Association between school-based physical activity promotion and mental health: a population-based cross-sectional...

Growing evidence emphasizes the crucial role of schools in promoting both physical activity (PA) and mental health. This study examined the associations of school-based PA promotion measures with mental health among schoolchildren in Finland. The data were extracted from two sources: the Finnish School Health Promotion study providing individual-level data and the Finnish Benchmarking System for Health Promotion Capacity Building providing school-level data. The combined dataset comprised 87 372 schoolchildren from 1662 schools. The PA promotion efforts were measured in four categories. Mental health outcomes included depressive and anxiety symptoms, self-esteem, and prosocial behaviour. Multilevel binary logistic regression was used as a statistical method. In adjusted analyses, enabling the utilization of indoor sports facilities outside of physical education (PE) classes was associated with lower likelihood of low self-esteem (odds ratio [OR]: 0.93, 95% confidence interval [CI]: 0.87-0.99). Furthermore, extended PA breaks were associated with lower likelihood of low self-esteem among boys (OR: 0.91, 95% CI: 0.83-0.99), and enabling the utilization of indoor sports facilities outside of PE classes was associated with a lower likelihood of depressive symptoms among girls (OR: 0.93, 95% CI: 0.87-0.99). The simultaneous implementation of all four PA promotion measures was associated with better prosocial skills (OR: 1.06, 95% CI: 1.01-1.11). School-based PA promotion may enhance children's self-esteem and prosocial skills, and in girls reduce the risk of depressive symptoms, although the observed associations were particularly weak. To support the mental health of schoolchildren, PA should be promoted in schools through a variety of approaches.