Schools are a critical setting for children to accrue recommended levels of physical activity, and after-school programmes are suggested to supplement existing programmes such as physical education. This review of reviews provides a comprehensive picture of the effects of after-school physical activity programmes on student physical activity and health. We completed a literature search of electronic databases and identified six existing systematic reviews and meta-analyses of the effects of after-school programmes on child and adolescent physical activity and health. We compared these reviews on numerous factors, including the databases searched, aims, outcome variables, physical activity measures, inclusion criteria, and quality of original studies. Our review of reviews identified considerable differences among the published reviews in the number and type of studies included, and in the conclusions drawn. In general, the reviews identified better outcomes when conducting the programmes in school rather than community settings, providing sessions on two or more days a week, and ensuring high programme attendance rates. Subgroup analyses indicated that girls were more receptive than boys to intervention programmes that promoted weight control. Additionally, there were some benefits for increasing physical activity levels among overweight youth and boys. This review of reviews suggests there is currently only modest support of the benefits of after-school programmes on child and adolescent physical activity levels and body composition. Many questions remain unanswered, and there is further need to design, implement, and assess quality after-school interventions that target physical activity in diverse settings.