Background <p> Therapeutic climbing is increasingly applied as a physical activity intervention targeting mental health in children and adolescents. However, the evidence base regarding its effectiveness and implementation remains fragmented. This systematic review aimed to synthesize current evidence on the effects of therapeutic climbing on mental health and interrelated psychological domains in children and adolescents.</p> Methods <p> The review followed PRISMA guidelines and was registered in PROSPERO. Seven electronic databases (Pubmed, PsycINFO, PsycARTICLES, PubPsych, Medline, Web of Science, and CINAHL) were systematically searched for controlled trials investigating therapeutic climbing in children and adolescents, focusing on outcomes on mental health and interrelated domains such as affective and emotional responses, self-efficacy and social dimensions. Study selection, data extraction, and risk of bias assessment were conducted independently by two reviewers.</p> Results <p> Five controlled trials met the inclusion criteria, including three randomized controlled trials and two non-randomized studies. Significant heterogeneity in study designs, intervention characteristics, and outcome measures limited comparability across studies. Reported benefits included improvements in overall mental health, psychological distress, self-efficacy, alienation, and affective and emotional states. However, reliance on wait-list controls, the absence of active control groups, small sample sizes, and potential expectancy biases complicated the interpretation of findings. Additionally, variability in group sizes, facilitator roles, and intervention settings highlighted the need for standardized protocols to enhance consistency and reliability in future research.</p> Conclusions <p> Therapeutic climbing showed promise as a psychologically beneficial intervention for children and adolescents. However, the current evidence base is limited, with few studies and significant variability in study designs, populations, and outcome measures. Notably, it remains unclear whether therapeutic climbing is superior to other physical activity interventions. Future research should address methodological limitations, incorporate active control groups to disentangle climbing-specific effects from general physical and social benefits, and investigate the mechanisms underlying observed effects. Greater emphasis on clinical populations and diverse settings will enhance the evidence base and guide practical applications.</p> Trial registration <p> The systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (registration number: CRD42024619108)</p>