A Sports Program Improves Adolescent Mental Health Through Resilience And Sleep Quality: A Randomized Controlled Trial

Abstract

Background: Research showing the mental health benefits of physical activity usually based on at-risk subjects, e.g. psychiatric patients. Randomized controlled trial on healthy subject yielded no significant improvement on mental outcomes. This study aims to assess the effectiveness of a positive youth development (PYD)-based sports mentorship program on mental well-being of adolescents recruited in a community setting, as well as the mechanism in-between. Methods: This is a randomized controlled trial recruiting students from 12 secondary schools in Hong Kong, China. Participants were randomly assigned in a 1:1 ratio to an intervention or a control arm after stratification for school, from October 2013 to June 2014. Participants were not blinded to allocation due to the nature of intervention. Students in the intervention arm received an after-school PYD-based sports mentorship for 18 weeks. Each weekly session lasted for 90 minutes. Students in the control arm received exclusive access to a health education website. Results: 664 students (mean age 12.3 [SD 0.76]; 386 females [58.1%]) completed baseline and post-intervention assessments. The intervention improved students’ mental well-being (Cohen’s d 0.25, 95% confidence interval 0.10–0.40, P=0.001), sleep quality (0.17, 0.02–0.32, P=0.03), self-efficacy (0.22, 0.07–0.37, P=0.01), resilience (0.19, 0.03–0.34, P=0.02), physical fitness (flexibility [0.28, 0.13–0.43, P=0.02], lower limb muscle strength [0.18, 0.03–0.33, P=0.03], dynamic balance [0.21, 0.06–0.37, P=0.01]), and physical activity level (0.39, 0.24–0.55, P<0.0001). Path analysis shows that the benefits on mental health are partially mediated through resilience and sleep quality. Conclusions: This study shows that a PYD-based sports mentorship intervention could improve healthy adolescents’ mental well-being through resilience and sleep quality. Implications will be discussed.