Physical Activity Interventions for Mental Health Among Youth in South Africa: Scoping Review

1. Introduction

Mental health disorders are a leading contributor to the global burden of disease, increasingly affecting adolescents and young adults. Conditions such as depression, anxiety, post-traumatic stress disorder (PTSD), and substance use disorders compromise not only individuals’ well-being but also educational attainment, employability, and long-term health outcomes [1]. The World Health Organisation estimates that up to 20% of youth worldwide experience mental health problems, yet the majority remain untreated, particularly in low- and middle-income countries (LMICs) where health systems face severe resource constraints [2].

In South Africa, mental health disorders are similarly widespread across the country. National surveys estimate that approximately 16.5% of South Africans experience mental issues such as stress, depression and anxiety in their lifetime, with adolescents and youth being disproportionately affected [3]. More recent provincial studies suggest that depression prevalence among youth ranges between 15-20%, while anxiety symptoms are reported in up to one-third of school-going youth, particularly in under-resourced rural provinces [4]. These figures underscore a substantial treatment gap, as fewer than 25% of the affected individuals receive appropriate care [5].

Given these challenges, interest in accessible, cost-effective interventions that can support youth mental health outside traditional clinical settings has increased. Research promotes physical activity (PA) as a promising non-pharmacological strategy for preventing and managing mental health conditions. Global evidence shows that regular participation in PA effectively reduces symptoms of depression and anxiety, improves mood and cognitive functioning, and enhances social connectedness and self-esteem [6]. Interventions such as sport, dance, aerobic routines, and recreational play not only promote psychological well-being but also strengthen resilience and prosocial behaviours [7,8,9]. Although these benefits are well-documented, significant gaps remain in the literature.

Much of the literature is concentrated in high-income and urban settings, where infrastructure, school systems, and health services support the delivery of programs [10]. Evidence in these areas highlights the value of physical activity for adolescent health and psychosocial development [11]. Rural youth remain largely overlooked in both research and policy [12]. Research in rural areas, which faces substantial barriers, remains scarce [13]. Multiple structural and socio-cultural barriers contribute to this neglect. These often lack safe recreational facilities, trained facilitators, and supportive infrastructure, while poverty and gendered norms further constrain participation in physical activity [14]. Simultaneously, stigma surrounding mental illness, combined with limited access to formal healthcare, encourages delays in help-seeking, leaving many adolescents undiagnosed and untreated [15]. Alarmingly, recent studies estimate that the treatment gap for adolescent mental health in rural South Africa exceeds 70%, highlighting a pressing public health crisis [16].

Addressing these inequities requires evidence that reflects the realities of rural areas. Interventions developed in urban or clinical contexts may have limited relevance in settings where resources are scarce and where cultural norms strongly shape both physical activity practices and perceptions of mental illness [17]. A context-specific evidence base is therefore crucial for designing sustainable, community-driven interventions that align with the needs of rural communities.

This scoping review addresses these gaps by systematically reviewing existing evidence on physical activity interventions for youth mental health in rural South Africa. Unlike systematic reviews that narrowly assess the effectiveness of interventions, a scoping review approach captures the breadth of available research, identifies key concepts and intervention models, and highlights evidence gaps [18]. By synthesising this knowledge, the review aims to guide researchers, practitioners, and policymakers in developing culturally relevant and scalable strategies to reduce rural–urban disparities in youth mental health and to advance physical activity as a tool for equitable health promotion.

Research Objective

This scoping review aims to explore and map existing physical activity interventions designed to improve mental health outcomes among youth in South Africa.

2. Materials and Methods

2.1. Study Design

This study adopts a scoping review design, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The review follows the methodological framework proposed by Arksey and O’Malley [19], further refined by Levac [20], to systematically map existing literature and identify key concepts, types of interventions, evidence gaps, and research trends relevant to physical activity and mental health among rural youth in South Africa.

2.2. Protocol and Registration

The protocol for this scoping review was prospectively registered on the Open Science Framework (OSF) to enhance transparency and methodological rigour [21]. The protocol outlines the review objectives, eligibility criteria, and planned methods, ensuring alignment with best practices for scoping reviews as recommended by PRISMA-ScR guidelines.

2.3. Eligibility Criteria

This review applies the Population Concept Context (PCC) framework to guide the selection of studies.

• Population: The review will include studies focusing on youth aged 14 to 35 living in rural areas of South Africa. This age range aligns with national definitions of youth and reflects the transitional life stage during which mental health vulnerabilities commonly emerge.
• Concept: Eligible studies must involve physical activity or exercise-based interventions designed to improve mental health. These may include structured or unstructured forms of physical activity such as aerobic exercise, sports, recreational play, dance, or community movement programs.
• Context: The review will focus on mental health promotion, prevention, or treatment interventions in South Africa.

Table 1. Inclusion and Exclusion

Criteria	Inclusion	Exclusion
Timeframe	Studies published between 2014 and 2025	Studies published before 2014
Study Design	All empirical study designs: quantitative, qualitative, or mixed methods	Editorials, commentaries, and non-peer-reviewed literature
Population	Youth (14–35 years) in South Africa	Studies focused only on older people/children’s
Intervention	Any physical activity or exercise intervention	Interventions focused only on elite or professional athletes
Outcomes	Studies that report on mental health outcomes.	Studies that do not assess mental health outcomes
Language	Articles published in English	Articles published in other languages without an English translation

Table 1. Inclusion and Exclusion

Criteria	Inclusion	Exclusion
Timeframe	Studies published between 2014 and 2025	Studies published before 2014
Study Design	All empirical study designs: quantitative, qualitative, or mixed methods	Editorials, commentaries, and non-peer-reviewed literature
Population	Youth (14–35 years) in South Africa	Studies focused only on older people/children’s
Intervention	Any physical activity or exercise intervention	Interventions focused only on elite or professional athletes
Outcomes	Studies that report on mental health outcomes.	Studies that do not assess mental health outcomes
Language	Articles published in English	Articles published in other languages without an English translation

2.4. Search Strategy

A comprehensive and systematic search was conducted in multiple electronic databases to identify relevant studies examining physical activity interventions for mental health among rural youth in South Africa. The databases searched included PubMed, CINAHL and Google Scholar. The search covered the period January 2014 to September 2025 to capture the most recent and relevant evidence

The population guided the search strategy using the Concept-Context framework (PCC), where the population was youth in rural South Africa and the concept was physical activity or exercise interventions. The context was mental health and well-being. The search terms combined key concepts related to physical activity, mental health, youth populations, and rural settings in South Africa.

The search string:

(“physical activity” OR exercise OR “sport-based intervention” OR “recreational activity”) AND (“mental health” OR depression OR anxiety OR stress OR “psychological well-being”) AND (youth OR adolescent OR “young people” OR “young adult” OR teenager) AND (“rural South Africa” OR “rural communities”)

In addition to peer-reviewed journal articles, gray literature was included where relevant and methodologically sound. These sources were identified through a hand-search of reference lists.

2.5. Study Selection

All articles retrieved from the database searches will be imported into Zotero, a reference management software, to manage citations and remove duplicates efficiently [22]. Two independent reviewers (M.O.L. and V.R.) will initially screen titles and abstracts to assess relevance based on the predefined eligibility criteria [23]. Following this, the full texts of potentially eligible articles will be retrieved and thoroughly screened against the inclusion and exclusion criteria to determine final eligibility. Any disagreements between reviewers during screening will be resolved through discussion. If consensus is not reached, a third reviewer (T.L.) will be consulted to adjudicate, ensuring transparency and minimising selection bias [18]. The study selection process will be documented and reported using a PRISMA-ScR flow diagram [18].

2.6. Data Extraction

Data from included studies will be systematically extracted using a standardised data extraction form developed a prior to ensure consistency and comprehensiveness (Peters et al., 2020). Extracted information will include:

• Author(s) and year of publication: To track publication trends and contextualise findings.
• Study design and methodology: To understand the research approaches and quality.
• Sample characteristics, including age, gender distribution, and geographical location, are used to describe the population.
• Setting: Details of where the intervention occurred, such as schools, community centres, or clinics.
• Type and description of physical activity intervention: Including intervention format, duration, frequency, and delivery method.
• Mental health outcomes assessed, such as depression, anxiety, stress, or other psychological well-being measures.
• Main findings and conclusions: To summarise intervention effectiveness and key insights.

Two reviewers will independently perform data extraction, discrepancies resolved through discussion or the participation of a third reviewer, as necessary, according to the best practices for reviewing the scope [20].

3. Results

3.1. Study Selection

The systematic search was conducted across Google Scholar, PubMed, and CINAHL. The search identified 42,384 records (Google Scholar: 21,700; PubMed: 8,658; CINAHL: 12,026). After removing 10,142 duplicates, 32,242 records remained for title and abstract screening. Following this stage, 160 articles were selected for full-text review based on relevance to the eligibility criteria. Of these, 12 studies met the inclusion criteria and were included in the final synthesis. A PRISMA-ScR flow diagram summarising the study selection process is presented in Figure 1.

3.2. Characteristics of Included Studies

The 12 studies varied in design, population, and outcomes (Table 2). They included six cross-sectional studies, two qualitative studies, one intervention development study, one systematic review, one scoping review, and one conceptual paper. Sample sizes ranged from fewer than 50 (qualitative interviews) to several hundred participants (cross-sectional surveys). Most studies were school- or community-based, with a few focusing on healthcare providers or national datasets.

Narrative Summary of Individual Studies

• Asare [16] conducted a cross-sectional study among adolescents in KwaZulu-Natal, finding that higher physical activity levels were significantly associated with fewer behavioural problems and enhanced prosocial behaviour, underscoring PA’s role in resilience-building.
• Kinsman [24] used qualitative interviews and focus groups with rural adolescent girls in Mpumalanga. They highlighted barriers such as body image concerns, identity issues, and safety concerns, and proposed a model for increasing participation among girls.
• Micklesfield [14] examined 381 adolescents in a rural surveillance site in Mpumalanga. The study showed low levels of moderate-to-vigorous physical activity (MVPA), particularly among girls, and identified socioeconomic factors shaping PA and sedentary behaviour.
• Vancampfort [25] reviewed studies from Sub-Saharan Africa. They found policy- and community-level interventions were limited but essential for addressing the mental health needs of people with psychiatric conditions, indirectly reinforcing the importance of context-driven PA programs.
• Marais [26] interviewed South African mental health professionals and found positive attitudes toward PA as an adjunctive therapy, though most reported insufficient training and institutional support to integrate exercise into care.
• Burger [27] presented a conceptual model advocating for the integration of sport and exercise psychiatry into South Africa’s mental health systems, highlighting feasibility but calling for professional capacity-building.
• Zimu [28] developed the Nyakaza–Move-for-Health program in KwaZulu-Natal, a culturally tailored school- and community-based PA intervention. The program successfully improved adolescent engagement and demonstrated the importance of cultural adaptation.
• Siduli [29] conducted a cross-sectional survey of adolescents in the Eastern Cape. They reported positive associations between PA participation, body composition, and mental well-being, further emphasising PA’s dual health benefits.
• Draper [30] studied young women in urban Soweto and found that high sedentary behaviour correlated with poorer mental health outcomes. Although urban, the findings offer insight into likely patterns in rural youth with even fewer opportunities for PA.
• Bermejo-Cantarero [31] carried out a systematic review and meta-analysis of global RCTs in adolescents, confirming that structured PA interventions significantly improved health-related quality of life and emotional well-being.
• Kunene & Taukobong [32] examined PA levels among healthcare professionals in rural KwaZulu-Natal and found very low engagement, raising concerns about their role as promoters of active lifestyles.
• Mumbauer [33] conducted a scoping review of youth-focused interventions in South Africa and recommended culturally relevant, school-based approaches to integrate PA into broader mental health promotion strategies.

3.3. Overall Synthesis

Taken together, these studies consistently affirm that physical activity has protective effects on youth mental health, but most available evidence is cross-sectional and urban-focused. Interventions specifically targeting rural youth were rare, with Nyakaza–Move-for-Health being the strongest example of a context-sensitive model. Methodological limitations, weak reporting, and under-representation of rural adolescents highlight significant gaps that require attention and improvement.

4. Discussion

This scoping review set out to examine existing evidence on physical activity (PA) interventions aimed at managing mental health disorders among rural youth in South Africa. The review responded to the increasing mental health burden among adolescents and young adults and the growing recognition of exercise as a non-pharmacological treatment for depression, anxiety, and behavioural challenges. Across the 12 included studies, evidence suggests that physical activity has positive implications for the mental health of youth. However, implementing these interventions remains limited, with context-specific challenges affecting uptake and sustainability, particularly in rural areas where infrastructure, resources, and cultural dynamics differ significantly from urban centres.

4.1. Summary of Key Findings

This review synthesised findings from 12 studies, demonstrating that physical activity (PA) is positively associated with youth mental health, yet participation levels remain low, especially in rural South Africa. Evidence from empirical studies shows that higher PA engagement is linked to fewer behavioural problems and stronger prosocial functioning among adolescents [16], while insufficient PA was reported in a large rural surveillance site, with gender gaps disadvantaging girls [14]. Similarly [29] found positive associations between PA, body composition, and mental well-being among Eastern Cape adolescents, reinforcing exercise’s dual psychological and physical benefits. Although conducted in an urban setting, research confirmed that sedentary behaviour is strongly linked to poor mental health, a trend likely magnified in rural youth where infrastructure is more limited [30].

Promising intervention models were identified. The Nyakaza–Move-for-Health programme in KwaZulu-Natal demonstrated how culturally adapted interventions can enhance adolescent PA engagement [28]. Similarly, a rural Mpumalanga model targeting adolescent girls addressed safety, body image, and identity as barriers to participation [24]. These findings highlight that contextualisation, cultural sensitivity, and school–community partnerships are critical to effective program delivery.

At the systems level, [26] reported that although mental health professionals value exercise as an adjunctive therapy, most lack the training and institutional support to integrate it into clinical practice. Low PA participation among healthcare providers themselves [33] further complicates their role as promoters of active lifestyles. To address these gaps, [27] proposed a South African sport-and-exercise psychiatry model for LMICs, advocating for specialist roles within mental health services.

Global and regional reviews strengthen the case for PA as a mental health strategy. A meta-analysis confirmed that structured PA improves health-related quality of life and emotional well-being in adolescents [31], while a Sub-Saharan Africa review highlighted the importance of community and policy interventions to scale PA for people with mental illness [25]. A recent South African scoping review highlighted the need for culturally grounded, school-based mental health promotion strategies for youth, aligning with local interventions such as Nyakaza–Move-for-Health [33].

In sum, these studies consistently affirm PA’s protective role for youth mental health while exposing persistent challenges: very low participation rates, gender disparities, limited rural-focused interventions, and inadequate professional capacity. They collectively argue for culturally relevant, community-driven, and school-integrated approaches to bridge the gap between evidence and practice in rural South Africa.

4.2. Interventions and Context-Specific Models

Among the reviewed studies, intervention-focused research provided particularly valuable insights into culturally grounded and contextually relevant strategies. Som researchers introduced Nyakaza-Move-for-Health, a school- and community-based intervention tailored to adolescents in KwaZulu-Natal [28]. By integrating local cultural practices, involving caregivers, and using participatory design, this program successfully enhanced both engagement and perceived benefits of physical activity. Likewise [24] developed a model targeting rural adolescent girls, highlighting the importance of identity, body image, and safety concerns in shaping participation. These interventions illustrate that programs designed in collaboration with communities and responsive to local socio-cultural dynamics are more likely to succeed.

In contrast, studies [30], which examined physical activity and mental health in Soweto (an urban setting), demonstrated the urban bias in much of the existing literature. Although relevant for understanding adolescent behaviour, such studies are less applicable to rural communities where access to infrastructure, cultural norms, and safety dynamics differ substantially. This indicates the need for more rural-specific interventions to avoid misalignment between research evidence and real-world applicability.

4.3. Health Systems and Professional Perspectives

The integration of physical activity into formal healthcare services remains limited. One study found that while South African mental health professionals recognise the therapeutic potential of exercise, few are adequately trained to implement physical activity interventions in practice [26]. Systemic barriers, such as a lack of guidelines, limited infrastructure, and insufficient funding, further hinder integration. Another study echoed these findings in their conceptual paper, calling for the establishment of sport and exercise psychiatry models in South Africa and other low- and middle-income countries [27]. Their framework emphasised the importance of creating specialised professional roles to champion exercise as medicine within mental health services.

4.4. Global Comparisons and Broader Insights

Findings from South Africa align with international evidence confirming that physical activity is an effective strategy for improving youth mental health. Global reviews, [6,9] report that structured exercise interventions, including aerobic and resistance training, reduce depression and anxiety in young populations. More recently conducted meta-analysis demonstrates that physical activity interventions improved health-related quality of life and emotional well-being among adolescents across diverse contexts [31].

However, the South African context differs significantly from those of high-income countries, where interventions often benefit from greater infrastructure, school-based delivery systems, and policy support. In rural South Africa, challenges such as limited recreational facilities, inadequate transportation, and socio-cultural perceptions around gender and physical activity remain barriers. Comparable studies from rural Australia and New Zealand also highlight these structural and cultural barriers, underscoring the global importance of tailoring interventions to the specific needs of rural populations [10].

4.5. Gaps in the Literature

This review highlights several critical gaps. First, most included studies were cross-sectional [14,16], limiting the ability to draw causal inferences. Few randomised controlled trials (RCTs) or quasi-experimental evaluations exist that test the efficacy of physical activity interventions for rural youth. Without stronger designs, it is difficult to establish long-term effectiveness or determine optimal intervention components.

Secondly, rural youth remain underrepresented. Even when rural populations were included, findings were often not disaggregated by geographic location, which reduced their applicability. Studies illustrate this urban focus, leaving rural youth, who are among the most vulnerable groups, overlooked [11].

Third, poor reporting remains a problem. Globally, many studies fail to provide adequate details on intervention frequency, duration, and adherence. This limitation reduces replicability and hinders scalability [9].

Finally, certain vulnerable groups, including out-of-school youth, adolescents with disabilities, and LGBTQ+ populations, are rarely represented. This omission perpetuates inequities and restricts understanding of how physical activity may benefit diverse youth subgroups in rural contexts.

4.6. Implications for Research, Policy, and Practice

The evidence generated by this review suggests that physical activity should be recognised as a critical tool for addressing youth mental health challenges in South Africa. To be effective, programs must be community-driven and culturally sensitive, engaging youth, families, and local leaders in design and implementation. Given their reach and potential for structured, sustainable programming, school settings should be leveraged as primary delivery platforms for these initiatives. Some research offers a successful example of how cultural tailoring and school-community partnerships can improve outcomes [34].

Policy alignment is also vital. Integrating physical activity into existing national strategies on mental health, education, and sport development can ensure institutional backing, resource mobilisation, and inter-sectoral coordination. Building capacity among mental health professionals, as recommended by some studies is essential for embedding physical activity into both clinical and community-based care [26,27].

Researchers urgently need to conduct longitudinal and experimental studies to establish causal pathways and evaluate the effectiveness of interventions in rural contexts. Mixed-methods approaches could further explore how cultural, gender, and infrastructural factors shape participation. Including marginalised youth subgroups is necessary to ensure interventions are equitable and inclusive. Scaling up physical activity as a mental health intervention in rural South Africa requires rigorous evidence and robust implementation systems. Community ownership, school integration, and policy support represent the pillars for sustainable change. If pursued, these approaches can help reduce the rural–urban mental health gap and provide young people with accessible, non-stigmatising pathways to well-being.

5. Conclusions

This scoping review found consistent evidence that physical activity improves mental health outcomes among youth in South Africa, reducing depression, anxiety, and behavioural challenges while enhancing resilience and prosocial behaviours. However, participation levels remain low, and rigorous intervention trials targeting rural youth are scarce. Policy and practice efforts should focus on integrating physical activity into youth mental health promotion through schools, community centres, and primary healthcare systems, particularly in rural areas. Cross-sector collaboration between health, education, and sport development is essential to ensure sustainability, scalability, and equity. Building the capacity of healthcare professionals to deliver and advocate for PA-based interventions will further strengthen implementation.

Looking forward, these findings underscore the need for integrated health and education interventions that embed culturally tailored physical activity programs within broader youth development agendas. In LMIC contexts such as South Africa, such strategies can reduce rural–urban disparities, provide non-stigmatising pathways to care, and promote long-term well-being for vulnerable youth populations. This review was conducted in accordance with a prospectively registered protocol on the Open Science Framework.