Journal of Childhood

Introduction
The mental health of primary school children is a critical global concern, especially in the post-endemic context. Academic and social pressures during this period have increased stress levels. Pre-adolescent girls exhibit particular vulnerability to cognitive and physical distress due to the intersection of biological and psychosocial factors. Cognitive anxiety, with excessive worry, impairs academic and social performance, and physical anxiety manifests as debilitating physiological symptoms. Mindfulness-based interventions have shown promise in addressing these issues. Emerging evidence suggests that combining mindfulness with physical activity can have synergistic benefits by using movement as an anchor for attention training. However, the existing literature is limited by its focus on adolescents and adults, leaving a gap for developmentally appropriate interventions for younger children. This study examined the effectiveness of an innovative mindfulness-based exercise program for elementary school female students.
Research Methods 
This quasi-experimental study was conducted with a pretest-posttest design with a parallel control group. Sixty female students (9-11 years old) from elementary schools in Qom were randomly assigned to the experimental (30) and control (30) groups. The experimental group received an 8-week Integrated Sports Mindfulness Program (ISMP), adapted from the Integrated Mindfulness and Physical Activity Protocol (IMAP) and localized for the Iranian context. The program combined three main components in 45-minute sessions three times a week: 1) psychoeducation about stress responses, 2) mindfulness-based movement exercises, and 3) sport-specific attention regulation training. The control group followed the regular school curriculum. Multidimensional assessment was conducted using validated self-report scales, including the Perceived Stress Scale (PSS), the Cognitive-Somatic Anxiety Inventory (CSAI-2R), and the Child and Adolescent Mindfulness Measure (CAMM). Data were analyzed using multivariate analysis of covariance (MANCOVA) and analysis of covariance (ANCOVA) using pretest scores as covariates. Fidelity of implementation was ensured through standardized facilitator training and weekly monitoring. 

Results 
The intervention group showed statistically significant improvements in all outcomes compared to the control group. Quantitative analysis revealed a significant reduction in the primary outcomes: stress symptoms (32.09%), cognitive anxiety (22.93%), and somatic anxiety (28.13%). The MANCOVA results indicated a significant overall effect for the intervention. Subsequent ANCOVA analyses confirmed significant between-group differences for each variable. Logistic regression analysis showed that history of exercise activity was a significant predictor of positive response to the intervention, while age and socioeconomic status were not. Implementation fidelity was excellent and no study dropouts occurred.
Conclusion
This study provides strong evidence for the effectiveness of an integrated exercise and mindfulness program in promoting mental health in primary school girls. The significant reductions in stress and both dimensions of anxiety highlight the effectiveness of an integrated mind-body approach. The SMIP provides a practical, feasible, and cost-effective model that can be integrated into existing school frameworks (such as physical education lessons) without the need for specialized clinical resources. These findings are highly relevant to educational policymakers seeking evidence-based preventive strategies to address the growing youth mental health crisis. The predictive role of previous physical activity indicates that children with movement experience are likely to benefit more, a point worth considering in program implementation. Future research should include long-term follow-up assessments, explore the mechanisms of underlying change more deeply, and examine program efficacy in broader demographic and cultural contexts. 
Ethical Considerations
Compliance with ethical guidelines
The ethical principles observed in the article, such as the informed consent of the participants, the confidentiality of information, the permission of the participants to cancel their participation in the research. Ethical approval was obtained from the Research Ethics Committee of the University of Qom (Cod: IR.QOM.REC.1402.045).




Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Authors contributions
Methodological design, supervision, editing, and final review of the article: Mehdi Fahimi; Statistical data analysis, and drafting of discussion and conclusion sections: Khalil Alavi; Practical implementation of the intervention and planning of sessions, data collection, and preparation of the initial draft of the article: Fatemeh Salimi.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgments
The authors would like to thank all participants of the present study.