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

Background: Rural left-behind children (LBC) often face both physical and psychological challenges. This study evaluated a 12-week school-based mixed physical education (PE) program combining cooperative games and ball sports to improve psychosocial well-being and physical fitness. Methods: We conducted a randomized controlled trial to test a 12-week mixed PE program integrating cooperative sport games and ball sports. Forty boarding-school left-behind sixth graders (12.2±0.3 years) were randomized to a mixed training group (MTG, n=20) or usual PE (CONG, n=20). MTG completed three 90-min lessons/week, with cooperative games (20–25 min) and soccer/basketball drills and small-sided games (55–60 min) delivered with progressive target heart-rate zones (120–170 beats·min ⁻¹ ; ≈60–85% of age-predicted maximal heart rate, HRmax). Mental health was assessed using the Mental Health Test (MHT), and fitness was assessed via Vital Capacity, 50-m Dash, 8×50-m Shuttle Run, Rope Skipping, Sit-ups, Sit-and-Reach, and Body Mass Index (BMI). Data were analyzed using two-way repeated-measures ANOVA. Results: Two-way repeated-measures ANOVA revealed significant time×group interaction for MHT Total Score, Interpersonal Anxiety, and Self-Blame Tendency ( p <0.05). MTG also improved Vital Capacity, 50-m Dash, 8×50-m Shuttle Run, Rope Skipping, Sit-and-Reach versus CONG, while BMI and Sit-ups were unchanged. Conclusions: A structured integration of sport games and ball sports within routine PE can selectively improve psychosocial well-being and key fitness components in rural left-behind children without extra-curricular burden. Trial registration: ClinicalTrials.gov, NCT07452302. Registered 04 March 2026. Retrospectively registered.