Background <p>Youth physical health remains a significant challenge in global public health governance. Low sports participation among youth in China significantly impedes the progress of the Healthy China 2030 initiative. While policy tools are essential for addressing this issue, their combined effects and regional adaptability are not well understood.</p> Methods <p>This study uses a mixed-methods approach, combining procedural grounded theory and fuzzy-set qualitative comparative analysis (fsQCA). We first reviewed 39 national youth physical health policies to identify four main types of policy tools: substantive, incentive, capacity-building, and symbolic and persuasive tools. Then, fsQCA was used to analyze 25 provincial cases, exploring how different combinations of policy tools influence youth participation in sports.</p> Results <p>This paper identifies three configuration paths: Configuration 1 (substantive, incentive, and capacity-building tools) shows that these three categories cover 40.1% of the cases (consistency = 0.874). For example, in Jiangsu province, youth sports participation has been successfully increased through institutional coercion, financial incentives, and investments in facilities. Configuration 2 (substantive, incentive, and symbolic and persuasive tools) reveals that capacity-building tools are not essential (consistency = 0.973). For instance, Liaoning province replaces capacity-building tools with administrative accountability mechanisms and health communication strategies under resource constraints. Configuration 3 (symbolic and persuasive tools, capacity-building tools) indicates that a non-coercive pathway is viable (consistency = 1.000). The case in Guangdong province demonstrates that when health concepts are internalized into social norms through symbolic and persuasive tools, community sports self-organizations and digital service platforms—supported by capacity-building tools—can form and operate spontaneously, which may help reduce reliance on substantive and incentive-based tools.</p> Conclusions <p>Chinese policymakers tend to favor substantive and incentive-based tools, which are seen as producing faster results. However, they often overlook capacity-building, along with symbolic and persuasive strategies. We suggest adopting flexible, region-specific approaches that consider local resources and cultural contexts. These insights might provide practical guidance for improving the World Health Organization’s Global Action Plan on Physical Activity across different socioeconomic settings.</p>