Background <p>Schizophrenia impacts cognitive function, social engagement, and quality of life (QOL), with existing pharmacological treatments often failing to address these domains effectively. This study evaluated the effect of a 3-month structured ping-pong intervention versus standard care on QOL in individuals with schizophrenia.</p> Methods <p>A Randomized Controlled Trial 11study (RCT), involving 86 long-stay patients with schizophrenia was conducted between September and December 2024 at the Psychiatric Hospital of the Cross-Lebanon (HPC). Participants were randomly allocated to either a 12-week ping pong program (18 sessions) or standard care. The primary outcome was QOL, assessed using the Arabic version of the WHOQOL-BREF. Secondary outcomes included social functioning, clinical symptoms, and cognitive performance.</p> Results <p>WHOQOL total scores showed a trend toward improvement over time (<i>p</i> = 0.083), with no significant group effect (<i>p</i> = 0.895) or time × group interaction (<i>p</i> = 0.448). Physical and social QOL domains improved from baseline to post-intervention in both groups, whereas psychological and environmental domains declined over time. Social functioning (QFS total and satisfaction subscale) decreased, with no differences between groups. Clinical symptoms improved significantly for PANSS total (<i>p</i> = 0.040) and general psychopathology (<i>p</i> = 0.009), while cognitive performance remained unchanged.</p> Conclusion <p>Improvements in physical and social quality-of-life domains and reductions in clinical symptoms were observed over time; however, these changes were not specific to the intervention group. Future work should focus on enhancing the structure, duration, and intensity of the ping-pong program to better support functioning and well-being in long-stay patients with schizophrenia.</p> Trial registration <p>The Trial was registered on Clinicaltrials.gov ID NCT06715553; on 03 December 2024.</p>