Effects of exercise type and total physical activity on high-altitude acclimatization among college students

Malacclimatization to the hypobaric hypoxic environment at high altitude represents a core health concern among college students residing on the plateau. Exercise serves as an important non-pharmacological strategy to improve high-altitude acclimatization; however, its underlying pathways and boundary conditions remain unclear.

This study aimed to examine the effects of basketball and badminton on high-altitude acclimatization score among college students at high altitude, and to test the mediating role of sleep quality and the moderating effect of daily total physical activity, thereby providing empirical evidence for personalized exercise interventions for plateau populations.

A post-test only cluster-randomized controlled design was adopted. A total of 295 sophomores living at high altitude were enrolled (146 in the basketball group and 149 in the badminton group), who received a standardized 18-week exercise intervention. Data were collected using the High-Altitude Adaptation Scale, the Pittsburgh Sleep Quality Index (PSQI), and the International Physical Activity Questionnaire (IPAQ), along with physiological measurements. After controlling for demographic and physiological covariates, statistical analyses were performed using the Mann-Whitney U test and mediation-moderation models based on Hayes' PROCESS macro. HC3 heteroscedasticity-robust standard errors and 5,000 bootstrap samples were applied to ensure robustness of the results.

(1) Total physical activity significantly moderated the relationship between exercise type and high-altitude acclimatization (interaction B = -2.9965, p = 0.0056). The Johnson-Neyman interval test revealed that the badminton group showed significantly lower high-altitude acclimatization scores, indicating better adaptation than the basketball group only at a high activity level. (2) No significant mediating effect of sleep quality was found in the above relationship, and the prerequisite condition for mediation testing was not met.

The effect of exercise type on high-altitude acclimatization score is moderated by total physical activity. Differences between basketball and badminton only emerge within a specific range of activity volume. Sleep quality did not mediate this pathway under the current intervention conditions. These findings reveal boundary conditions of exercise intervention effects and provide a scientific reference for college students at high altitude to select appropriate exercise modes.