Background/Objective <p>Rural children face challenges to participating in physical activity (PA). These barriers include lack of facilities, adequate equipment, trained personnel, and transportation limitations. The primary objective of this study was to evaluate intervention feasibility, particularly focusing on the trial- and intervention-related indicators. The secondary objective was to assess preliminary efficacy and outcome trends in accelerometer-collected PA data from pre-, mid-, to post-intervention, as well as changes in physical measures (i.e., maximum plank test, 6-minute walk test).</p> Methods <p>We conducted a 1-year controlled cohort study of 83 6th-8th grade children attending an under-resourced rural middle school in the Midwestern United States. The intervention, Hoosier Sport, was implemented by trained college students in an undergraduate service-learning course. The test group participated in enhanced PE classes including various sports and positive youth development lessons. The control group participated in standard health class curriculum. The primary outcomes were trial- and intervention-related feasibility indicators for children and college student implementers. The measures included AIM (Acceptability of Intervention Measure), IAM (Intervention Appropriateness Measure), and FIM (Feasibility of Intervention Measure), as well as recruitment and retention. Secondary outcomes included light, moderate, vigorous, and total PA, self-reported weekly PA, a maximum plank test, and 6-minute walk test. Given the repeated measures design at three time points (pre-, mid-, and post-intervention) and our primary interest in detecting within-subject changes and between-group differences, analysis focused on linear mixed models with within–between interaction effects.</p> Results <p>FIM (median = 17), AIM (median = 18), and IAM (median = 17) scores exceeded the success threshold (median &gt; 16) when assessed at post-intervention. Total minutes of PA decreased from baseline to mid (<i>β</i> = -42.762, 95% <i>CI</i>(-101.220, 15.696)) and baseline to post (<i>β</i> = -35.952, 95% <i>CI</i>(-89.617, 17.713)), but neither difference was significant (<i>p</i> = 0.149 &amp; 0.185, respectively). At baseline, the test group estimated 64.91 more total minutes of PA than the control group (<i>t</i>(101.13) = 1.82, <i>p</i> = 0.072, <i>dz</i> = 0.771), with a marginally significant difference. There were no significant differences in change over time of total or self-reported PA between the groups (<i>p</i> &gt; 0.05).</p> Conclusions <p>The 1-year intervention was feasible to implement, with high appropriateness and acceptability among rural middle school children. Refinements are needed to continue targeting improvements in children’s PA.</p> Trial registration <p>ClinicalTrials.gov ID: NCT06602596 Registration Date: 09.17.2024.</p>