Peer-reviewed article

The impact of a mixed exercise intervention on the physical and mental health of left-behind children: a randomized controlled trial combining sports games and ball sports.

Fang T, Wang A, Wang Y, Li H · 20 Jul 2026

Abstract

Background Left-behind children (LBC) in rural China often have limited opportunities for regular physical activity and may face heightened psychological difficulties. School physical education (PE) provides a practical setting in which structured interventions can be delivered to this group. This study examined whether a 12-week PE program combining cooperative sports games with ball-sport activities was related to changes in physical fitness and psychological health among rural LBC. Methods Forty sixth-grade LBC from a rural boarding primary school were randomly allocated to a mixed training group (MTG, n = 20) or a control group (CONG, n = 20). The MTG completed the mixed exercise program during regular PE classes for 12 weeks, with three 90-min sessions each week. The CONG continued with routine PE. Psychological health was measured using the Mental Health Test (MHT). Physical fitness was assessed with standard school-based indicators, including vital capacity, 50-m dash, 8 × 50-m shuttle run, rope skipping, sit-ups, sit-and-reach, and body mass index (BMI). Group-by-time effects were examined using repeated-measures ANOVA. Results Following the 12-week period, the MTG showed greater improvements in selected psychological and physical outcomes compared with the CONG. Significant group-by-time interactions were found for MHT total score (p < 0.001, d = -1.07), interpersonal anxiety (p = 0.007, d = -0.73), and self-blame tendency (p = 0.002, d = -1.41). Among physical fitness outcomes, significant group-by-time interactions were observed for vital capacity (p < 0.001, d = 0.97), 8 × 50-m shuttle run performance (p < 0.001, d = -0.90), 50-m dash performance (p = 0.002, d = -0.78), and rope skipping (p = 0.024, d = 0.73). However, BMI and sit-ups showed no significant group-by-time interactions. No exercise-related injuries or other adverse events occurred during the study. Conclusion A 12-week mixed exercise program embedded in routine PE was associated with selective improvements in psychological health and physical fitness among rural LBC. These findings provide preliminary support for the potential value of combining cooperative sports games with ball-sport activities in school PE. Larger multi-site studies with longer follow-up are needed to confirm these findings.