Physical activity and mental health in Chinese high school students: a cross-sectional study

This study provides a comprehensive examination of the intricate relationships between PA and mental health amongst Chinese high school students, uncovering the significant roles of gender, grade level, MVPA compliance and awareness of mental health resources in shaping psychological well-being. Gender was found to be an important factor, with boys demonstrating better mental health outcomes and engaging in significantly more MVPA than girls. Girls showed lower PA compliance rates, sports participation levels, and mental health scores. These findings suggest that adolescent girls may be more vulnerable to mental health issues, potentially due to physiological and psychosocial factors, such as heightened emotional sensitivity and stress^21,22. Moreover, existing studies highlight marked gender differences in PA and sedentary behavioural patterns, with boys exhibiting higher baseline MVPA levels but steeper declines over time, whilst girls maintain consistently lower levels and smaller variations²³. These disparities underscore the necessity of gender-sensitive interventions that align with the proactive health paradigm, emphasising behavioural self-management and preventive strategies. Tailored interventions for girls that address these barriers may effectively enhance their PA participation and improve their mental health outcomes^24,25.

Grade level also exerts a profound influence on mental health, with grade 11 students identified as facing a significantly higher risk of psychological distress compared to their grade 10 and 12 peers. This can be attributed to the unique ‘sandwich grade’ effect, where students experience heightened academic stress combined with insufficient psychological and social support²⁶. Grade 10 students generally face lower academic pressure as they adapt to high school life and retain a sense of optimism about their future. However, Grade 11 students encounter a significant transition. They begin preparing for major exams such as the Gaokao, which often causes them to confront the gap between their idealized expectations and the realities of their academic situation. This can lead to stress and uncertainty about their future academic and career choices. Many students at this stage report feeling unsure about their paths, which exacerbates psychological strain. In contrast, Grade 12 students, while still under the pressure of impending exams, often have a clearer sense of direction. By this stage, students are typically more confident in their future plans, whether for further study or entering the workforce. This greater sense of preparedness helps alleviate some of the anxiety that is more pronounced in Grade 11. Furthermore, Grade 12 students have more experience managing academic and life pressures, which contributes to better psychological adjustment²⁷.

To support these students, it is essential to recognize the distinct psychological challenges faced by Grade 11 students. Tailored interventions, including stress management programs and mental health support, can help mitigate the unique pressures they experience, promoting better mental health outcomes^24,25.

The protective effects of MVPA compliance on mental health are demonstrated in this study. The students who met the recommended 60 min of daily MVPA exhibited significantly better mental health compared with their non-compliant peers. These findings align with previous research indicating that regular MVPA alleviates anxiety, reduces depression and enhances psychological resilience and social connectedness²². Visier-Alfonso et al.²⁸ and Chu et al.²⁹ indicated that consistent engagement in MVPA during adolescence not only fosters mental health but also indirectly enhances academic performance by improving executive functions, cognitive flexibility and social interaction. However, the low MVPA compliance rate observed in this study—only 30.9% of the students met the daily recommendation—highlights a pervasive lack of sufficient PA amongst high school students, particularly those in grade 11. This insufficiency likely compounds students’ mental health vulnerabilities, as supported by prior findings on the positive association between MVPA and mental health^24,25.

Furthermore, this study corroborates the bidirectional relationship between PA and mental health, wherein PA promotes psychological well-being, and better mental health facilitates greater PA engagement. The students with poorer mental health are more likely to engage in low-intensity activities and exhibited reduced participation in high-intensity PA. De Meester et al.²⁴ and Khodaverdi et al.³⁰ underscored the influence of actual and perceived motor competence on adolescents’ motivation to engage in PA and their psychological well-being.

Several targeted recommendations are proposed based on these findings to enhance the PA levels and mental health outcomes amongst high school students. First, greater attention must be directed toward improving girls’ mental health and participation in PA. Schools should design gender-sensitive programs, such as inclusive sports courses, extracurricular sports clubs and community-based initiatives, to encourage girls’ engagement in physical activities³¹. Additionally, implementing mental health education and peer-support programs could help girls better manage academic stress and psychosocial challenges³². Efforts to improve girls’ perceived motor competence (PMC) are particularly critical, as increased PMC has been shown to significantly boost sports participation and mental health outcomes³⁰.

Tiered intervention strategies should be developed to address the elevated mental health risks faced by grade 11 students. Schools can offer stress management training, time management workshops and mental health seminars tailored to the specific needs of grade 11 students. In terms of PA, short, high-impact interventions, such as high-intensity interval training or 10–15 min brisk walking and stretching sessions, have been demonstrated to significantly increase MVPA compliance whilst improving mental health outcomes^33,34.

Promoting MVPA compliance is a critical step in safeguarding mental health. Schools should optimise their physical education curricula to ensure that sufficient time is allocated to PA whilst also diversifying activities to include engaging options, such as basketball, soccer and running^35,36. Families can play a complementary role by organising outdoor activities and participating in PA with their children, consistent with evidence that highlights the positive effect of family support on PA participation^37,38.

Reducing sedentary behaviour should also be prioritised as a key intervention strategy. Sedentary behaviour is negatively associated with mental health, and schools and families can implement measures to address this issue. For instance, schools can introduce short activity breaks during class periods, whilst families can limit screen time and encourage outdoor activities to promote healthier behavior³⁹.

Lastly, the promotion and utilization of mental health resources must be enhanced. Schools should take proactive measures to increase awareness and accessibility of these resources, such as organizing mental health campaigns and sharing case studies during counseling sessions. Additionally, a tiered and diverse PA intervention system should be established to accommodate students with varying mental health needs. For instance, students with poorer mental health can begin with low-intensity activities and gradually progress to higher-intensity exercises with structured guidance and motivational support. Such individualized approaches have been shown to significantly improve mental health outcomes⁴⁰.

Despite the contributions of this study, it has several limitations. First, the cross-sectional design of this study limits causal inferences, making longitudinal research essential to understand the long-term effects of PA on mental health and clarify underlying mechanisms. Second, the sample is drawn from a single high school in Xiamen, Fujian Province, limiting the generalizability of the findings to other regions or cultural contexts where PA and mental health patterns may differ. Third, PA measurements relied on self-reported questionnaires, which are subject to recall bias and may not fully capture actual PA levels. Moreover, potential confounding variables, such as SES, social support, dietary habits and sleep quality, are not fully controlled, introducing potential bias. Lastly, although the MSSMHS is a reliable and valid tool, it lacks the capacity to capture more complex dimensions of mental health, such as well-being and life satisfaction, resulting in an incomplete assessment of psychological characteristics.

Future research should address these limitations by adopting longitudinal designs to explore the dynamic and causal relationships between PA and mental health. Expanding the sample to include diverse regions and schools would improve generalizability, whilst integrating objective PA measurement tools, such as accelerometers and heart rate monitors, could mitigate the limitations of self-reported data. Additionally, future studies should incorporate a wider range of confounding variables to develop a more comprehensive analytical framework and explore how factors, such as social support, family environment and sleep quality, mediate or moderate the relationship between PA and mental health.

Further research should also investigate broader mental health dimensions, such as well-being and life satisfaction, using multidimensional assessment tools to capture the full effect of PA. The interplay between gender and grade level requires deeper analysis, especially to understand the reasons for the decline in PA during late adolescence and its effect on mental health. Intervention studies in schools and communities are crucial to develop tailored PA programs for different genders and grade levels and assess their effectiveness in improving mental health outcomes⁴¹. Additionally, the incorporation of neuroscientific methods, such as EEG or neuroimaging tools, could provide valuable insights into the neurocognitive mechanisms linking PA to enhanced mental health outcomes²⁹.

In conclusion, this study underscores the significant association between PA and mental health amongst Chinese high school students, highlighting the protective role of sufficient MVPA and the urgent need for targeted interventions, particularly for girls and grade 11 students. The findings suggest that promoting PA, reducing sedentary behaviour and optimising extracurricular time management can enhance the PA levels and mental health, aligning with the principles of proactive health. Addressing the study’s limitations and pursuing the proposed research directions will provide more comprehensive evidence to inform policy and practice, ultimately advancing adolescent well-being and contributing to the ‘Healthy China 2030’ initiative.