Leisure-Time Physical Activity Frequency and Emotional/Behavioral Difficulties: a Graded Pattern in Children and Adolescents from a National Health Survey

Childhood mental health is a fundamental component of well-being and development in children. This study examined the association between leisure-time physical activity frequency (PAF) and emotional and behavioural difficulties in Spanish children aged 6–14 years (ESdE). A cross-sectional analysis was conducted using a nationally representative sample of 2,328 children. Emotional and behavioural difficulties were assessed using the Strengths and Difficulties Questionnaire (SDQ), which was classified into three ordinal categories. PAF, age, sex, body mass index (BMI), and the presence of chronic and neurodevelopmental conditions were analysed as explanatory variables using multivariable ordinal logistic regression models (proportional odds). Higher PAF was associated with a substantially lower probability of belonging to the higher SDQ difficulty categories. Neurodevelopmental, mental health, and function-related conditions (MNF-H) showed the strongest association with these difficulties. Younger age and male sex were also associated with a higher probability of difficulties, whereas BMI categories were not independently associated with the outcome after adjusting for the remaining variables. These findings highlight the potential relevance of promoting regular physical activity during childhood as part of broader strategies to improve mental health and wellbeing.