Effects of cognitively engaging physical activity on executive function, mental health, and physical fitness in school-age children: a cluster-randomized controlled trial

Over 80% of school-aged children worldwide engage in insufficient physical activity, compromising their executive function development during a critical neuroplasticity window. Cognitively Engaging Physical Activity (CEPA), which integrates cognitive challenges into physical exercise, may offer superior benefits compared to traditional physical education curriculum (TPEC), yet comprehensive evidence across cognitive, psychological, and physical domains remains limited. This study examined the differential effects of CEPA and TPEC on executive function (EF), mental health, and physical fitness in school-aged children. A total of 96 school-aged children were randomly assigned to either the CEPA group (n = 48, age = 9.31 ± 0.47, 54% boys) or the TPEC group (n = 48, age = 9.40 ± 0.49, 52% boys). The intervention lasted for 11 weeks, with sessions held three times per week for 45 min each. Pre- and post-intervention assessments included overall executive function (quantified by composite EF score), mental health (general mental health, resilience, emotion regulation), and physical fitness (speed, endurance, explosive power, flexibility, agility and coordination). A mixed-design ANOVA was conducted, and effect sizes were reported as partial eta squared (η²p). The CEPA group demonstrated superior improvements (time*group interaction effects) in executive function (η²p = 0.634), resilience (η²p = 0.042), emotion regulation( η²p = 0.081), speed (η²p = 0.048), explosive power (η²p = 0.041), endurance (η²p = 0.627), and agility (η²p = 0.181) compared to controls (all p < 0.05). No significant time*group effects were observed for overall mental health or flexibility. Girls showed greater speed improvements than boys in the CEPA condition (interaction p = 0.039). Within the studied cohort, the 11-week CEPA intervention was more effective than the TPEC in improving EF, The 11-week CEPA intervention was more effective than the TPEC in improving EF, resilience, emotion regulation, speed, endurance, and agility-coordination, with gender differences evident in speed performance. As a low-cost and scalable approach, CEPA provides empirical support for school-based health promotion and offers a promising public health strategy for enhancing children’s physical and mental development. This study was retrospectively registered at ChiCTR (Identifier ChiCTR2500101607) on April 27, 2025.