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There was a significant positive overall association between physical fitness and mental health in children and adolescents (pooled r = 0.206, p 0.001). We found suggestive evidence of moderation by age group, fitness components and socioeconomic status (all p 0.08). No relevant studies focusing on preschoolers were identified. Evidence based on longitudinal and intervention studies was limited. We observed a small to medium sized positive association between physical fitness and overall mental health in youth. However, as t