Teamwork-Oriented Physical Education Course Organisation and Survey-Wave Differences in Physical Activity, Sitting Time, and Perceived Physical Literacy Among Medical Students: A Two-Wave Unlinked Parallel-Group Evaluation

Medical students face health risks associated with high academic demands and limited discretionary time, yet evidence remains insufficient on whether health-promoting strategies embedded within existing curricula can improve their health-related behaviours and outcomes. We conducted a non-randomised, two-wave unlinked parallel comparison within a compulsory physical education course. Across four survey cells, 354 questionnaire responses, rather than 354 unique longitudinal participants, were analysed. Physical activity and sitting time were assessed using the International Physical Activity Questionnaire–Short Form, perceived physical literacy using the Perceived Physical Literacy Instrument, academic burnout using the Maslach Burnout Inventory–Student Survey, psychological distress using the Depression Anxiety Stress Scales-21, and sleep quality using the Pittsburgh Sleep Quality Index. Differential changes were estimated using Group × Wave models. Relative to the comparison condition, the teamwork-oriented condition showed more favourable changes in moderate-to-vigorous physical activity (MVPA) (67.15 min/week, 95% CI 2.23 to 132.07; p = 0.043) and sitting time (−87.08 min/day, 95% CI −159.28 to −14.88; p = 0.018); BH-FDR-adjusted q values were 0.058 and 0.054. Perceived physical literacy showed a favourable but imprecise estimate (2.11 points, 95% CI −0.07 to 4.29; q = 0.058). No clear differential changes were detected for academic burnout, psychological distress, or sleep quality. The focal outcomes showed favourable estimated patterns, but none met the conventional 0.05 threshold after multiplicity adjustment. Given the non-randomised design, unlinked surveys, and complete confounding of instructor with course condition, the findings should be interpreted as differences between two specific instructor–course contexts rather than as causal effects of the instructional approach.