Effects of different types of badminton training on sleep quality, anxiety, and related baseline physiological markers in graduate students with sleep disorders: a randomized controlled trial

Abstract

Background

The prevalence of sleep disorders and anxiety is on the rise among high-stress groups like graduate students. Physical activity interventions have revealed effectiveness in improving mental health, yet the effect of specialized badminton training on sleep-disordered populations remains under-researched. Besides, the effects of various forms of badminton training on sleep quality and anxiety in graduate students vary.

Objective

Our study aims to evaluate the effect of basic skill, advanced skill, and physical conditioning-focused badminton training on sleep quality, anxiety levels, and baseline physiological markers in graduate students with sleep disorders.

Methods

A randomized controlled trial (RCT) was conducted (Clinical Registry Number: TCTR20250119001, 16 January 2025), involving 160 graduate students randomly assigned to one of four groups: Badminton Basic Skills Training Group (BBSTG), Badminton Advanced Skills Training Group (BASTG), Badminton Specialized Physical Training Group (BSPTG), and a Control Group (CG), with 40 participants per group. The experimental groups trained three times weekly for one hour per session over 12 weeks, while the CG received only standard lifestyle guidance. Repeated measurements of sleep quality and anxiety levels were assessed at baseline, 4, 8, and 12 weeks using the Pittsburgh Sleep Quality Index (PSQI) and Self-Rating Anxiety Scale (SAS), with resting heart rate and blood pressure also recorded at each time point.

Results

(i) Baseline Measurements: Prior to the intervention, no statistically significant differences were uncovered among groups in terms of sleep quality, anxiety levels, basic physiological data (resting heart rate, blood pressure), or general characteristics (age, height, weight, BMI) (p > 0.05). Attrition rates of 8%- 11% were observed across groups, causing final group sizes of 36, 37, 35, and 36 for BBSTG, BASTG, BSPTG, and CG, respectively. This attrition had minimal impact on statistical analysis. (ii) PSQI Scores: Sleep quality enhanced significantly across all experimental groups over the 12-week period, with the BSPTG group showing the greatest improvement. At week 12, the BSPTG's PSQI score was 5.8 ± 0.8, significantly better than that of the CG (p < 0.001, 95% CI [- 2.7, - 1.4]). The BSPTG consistently outperformed the control group at all time points, with an F-value of 10.32 at week 12 (p < 0.001), stressing the positive effect of badminton training on sleep quality. (iii) SAS Scores: At week 12, the BSPTG’s SAS score was 36.3 ± 4.0, significantly lower than that of the CG (p < 0.001, 95% CI [- 6.1, - 3.2]). Anxiety levels reduced significantly across all experimental groups, with the BSPTG demonstrating the most notable reduction, further illustrating the significant effect of physical conditioning training on anxiety relief. (iv) Resting Heart Rate and Blood Pressure: Resting heart rate reduced significantly over the 12-week period, with the BSPTG achieving a final rate of 66.1 ± 4.8, significantly better than that of the CG (p < 0.001, 95% CI [- 6.9, - 3.2]). While blood pressure displayed some reduction post-intervention, differences were not statistically significant (p > 0.05), revealing limited short-term effect of badminton training on blood pressure. (v) Effect Sizes (Cohen’s d): In PSQI scores, BSPTG showed a large effect (d = 0.8), BASTG a medium effect (d = 0.5), and BBSTG a small effect (d = 0.3). For SAS scores, BSPTG demonstrated a medium-to-large effect (d = 0.7), BASTG a medium effect (d = 0.5), and BBSTG a small effect (d = 0.3). In resting heart rate, BSPTG showed the most significant improvement (d = 0.6), with BASTG showing a small-to-medium effect (d = 0.4) and BBSTG showing minimal improvement. Effect sizes for blood pressure were not significant.

Conclusion

Specialized badminton training, in detail, physical conditioning training, can significantly improve sleep quality and reduce anxiety levels in graduate students with sleep disorders and decrease resting heart rate. As a non-pharmacological intervention, specialized badminton training has underlying applications for enhancing mental health and cardiovascular health.

Trial registration

Randomized Controlled Trials, TCTR20250119001, 16 January 2025.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-025-22551-4.

Introduction

As modern life accelerates and work-related stress increases, the prevalence of sleep disorders and anxiety is rising [1]. In particular, since the onset of the COVID- 19 pandemic, mental health and sleep quality issues have intensified among high-stress groups like college and graduate students, who face multiple pressures tightly linked to academics, career prospects, and future uncertainties [2]. Sleep disorders, interestingly, not only affect daily quality of life, but are also linked to a range of psychological and physical health issues, comprising depression, anxiety, and cardiovascular diseases [3]. Consequently, determining effective interventions to enhance sleep quality and alleviate anxiety has significant public health implications.

Exsiting article has indicated that physical activity interventions have emerged as a safe, natural, and non-pharmacological approach widely studied for their ability to enhance mental health and improve physical fitness [4]. Numerous studies confirm that regular moderate-intensity exercise, especially aerobic activities, can effectively enhance sleep quality [5], reduce anxiety [6], and alleviate depressive symptoms [6, 7], with significant effects reported in these areas. As a blend of aerobic and anaerobic exercise, badminton is not only engaging, but also enhances physical endurance, cardiopulmonary fitness, and coordination [8, 9]. Despite the growing body of literature on the mental and physical health benefits of exercise, research specifically focusing on the effects of badminton training remains limited. Previous study has primarily focused on the physiological and psychological benefits of physical activity in general, often assessing the impact of competitive sports or less structured exercise interventions [10]. However, few studies have investigated the specific effects of structured badminton training, particularly in populations with sleep disorders or anxiety. In this context, badminton training—distinct from simply playing the sport—entails a structured program designed to improve physical conditioning, emphasizing endurance, agility, and explosiveness, rather than the competitive aspects of the game [11, 12].

Moreover, existing research does not provide clear evidence on how different types of badminton training (e.g., basic skill training, advanced skill training, and physical conditioning training) affect sleep quality and anxiety levels. Given the differences in training intensity, goals, and physiological load between skill training and conditioning training [13], it is plausible that these distinct forms of training may cause varying effects on mental and physical health. To address this gap, the present study aims to delve into how different types of badminton training impact sleep quality, anxiety levels, and baseline physiological markers (such as resting heart rate and blood pressure) in graduate students with sleep disorders. By comparing the effects of basic skill training, advanced skill training, and physical conditioning training, we seek to provide insights into the specific ways in which these types of training affect mental and physical health.

Our study also aims to contribute new knowledge on the unique role of badminton training as an effective, non-pharmacological intervention for improving the mental and physical health of high-stress populations. Specifically, we hypothesize that badminton training will significantly improve sleep quality and reduce anxiety levels, with physical conditioning training potentially demonstrating greater effectiveness compared to skill-based training. By examining the differential effect of these training approaches, our research will provide empirical evidence that supports strategies for improving mental health, particularly for graduate students with sleep disorders. This research is unique in its focus on comparing the effects of different badminton training types and fills a critical gap in the existing literature.

Methods

Study design

This study utilized a randomized controlled trial (RCT) design, targeting graduate students from Qufu Normal University as participants. The design and methodology strictly adhered to the ethical principles outlined in the Declaration of Helsinki by the World Medical Association [14]. The research protocol was approved by the Biomedical Ethics Committee of Qufu Normal University (approval number: 2023131). All participants provided informed consent prior to participation, and they were told that they could withdraw at any time. The experiment was conducted from March 19, 2023, to June 11, 2023. Notably, the trial was retrospectively registered with the Thai Clinical Trials Registry (TCTR) on January 16, 2025, under the registration number TCTR20250119001. This retrospective registration was due to administrative procedures, and we have clarified this in the manuscript to ensure full transparency.

Sample selection

Sample size

The sample size was estimated based on the effect size (EZ) and standard deviation reported in previous similar studies on the effect of exercise interventions on mental health and sleep quality, with a significance level of 0.05 and statistical power set at 0.80 [15]. In the sample size calculation, we used G*Power software [16]. Initially, a larger pool of graduate students was approached from Qufu Normal University. After screening, 160 participants were enrolled in the study, all of whom had sleep disorders. The inclusion criteria required participants to have a Pittsburgh Sleep Quality Index (PSQI) score greater than 5, indicating poor sleep quality. The exclusion criteria removed participants with severe physical or mental health conditions that could interfere with the study. Initially, more than 160 participants were recruited, but after applying the inclusion and exclusion criteria, 160 students met the necessary requirements and provided informed consent to participate.

To ensure all participants had sleep disorders, we employed the PSQI as a diagnostic tool. The PSQI is a widely used and validated instrument that measures sleep quality over the past month, with a score greater than 5 indicating poor sleep quality and thus sleep disorders. All 160 participants were initially assessed using the PSQI, and all had scores greater than 5, confirming that they met the inclusion criteria for sleep disorders. This rigorous screening process ensured that all enrolled participants had sleep disorders at the time of the study.

Inclusion and exclusion criteria

Inclusion Criteria: (i) Participants are graduate students (Master’s or PhD) aged between 22 and 35 years, as this age range reflects the typical age of graduate students at Qufu Normal University and represents a period of significant academic and career pressures, as well as physiological and psychological stability, making it ideal for studying sleep disorders and anxiety.

(ii) Participants must have a PSQI score greater than 5, indicating poor sleep quality [17]. Participants will be further assessed by a clinical evaluation to confirm the presence of sleep disorders as defined by standard diagnostic criteria. (iii) Participants should not have severe physical illnesses or chronic diseases (such as heart disease, diabetes, etc.) that prevent them from participating in badminton training. (iv) Participants are willing and able to comply with the study protocol, including attending training sessions three times per week, one hour per session, and maintaining normal daily habits throughout the study period. (v) Participants voluntarily agree to participate in the study after being fully informed and have signed the informed consent form.

Exclusion Criteria: (i) Individuals with severe mental health issues, requiring professional treatment, including but not limited to untreated depression or anxiety disorders. (ii) Individuals with any serious health conditions, such as heart disease, asthma, diabetes, severe musculoskeletal injuries, or movement disorders, which may affect their ability to participate in badminton training. (iii) Individuals who have been using sleeping pills, sedatives, or other medications (such as antidepressants) that affect sleep quality on a long-term basis. (iv) Individuals who have previously participated in similar badminton or exercise intervention studies. (v) Pregnant or breastfeeding women, to avoid potential health or training effects. (vi) Individuals who are simultaneously involved in other treatments that may affect sleep quality. (vii) Individuals who, for any personal reason, are unable to complete the entire study protocol.

Grouping and training protocol

Eligible participants were randomly allocated into four groups: three intervention groups and one control group, each with 40 participants. The groups and interventions were as follows:

• (i)Badminton Basic Skills Training Group (BBSTG): Participants received training focused on fundamental badminton skills. The session was designed to introduce foundational movements and techniques, including forehand and backhand drives, basic serves, and footwork patterns such as the side-step and split-step. The intensity of the training was monitored using the Rating of Perceived Exertion (RPE) scale, with participants expected to stay within an RPE range of 12–14 (moderate intensity) during most exercises. This ensured that participants were engaged in physical activity without overexertion, allowing them to master basic skills while improving coordination and physical endurance. Sessions were tailored to accommodate participants of varying badminton experience, with difficulty progressively increasing throughout the 12-week period, focusing on technical precision and consistency.
• (ii)Badminton Advanced Skills Training Group (BASTG): In addition to the basic skills training, participants in this group received training on more advanced tactical and technical badminton skills. These included net kills, backcourt clears, drop shots, and footwork combinations such as jump smashes and pivoting movements. The intensity was also monitored using RPE, targeting an RPE range of 14–16 (high intensity) to engage more complex movements and rapid changes in direction. Advanced skill exercises were structured with drills that combined multiple skills, progressing from isolated movements to continuous rallies that required higher cognitive focus and physical effort. For example, a typical session involved performing a combination of footwork drills followed by shot execution, with 4–6 sets per exercise and short rest intervals of 30 s to 1 min between sets. This progressive training approach ensured participants were challenged as their technique and physical capabilities improved.
• (iii)Badminton Specialized Physical Training Group (BSPTG): This group focused specifically on enhancing physical conditioning tailored to the demands of badminton. The primary emphasis was on improving endurance, explosiveness, and agility, which are crucial for optimal performance in badminton. Sessions included high-intensity interval training (HIIT) involving exercises like shuttle sprints, squat jumps, and rapid start-stop drills to enhance anaerobic capacity. A typical HIIT session consisted of 20–30 s work intervals followed by 10–20 s rest intervals, repeated for 5–8 sets, with intensity progressively increasing over the 12 weeks. The rest periods were shortened as participants adapted to the training, and the volume of high-intensity efforts gradually increased. Additionally, agility drills, such as lateral shuffles, cone drills, and ladder drills, were incorporated to improve reaction time and foot speed. Training intensity was carefully monitored using both heart rate zones and RPE, with the goal of maintaining a high level of exertion (RPE of 16–18) during key portions of the session, especially during the anaerobic sprints and explosive movements. The training progression included increased duration of intervals and decreased rest time to ensure continuous physiological adaptation.
• (iv)Control Group (CG): Participants in the control group did not engage in any badminton-specific skill training but instead received standard lifestyle and sleep quality improvement guidance. This included maintaining regular sleep schedules, practicing relaxation techniques (e.g., deep breathing and progressive muscle relaxation), and improving sleep hygiene practices. These sessions aimed to provide general guidance on how to enhance well-being without engaging in any physical training.

Training Frequency and Intensity: All intervention groups trained three times per week, with each session lasting one hour. The intensity was adjusted to ensure that participants were exposed to a consistent level of challenge that would facilitate skill improvement or physical conditioning without leading to overtraining. For the BBSTG and BASTG groups, intensity was controlled by the difficulty of the tasks, starting with basic movements and progressing to more complex drills. For the BSPTG group, intensity was directly controlled through adjustments in work-to-rest ratios during HIIT and agility drills. For all groups, monitoring involved using both objective metrics (heart rate and duration of effort) and subjective ratings (RPE) to ensure appropriate intensity levels throughout the 12-week period [18, 19].

By employing this structured and progressive approach to each training protocol, we ensured that the interventions were tailored to the participants'baseline fitness levels and were scalable across the 12-week duratio [20].

Data collection and measurement tools

Measurement tools

We used the following assessment tools: (i) Sleep Quality Measurement: Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) [17]. The PSQI assesses sleep quality over the past month, comprising seven components: subjective sleep quality, sleep latency, sleep duration, sleep efficiency, and more. Scores range from 0 to 21, with higher scores confirming poorer sleep quality. PSQI score changes at baseline, the 4 th, 8 th, and 12 th weeks were used to dynamically observe the effect of badminton training on sleep quality. (ii) Anxiety Level Measurement: Anxiety levels were measured using the Self-Rating Anxiety Scale (SAS) [21]. The SAS is a self-assessment scale with 20 items, each rated on a scale of 1 to 4, with the total score converted to a standard score to assess anxiety severity. Higher scores indicate greater anxiety. Changes in SAS scores at baseline, the 4 th, 8 th, and 12 th weeks were used to evaluate the effects of different badminton training protocols on anxiety levels, observing anxiety trends over the intervention period. (iii) Basic Physiological Data Measurement: Resting heart rate and blood pressure were assessed using an electronic blood pressure monitor and heart rate monitor at each data collection point to observe the effects of badminton training on the participants'physiological status. Basic physiological data provided supplementary information to support a comprehensive analysis of the intervention’s impact on physical and mental health. The PSQI scale [22] and the SAS scale [23] have been indicated to have good reliability and validity among Chinese university students, and therefore were used for this assessment.

Data collection procedure

Baseline Measurement (Pre-Intervention): A week before the intervention, baseline measurements were taken for all participants, recording initial sleep quality, anxiety levels, and basic physiological data to serve as a basis for subsequent comparisons.Periodic Measurements: Data collection was conducted during the 4 th, 8 th, and 12 th weeks of the intervention, comprising measurements of sleep quality, anxiety levels, and basic physiological data at each point. All measurements were taken in the morning or afternoon to lower the effect of circadian rhythms on the data. Data Collection Timing: Data collection occurred on set dates every four weeks to ensure consistency in measurement timing, facilitating comparative analysis.

Data management

All data were anonymized immediately after collection by a designated research assistant who was not involved in data analysis or intervention delivery. Participant identifiers, such as names and student IDs, were replaced with unique alphanumeric codes to ensure confidentiality. The key linking these codes to participant identities was stored separately in a secured location accessible only to the principal investigator, allowing follow-up if necessary while maintaining privacy. Anonymized data were entered into a unified, password-protected database, with access restricted to authorized personnel. These procedures were approved by the Biomedical Ethics Committee of Qufu Normal University (approval number: 2023131) and adhered to the ethical standards of the Declaration of Helsinki.

Randomization and blinding

To ensure that group assignments were random and unbiased, we used a computer-generated random number table (RNT) for randomization. Participants were randomly assigned to either the BBSTG, the BASTG, or the BSPTG based on the assigned random number at the time of group entry. Stratified randomization was employed to ensure that the groups were balanced with respect to gender and baseline severity of sleep issues. This stratification process helped to control for potential confounding variables that could affect the outcomes. Additionally, the sample size of each training group was kept relatively equal to avoid bias in the allocation process. Block randomization was used to ensure an even distribution of participants across the groups throughout the course of the trial. To further minimize selection bias, the researchers were blinded to the specific group assignments during the allocation process. This approach ensured transparency in the randomization process and increased the reliability of the results. A single-blind approach was used to lower subjective bias among researchers and participants, enhancing objectivity and reliability of the results. Participants were unaware of their specific intervention group after randomization. In the context of the intervention, researchers provided training instructions or lifestyle guidance without disclosing the specific aims of the training content to prevent expectation effects from influencing results. Additionally, data collection and entry were performed by specialized staff who anonymized data coding. Data analysts were blinded to group assignments before formal analysis, further lowering analytical bias. Researchers responsible for intervention delivery did not participate in data collection or analysis to avoid subjective influence on outcomes. The designated staff members who recorded sleep quality, anxiety levels, and physiological data were blinded to participant group allocation to ensure objectivity in the measurement process.

Data analysis

Statistical analyses were conducted using SPSS 26 software [24]. All data are presented as mean ± standard deviation (M ± SD) [25]. A significance level of α = 0.05 [26] and a 95% confidence interval (95% CI) were set. Specific procedures include: (i) Between-Group Comparison: Post-intervention data from the experimental and control groups were compared using ANOVA [27] to explore the differences in sleep quality and anxiety levels across different badminton training protocols. (ii) Within-Group Comparison: Paired t-tests^[25]were used to compare changes in sleep quality and anxiety levels before and after the intervention in each group to assess the effectiveness of each protocol. (iii) Group Difference Comparison: Two-way ANOVA [28] was used to analyze the effect differences across the three badminton training types. (iv) Effect Size Calculation: Effect sizes (e.g., Cohen’s d) [29] were calculated to confirm the practical significance of the training interventions. The Plot graphs for each indicator were generated using GraphPad Prism 8.0.2.

Results

Baseline measurements

Baseline measurements were conducted one week prior to the intervention, displaying no significant differences between the groups in terms of sleep quality, anxiety levels, and basic physiological data (resting heart rate and blood pressure) (p > 0.05), confirming uniform initial conditions across all groups. Besides, no significant differences were shown in basic characteristics such as age, height, weight, and BMI (p > 0.05), further suggesting comparable baseline conditions for each group.

During the interventions, each group experienced an 8%− 11% attrition rate, causing a slight decline in the final sample size. Specifically: (i) BBSTG: 36 participants remaining (10% attrition); (ii) BASTG: 37 participants remaining (7.5% attrition); (iii) BSPTG: 35 participants remaining (12.5% attrition); (iv) CG: 36 participants remaining (10% attrition). Figure 1illustrates the inclusion and attrition of participants.

Fig. 1.

Inclusion and attrition of subjects

Attrition was mainly due to personal reasons, health issues that rendered participants unsuitable for continued involvement, and scheduling conflicts. Despite the minor attrition, the similar attrition rates across groups reduced the impact on the statistical analysis of intervention effects. Table 1 below illustrates the baseline characteristics of participants and details on sample attrition.

Table 1.

Baseline characteristics of participants and sample attrition

Group	BBSTG	BASTG	BSPTG	CG	P 值
Sample Size (Baseline)	40	40	40	40	-
Sample Size (Final)	36	37	35	36	-
Male/Female(n)	18/18	19/18	17/18	16/18	-
Attrition Rate (%)	10%	7.50%	12.50%	10%	-
Age (years)	23.4 ± 1.8	23.6 ± 1.9	23.5 ± 1.7	23.3 ± 1.8	> 0.05
Height (cm)	172.5 ± 7.2	172.7 ± 7.3	172.6 ± 7.1	172.4 ± 7.2	> 0.05
Weight (kg)	68.3 ± 8.6	68.5 ± 8.7	68.4 ± 8.5	68.2 ± 8.4	> 0.05
BMI (kg/m2)	22.9 ± 2.1	23.0 ± 2.2	22.8 ± 2.0	22.7 ± 2.1	> 0.05
PSQI Score	8.5 ± 1.2	8.7 ± 1.3	8.6 ± 1.1	8.4 ± 1.2	> 0.05
SAS Score	45.3 ± 5.4	45.5 ± 5.6	45.4 ± 5.3	45.2 ± 5.5	> 0.05
Resting Heart Rate (bpm)	72.5 ± 6.3	72.7 ± 6.1	72.6 ± 6.4	72.4 ± 6.2	> 0.05
Blood Pressure (mmHg)(Systolic/Diastolic)	118.3 ± 8.5/76.2 ± 7.1	118.5 ± 8.6/76.4 ± 7.0	118.4 ± 8.3/76.3 ± 7.2	118.2 ± 8.4/76.1 ± 7.3	> 0.05

Effect of badminton training on PSQI scores

The effect of badminton training on sleep quality, assessed by PSQI scores, was evaluated at the 4 th, 8 th, and 12 th weeks of intervention, with further analysis using ANOVA and between-group comparisons to assess the effects of each training type. At the 4 th week, the mean PSQI scores for the groups were BBSTG (7.9 ± 1.1), BASTG (7.5 ± 1.2), BSPTG (7.3 ± 1.0), and CG (8.2 ± 1.3). ANOVA results (F(3, 156) = 4.58, p = 0.004) indicated that BASTG and BSPTG showed significantly better sleep quality than the control group, with the 95% CI for BSPTG vs. CG being [−1.5, −0.3]. By the 8 th week, PSQI scores had further enhanced across the intervention groups, with mean scores of BBSTG (7.4 ± 1.0), BASTG (6.9 ± 1.1), BSPTG (6.5 ± 0.9), and CG (8.1 ± 1.2). The ANOVA results (F(3, 156) = 6.87, p < 0.001) showed a more pronounced difference for BSPTG vs. CG (p < 0.01, 95% CI [−2.0, −0.7]), with BASTG also showing significant improvement (95% CI [−1.8, −0.5]). At the 12 th week, the improvements in sleep quality were most substantial, with mean PSQI scores of BBSTG (7.1 ± 0.9), BASTG (6.2 ± 1.0), BSPTG (5.8 ± 0.8), and CG (8.0 ± 1.1). ANOVA results (F(3, 156) = 10.32, p < 0.001) indicated that all intervention groups achieved significantly better PSQI scores than the control group, particularly BSPTG, which demonstrated the largest improvement (p < 0.001, 95% CI [−2.7, −1.4]). The improvements for BASTG and BBSTG compared to CG were also significant, with 95% CIs of [−2.3, −1.0] and [−1.6, −0.5], respectively. These results, summarized in Table 2, highlight the positive effect of specialized badminton training on improving sleep quality in graduate students with sleep disorders. In addition, Fig. 2 demonstrates Plots of PSQI Score, SAS Score, Resting Heart Rate, Systolic and Diastolic Blood Pressure at different time points for each group during badminton-specific training.

Table 2.

Effect of different badminton training types on PSQI scores in graduate students with sleep disorders

Group	BBSTG (n = 36)	BASTG (n = 37)	BSPTG (n = 35)	CG (n = 36)
4 th Week PSQI Score M ± SD	7.9 ± 1.1	7.5 ± 1.2	7.3 ± 1.0	8.2 ± 1.3
4 th Week F Value	4.58	4.58	4.58	4.58
4 th Week p Value	0.004	0.004	0.004	0.004
4 th Week 95% CI (vs. CG)	-	[−1.5, −0.3]	[−1.5, −0.3]	-
8 th Week PSQI Score M ± SD	7.4 ± 1.0	6.9 ± 1.1	6.5 ± 0.9	8.1 ± 1.2
8 th Week F Value	6.87	6.87	6.87	6.87
8 th Week p Value	< 0.001	< 0.001	< 0.001	< 0.001
8 th Week 95% CI (vs. CG)	-	[−1.8, −0.5]	[−2.0, −0.7]	-
12 th Week PSQI Score M ± SD	7.1 ± 0.9	6.2 ± 1.0	5.8 ± 0.8	8.0 ± 1.1
12 th Week F Value	10.32	10.32	10.32	10.32
12 th Week p Value	< 0.001	< 0.001	< 0.001	< 0.001
12 th Week 95% CI (vs. CG)	[− 1.6, − 0.5]	[−2.3, −1.0]	[−2.7, −1.4]	-

Fig. 2.

Plots of PSQI score, SAS acore, resting heart rate, systolic and diastolic blood pressure at different time points for each group during badminton-specific training

Effect of badminton training on anxiety levels (SAS scores)

Throughout the intervention, changes in SAS scores at various time points (4 th, 8 th, and 12 th weeks) were analyzed to assess the effect of badminton training on anxiety levels. Table 3 summarizes the effects of different badminton training types on the anxiety levels (SAS scores) of graduate students with sleep quality issues.

Table 3.

Effect of different badminton training types on anxiety levels (SAS Scores) in graduate students with sleep disorders

Group	BBSTG (n = 36)	BASTG (n = 37)	BSPTG (n = 35)	CG (n = 36)
4 th Week SAS Score M ± SD	42.8 ± 5.1	41.5 ± 4.9	40.9 ± 4.7	44.3 ± 5.2
4 th Week F Value	3.72	3.72	3.72	3.72
4 th Week p Value	0.013	0.013	0.013	0.013
4 th Week 95% CI (vs. CG)	-	[− 3.8, − 1.2]	[− 3.8, − 1.2]	-
8 th Week SAS Score M ± SD	41.2 ± 4.8	39.4 ± 4.6	38.1 ± 4.4	44.0 ± 5.1
8 th Week F Value	5.49	5.49	5.49	5.49
8 th Week p Value	< 0.001	< 0.001	< 0.001	< 0.001
8 th Week 95% CI (vs. CG)	-	[− 3.9, − 1.6]	[− 4.6, − 2.0]	-
12 th Week SAS Score M ± SD	40.1 ± 4.5	37.8 ± 4.2	36.3 ± 4.0	43.8 ± 5.0
12 th Week F Value	8.21	8.21	8.21	8.21
12 th Week p Value	< 0.001	< 0.001	< 0.001	< 0.001
12 th Week 95% CI (vs. CG)	[− 4.5, − 1.7]	[− 5.3, − 2.5]	[− 6.1, − 3.2]	-

4 th Week

After 4 weeks of intervention, SAS scores decreased across all groups, showing an initial improvement in anxiety levels due to badminton training. Specifically, SAS scores were 42.8 ± 5.1 for BBSTG, 41.5 ± 4.9 for BASTG, 40.9 ± 4.7 for BSPTG, and 44.3 ± 5.2 for CG. ANOVA results displayed a statistically significant difference between groups (F(3, 156) = 3.72, p = 0.013). Further group comparisons suggested that both BASTG and BSPTG had significantly lower SAS scores than the control group (p < 0.05), with BSPTG showing a particularly noticeable improvement in anxiety levels. The 95% CI between BSPTG and CG was [− 3.8, − 1.2].

8 th week

After 8 weeks of intervention, SAS scores continued to decline in the experimental groups, signifying a continuous reduction in anxiety. SAS scores were 41.2 ± 4.8 for BBSTG, 39.4 ± 4.6 for BASTG, 38.1 ± 4.4 for BSPTG, and 44.0 ± 5.1 for CG. ANOVA results confirmed a significant difference between groups (F(3, 156) = 5.49, p < 0.001). Group comparisons showed that BSPTG had significantly lower anxiety levels than the control group (p < 0.01), with a 95% CI of [− 4.6, − 2.0]. BASTG also displayed a significant improvement, with a 95% CI of [− 3.9, − 1.6].

12 th week

At the 12 th week, all three experimental groups exhibited significantly lower SAS scores compared to the control group, demonstrating substantial anxiety improvement. SAS scores were 40.1 ± 4.5 for BBSTG, 37.8 ± 4.2 for BASTG, 36.3 ± 4.0 for BSPTG, and 43.8 ± 5.0 for CG. ANOVA results showed a notable difference between groups (F(3, 156) = 8.21, p < 0.001). Further group comparisons indicated that BSPTG achieved the most significant reduction in anxiety levels compared to CG (p < 0.001), with a 95% CI of [− 6.1, − 3.2]. BASTG showed the second highest improvement, with a 95% CI of [− 5.3, − 2.5], while BBSTG, although with a smaller improvement margin, was still significantly better than CG, with a 95% CI of [− 4.5, − 1.7].

Effect of badminton training on basic physiological data (Resting Heart Rate and Blood Pressure)

Throughout the intervention, the effect of badminton training on basic physiological data, specifically resting heart rate and blood pressure, was assessed at various time points (4 th, 8 th, and 12 th weeks). Mean values and standard deviations (M ± SD) for each group at each time point were analyzed using ANOVA, along with p-values, F-values, and 95% confidence intervals (CI), as presented in Table 4.

Table 4.

Effect of different badminton training types on basic physiological data in graduate students with sleep disorders

Group	BBSTG (n = 36)	BASTG (n = 37)	BSPTG (n = 35)	CG (n = 36)
4 th Week Resting Heart Rate M ± SD	71.5 ± 5.8	70.8 ± 5.6	69.2 ± 5.4	72.3 ± 5.9
4 th Week Systolic/Diastolic BP M ± SD (mmHg)	117.2 ± 8.1/75.3 ± 6.8	116.8 ± 7.9/75.0 ± 6.6	115.9 ± 7.6/74.5 ± 6.5	118.5 ± 8.2/76.1 ± 7.0
4 th Week F Value (Resting Heart Rate)	3.25	3.25	3.25	3.25
4 th Week p Value (Resting Heart Rate)	0.022	0.022	0.022	0.022
4 th Week 95% CI (Resting Heart Rate, vs. CG)	-	-	[− 3.8, − 0.5]	-
8 th Week Resting Heart Rate M ± SD	70.1 ± 5.5	69.0 ± 5.3	67.5 ± 5.1	72.0 ± 5.8
8 th Week Systolic/Diastolic BP M ± SD (mmHg)	116.4 ± 7.8/74.9 ± 6.6	115.5 ± 7.6/74.5 ± 6.4	114.2 ± 7.3/74.0 ± 6.2	118.2 ± 8.0/75.8 ± 6.9
8 th Week F Value (Resting Heart Rate)	4.63	4.63	4.63	4.63
8 th Week p Value (Resting Heart Rate)	< 0.01	< 0.01	< 0.01	< 0.01
8 th Week 95% CI (Resting Heart Rate, vs. CG)	-	[− 4.0, − 1.0]	[− 5.4, − 1.9]	-
12 th Week Resting Heart Rate M ± SD	69.3 ± 5.3	67.4 ± 5.1	66.1 ± 4.8	71.8 ± 5.6
12 th Week Systolic/Diastolic BP M ± SD (mmHg)	115.8 ± 7.6/74.5 ± 6.4	114.2 ± 7.4/73.9 ± 6.2	113.0 ± 7.1/73.5 ± 6.0	118.0 ± 7.8/75.5 ± 6.8
12 th Week F Value (Resting Heart Rate)	6.27	6.27	6.27	6.27
12 th Week p Value (Resting Heart Rate)	< 0.001	< 0.001	< 0.001	< 0.001
12 th Week 95% CI (Resting Heart Rate, vs. CG)	[− 4.5, − 1.7]	[− 5.6, − 2.0]	[− 6.9, − 3.2]	-

4 th week

After 4 weeks, the initial effects of badminton training on resting heart rate began to emerge. Resting heart rates were as follows: BBSTG = 71.5 ± 5.8, BASTG = 70.8 ± 5.6, BSPTG = 69.2 ± 5.4, and CG = 72.3 ± 5.9. ANOVA results showed a statistically significant difference between groups (F(3, 156) = 3.25, p = 0.022), with BSPTG exhibiting a significantly lower resting heart rate than the control group, 95% CI = [−3.8, −0.5]. For blood pressure, BBSTG’s systolic/diastolic values were 117.2 ± 8.1/75.3 ± 6.8, BASTG 116.8 ± 7.9/75.0 ± 6.6, BSPTG 115.9 ± 7.6/74.5 ± 6.5, and CG 118.5 ± 8.2/76.1 ± 7.0. The between-group differences in blood pressure were not statistically significant (p > 0.05), indicating limited short-term effects on blood pressure.

8 th week

After 8 weeks, the experimental groups’ resting heart rates continued to decrease, demonstrating the sustained effect of badminton training. Resting heart rates were BBSTG = 70.1 ± 5.5, BASTG = 69.0 ± 5.3, BSPTG = 67.5 ± 5.1, and CG = 72.0 ± 5.8. ANOVA results indicated a significant difference among groups (F(3, 156) = 4.63, p < 0.01), with BSPTG significantly lower than the control group (95% CI = [− 5.4, − 1.9]) and BASTG also showing a significant improvement (95% CI = [− 4.0, − 1.0]). Blood pressure values were BBSTG = 116.4 ± 7.8/74.9 ± 6.6, BASTG = 115.5 ± 7.6/74.5 ± 6.4, BSPTG = 114.2 ± 7.3/74.0 ± 6.2, and CG = 118.2 ± 8.0/75.8 ± 6.9. Although BSPTG’s blood pressure was slightly lower than CG, the differences were not statistically significant (p > 0.05).

12 th week

At the 12 th week, resting heart rates were significantly lower across all experimental groups compared to the control group, showing a marked effect. Resting heart rates were BBSTG = 69.3 ± 5.3, BASTG = 67.4 ± 5.1, BSPTG = 66.1 ± 4.8, and CG = 71.8 ± 5.6. ANOVA results showed the greatest difference among groups at this stage (F(3, 156) = 6.27, p < 0.001), with BSPTG having a notably lower resting heart rate than CG (p < 0.001), 95% CI = [−6.9, −3.2], followed by BASTG (95% CI = [−5.6, −2.0]). Blood pressure values were BBSTG = 115.8 ± 7.6/74.5 ± 6.4, BASTG = 114.2 ± 7.4/73.9 ± 6.2, BSPTG = 113.0 ± 7.1/73.5 ± 6.0, and CG = 118.0 ± 7.8/75.5 ± 6.8. Although BSPTG had slightly lower systolic and diastolic blood pressure than CG, the difference was not statistically significant (p > 0.05), suggesting limited effects of badminton training on blood pressure.

Between-group and within-group comparisons

To further evaluate the effects of badminton training on sleep quality, anxiety levels, and basic physiological data, statistical comparisons were conducted both between and within groups. ANOVA and paired t-tests were used to analyze the significance of differences between experimental and control groups under various intervention protocols, with effect sizes calculated. Table 5 presents the results of between-group and within-group comparisons.

Table 5.

Results of between-group and within-group comparisons

Comparison	PSQI score	SAS score	Resting heart rate	Blood pressure
Between-Group F Value (12 th Week)	10.32	8.21	6.27	-
Between-Group p Value (12 th Week)	< 0.001	< 0.001	< 0.001	> 0.05
BSPTG vs CG 95% CI	[−2.7, − 1.4]	[−6.1, − 3.2]	[−6.9, −3.2]	-
BASTG vs CG 95% CI	[−2.3, − 1.0]	[−5.3, − 2.5]	[−5.6, −2.0]	-
BBSTG vs CG 95% CI	[−1.6, − 0.5]	[−4.5, − 1.7]	[−4.5, −1.7]	-
Within-Group Effect Size (Cohen’s d)	BSPTG > 0.8, BASTG > 0.5	BSPTG > 0.7, BASTG > 0.5	BSPTG > 0.6, BASTG > 0.4	> 0.05

Between-group comparisons

PSQI scores

By the 12 th week, PSQI scores for BBSTG, BASTG, and BSPTG were all significantly lower than those for CG, with BSPTG showing the greatest improvement (F(3, 156) = 10.32, p < 0.001), 95% CI = [−2.7, − 1.4]. BASTG followed (95% CI = [−2.3, − 1.0]), and BBSTG showed a smaller yet still significant improvement over the control group (95% CI = [−1.6, − 0.5]). These results reveal that all levels of badminton training significantly enhanced sleep quality, with physical conditioning training (BSPTG) being the most effective.

SAS scores

Anxiety levels changed significantly across all experimental groups, with BSPTG achieving the greatest reduction in SAS scores by the 12 th week, significantly outperforming CG (F(3, 156) = 8.21, p < 0.001), 95% CI = [−6.1, −3.2]. BASTG followed (95% CI = [−5.3, −2.5]), and BBSTG showed a smaller yet significant reduction compared to CG (95% CI = [−4.5, −1.7]). These findings highlight the substantial effect of physical training on anxiety reduction, with BSPTG showing the strongest results.

Resting heart rate and blood pressure

At the 12 th week, resting heart rate was significantly lower in all experimental groups compared to CG (F(3, 156) = 6.27, p < 0.001). BSPTG showed the most significant reduction in resting heart rate (95% CI = [−6.9, −3.2]), indicating the positive effect of physical training on cardiovascular regulation, followed by BASTG (95% CI = [−5.6, −2.0]) and BBSTG with the smallest improvement. For blood pressure, though all experimental groups experienced slight decreases, the between-group differences did not reach statistical significance (p > 0.05), suggesting that the short-term effect of badminton training on blood pressure was limited.

Within-group comparisons

PSQI scores

Within-group comparisons showed significant improvements in PSQI scores from pre- to post-intervention in all experimental groups (p < 0.01), with BSPTG showing the most substantial decrease, achieving a strong effect size (Cohen’s d > 0.8). BASTG showed a moderate effect size (d > 0.5), while BBSTG demonstrated a smaller yet significant improvement.

SAS scores

Within-group comparisons indicated significant changes in anxiety levels across all experimental groups, with BSPTG showing the greatest improvement (effect size d > 0.7), followed by BASTG, and BBSTG showing relatively smaller improvements. The control group showed no significant changes in SAS scores pre- and post-intervention (p > 0.05).

Resting heart rate and blood pressure

BSPTG showed the most significant improvement in resting heart rate, with post-intervention levels significantly lower than baseline (p < 0.01) and a large effect size (d > 0.6). BASTG also showed significant improvement, though with a smaller effect size, while BBSTG had the smallest change. Blood pressure changes within groups were not statistically significant, indicating limited short-term effects of badminton training on blood pressure.

Effect size (Cohen’s d)

Effect sizes (Cohen’s d) were calculated for each variable to quantify the significance and strength of changes between pre- and post-intervention under different training protocols. Table 6 presents the results of effect sizes.

Table 6.

Results of effect size analysis

Group	BBSTG (n = 36)	BASTG (n = 37)	BSPTG (n = 35)
PSQI Score Cohen's d	0.3	0.5	0.8
SAS Score Cohen's d	0.3	0.5	0.7
Resting Heart Rate Cohen's d	0.2	0.4	0.6
Blood Pressure Cohen's d	Not significant	Not significant	Not significant

PSQI scores

In the BSPTG group, PSQI scores showed a significant decrease post-intervention, with a Cohen’s d value of 0.8, indicating a strong effect. This result suggests that physical conditioning training had a substantial impact on improving sleep quality. The effect size for BASTG was moderate (d = 0.5), indicating that advanced skills training also effectively enhanced sleep quality, though to a lesser degree than physical training. BBSTG showed a small effect size (d = 0.3), indicating that basic skills training had a limited but positive impact on sleep quality.

SAS scores

For anxiety levels, BSPTG demonstrated a Cohen’s d value of 0.7, indicating a moderate to strong effect, suggesting that physical conditioning training had a significant impact on alleviating anxiety. BASTG had a moderate effect size (d = 0.5), showing that advanced skills training effectively reduced anxiety. BBSTG had a small effect size (d = 0.3), indicating a limited but positive effect on anxiety reduction.

Resting heart rate and blood pressure

In the BSPTG group, resting heart rate showed a significant improvement post-intervention, with a Cohen’s d value of 0.6, indicating a moderate effect. This suggests that physical conditioning training enhanced cardiovascular endurance. BASTG had a smaller but positive effect size (d = 0.4), indicating that advanced skills training also contributed to improvements in resting heart rate. BBSTG had the smallest effect size, showing minimal improvement. Although systolic and diastolic blood pressure in all three experimental groups showed slight decreases post-intervention, the effect sizes did not reach significance, suggesting that short-term badminton training may not have a noticeable impact on blood pressure, potentially requiring a longer intervention period to observe significant effects.

Discussion

Key findings

The main findings of this study demonstrate that specialized badminton training significantly enhances sleep quality, alleviates anxiety, and lowers resting heart rate in graduate students with sleep disorders. All three types of badminton training (basic skill training, advanced skill training, and physical conditioning training) had positive impacts on sleep and psychological states, with BSPTG showing the most substantial effects across psychological and physiological measures.

Specifically, physical conditioning training (BSPTG) showed the most pronounced improvements at the end of the intervention, significantly reducing PSQI and SAS scores, indicating strong effects on sleep quality and anxiety reduction. BSPTG also significantly lowered resting heart rate, suggesting a positive impact on cardiovascular health. These findings indicate that physical conditioning training may offer dual psychological and physiological benefits by enhancing fitness and physical endurance. In comparison, BASTG also enhanced sleep quality and lowered anxiety levels, albeit to a lesser degree than BSPTG, while BBSTG had milder effects. Overall, specialized badminton training not only supported improvements in sleep and psychological states but, with the help of physical conditioning, also contributed to cardiovascular health regulation. These findings support the potential of badminton training as an effective intervention for mental and physical health improvement.

Notably, in this study, badminton training significantly improved sleep quality and reduced anxiety levels among graduate students with sleep disorders. These findings are highly relevant in real-world contexts, especially for university health programs. Given the high prevalence of sleep and anxiety disorders among university students due to academic and social pressures, incorporating badminton into university wellness programs could offer a practical, non-pharmacological intervention to enhance students'mental health. The positive effects observed in this study suggest that badminton training could be an effective and low-cost addition to existing mental health support services in universities. Furthermore, while this study centered on graduate students, the findings may have broader implications. Non-student populations, such as adults in high-stress professions or individuals with mental health challenges, could also potentially benefit from badminton training. The use of badminton as an intervention could be extended to other groups with sleep disorders, anxiety, or related health issues to explore its effectiveness in different demographic groups. This would help determine if badminton training could serve as a scalable solution for improving mental health on a larger scale.

Concerning the non-significant result related to blood pressure, several scientific and methodological factors may explain the lack of observed effects. One possible explanation is individual variability in blood pressure responses to exercise. Blood pressure is influenced by a variety of factors, including genetic predisposition, diet, lifestyle, and stress levels, which vary significantly among individuals. These variations may have masked any potential effects of the intervention [30]. Besides, baseline blood pressure characteristics could have played a role. Interestingly, if participants already had near-normal blood pressure levels at baseline, there may have been limited room for improvement, making it difficult to detect significant changes. Furthermore, the measurement protocol may have cause the non-significant findings. It is significant to note whether multiple readings were taken at each time point to account for potential measurement variability. Inaccuracies or inconsistencies in blood pressure readings, such as those caused by situational factors (e.g., time of day, participant stress, or cuff placement), could have affected the results.

The intervention duration and intensity may also not have been sufficient to produce significant changes in blood pressure. Although badminton is a combination of aerobic and anaerobic exercise, its intensity may not have been high enough to induce substantial reductions in blood pressure, particularly given the relatively short 12-week intervention period. Longer training durations or higher intensity exercises might be necessary to observe significant changes in blood pressure. Dietary factors, notably, which are well known to affect blood pressure, may have influenced the outcomes. Since dietary habits were not strictly controlled in this study, variations in sodium intake, hydration levels, or other dietary habits could have contributed to the lack of a clear effect of the intervention on blood pressure.

We acknowledge that these factors may have played a role in the observed non-significant results and suggest that future studies control for baseline blood pressure characteristics, ensure consistent measurement protocols, and examine the potential influence of diet on blood pressure outcomes.

In addition to the physiological and psychological benefits directly attributable to the badminton training interventions, notably, the social and emotional aspects of participating in a group context likely played a role in the observed improvements in sleep quality and anxiety reduction. Meeting regularly in a structured group setting provided participants with opportunities to socialize, share experiences, and build camaraderie [31]. These interactions may have fostered a sense of belonging and mutual support, which are known to contribute positively to mental health [31].

Furthermore, participants may have discussed their progress and training experiences in positive terms, creating an atmosphere of motivation and encouragement. Such group dynamics could enhance participants'engagement with the intervention and amplify its benefits [32]. This effect likely extended across the three intervention groups (BBSTG, BASTG, BSPTG), as they all involved interactive group-based training sessions, but was less pronounced in the control group, which did not participate in such activities.

These social and emotional factors align with broader research suggesting that group-based physical activity interventions often yield greater mental health benefits compared to solitary activities. Future studies could further explore the specific contribution of social interactions to the outcomes observed in group-based training programs, potentially disentangling these effects from those of the physical training itself.

Comparison with existing research

The results of this study align with existing research on the effects of exercise interventions on sleep quality and anxiety levels. Numerous studies have shown that regular exercise interventions significantly enhance sleep quality and effectively alleviate anxiety, with these effects being widely validated in aerobic exercise and resistance training [33, 34]. This study further supports these findings, showing that specialized badminton training can also result in significant mental and physical health improvements.

Existing evidence has confirmed that regular aerobic exercise, particularly moderate-intensity activities like badminton, has been shown to significantly improve sleep quality by reducing sleep latency and enhancing sleep efficiency [35].Besides, interestingly, another article has revealed that aerobic exercise, especially regular aerobic exercise, has been shown to significantly improve sleep quality and alleviate psychological distress, such as anxiety and depression, particularly in populations at risk for chronic conditions [36]. The results of this study, which demonstrate the effectiveness of badminton-specific training in improving sleep and reducing anxiety, align with these findings. Aerobic exercises like badminton positively impact the cardiovascular and nervous systems, which in turn enhance sleep quality and reduce anxiety [5, 37, 38]. In this study, physical conditioning training significantly lowered resting heart rate, reflecting enhanced cardiovascular health. Moreover, physical conditioning training in this study significantly lowered resting heart rates, reflecting improved cardiovascular health, which is consistent with previous research linking aerobic exercise to reduced anxiety levels, likely due to the release of endorphins that reduce stress and elevate mood [39–41].

Compared to other types of exercise, badminton training offers certain unique characteristics. Badminton is a moderately intense exercise that combines aerobic and anaerobic physical demands, requiring coordination and explosive power [5, 8–42]. In particular, the physical conditioning training in badminton effectively enhances cardiopulmonary and muscle endurance, likely directly benefiting the cardiovascular system [5, 8–43]. Additionally, as a sport that involves competitiveness and strategy, badminton demands concentration, coordination, and quick responses, which may uniquely contribute to anxiety relief [44, 45]. This dual mechanism may explain why badminton training has a unique advantage in improving both anxiety and sleep.

Overall, this study provides new evidence for exercise interventions to enhance mental health, indicating that badminton, a sport requiring both fitness and skill, can play a unique role in improving sleep and alleviating anxiety. Future studies could further compare different exercise modalities to better understand the specific benefits and mechanisms of badminton training.

Analysis of the superior effect of physical conditioning training

The study found that BSPTG was significantly more effective than basic and advanced skill training in improving sleep quality and alleviating anxiety. This superior effect is likely tightly related to the direct effect of physical conditioning on physical strength and metabolic function. Physical conditioning training enhances cardiopulmonary endurance, muscle strength, and metabolic efficiency, which directly enhances physiological status [46] and has a positive effect on mental health [6].

From a physiological perspective, systematic cardiopulmonary and endurance training in BSPTG effectively enhanced cardiovascular and respiratory functions. This enhanced cardiopulmonary function helps regulate oxygen delivery and metabolism throughout the body, laying a solid foundation for enhanced sleep quality. Evidence suggests that increased cardiopulmonary endurance helps regulate sympathetic and parasympathetic activity, facilitating a shift from high-stress states to relaxation, which enhances sleep onset quality and deep sleep duration [47].

This study found that BSPTG had significantly better outcomes in improving sleep quality and reducing anxiety compared to basic and advanced skill training groups. This superiority may be tightly related to the direct effects of physical conditioning training on physical strength and the metabolic system. Physical conditioning training, by enhancing cardiopulmonary endurance, muscle strength, and metabolic efficiency, directly enhances participants'physiological state [41] and also has a positive regulatory effect on mental health [6].

From a physiological perspective, systematic cardiopulmonary and endurance training in physical conditioning effectively enhances cardiovascular and respiratory function, which supports enhanced oxygen delivery and metabolism throughout the body, laying a strong foundation for enhanced sleep quality. Studies have shown that increased cardiopulmonary endurance can help regulate sympathetic and parasympathetic nerve activities, promoting the body's transition from a stressed to a relaxed state, which significantly enhances sleep onset and duration of deep sleep [47]. Furthermore, physical conditioning training increases metabolic rate, accelerating energy expenditure and waste elimination, which helps regulate the biological clock and alleviate chronic stress responses, possibly leading to enhanced sleep.

In terms of anxiety relief, physical conditioning training not only enhances physical strength, boosting confidence and emotional control, but may also influence emotions through a series of neurochemical responses. Psychological theories suggest that regular physical conditioning can promote the release of dopamine, endorphins, and serotonin—neurotransmitters tightly related to emotional regulation that help relieve anxiety and boost mood [48, 49]. Additionally, physical conditioning training increases a sense of body control, helping reduce anxiety, particularly in self-regulating under stress or negative emotions. Compared to less intense skill training, physical conditioning training has a higher physiological intensity, which helps participants release emotional stress, resulting in more substantial anxiety relief.

Viewed through the dual lens of psychological and physiological regulation, physical conditioning training provides a deeper regulatory effect through body-mind interaction. On one hand, physical training enhances physical health and strength, leading to positive psychological impacts [51]. On the other hand, anxiety relief through physical conditioning provides"psychological resources"for improving mental state, enhancing emotional resilience and making it easier for participants to cope with life stress [51, 52]. This dual regulation mechanism helps explain why physical conditioning training is superior in improving sleep quality and alleviating anxiety, providing theoretical support for the design of future exercise-based mental health improvement programs.

Analysis of basic and advanced skill training effects

This study shows that BBSTG and BASTG also produced positive effects on sleep quality and anxiety relief, although these effects were milder than those observed with BSPTG. This difference may relate to the focus and intensity of skill training. Unlike physical conditioning, which emphasizes comprehensive improvement in cardiopulmonary endurance and metabolic function, skill training mainly focuses on mastering technical movements and improving sports techniques, with its mental benefits derived more from the enjoyment and sense of achievement than from significant physical improvement [53, 54].

Basic and advanced skill training focuses on proficiency in badminton movements and skill refinement. This relatively moderate exercise intensity may increase physical activity levels but has limited improvements in cardiopulmonary endurance and muscle strength. Consequently, compared to physical conditioning training, skill training has a weaker direct impact on sleep quality, likely because it does not provide sufficient benefits to physiological endurance and metabolic function. Significant sleep quality improvements often require higher levels of physical exertion and metabolic regulation [5–55], and the physiological load of skill training is too light, resulting in less impact on sleep quality than physical conditioning training.

For anxiety relief, skill training may enhance mental state through increased enjoyment and a sense of accomplishment. Basic and advanced skill training emphasizes technical mastery and movement precision, allowing participants to gradually build a sense of achievement. The self-satisfaction and sense of progress experienced through skill mastery help to stimulate positive emotional experiences, thus reducing anxiety [56, 57]. However, due to the relatively low physical demand of skill training, it is less effective for stress release through high-intensity physical output or for adjusting physiological hormone levels, resulting in less anxiety relief than physical conditioning training.

Overall, the effect of skill training on psychological improvement mainly comes from enhancing the participant's exercise experience, boosting confidence, and fostering a sense of achievement. This psychological effect is significant for mental health improvement, though its impact on sleep and anxiety is moderate, with limited physical fitness benefits. Therefore, physical conditioning training may be more suitable for individuals seeking substantial physiological improvement and deep psychological regulation through exercise, while skill training is more suitable for those centered on skill improvement and enjoying the activity. This analysis provides insights into the design of exercise interventions by adjusting training content and focus to meet the needs of different target groups.

Discussion on the non-significance of blood pressure changes

This study found that while specialized badminton training significantly improved sleep quality, anxiety levels, and resting heart rate, it did not significantly impact blood pressure. This result may be due to factors such as the relatively short intervention duration and the complex nature of blood pressure regulation mechanisms.

Badminton, as a moderate-intensity exercise, may require a longer intervention period to significantly impact blood pressure. Existing studies indicate that the blood pressure-regulating effects of exercise often require continuous intervention lasting longer than 12 weeks to manifest fully [58]. Since this study’s intervention lasted only 12 weeks, it may not have met the minimum duration necessary for exercise to regulate blood pressure effectively. Therefore, the short-term badminton training may not have been sufficient to observe significant blood pressure changes in this study.

Blood pressure regulation is a complex physiological process influenced by multiple factors, comprising long-term adaptations in the cardiovascular system, autonomic nervous system regulation, and hormonal balance [58, 59]. Mechanisms through which exercise affects blood pressure typically involve improving vascular elasticity, endothelial function, and reducing peripheral resistance. These changes often require gradual accumulation over a prolonged period to yield significant effects [58, 59]. While badminton training positively impacted resting heart rate and cardiopulmonary endurance, the relatively short training duration may have been insufficient for adaptive changes in vascular function to appear fully.

Additionally, the existing literature suggests that higher-intensity aerobic or physical conditioning exercises are more effective at lowering blood pressure, whereas badminton, as a moderate-intensity activity, may have a relatively weaker effect on blood pressure [58, 59]. Thus, future studies may consider increasing the intensity or frequency of badminton training to explore the potential effects of high-intensity or more frequent badminton sessions on blood pressure regulation.

Based on these observations, this study suggests extending the intervention period to 16 weeks or longer in future research to examine the effects of badminton training on blood pressure over a more extended period. Additionally, incorporating higher-intensity training methods, such as HIIT, or increasing the number of weekly sessions could enhance vascular stimulation and blood pressure regulation effects. These modifications would provide a more comprehensive understanding of the potential of specialized badminton training in blood pressure regulation and offer stronger evidence for optimizing exercise intervention strategies.

Strengths and limitations of the study

This study has several strengths that enhance its scientific rigor and practical relevance. By employing a RCT design, the study minimizes biases and ensures robust comparisons between intervention and control groups, strengthening the reliability of the findings. The inclusion of three distinct badminton training protocols—basic skill, advanced skill, and physical conditioning—allows for a comprehensive analysis of their differential effects on sleep quality, anxiety, and baseline physiological markers. Targeting graduate students, a high-stress population prone to sleep disorders and anxiety, highlights a critical and underexplored area of mental health research. The use of validated measurement tools, such as the PSQI and SAS, ensures the credibility of the data collected. Furthermore, emphasizing a non-pharmacological, cost-effective intervention like badminton training offers practical and scalable solutions for improving mental and physical health. The structured training sessions closely mirror real-world scenarios, making the findings highly applicable to university and community wellness programs. These strengths collectively underscore the study's contribution to advancing non-pharmacological approaches for mental health and sleep improvement.

However, this study has several limitations. Firstly, the sample size is limited. Although the initial sample size was relatively balanced across groups, the overall sample size was small, which affected the statistical power and generalizability of the results. Secondly, the intervention duration was relatively short at only 12 weeks. While some psychological and physiological improvements were observed, this period may not have been sufficient to demonstrate the long-term effects of badminton training on blood pressure and other indicators. Additionally, this study’s sample consisted primarily of graduate students, a population with relatively homogeneous age, health status, and lifestyle. Consequently, the applicability of these results to other age groups remains uncertain. To generalize the findings to a broader adult population, future studies should consider verifying the effects of badminton training in a more diverse cohort.

Recommendations for extended follow-up and long-term monitoring

While this study provides significant evidence of the positive effects of specialized badminton training on sleep quality, anxiety reduction, and resting heart rate, It is significant to note that the intervention duration of 12 weeks may be insufficient to observe long-term physiological changes, particularly in blood pressure. Although we found modest reductions in resting heart rate, no significant improvements in blood pressure were observed during the study period. This outcome is consistent with previous research, which suggests that cardiovascular adaptations, including blood pressure regulation, often require prolonged and consistent training interventions to become statistically significant.

The relatively short 12-week period may not have allowed for the full manifestation of the cardiovascular benefits associated with regular aerobic exercise. blood pressure regulation is a complex physiological process influenced by a range of factors, including vascular function, autonomic nervous system regulation, and hormonal balance, all of which adapt gradually to sustained training. Previous studies have indicated that the effects of exercise on blood pressure may not become apparent until after several months of consistent physical activity, particularly in populations with pre-existing health conditions such as elevated blood pressure or stress-related disorders [60, 61]. To gain a more comprehensive understanding of the long-term benefits of specialized badminton training on blood pressure and other physiological markers, future research could extend the follow-up period beyond 12 weeks. A longitudinal approach with multiple follow-up assessments could provide valuable insights into the trajectory of these physiological changes over time. Repeated measurements of blood pressure at regular intervals (e.g., 6 months, 1 year) would help determine whether the effects of badminton training are sustained or if further adaptations are needed to achieve meaningful reductions in blood pressure. Moreover, it would be beneficial to include a larger, more diverse sample that accounts for varying baseline blood pressure levels, as individual variations in blood pressure responses to exercise could influence the outcomes. Stratified randomization based on blood pressure levels could allow for a more nuanced understanding of how different groups respond to exercise interventions over time.

In conclusion, while the current study provides strong evidence for the immediate benefits of specialized badminton training on mental health and cardiovascular health, further investigation is warranted to explore the long-term effects, particularly on blood pressure. Extending the follow-up period and including repeated measures over an extended timeframe would help clarify the sustained impact of this intervention and its potential as a long-term strategy for improving cardiovascular and mental health.

Directions for future research

Future studies can be enhanced in several ways. Extending the intervention duration beyond 12 weeks is recommended to capture the long-term effects of badminton training on blood pressure and other physiological and psychological indicators. A longer intervention period would provide a better understanding of sustained physiological adaptations, especially in terms of cardiovascular and metabolic health. Additionally, conducting similar studies across different age groups, such as middle-aged and older adults, as well as groups under varying occupational stress, or individuals with different health conditions (e.g., hypertension, diabetes, chronic stress), would broaden the applicability of this research. Exploring the effects of badminton training in these populations could yield more comprehensive insights into its potential benefits. Future research could also incorporate other exercise modalities, such as HIIT or yoga, to explore diverse approaches for enhancing mental health and clarify badminton training’s unique role in psychological health interventions. A multi-perspective, multi-group research design could more thoroughly reveal the potential benefits of badminton training in a variety of contexts and populations.

Practical implications

Notably, this study provides vital evidence for the application of badminton training in improving mental and physiological health. As a moderately intense sport with enjoyable and interactive aspects, badminton training could serve as a health intervention for graduate university students and other high-stress populations, helping them enhance sleep quality, relieve anxiety, and enhance cardiovascular health amid demanding academic or professional lives. This study highlights the specific benefits of physical conditioning training in promoting mental health and maintaining cardiovascular health, confirming that badminton training not only provides physical exercise but also offers positive psychological interventions. Integrating specialized badminton training into health programs for schools and workplaces or recommending it as a regular physical activity can promote individuals'physical health, help alleviate stress, and enhance overall quality of life.

Conclusion

This study demonstrates that all three types of badminton training significantly enhanced sleep quality and reduced anxiety, with the most pronounced effects observed in physical conditioning training, characterized by a large effect size. Specifically, physical training showed notable advantages in enhancing sleep quality, reducing anxiety, and lowering resting heart rate, indicating a substantial cardiovascular regulatory effect. Advanced skills training also exhibited moderate efficacy in improving sleep and anxiety, although to a lesser extent than physical training. Basic skills training had relatively limited effects on sleep quality and anxiety but still showed some positive outcomes. Furthermore, no significant changes in blood pressure were observed during this short-term intervention, suggesting that the effect of badminton training on blood pressure may require a longer observation period. Between-group and within-group comparisons further supported the positive effects of badminton training as an intervention. Notably, physical conditioning training demonstrated exceptional benefits in improving mental health and cardiovascular endurance, highlighting its potential as an effective intervention.

Our study suggests that specialized badminton training, particularly physical conditioning training, can effectively enhance sleep quality, alleviate anxiety, and enhance cardiovascular health in individuals with sleep disorders. Future research should consider extending the intervention duration, increasing the sample size, and targeting a wider range of populations, comprising older adults and individuals with pre-existing health conditions. Moreover, delving into the potential strengths of HIIT or yoga as alternative exercise modalities could provide additional insights into the most effective interventions for mental health. From a practical perspective, implementing physical badminton training in educational settings (e.g., universities and schools) and community health programs could be highly beneficial. This approach could offer a sustainable, low-cost intervention to promote both mental and physical health among students and broader community populations, especially those under stress. Future research should also explore the feasibility and effectiveness of such interventions on a larger scale.

Authors’ contributions

Qi Zhang and Jianda Kong are responsible for writing this manuscript, with Jianda Kong also responsible for proofreading; Rao Fan collected data and participated in the modification and review process; Jizhi Fu participated in some of the writing and verification.

Funding

There is no funding.

Data availability

The datasets generated and/or analysed during the current study are included in the supplementary files attached to this manuscript. These supplementary files will be provided upon submission, ensuring that all data supporting our research findings are accessible to readers for further verification and analysis.

Declarations

Ethic approval and consent to participate

The research protocol was approved by the Biomedical Ethics Committee of Qufu Normal University (approval number: 2023131).

All participants agreed to participate and signed an informed consent form.

Consent for publication

The datasets generated and/or analysed during the current study are included in the supplementary files attached to this manuscript. These supplementary files will be provided upon submission, ensuring that all data supporting our research findings are accessible to readers for further verification and analysis.

Competing interests

The authors declare no competing interests.