = 11). Additionally, 34 included studies reported light to vigorous intervention intensity, with the moderate intensity being the most popular among the studies (n = 31).
The physical self-perception was measured with different instruments: 31 studies used Physical Self-Perception Profile, 2 studies utilized the Exercise Self-Efficacy Scale,41,58 and 1 each adopted Physical Self-Description Questionnaire,42 the Tennessee Self-Concept Scale,43 the Intrinsic Motivation Inventory,67 the Self-Esteem Scale,23 the Self-Description Questionnaire,59 the Cosmetic Procedures Screening Questionnaire,51 and the Physical Self-Efficacy Scale.70
Risk of Bias Assessment
The risk of bias in 17 RCT studies is shown in Figure 2. The majority of studies were rated as having “some concerns” overall. Specifically, 12 studies were noted for concerns related to deviation from the intended intervention, missing outcome data, and selection of the reported result. All RCT studies had low risk of bias during outcome measures. Notably, one study showed a high risk of bias due to deviations from the intended intervention.72 Additionally, 10 studies had “No information” regarding the selection in reporting results and deviation from the intended intervention.
—Risk of bias in included RCT studies. RCT indicates randomized controlled trial.
Citation: Journal of Physical Activity and Health 21, 10; 10.1123/jpah.2024-0055
The risk of bias in 23 non-RCT studies is shown in Figure 3. The results indicated that half of the studies had a moderate risk of bias. Specifically, 14 studies exhibited moderate risks in various domains, while 4 studies had serious risks related to confounding and selection of participants. Most studies had low risk of bias in terms of intervention classification, intended intervention, missing data, and outcome measures. Moreover, 18 studies were classified as having “No information” regarding the selection of participants, intended interventions, measurement of outcomes, and selection in reporting results. None of the non-RCT studies were classified as having critical risks of bias.
—Risk of bias in included non-RCT studies. RCT indicates randomized controlled trial.
Citation: Journal of Physical Activity and Health 21, 10; 10.1123/jpah.2024-0055
Meta-Analysis of Effects on Physical Self-Perception
Physical Self-Worth
Thirty-two studies (n = 4280) with 49 effect sizes reported effect of physical activity interventions on physical self-worth among college students. These studies exhibited medium heterogeneity (I2 = 69%), leading to the use of a random-effect model. The results of meta-analysis showed that physical activity interventions had a small but significant effect on physical self-worth of college students (SMD = 0.44, 95% CI [0.32–0.55], P < .00001; Figure 4). Sensitivity analysis revealed minimal change in the effect size, with heterogeneity decreasing to 42% upon excluding one study.53
—Forest plot of physical self-worth.
Citation: Journal of Physical Activity and Health 21, 10; 10.1123/jpah.2024-0055
Perceived Sport Competence
Thirty-seven studies (n = 4617) with 56 effect sizes examined the effect of physical activity interventions on perceived sport competence among college students, in which significant heterogeneity was found (I2 = 84%). The meta-analytic results showed that physical activity interventions had a moderate, significant effect in improving perceived sport competence among college students (SMD = 0.60, 95% CI [0.45–0.76], P < .00001; Figure 5) compared with the control group. Sensitivity analysis indicated little changes in both the effect size and heterogeneity when excluding any individual study.
—Forest plot of perceived sport competence.
Citation: Journal of Physical Activity and Health 21, 10; 10.1123/jpah.2024-0055
Perceived Physical Condition
Thirty-two studies, involving 4252 participants and reporting 50 effect sizes investigated the effect of physical activity interventions on perceived physical condition among college students. The meta-analytic results indicated that physical activity interventions could significantly improve perceived physical condition, but with high heterogeneity (SMD = 0.45, 95% CI, 0.32–0.57, P < .00001, I2 = 74%, Figure 6). Sensitivity analysis hardly showed any changes in both the effect size and heterogeneity when excluding one by one study.
—Forest plot of perceived physical condition.
Citation: Journal of Physical Activity and Health 21, 10; 10.1123/jpah.2024-0055
Perceived Physical Strength
Thirty-two studies (n = 4152) with 49 effect sizes assessed the effect of physical activity interventions on the perceived physical strength of college students. Due to the high heterogeneity of these studies (I2 = 72%), the random-effects model was used. The meta-analytic results revealed that physical activity interventions had a moderate, significant effect on perceived physical strength of college students (SMD = 0.53, 95% CI, 0.40–0.65, P < .00001, Figure 7). Sensitivity analysis did not reveal any changes in either the effect size or heterogeneity when excluding any individual study.
—Forest plot of perceived physical strength.
Citation: Journal of Physical Activity and Health 21, 10; 10.1123/jpah.2024-0055
Perceived Body Attractiveness
Thirty-four studies (n = 4459) with 52 effect sizes examined the effect of physical activity interventions on the perceived body attractiveness among college students. These studies exhibited significant heterogeneity (I2 = 79%), leading to the use of the random-effects model. The meta-analytic results showed that physical activity interventions had a moderate and significant effect in improving perceived body attractiveness of college students (SMD = 0.54, 95% CI, 0.40–0.67, P < .00001, Figure 8). Sensitivity analysis did not show any changes in either the effect size or heterogeneity when excluding any individual study.
—Forest plot of perceived body attractiveness.
Citation: Journal of Physical Activity and Health 21, 10; 10.1123/jpah.2024-0055
Subgroup Analyses
Subgroup analyses revealed significant influences of study design on perceived sport competence, perceived physical strength, and perceived body attractiveness (P = .031–.039). Compared with non-RCTs, the effect sizes of these outcomes in RCTs were larger (SMD = 0.42–0.82, I2 = 59%–86%, P = .000). Intervention type significantly affected physical self-worth, perceived physical strength, perceived physical condition, and perceived body attractiveness (P = .003–.031), with resistance training showing the largest effect sizes (SMD = 0.58–1.85, P = .000–.030). Intervention duration significantly influenced physical self-worth, perceived sport competence, perceived physical strength, and perceived body attractiveness (P = .002–.036), with the largest effect sizes observed in 12-week physical activity interventions (SMD = 0.41–0.83, I2 = 81%–87%, P = .000). No significant differences were found in intervention time and frequency on college students’ physical self-perception (P = .159–.939; see Table 2).
Subgroup Analysis of Physical Self-Perception on College Students
| Group | Subgroup | N | SMD | 95% CI | I2 (%) | P value for heterogeneity | P value between groups |
|---|---|---|---|---|---|---|---|
| Physical self-worth | |||||||
| Design | RCT | 13 | 0.47 | 0.24, 0.71 | 51 | .000 | .656 |
| Non-RCT | 19 | 0.41 | 0.29, 0.53 | 81 | .000 | ||
| Intervention | Aerobic exercise | 27 | 0.41 | 0.28, 0.54 | 69 | .000 | .003 |
| Resistance training | 1 | 0.58 | 0.95, 2.63 | \ | .000 | ||
| Combined exercise | 4 | 1.8 | 0.41, 0.75 | 25 | .000 | ||
| Time, min | <90 | 21 | 0.49 | 0.34, 0.64 | 70 | .000 | .583 |
| ≥90 | 14 | 0.63 | 0.40, 0.86 | 78 | .000 | ||
| Frequency, time/wk | <3 | 12 | 0.54 | 0.38, 0.71 | 58 | .000 | .159 |
| ≥3 | 22 | 0.38 | 0.23, 0.54 | 73 | .000 | ||
| Duration, wk | <12 | 8 | 0.26 | 0.13, 0.39 | 8 | .000 | .007 |
| 12 | 10 | 0.41 | 0.10, 0.72 | 84 | .000 | ||
| >12 | 14 | 0.57 | 0.43, 0.71 | 58 | .000 | ||
| Perceived sport competence | |||||||
| Design | RCT | 15 | 0.82 | 0.55, 1.10 | 86 | .000 | .039 |
| Non-RCT | 22 | 0.48 | 0.30, 0.66 | 81 | .000 | ||
| Intervention | Aerobic exercise | 30 | 0.64 | 0.46, 0.82 | 85 | .000 | .420 |
| Resistance training | 2 | 0.87 | −1.17, 2.91 | 94 | .404 | ||
| Combined exercise | 5 | 0.41 | 0.09, 0.72 | 83 | .011 | ||
| Time, min | <90 | 22 | 0.61 | 0.39, 0.83 | 88 | .000 | .939 |
| ≥90 | 15 | 0.60 | 0.41, 0.79 | 69 | .000 | ||
| Frequency, time/wk | <3 | 15 | 0.53 | 0.32, 0.73 | 76 | .000 | .392 |
| ≥3 | 23 | 0.66 | 0.44, 0.88 | 87 | .000 | ||
| Duration, wk | <12 | 11 | 0.38 | 0.16, 0.61 | 68 | .001 | .036 |
| 12 | 10 | 0.79 | 0.46, 1,13 | 86 | 0.000 | ||
| >12 | 15 | 0.77 | 0.52, 1.03 | 88 | 0.000 | ||
| Perceived physical strength | |||||||
| Design | RCT | 13 | 0.71 | 0.48, 0.94 | 59 | .000 | .032 |
| Non-RCT | 19 | 0.40 | 0.27, 0.53 | 78 | .000 | ||
| Intervention | Aerobic exercise | 27 | 0.50 | 0.37, 0.64 | 71 | .000 | .016 |
| Resistance training | 1 | 0.83 | −1.27, 2.31 | \ | .030 | ||
| Combined exercise | 4 | 0.69 | 0.43, 0.96 | 65 | .000 | ||
| Time, min | <90 | 19 | 0.49 | 0.34, 0.64 | 70 | .000 | .305 |
| ≥90 | 13 | 0.63 | 0.40, 0.86 | 78 | .000 | ||
| Frequency, time/wk | <3 | 12 | 0.46 | 0.30, 0.63 | 57 | .000 | .365 |
| ≥3 | 21 | 0.57 | 0.40, 0.74 | 77 | .000 | ||
| Duration, wk | <12 | 8 | 0.25 | 0.11, 0.39 | 31 | .000 | .002 |
| 12 | 10 | 0.80 | 0.52, 1.08 | 81 | .000 | ||
| >12 | 14 | 0.52 | 0.36, 0.68 | 69 | .000 | ||
| Perceived physical condition | |||||||
| Design | RCT | 13 | 0.52 | 0.28, 0.76 | 81 | .000 | .479 |
| Non-RCT | 19 | 0.38 | 0.25, 0.50 | 54 | .000 | ||
| Intervention | Aerobic exercise | 26 | 0.39 | 0.26, 0.52 | 72 | .000 | .005 |
| Resistance training | 1 | 1.48 | 0.68, 2.30 | \ | .000 | ||
| Combined exercise | 4 | 0.67 | 0.52, 0.82 | \ | .000 | ||
| Time, min | <90 | 19 | 0.48 | 0.28, 0.60 | 78 | .000 | .566 |
| ≥90 | 13 | 0.41 | 0.23, 0.59 | 66 | .000 | ||
| Frequency, time/wk | <3 | 12 | 0.38 | 0.20, 0.56 | 65 | .000 | .596 |
| ≥3 | 21 | 0.51 | 0.20, 0.56 | 79 | .000 | ||
| Duration, wk | <12 | 7 | 0.32 | 0.18, 0.46 | 20 | .000 | .199 |
| 12 | 11 | 0.47 | 0.16, 0.79 | 86 | .003 | ||
| >12 | 14 | 0.50 | 0.36, 0.63 | 54 | .000 | ||
| Perceived body attractiveness | |||||||
| Design | RCT | 13 | 0.74 | 0.50, 0.98 | 81 | .000 | .031 |
| Non-RCT | 20 | 0.42 | 0.26, 0.59 | 76 | .000 | ||
| Intervention | Aerobic exercise | 27 | 0.52 | 0.38, 0.67 | 78 | .000 | .032 |
| Resistance training | 1 | 1.65 | 0.82, 2.47 | \ | .000 | ||
| Combined exercise | 5 | 0.59 | 0.22, 0.95 | 86 | .002 | ||
| Time, min | <90 | 21 | 0.51 | 0.33, 0.70 | 82 | .000 | .444 |
| ≥90 | 13 | 0.61 | 0.44, 0.79 | 64 | .000 | ||
| Frequency, time/wk | <3 | 12 | 0.51 | 0.35, 0.67 | 56 | .000 | .596 |
| ≥3 | 22 | 0.58 | 0.38, 0.77 | 84 | .000 | ||
| Duration, wk | <12 | 8 | 0.20 | 0.07, 0.34 | 49 | .003 | .004 |
| 12 | 11 | 0.83 | 0.51, 1.15 | 87 | .000 | ||
| >12 | 14 | 0.56 | 0.38, 0.73 | 73 | .000 | ||
Note: k, number of effect sizes; SMD, standardized mean difference.
Publication Bias
Funnel plot analyses were conducted to assess potential publication bias across physical self-worth, perceived sport competence, perceived physical strength, perceived physical condition, and perceived body attractiveness. The results revealed symmetrical scatter points on the funnel plots, indicating that the meta-analysis of these outcomes was not influenced by publication bias. All funnel plots are presented in the Figure S3 to Figure S7 (see Supplementary Material [available online]).
Discussion
Summary and Discussion of the Main Findings
This systematic review and meta-analysis investigated the effects of physical activity interventions on physical self-perception in college students. The findings suggested that overall, physical activity interventions improved physical self-perception. Significant moderate effect sizes were found for improved perceived sports competence, perceived physical strength and perceived body attractiveness, and small effect sizes for improved physical self-worth perceived physical condition.
The current meta-analysis reinforces the positive impact of physical activity on physical self-perception among college students, aligning with prior studies on both Chinese college students30 and children and adolescents.28,29,31 It is worth noting that both our review and a previous study30 indicate a medium positive effect in most subdomains for college students, whereas research on children and adolescents28,29,31 suggest a smaller effect. One potential explanation may be that age plays an important moderating role between physical activity and physical self-perception. College students are in the transition period from adolescence to early adulthood and may experience a significant increase in body dissatisfaction therefore the intervening effect of physical activity on their physical self-perception may be more obvious.79,80 Therefore, it is necessary to further examine the effects of physical activity on physical self-perception in different age groups in the future to determine the moderating role of age.
In addition, compared with a previous meta-analysis on Chinese college students,30 the present review found smaller effect sizes of physical activity in physical self-worth, perceived physical attractiveness, and perceived physical condition. Several factors might explain this discrepancy. First, the previous review30 used weighted mean difference while the present study used SMD. Second, the previous review30 included only 9 studies, whereas the present study included 40 studies, potentially providing stronger evidence. Third, the present review considered multiple forms of physical activity, such as aerobic exercise, resistance training, and combined exercise, while the previous review focused solely on an aerobic exercise program. Exploring the impact of aerobic exercise alone on physical self-perception may shed more light on the relationship. Although combined exercise and resistance training showed better effects in subgroup analyses, potentially due to their muscle tone and strength-enhancing effects,81 there is limited evidence to support these findings. In fact, aerobic exercise was the most common intervention in this review. Its unique advantages set it apart from other interventions, which offers diverse exercise forms suitable for different age groups and is commonly used for weight loss and management, contributing to its positive impact on body image.82,83 Future research is worthy of comparing the effects of different intervention types on physical self-perception to provide more effective exercise guidance for college students.
The current review highlighted that physical activity interventions had the greatest impact on college students’ perceived sport competence, followed by perceived body attractiveness, and physical self-worth. From the perspective of Exercise and Self-esteem Model, participation in physical activity can enhance self-efficacy, therefore leading to improvements in sports competence and physical acceptance.84 Additionally, engaging in physical activities or sports allows students to develop perceived sport competence through skill acquisition and training.85 Thus, this may explain why physical activity interventions have the greatest impact on college students’ perceived sports competence. As for perceived body attractiveness, regular physical activity contributes to it by maintaining a healthy body composition, such as lower body fat levels and well-defined muscles.86 People who are physically active may be perceived as more attractive according to current popular aesthetic standards.87 However, for physical self-worth, it can be influenced by various factors beyond physical activity, such as social and cultural factors and mental health,88–90 so physical activity has the least effect on it. Given the complexity of physical self-perception, future research should aim to uncover relevant mechanisms through high-quality studies.
Subgroup analyses showed greater effect sizes for college students’ physical self-perception in RCT studies, resistance training, and 12-week or longer intervention duration. This could be attributed to several reasons. First, RCTs are considered to provide more rigorous control over confounding factors and reducing bias.91 The largest effect sizes observed in RCT subgroups may result from the careful control and design of these studies. Second, resistance training can lead to improvements in muscle tone and physical strength, which can positively influence individuals’ perception of their physical strength and body attractiveness.81 But it could also be influenced by the limited number of available studies, which may affect the reliability of these results. Finally, longer intervention duration allows for more consistent engagement, then leading to noticeable changes in physical self-perception.
Practical Implications
The practical implications encompass following key areas. Educational institutions like colleges and universities can enhance college students’ physical self-perception through various strategies. They can promote sports involvement and provide fitness facilities, offering opportunities for physical activities that can positively impact their physical self-perception. Additionally, integrating physical activity, especially aerobic exercise, into mental health counseling or psychology classes by mental health counselors or psychology teachers can serve as a psychological health intervention. A 12 weeks of intervention program, 3 times or more per week, each lasting 90 minutes or more, appears to be more suitable for college students.
Limitations and Future Directions
Although this review provides some important findings regarding the effects of physical activity on college students’ physical self-perception, several limitations should be acknowledged. First, only English and Chinese studies were included in this review. Second, the inclusion of non-RCTs may affect methodological quality, highlighting the need for prioritizing RCTs in future research. Third, variations in measurement tools could impact result accuracy and comparability. Future researches should employ reliable and valid measurement tools to ensure accurate and consistent measurement across studies. Fourth, the predominance of studies from China may limit generalizability of the findings. Last, gender-based subgroup analyses could not be performed due to the lack of comparative gender data in many studies. In the future, there is a need for high-quality RCTs that specifically investigate gender differences in physical self-perception.
Conclusions
Based on existing evidence, this systematic review showed that physical activity interventions appear to have small to moderate beneficial effects on physical self-perception among college students. This suggests that participation in well-designed physical activity, especially lasting 12 weeks, 3 times or more per week, and 90 minutes or more per session might be a promising way to improve physical self-perception in this group. More high-quality RCTs should be developed in the future to determine the effects of physical activity on college students’ physical self-perception, with a greater focus on gender differences to provide more robust evidence in this area.
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