Association between adherence to 24-hour movement guidelines and anxiety and depression: A systematic review and meta-analysis of observational studies.

Publication date: May 26, 2026

Depression and anxiety constitute a global health crisis, with prevalence increasing by 27. 6% during the COVID-19 pandemic. The 24-Hour Movement Guidelines, integrating physical activity, sedentary behavior, and sleep, have been linked to improved mental health, yet no meta-analysis has quantified these associations. Following PRISMA guidelines, PubMed, Embase, Cochrane Library, and Web of Science were searched through January 1, 2026. Observational studies examining adherence to the 24-Hour Movement Guidelines and anxiety or depression were included. Cross-sectional and cohort studies were assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Tools, with the 8-item checklist for cross-sectional studies and the 11-item checklist for cohort studies. Random-effects models generated pooled odds ratios (ORs) with 95% confidence intervals (CIs). Twenty studies (17 cross-sectional, 3 cohort) involving 323,440 participants from seven countries were included, with the majority being adolescents (n = 210,394, 65%). Adherence to the 24-Hour Movement Guidelines was significantly associated with lower odds of anxiety and depression symptoms. Meeting one, two, or three guideline components was consistently linked to lower odds of anxiety (ORs = 0. 74, 0. 59, and 0. 43, respectively) and depression (ORs = 0. 73, 0. 55, and 0. 41, respectively). Among individual components, adherence to sleep recommendations demonstrated the strongest associations for both anxiety (OR = 0. 72) and depression (OR = 0. 69), followed by sedentary behavior and physical activity. Sensitivity and publication bias analyses confirmed robustness. Adherence to the 24-Hour Movement Guidelines is significantly associated with lower risks of anxiety and depression, supporting their integration into mental health prevention strategies.

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