{
  "abstract": "Background: Peer relationships are an important indicator of adolescents’ school-based mental health and social adjustment, but experimental evidence on whether cognitively engaging physical activity (CEPA) improves them remains limited. This trial tested the effect of a CEPA curriculum on peer relationships relative to a traditional physical education curriculum (TPEC), with exploratory pathways through executive function and cognitive reappraisal.\n\nMethods: In this parallel two-arm cluster randomized controlled trial, 12 intact classes comprising 650 students in grades 10 and 11 from three urban public high schools in eastern China were randomly assigned within school-by-grade strata to 12 weeks of CEPA or TPEC (three 45-min sessions per week; six classes per arm). The primary outcome was the posttest total peer relationship score; secondary outcomes were executive function and cognitive reappraisal. Analyses followed the intention-to-treat principle, using linear mixed models with class random intercepts and multiple imputation; serial mediation was examined in exploratory analyses with Monte Carlo confidence intervals.\n\nResults: 650 students entered baseline assessment (CEPA, 327; TPEC, 323) and 612 (94.2%) completed the posttest. CEPA improved peer relationships relative to TPEC (between-group difference, 4.39 points; 95% CI, 0.64 to 8.13; d = 0.38; p = 0.029). Between-group differences for executive function (2.28; 95% CI, − 0.22 to 4.79; d = 0.35) and cognitive reappraisal (1.38; 95% CI, − 0.13 to 2.90; d = 0.36) were not statistically significant after Holm correction. Exploratory indirect-effect estimates through executive function, cognitive reappraisal, and their serial pathway were positive, with 95% confidence intervals that included zero. The primary result was consistent across sensitivity analyses, and observed contamination in TPEC classes was 2.3% of sessions.\n\nConclusions: A 12-week CEPA curriculum improved adolescents’ peer relationships relative to traditional physical education. Executive function and cognitive reappraisal remain candidate pathways for further testing. CEPA offers a practical approach within routine school physical education.\n\nTrial registration: Chinese Clinical Trial Registry, ChiCTR2500114337 (retrospectively registered 10 December 2025).",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": null,
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "name": "Yifan Xu"
    },
    {
      "name": "Yifan Shi"
    },
    {
      "name": "Kaiqiang Zhong"
    },
    {
      "name": "Wanqi Zhang"
    },
    {
      "name": "Wange Wang"
    },
    {
      "name": "Shimeng Wang"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/c2869dewnrcc6.bib",
  "cited_by": 0,
  "doi": "10.1186/s12889-026-30161-x",
  "fulltext_url": null,
  "id": "c2869dewnrcc6",
  "issns": [
    "1471-2458"
  ],
  "landing_url": "https://link.springer.com/article/10.1186/s12889-026-30161-x",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [],
  "openalex": null,
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-31",
  "publisher": "Springer Science and Business Media LLC",
  "ris": "https://research.draconitic.com/paper/c2869dewnrcc6.ris",
  "sources": [
    {
      "first_seen": "2026-10-31T12:21:30Z",
      "native_id": "10.1186/s12889-026-30161-x",
      "source": "crossref",
      "url": "https://link.springer.com/article/10.1186/s12889-026-30161-x"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "issn:1471-2458",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Effects of cognitively engaging physical activity on peer relationships among adolescents: a cluster randomized controlled trial exploring the roles of executive function and cognitive reappraisal",
  "title_text": "Effects of cognitively engaging physical activity on peer relationships among adolescents: a cluster randomized controlled trial exploring the roles of executive function and cognitive reappraisal",
  "type": "peer-reviewed",
  "updated_at": "2026-11-02T00:21:52Z",
  "url": "https://research.draconitic.com/paper/c2869dewnrcc6",
  "venue": "BMC Public Health",
  "versions": []
}