Effects of brief bouts of exercise, embodied cognitive training, and their combination on social anxiety in rural left-behind children: a randomized controlled trial

Objectives This study aimed to examine the effects of three intervention modes on social anxiety among rural left-behind children in China, including brief bouts of exercise, defined as short, structured periods of physical activity integrated into daily routines; embodied cognitive training, defined as training that integrates cognitive tasks with goal-directed bodily movements; and a combined intervention incorporating both approaches, with outcomes assessed at baseline, post-intervention, and follow-up. Methods A randomized controlled trial (RCT) was conducted to examine the effects of different interventions on social anxiety among rural left-behind children. Participants were recruited purposively from one rural primary school in Shaodong City, Hunan Province, and then randomly allocated to four groups ( n = 25 each): brief bouts of exercise (BBEG), embodied cognitive training (ECG), combined intervention (CIG), or control (CG). Demographic information was collected using a researcher-designed questionnaire. The interventions were delivered over a 12-week period, with all intervention groups receiving their respective interventions four times per week, followed by a 6-week follow-up. Social anxiety was assessed using the self-report Social Anxiety Scale for Children at baseline, immediately post-intervention, and follow-up. Outcomes were analyzed using repeated-measures ANOVA to examine group, time, and interaction effects. Results At baseline, no significant differences were observed among groups in social anxiety (SA), fear of negative evaluation (FNE), or social avoidance and distress (SAD) (all p > 0.05), indicating good baseline comparability. Mixed-design analyzes of variance revealed significant Group × Time interactions across all outcome measures ( p < 0.05), indicating that changes over time differed significantly across groups. From pre-test to post-test, participants in the brief bouts of exercise group, embodied cognitive training group, and combined intervention group showed significant reductions in SA, FNE, and SAD ( p < 0.001), whereas no significant changes were observed in the control group ( p > 0.05). These improvements were maintained at follow-up ( p < 0.01). Post hoc comparisons indicated that, at both post-test and follow-up, all intervention groups demonstrated significantly greater symptom reductions than the CG ( p < 0.05). Notably, the CIG exhibited significantly greater improvements than both single-intervention groups across all outcomes, and the BBEG achieved greater reductions than the ECG ( p < 0.05). Conclusion All three interventions were associated with reductions in social anxiety relative to the control group. Compared with single-modality interventions, the combined intervention demonstrated greater improvements during the intervention period and follow-up.