Relationship between Physical Activity and Body Image in Adolescents

Practicing physical activity correctly and regularly by adolescents can have positive effects on body image. In addition, it promotes the development of a positive relationship with your own body and improves your emotional well-being. In this sense, the objectives of this study were to carry out a systematic review of research that implemented interventions to evaluate the effects of physical activity on body image in adolescents, as well as to describe and analyze them. In order to achieve these purposes, a systematic review was conducted that examined research related to physical activity and body image in adolescents. To carry out this review, the PRISMA Statement was used. The results obtained demonstrate that the incorporation of regular physical activity in adolescents provides significant improvements in the perception of body image and physical self-perception. Furthermore, an improvement in the enjoyment of physical activity is highlighted, which is relevant to promote adherence to it. In this way, the review of the articles reflects a general agreement on the positive benefits on body image of including physical exercise in adolescents. However, the need to carry out future research that provides more current and established results, specifically aimed at the young population, is highlighted.

Adolescence is a critical period in the development of identity and self-esteem, during which young people experience significant changes in their body and their perception of themselves. Body image, defined as a person's perception and evaluation of his or her own body [1] plays a fundamental role in this process. A positive body image has been linked to higher self- esteem, confidence and psychological well-being [2], whereas a negative body image may be associated with eating disorders, depression and anxiety [3].

Physical activity is also an important aspect of adolescents' lives, as it has been shown to have physical and mental health benefits [4]. This factor can positively influence body image perception by improving physical fitness, self-confidence, and body satisfaction. However, complex interactions may also arise, for example, social pressure to achieve certain beauty standards may affect both participation in physical activities and body image perception. It has to be added, furthermore, that adolescents who have a negative body image may avoid physical activity due to embarrassment or lack of confidence in their physical abilities [5]. Numerous studies have investigated the relationship between body image and physical activity in adolescents, but results are inconsistent and there is no clear understanding of how these variables interact. Some studies suggest that participation in physical activities may improve body image [6] while others found that negative body image may be a barrier to participation in physical activities [7].

Leading an active and healthy lifestyle and, especially the practice of physical exercise and physical activity outside the school environment, is gradually incorporated during the socialization process, highlighting childhood and adolescence as crucial moments in this process. During this developmental stage, behaviors with significant short- and long-term health implications are internalized, the modification of which in adult life can be challenging [8].

Lack of participation in physical activity during adolescence is not only unfavorable because of the health risks involved in adulthood, but also because of other immediate consequences, such as decreased physical fitness, reduced self-esteem, and a negative perception of body image [9].

In conclusion, research on body image and physical activity in adolescents is of utmost importance to understand and address the physical and mental health challenges facing young people today. Furthermore, it contributes to fostering a positive relationship with their body and improving their emotional well-being. Thus, the objectives of the present study were to conduct a systematic review of research that implemented interventions to assess the effects of physical activity on body image in adolescents, as well as to describe and analyze them.

The present work consisted of the elaboration of a systematic review in which we analyzed research that studied whether the practice of physical activity in adolescents contributed positively to their body image. To carry out this systematic review we used the PRISMA Statement and the practical guide referring to systematic reviews with or without meta-analysis [10-12].

Eligibility criteria

The eligibility criteria applied in this work were: a) full-text articles, b) publication date of the studies between 2000-2023, c) language: English, Spanish and Portuguese, d) that had performed pretest and posttest and e) age between 12 and 18 years. In addition to this, another criterion was taken into account in the search phrase: f) that it was an intervention, experimental study, quasi- experimental study or randomized controlled trial.

On the other hand, the exclusion criteria were: a) studies not related to the practice of physical activity in adolescents and its impact on body image, b) systematic review or meta-analysis, c) studies in languages other than Spanish, Portuguese and English. Thus, the articles were included after having been screened according to the aforementioned eligibility criteria.

Sources of information

A systematic search was carried out in four databases (Web of Science, SportDiscus, Scopus and Pubmed) during the month of December 2023. To this end, blocks were considered to elaborate the search phrase: 1) body image 2) physical activity OR exercise 3) secondary school OR high school 4) Students OR adolescents 5) intervention OR experimental OR quasi-experimental OR randomized controlled trial.

Study selection and data extraction process

Once the database search was completed, the titles and abstracts of each article acquired were thoroughly examined in order to identify and select those articles that were related to the object of the study and to discard those that did not meet the established inclusion criteria. In addition, the population and intervention components were taken into account. Thus, a total of six articles were selected for data collection: 2 from Web of Science and 4 from PubMed. However, no publications meeting the inclusion criteria were found in the Sport Discus and Scopus databases.

To reduce selection bias, two investigators (V.S.M.) and (J.A.T.F.) examined each study independently to determine whether it met the inclusion criteria. In cases of disagreement about the inclusion or exclusion of a study, it was resolved in consultation with another investigator (A.L.A.).

Quality assessment

The quality assessment of the articles that were selected was carried out using the standard Qualsyst assessment for quantitative studies [13]. This assessment covered 14 items related to the objective, study design, sample, methodology, data analysis, results and conclusions. Each criterion was scored 2 (satisfactory), 1 (partially satisfactory), 0 (unsatisfactory) and NA (not applicable). The final score was obtained from the following formula [(“number of satisfactory” x 2)

+ (“partially satisfactory” x 1) / 28 - (not applicable x 2)]. Finally, the scores were expressed as a percentage with a range between 0 and 100%.

Selection of studies

After the initial search, a total of 315 results were identified. The documents obtained were subjected to meticulous analysis; however, no additional studies were found through the review of the bibliographic references or by consulting other sources. It is important to note that duplicate papers were excluded, resulting in the elimination of 28 studies. Of the remaining articles, 28 were discarded because they were systematic reviews or meta-analyses, while 253 were excluded due to the application of relevant exclusion criteria. Finally, after the conclusion of the analysis, a total of 6 studies were included in this review (Figure 1).

Figure 1: Flowchart.

Quality of studies

The quality ratings of the articles were expressed as percentages, with a range from 0 to 100%, varying between 0.75 and 0.89 (Table 1). Inter-rater agreement was determined using the Intraclass Correlation Coefficient (ICC), which reached a value of .825 (p < .05), considered excellent according to Koo TK, et al. [14]. Subsequent to the application of inter-rater agreement, a conservative cut-off point was established for the selection of these, including those studies with scores no lower than 75% (> .75).

Characteristics of the studies

The main characteristics of the selected studies are presented in tables 2 and 3.

As shown in table 2, 6 articles related to physical activity and body image in adolescents and preadolescents were analyzed. Regarding the countries in which they were carried out, they varied widely. The work by Gehrman CA, et al. [15], was conducted in the United States, another was conducted in Poland [16,17] conducted it in the United Kingdom, while Dudley DA, et al. [18] conducted it in Australia. Another was conducted in Norway [19] and finally the remaining one in Slovakia [20].

As for the sample, the participants were adolescents and pre-adolescents studying in different high schools around the world. It is added that the age of the participants ranged from 10 to 17.

In relation to what the studies measured, all six measured body image, self-perception or physical satisfaction? As for physical activity, it was assessed by five of them [16-20]. The variable related to the dietary issue was also investigated and measured by part of a study [16]. Other physical and psychological factors of the participants such as BMI and family support were assessed in the studies of Burguess G, et al. [17] and Dudley DA, et al. [18], respectively.

In addition, the study by Kantanista A, et al. [16] assessed their participants' enjoyment of physical activity practice, as well as their concept of self-efficacy. Authors Sundgot-Borgen C, et al. [19], analyzed social network literacy and lifestyle variables in their sample. Finally, strength and endurance training variables related to body image were assessed in the study by Plevková L, et al. [20].

As shown in table 3, after reviewing the studies, the works conducted by Burguess G, et al. [17], Dudley DA, et al. [18], Kantanista A, et al. [16] and Plevková L, et al. [20], presented a common objective, which was to evaluate the influence or effect of a physical activity intervention on the body image of adolescents. On the other hand, in the study by Gehrman CA, et al. [15], they evaluated the effect of a physical activity program on body dissatisfaction. Finally, Sundgot-Borgen C, et al. [19], examined in their work the effects of healthy habits after an intervention on body image. Regarding the intervention duration of the studies, Burguess G, et al. [17], Plevková L, et al. [20], conducted an intervention that lasted 6 weeks. On the other hand, the studies by Gehrman CA, et al. [15], Kantanista A, et al. [16] and Sundgot-Borgen C, et al. [19], conducted an intervention lasting 8 weeks. Finally, the intervention of the study conducted by Dudley DA, et al. [18], had a duration of 11 weeks.

In relation to the main results, the study by Burguess G, et al. [17] concluded that participating in an aerobic dance intervention for six weeks significantly reduced participants' body image dissatisfaction and also improved physical self-perception. However, these improvements were not sustained after the intervention. The study by Gehrman CA, et al. [15] found no significant differences between participants who dropped out and those who completed the intervention. On the other hand, the study by Dudley DA, et al. [18], showed an improvement of the experimental group in terms of enjoyment of physical activity and body image with respect to the participants of the control group. The work conducted by Kantanista A, et al. [16], showed that the participants after the intervention, obtained higher levels in terms of enjoyment of physical activity and, in addition, more positive results with respect to body image. Continuing with the study by Sundgot-Borgen C, et al. [19], obtained positive changes in terms of body image and improved quality of life in girls. However, in boys, negative effects appeared after the intervention. Finally, the work by Plevková L, [20], found statistically significant improvements in body image perception within the experimental group.

The main purpose of this study was to conduct a systematic review of research studying the relationship between body image and physical activity in adolescents.

All included studies selected a sample of adolescents aged between 10 and 18 years. In addition, each study was conducted in different countries.

As for the duration of the intervention of the analyzed works, it was varied. Burguess G, et al. [17] and Plevková and Peráčková L, et al. [20], conducted an intervention with a duration of 6 weeks. On the other hand, the studies by Gehrman CA, et al. [15], Kantanista A, et al. [16] and Sundgot- Borgen C, et al. [19] implemented interventions with a duration of 8 weeks. Finally, the intervention in the study by Dudley DA, et al. [18] was spread over 11 weeks.

Of the six studies, all measured body image, physical self-perception, or body satisfaction or dissatisfaction. Three of the studies, measured BMI [18-20]. In terms of physical activity performed, the works by Burguess G, et al. [17], Dudley DA, et al. [18], Kantanista A, et al. [16] and Sundgot-Borgen C, et al. [19], measured the physical activity levels of adolescents, but the study by Kantanista et al. [16] in particular, measured the number of steps. In addition, studies by Dudley DA, et al. [18] and Kantanista A, et al. [16], measured the enjoyment of engaging in physical activity. On the other hand, there were studies that were responsible for analyzing more specific variables. The study by Burguess G, et al. [17], examined body attitudes. Concern about weight and physical maturity were analyzed in the work of Gehrman CA, et al. [15], likewise Dudley DA, et al. [18], examined family support and Kantanista A, et al. [16], assessed adolescent self-efficacy. Finally, the study by Sundgot-Borgen C, et al. [19], analyzed other variables such as eating habits, parental income and educational level, as well as the immigration status of adolescents.

Continuing with the protocol carried out by the studies, the work done by Kantanista A, et al. [16], evaluated two groups that had to perform the same thing, what differentiated it was that one group was previously given an objective and the other group was told to do the best they could. The rest of the studies analyzed had a control group and an experimental group. Continuing with the protocol followed, in the study conducted by Gehrman CA, et al. [15], the group undertook injury prevention training, while the experimental group undertook a physical activity and nutrition program. Dudley DA, et al. [18], in their study, implemented a physical activity program in their experimental group. Likewise, the work of Sundgot-Borgen C, et al. [19], with the experimental group carried out several workshops, specifically three. Each of these workshops was conducted every three weeks and addressed a different variable in each workshop. Plevková L, et al. [20], implemented in their experimental group a strength and endurance circuit. Finally, the study by Burguess G, et al. [17], used a crossover design, that is, both groups performed both the control group part which consisted of continuing the physical education classes in a natural way and on the other hand the experimental group, in which aerobic dance was implemented.

On the other hand, regarding measurements, the study by Burguess G, et al. [17] took measurements before, during and after the intervention at six weeks and twelve weeks afterwards as well. The rest of the works analyzed, took measurements pre and post intervention, specifically, the study by Sundgot-Borgen C, et al. [19], also took measurements at three months after performing the intervention and at six months.

Regarding the objectives of the analyzed works, the works conducted by Burguess G, et al. [17], Dudley DA, et al. [18], Kantanista A, et al. [16] and Plevková L, et al. [20] had a common objective: to evaluate the influence or effect of a physical activity intervention on body image in adolescents. On the other hand, in the study by Gehrman CA, et al. [15], the effect of a physical activity program on body dissatisfaction was evaluated. Finally, Sundgot-Borgen C, et al. [19] examined the effects of healthy habits after an intervention on body image in their work.

The study conducted by Burguess G, et al. [17], in their results, concluded that participation in an aerobic dance intervention for six weeks produced a significant reduction in body image dissatisfaction among participants, while improving physical self-perception. However, these improvements were not sustained after the intervention ended. Thus, Daley AJ, et al. [21], supports these results with their study, as it revealed that perceptions of physical competence were positively related to youth physical activity. The study conducted by Gehrman CA, et al. [15] found no significant differences between participants who dropped out of the intervention and those who completed it. On the other hand, the study conducted by Dudley DA, et al. [18] demonstrated a significant improvement in the enjoyment of physical activity and body image perception in the experimental group compared to the control group participants. In fact, most of the intervention participants expressed that the school sport program had helped them to enjoy physical activity more, and many reported feeling better about their participation in school sport and about themselves. In addition, in terms of self- perception, the intervention groups showed greater improvement in all domains. The study by Kantanista A, et al. [16] revealed that participants experienced higher levels of enjoyment of physical activity after the intervention, as well as more positive results in relation to body image, obtaining better results in the group with pre-set goals. Consistent with these results, in a study conducted by Pearson ES, et al. [22], a significant relationship was found between body image and self- determined forms of motivation to exercise. Following the study conducted by Sundgot-Borgen C, et al. [19], this revealed positive changes in body image and improved quality of life in girls after the intervention. However, negative effects were observed in boys after the intervention. The early results of this study coincide with that conducted by Neumark-Sztainer D, et al. [23], where they examined factors associated with changes in physical activity in inactive adolescents and found significant improvements in body image perception after participation in a physical activity program. Finally, Plevková L, et al. [20], demonstrated in their study that the inclusion of strength and resistance circuit training in physical education classes has proven to be an effective choice, as a decrease in the average body mass index was observed in the experimental group, and participants showed less dissatisfaction with their body. Likewise, they revealed a significant change in the Contour Drawing Rating Scale in the pre- and post-test measurement in the experimental group.

The systematic review conducted has some notable limitations. Firstly, the scarcity of available studies on the topic analyzed stands out. Furthermore, it is important to point out that the search was restricted to three languages - Spanish, English and Portuguese - and was limited to full- text articles, in addition to being carried out from the year 2000 onwards. In the review conducted, the effects of physical activity on body image in adolescents were evaluated, analyzing only those studies that performed an intervention. Thus, future research could focus on analyzing this topic by performing randomized interventions, obtaining more specific and updated results.

Considering the results obtained in this systematic review, it can be concluded that physical activity has a positive impact on the body image of adolescents.

The application of programs that include interventions that vary both in duration and type of physical activity, obtain significant improvements in the perception of body image, physical self- perception and enjoyment of physical activity among participants. However, the improvements are not always sustained in the long term after the interventions are completed.

Therefore, the application of this study will help professionals to be aware of the need to create adherence to physical activity in young people and encourage them to design physical activity programs adapted to the specific needs of adolescents, integrating elements that promote continuity and long-term enjoyment.

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