Is active commuting to school associated with meeting physical activity recommendations among Saudi adolescents? A cross-sectional study

Abstract

Rising rates of physical inactivity (PI) among adolescents represent urgent public health concern. Encouraging students to actively commute to school (walking or cycling rather than relying on motorized transport) is a scalable strategy to increase habitual physical activity (PA) in this population. Such an initiative would help adolescents to meet WHO’s recommendation that children and adolescents engage in an average of at least 60 min of moderate-to-vigorous physical activity (MVPA) per day across the week. This study examined whether active commuting to school by Saudi adolescents is associated with meeting PA recommendations, and whether this association varies by sex and city. A cross-sectional study was conducted with a sample of students ( N = 5,900) at 40 public intermediate schools across five Saudi cities (Riyadh, Jeddah, Dammam, Khamis Mushait, and Tabuk), of whom 5,588 had complete data for the primary analyses. The Global School-based Student Health Survey-based questionnaire was used to collect data on the frequency of active commuting over the past 7 days. Active commuting frequency was categorized as none (0 days), some days (1–4 days), or most/all days (5–7 days); meeting the PA recommendation was operationally defined, for this study, as engaging in ≥ 60 min of MVPA on all 7 days of the week, a stringent, study-specific criterion that is more conservative than WHO’s average-based guideline. The association between active commuting and meeting the PA recommendation was analyzed using multivariable logistic regression adjusted for sex, city, and age with standard errors clustered by school. The associations between active commuting and sex and active commuting and city were tested using likelihood ratio tests ( N = 5,588). 12.6% of the sample met WHO’s PA recommendation. Active commuting on most/all days was independently associated with higher odds of meeting the recommendation (adjusted odds ratio = 1.66, 95% CI 1.35–2.03, p < .001) relative to no active commuting; there was no association between active commuting on 1–4 days per week and meeting the WHO’s PA recommendation. The association between active commuting and sex approached significance ( p = .068): the association was significant among boys (adjusted odds ratio = 1.90, 95% CI 1.54–2.35) but not girls (adjusted odds ratio = 1.32, 95% CI 0.87–2.01). No significant association between active commuting and city was evident ( p = .981), despite the differing overall prevalence of active commuting by city. Habitual, near-daily active commuting was independently associated with meeting PA recommendations among Saudi adolescents. The association appeared stronger among boys, although the formal test for a sex interaction did not reach statistical significance; the association did not differ significantly by city. These findings suggest active commuting may be a promising, scalable target for future intervention research aimed at increasing PA among Saudi adolescents, with implications for school-transport and urban-design policy; prospective and intervention-based research, alongside sex-responsive strategies, is needed to confirm whether promoting active commuting would increase PA among girls.