BACKGROUND: The noticeable increase in the prevalence of elevated blood pressure (BP) among children and adolescents has been a public health concern. Although physical activity (PA) intervention has been widely applied in children BP controlling programs, the effectiveness of PA intervention in adolescents over 12, the dose-response relationship between PA intervention and BP and the optimal dose of exercise required for BP lowering are all remained unclear. Current systemic review and meta-analysis aimed to offer a comprehensive evaluation of the evidence linking PA intervention to BP reduction in children and adolescents. METHODS: According to PRISMA and MOOSE guidelines, we searched PubMed, Embase, MEDLINE Complete, Web of Science, and the Cochrane Library up to Jul 22, 2025, for randomized controlled trails examining the association between physical activity intervention and blood pressure in children and adolescents aged 6 to 24 years old. Pooled weighted mean differences (WMD) were calculated using a random-effects model. Restricted cubic splines method was used to assess the dose-response association between PA intervention dose and blood pressure change. RESULTS: A total of 22 RCT studies involving 3456 subjects were included in this meta-analysis. Pooled results revealed that PA intervention was significantly associated with mean reduction in systolic blood pressure (SBP) (MD -4.05, 95% Confidence Interval (95% CI) -6.05 to -2.06) and diastolic blood pressure (DBP) (MD -1.95, 95% CI -3.12 to -0.78). Both SBP and DBP showed a non-linear relationship with PA intervention dose with a max decrease at 700 MET-min/week. While the exercise intervention dose is within 0 to 700 MET-min/week, both DBP (beta -0.0054, p = 0.015) and SBP (beta -0.0111, p = 0.003) decrease as the exercise dose increases. However, when the exercise dose exceeds 700 MET-min/week, diastolic (beta 0.0059, p = 0.049) and systolic blood pressure (beta 0.0113, p = 0.029) rebound upward with further increases in exercise volume. CONCLUSION: Physical activity intervention could reduce blood pressure in children and adolescents. There is a V-shape dose-response relationship between physical activity intervention dose and changes in blood pressure among adolescents, with an optimized dose of 700 MET-minutes per week.

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