Physical inactivity represents the fourth highest cause of premature and preventable death globally [1]. The risk of all causes of mortality increases by 20–30% for inactive compared to active people [2]. Inactive people are at increased risk of non-communicable diseases (NCD) such as obesity [3], ischemic heart disease, diabetes [4], stroke [5] and numerous types of cancer [6].
Childhood and adolescent obesity is considered to be a major public health crisis globally. Globally the prevalence of overweight among adolescents increased from 4% in 1975 to more than 18% in 2016 [7]. In 2019, it was estimated around 38 million children under the age of five were overweight or obese, and half of these children lived in Asia [8]. Overweight and obese children are at least twice more likely to be obese at during adolescence and adulthood [9–11].
The fundamental cause of overweight and obesity among all age groups is the imbalance of calories consumed and expended. This is primarily associated with decreased physical activity (PA) and increased intake of energy dense foods [12]. A WHO led study among 1.6 million school-aged adolescents worldwide found more than 80% do not meet the minimum recommendation of PA and the percentage is higher among girls (85%) [13]. Physical inactivity is detrimental to adolescents' current and future health given the documented benefits of PA, which includes improved cardiorespiratory circulation, muscular fitness, and metabolic health [14]. In addition, PA has been found to have a positive impact on cognitive performance, academic attainment, and mental health outcomes among adolescents [15, 16].
Prior to the industrialisation of the Kingdom of Saudi Arabia (KSA) (approx. 30 years ago), people led a simple and active life with the physical challenges of daily life demanding an active lifestyle [17]. However, the KSA has undergone significant lifestyle changes, including an increase in sedentary behaviours and unhealthy eating habits that have coincided with increases in the prevalence of overweight and obesity. These lifestyle changes have been associated with significant increases in NCDs and associated complications [18, 19]. National estimates of combined overweight and obesity prevalence among 13–18-year-old Saudi students were 36.6% and 38.4% for males and females, respectively [17]. Over 84% of Saudi males and 91.2% of female adolescents reported more than the recommended screen time (ST) (>2 hours) daily, and almost 50% of males and 75% of females did not meet daily PA guidelines at least 60 minutes daily of moderate-to-vigorous intensity) [20]. Sedentary behaviour among adolescents as a result of increased ST was also associated with a negative impact on eating behaviours irrespective of PA levels [21].
A study among Saudi adolescents (n = 2571) found good knowledge and positive attitude towards PA and this was associated with increased PA levels [22]. Adolescents’ negative attitude towards adopting regular PA has been recognised as a barrier to PA behaviour later in life [23]. In addition to behaviour-related barriers, other identified barriers include: environmental (expense and inaccessibility of structures activities); school-based (limited PA time allocated, lack of variety of PA choices and lack of teacher support); and policy (policy facilitating school-based PA) may influence PA among adolescents [24]. Cultural influences and beliefs in the Arabic-speaking region may also present a barrier to PA for females [25, 26].
The COVID-19 Coronavirus (SARS-CoV-2) pandemic and the associated shutdown of schools, organised activities and public sports facilities in most countries has further impacted PA behaviour [27]. This has resulted in significant changes in adolescent’s daily habits and their opportunity to remain active [28]. Following the WHO declaration of COVID-19 as a pandemic on March 11, 2020, the Saudi Arabian government imposed a nationwide curfew to restrict movement for most of the daylight hours [29]. The Ministry of Health [30] outlined the following actions that were undertaken. In line with the WHO guidelines in dealing with the outbreak, Saudi Arabia also closed multiple facilities including schools, gyms, and other sports clubs, in an attempt to monitor the pandemic situation and contain the virus. Partial lockdowns were imposed between April 21st and May 11th and total lockdown from May 23rd to May 27th, 2020 which included the complete closure of all universities and educational institutions with a shift to online education. On May 28, the lockdown was partially lifted in all cities, the movement between regions was eased, and shopping malls were opened. The restrictions on domestic flights, restaurants and cafes, and parks were eased on May 31. The latest action was on June 21, where the partial lockdown was lifted on all regions. However, all levels of schools including higher education institutions continued online-based remote learning [30].
PA participation for adolescents offers benefits for physical and psychological well-being, particularly during the pandemic era [31]. At this critical stage of their development, it is important for them to achieve the recommended level of PA [32]. While WHO social distancing regulations were implemented to control the spread of COVID-19, it is essential to recognise that these restrictions have impacted adolescent PA and general well-being [33]. This paper reports findings from a broader study to explore knowledge, attitude and behaviours around overweight and obesity among adolescent students in Jeddah, KSA [34]. This paper will present self-reported PA knowledge, attitudes and behaviours and explore the associations between PA behaviours, and demographics, knowledge and attitudes. Influences on PA for males and females were also compared.