The relationship between physical activity and mental health (depression, anxiety and stress) in medical students in Asia and Middle East systematic review and meta analysis

Background : The academic and emotional stress factors experienced by medical students in Asia and the Middle East are high and lead to a common experience of depression, anxiety, and stress. Physical activity (PA) is regarded as protective for mental health, but the relationship between PA and psychological outcomes in this population or region is still relatively unexplored. Methods : A systematic review and meta-analysis were conducted, integrating data from 22 studies with 13,949 medical students. It specifically explored associations between physical activity and the psychological outcomes — depression, anxiety, and stress. Among the studies reviewed, physical activity was assessed by objective measures such as the International Physical Activity Questionnaire (IPAQ), Global Physical Activity Questionnaire (GPAQ) and Godin–Shephard Leisure-Time Physical Activity Questionnaire (GSLTPAQ), often expressed in Metabolic Equivalent Task minutes per week (MET-min/wk), which can provide comparisons between populations. Depression, anxiety, and stress were measured on established psychological scales. Depression was recorded using the Centre for Epidemiologic Studies Depression Scale (CES-D) and various versions of the Patient Health Questionnaire (PHQ). Anxiety was assessed with the Generalized Anxiety Disorder-7 (GAD-7) and the Self-Rating Anxiety Scale (SAS). Stress was measured using the Perceived Stress Scale (PSS) and the Depression, Anxiety, and Stress Scales (DASS-21). Other constructs, including psychological distress, sleep quality, well-being and burnout, also added to a general picture of mental health. The application of standardized scales enhances the consistency and comparability of analyses of physical activity. The differences were studied in subgroups based on gender and academic stage. Results : The pooled analyses showed a predominantly negative correlation between physical activity and symptoms of depression (p = 0.000511)and anxiety, implying that the more PA, the less distress present in the corresponding domains. There was no significant relationship between PA and stress symptoms (p = 0.737). Subgroup analysis showed that psychological distress was greater among females (The pooled samples for all outcomes were predominantly female (≈57%), with males comprising ≈43%). Still, the pooled academic stage data indicated a near-balanced distribution, with approximately 52.5% of students in the clinical stage and 47.5% in the pre-clinical stage. Variations in PA type, intensity, and assessment methods resulted in considerable heterogeneity across studies. Conclusion : Physical activity emerged as a modifiable protective factor against depression and anxiety among medical students living in culturally diverse countries across Asia and the Middle East, according to the findings. Incorporating physical activity (PA) into medical students' curricula may reduce their mental burdens and build resilience. Thus, future longitudinal research is warranted to elucidate causal mechanisms and implement culturally and contextually aware interventions.