Physical activity levels among undergraduate students at the College of Applied Medical Sciences, King Saud University, Riyadh: A prevalence study

Abstract

Physical inactivity and sedentary behavior pose significant health concerns, particularly among young adults like college students. However, little research exists on the attitudes towards physical activity among Saudi Arabian healthcare students. This study aimed to assess the prevalence of physical activity and determine the reason for being physically inactive among students and interns across all programs in the College of Applied Medical Sciences (CAMS) at King Saud University (KSU), Riyadh, Saudi Arabia. A cross-sectional online survey was conducted between March and May 2023. CAMS students aged 18 and above, fluent in Arabic or English, and willing to participate were included. The Global Physical Activity Questionnaire (GPAQ) was used to measure physical activity. Descriptive statistics were used for data analysis. Out of 433 respondents, 377 met the inclusion criteria (response rate: 89.3%). Physical activity prevalence was 54.60%, with walking being the most common activity (42.70%). Lack of time was the primary reason for inactivity (51.40%). On average, students engaged in 1.5 hours/day of vigorous-intensity activities and 1.3 hours/day of vigorous-intensity sports and fitness activities at work. Sedentary behavior, characterized by continuous sitting, averaged 5.37 hours per day. Approximately half of CAMS students are physically active, while 20% rely solely on short walks due to time constraints, limited activity hours, or sedentary habits. A lack of time was cited as the primary reason for inactivity by most students. Future research should focus on strategies to enhance physical activity among healthcare students. In addition, academicians and policymakers should propose time-efficient initiatives that accommodate the demanding and busy schedules of healthcare students.

1. Introduction

The term “physical activity” refers to any type of movement that involves the use of skeletal muscles and requires energy expenditure. The World Health Organization (WHO) advises persons between the ages of 18 and 64 to engage in at least 150 minutes of moderate-to-vigorous physical exercise and 2 days of muscle-strengthening activity each week to achieve health benefits.^[1] The WHO recommendations are justified by the fact that muscles can produce continuous movement when they are used in routine occupational, athletic, conditioning, domestic, and other activities.^[2] As a result, it has several advantages, such as better social skills, excellent health, a healthy body weight, and better sleep.^[3] Additionally, it can assist in lowering the risks of early mortality, coronary heart disease, strokes, high blood pressure, obesity, and non-communicable diseases (NCDs).^[4–6]

On the other hand, physical inactivity and sedentary behavior are major public health concerns, particularly among young adults like college students who struggle to balance academic, work, and personal responsibilities. In Saudi Arabia, physical inactivity is prevalent among both middle-aged and young individuals from diverse ethnic backgrounds. Saudi Arabia has one of the highest rates of physical inactivity among its different populations living in the country.^[7] In Saudi Arabia, one of the ministries of the General Authority for Statistics reports that in 2021, just 29.7% of the population engaged in moderate physical activity, compared to 48.2% of males and 38.3% of women who engaged in at least 30 minutes of physical exercise per week.^[8] The factors may include recent trends in population standards of living toward sedentary activity and a high-calorie food pattern, as well as rapid socioeconomic development.^[9,10] The country modern technological advancements have also caused people to require less physical activity overall.^[10] Unfortunately, this resulted in a scenario of significant unfavorable lifestyle changes and increased the prevalence of 32.15% in 2018^[11] to 73% in 2022 lifestyle-related NCDs in the nation,^[12] particularly in obesity and type 2 diabetes mellitus (T2DM).^[13] With that being said, Saudi Arabia ranked third among Middle Eastern nations for T2DM caused by obesity, after Kuwait and Iraq, over the past 20 years.^[13]

Recently, Saudi Vision Plan 2030 has taken a socially conscious stance.^[14,15] Its promotion of community participation in sporting activities, which highlights the value of engaging in physical exercise for at least 30 minutes per week, is one of its objectives. This novel concept of prioritizing the enhancement of people quality of life is exemplified by the Vision Program Quality of Life Program. It is noteworthy that both developed and developing nations are now embracing this approach. Notably, students in the College of Applied Medical Sciences (CAMS) at King Saud University in Riyadh, Saudi Arabia, are actively involved in this endeavor. CAMS is dedicated to providing comprehensive education and training to students pursuing careers in various healthcare fields, aligning with the objective of improving individuals’ well-being.

As future healthcare professionals, it is imperative for undergraduate students in this college to be knowledgeable about the importance of physical activity and to actively engage in regular exercise during study days, leisure time, and transportation. By doing so, they can serve as role models and advocates for physical activity promotion within their communities. By examining the physical activity patterns of these students, we can gain insights into their behaviors, motivations, and barriers related to physical activity engagement.

Research on healthcare students’ views toward physical activity is, however, scarce.^[16] Thus, this study sought to evaluate the prevalence of physical activity and determine the reason for being physically inactive among students and interns in departments of the College of Applied Medical Sciences (CAMS) at King Saud University (KSU) in Riyadh, Saudi Arabia. Ultimately, promoting physical activity among undergraduate students can contribute to improved health and academic outcomes and the development of a healthier and more active future healthcare workforce.

2. Materials and methods

Using the stratified sampling method, a cross-sectional questionnaire-based online survey study was conducted between March and May 2023 among undergraduate male and female students and interns who were randomly selected from the various departments in the CAMS, KSU, Riyadh, Saudi Arabia. The departments were Radiological sciences, Optometry sciences, Rehabilitation sciences, Biomedical Technology, Community health sciences, Clinical laboratory sciences, and Dental health. The targeted population included CAMS students aged 18 years or above, and willing to participate in the survey by signing the consent. The participants were assured that the data would be used only for research and would be maintained confidential throughout the study. Others who did not match the inclusion criteria were excluded.

This study was approved by the Institutional Review Board of King Saud University (IRB-E-23-7574). All participants signed the consent form before starting the questionnaire. The data collected in this study has been used for research purposes only and is completely anonymized.

Physical activity was assessed using the publicly available Global Physical Activity Questionnaire [GPAQ] at https://www.who.int. The close-ended with yes, no, or multiple-choice GPAQ was developed by the WHO for physical activity surveillance in countries.^[17] The GPAQ questionnaire was divided into 4 sections. The first section asks about personal information, such as age, sex, marital status, and household income. The second section contained 3 items divided into 2 subsections. The first subsection asked about which department of a college. The second subsection consists of 2 items: the years of study and grade point average (GPA). The third section is about the reasons for not practicing physical activities. The fourth section is about physical activity and sedentary. It consists of 16 items, about activity at work (6 items), moving to and from places (3 items), recreational activities (6- items), and sitting behavior (1 item). Recent studies used the same questionnaire and established reliability with Cronbach Alpha value of 0.85.^[10,16]

Physical activity intensity is measured in terms of metaphorical equivalents (MET). The term “MET” denotes the quantity of energy expended while one is still, and it is equivalent to 1 kcal/kg/hour of calorie intake.^[18] The following MET values were assigned in accordance with WHO recommendations for calculating a person overall energy expenditure using GPAQ: While vigorous activities use up 8 METs, moderate employment, travel, and leisure activities use up 4 METs. In MET, the sum of the time and energy expended for each of the 3 activity domains is calculated. Total physical activity time per week is the sum of all 5 settings combined in 1 week, whereas total energy expenditure per week, or MET, is the sum of all settings combined in 1 week. If a person engages in fewer than any of the following activities in a given week, they are considered to lead a sedentary lifestyle: 150 minutes of moderate-intensity activity (MIA), 75 minutes of vigorous-intensity activity (VIA), or an equal mix of moderate- and vigorous-intensity activity that results in at least 600 MET-minutes.

Students who were enrolled and present at the time of data collection were produced and supplied with the link to the survey (via Google Forms). The link includes a description of the survey methodology and aim. To ensure a maximum number of responses, email reminders were sent out 2 weeks after the initial invitation. As soon as they pressed the submit button, respondents were unable to go back and edit their responses. Participants were instructed to complete the questionnaire only once, regardless of how they obtained it, to prevent response overlap. Upon examination of the obtained data, no such issues, such as input errors, were discovered.

It was determined that a sample size of at least 100 was necessary. This was calculated using the survey software from Creative Research Systems, taking into account a population of more than 5000 people, a confidence level of 95%, and a confidence interval of 10. The demographic characteristics were summed together using descriptive statistics. The mean and standard deviation (SD) were used to present the values for the continuous data. The Statistical Package for the Social Sciences (SPSS) version 26 for Windows (SPSS Inc., Chicago, Illinois) was used to analyze the data.

3. Results

The flow of the study participants is presented in Figure 1. A total of 422 students responded to the survey, and 377 of them met our requirements, with a response rate of 89.3%. The average age is 19.3 (SD = 1.28). Around 59.15% of the population was males (n = 223), and 40.85% of the population was females (n = 154) with no missing data. Physical therapy students make up 10.60% (n = 40), followed by respiratory therapy students with a representation of 13.3% (n = 50). Third-year students made up 29.70% (n = 112) of the student body, which was slightly more than one-third of the first-year students (31%; n = 117). Over 2-thirds of the GPA (5–4), students had 71.60% (n = 270), and the GPA (3.99–3) pupils had 24.40% (n = 92). More than one-third of students (33.6%) and over one-third (n = 127) reported that their family monthly income was between Saudi riyals of 11,000 and 20,000, respectively (Table 1).

Figure 1.

The flow of the study participants.

Table 1.

Characteristics of undergraduate students.

Characteristics	N or mean	% or SD
Age in yr	19.3*	1.3**
Sex
Female	154	40.8
Male	223	59.2
Specialty
Radiological sciences	33	8.7
Optometry sciences	37	9.8
Respiratory therapy	50	13.3
Physical therapy	40	10.6
Audiology and speech pathology	34	9.0
Occupational therapy	33	8.7
Biomedical technology	39	10.3
Community health sciences	36	9.5
Clinical laboratory sciences	39	10.3
Dental health department	36	9.5
Years of study
First-year	117	31
Second year	92	24.4
Third year	112	29.7
Fourth year	36	9.5
Fifth year	8	2.1
Intern	12	3.1
GPA
A	270	71.6
B	92	24.4
C	15	4.0
Mitral status
Unmarried or single	373	98.9
Married	4	1.06
Family monthly income
<5000	28	7.4
6000–10,000	66	17.5
11,000–20,000	127	33.6
>20,000	156	41.3
Do you do any type of PA on a weekly basis?
Yes	206	54.6
No	171	45.4

GPA = grade point average, PA = physical activity, SD = standard deviation.

^*mean,

^**SD.

Walking was the most popular physical activity for about 42.70% of students, followed by gym or bodybuilding (37.80%), and football (11.60%). The majority of the students engaged in VIA for an average of 1.5 hours per day, followed by 1.4 hours of vigorous-intensity sports, fitness, or leisure activities (VISFRA). Weight control was ranked first among students’ goals (33%), then mood improvement (26.60%), and fitness (24.70%). Lack of time was cited by most students (51.40%), followed by an unwillingness to engage in physical activity (29.20%) and a lack of facilities (9.30%) (Fig. 2).

Figure 2.

Type of physical activity, time spent in a day, and its goal along with the reason for physical inactivity.

Approximately 55.3% of the students (n = 114) traveled to and from their destinations using a bicycle or by walking nonstop for at least 10 minutes. The average amount of time spent performing VIA and MIA at work on a normal day was 1.5 (SD = 0.91) and 0.98 (SD = 0.59), respectively. Additionally, more than half of the students (52.4%, n = 108) engaged in moderate-intensity sports, fitness, or recreational activities (MISFRA) for an average of 1.03 (SD = 0.63) hours each day, which resulted in significant increases in breathing or heart rate for at least 10 minutes continuously. Additionally, 60.7% of the students (n = 125) engaged in VISFRA (running or football) for an average of 1.36 (SD = 0.65) hours each day, which results in significant increases in respiration or heart rate for at least 10 minutes continuously. Moreover, it was found that sedentary activity, such as prolonged sitting, was 5.37 (SD = 3.05) mean hours per day (Table 2).

Table 2.

Timeframes and information about several forms of physical activity over a normal week.

Question	N (%)	Mean (SD)
Does your work involve a vigorous-intensity activity that causes large increases in breathing or heart rate like [carrying or lifting heavy loads, digging, or construction work] for at least 10 min continuously?
Yes	63 (30.6)
No	143 (69.4)
How much time do you spend doing vigorous-intensity activity at work on a typical day?		1.5 (0.91)
Does your work involve moderate-intensity activity that causes small increases in breathing or heart rate such as brisk walking [or carrying light loads] for at least 10 min continuously?
Yes	103 (50)
No	103 (50)
How much time do you spend doing moderate-intensity activities at work on a typical day?		0.98 (0.59)
Do you walk or use a bicycle (pedal cycle) for at least 10 min continuously to get to and from places?
Yes	114 (55.3)
No	92 (44.7)
Do you do any vigorous-intensity sports, fitness, or recreational (leisure) activities that cause large increases in breathing or heart rate like [running or football,] for at least 10 min continuously?
Yes	125 (60.7)
No	81 (39.3)
How much time do you spend doing vigorous-intensity sports, fitness, or recreational activities on a typical day?		1.36 (0.65)
Do you do any moderate-intensity sports, fitness, or recreational (leisure) activities that cause a small increase in breathing or heart rate such as brisk walking, (cycling, swimming, volleyball) for at least 10 min continuously?
Yes	108 (52.4)
No	98 (47.6)
How much time do you spend doing moderate-intensity sports, fitness, or recreational (leisure) activities on an atypical day?		1.03 (0.63)
How much time do you usually spend sitting on a typical day?		5.37 (3.05)

Around 22.3% (n = 18), 25.4% (n = 16), 29.6% (n = 32), and 23.2% (n = 29) of students did only 3 days in a week of moderate-intensity activities (MIA), VIA, MISFRA, and VISFRA, respectively. Walking or bicycling for at least 10 minutes continuously to get to and from places was done by 21.9% (n = 25) of students for 5 days a week (Table 3).

Table 3.

Days dedicated to engaging in various forms of physical activity within a normal week.

Question	1 d n (%)	2 d n (%)	3 d n (%)	4 d n (%)	5 d n (%)	6 d n (%)	7 d n (%)
In a typical week, how many days do you do vigorous-intensity activities as part of your work	8 (12.7)	7 (11.1)	16 (25.4)	13 (20.6)	12 (19)	7 (11.1)	0 (0)
In a typical week, how many days do you do moderate-intensity activities as part of your work	10 (9.7)	22 (21.3)	23 (22.3)	18 (17.4)	19 (18.4)	6 (5.8)	5 (4.8)
In a typical week, on how many days do you walk or bicycle for at least 10 min continuously to get to and from places?	10 (8.7)	13 (11.5)	21 (18.4)	18 (15.7)	25 (21.9)	7 (6.1)	20 (17.5)
In a typical week, on how many days do you do vigorous-intensity sports, fitness, or recreational (leisure) activities?	20 (16)	24 (19.2)	29 (23.2)	24 (19.2)	15 (12)	12 (9.6)	1 (0.8)
In a typical week, on how many days do you do moderate-intensity sports, fitness, or recreational activities?	13 (12)	27 (25)	32 (29.6)	18 (16.6)	14 (12.9)	4 (3.7)	0 (0)

4. Discussion

The current study assessed the prevalence of physical activity among students and interns in CAMS departments at KSU in Riyadh, Saudi Arabia. The findings revealed that the average survey response rate was 89.3%, with an average respondent age of 19.3 years and males being the dominant gender. Most students majoring in physical or respiratory therapy were in their third year and reported family incomes of between 11,000 and 20,000 Saudi riyals. The main findings revealed that most students were physically active and engaged in walking for 10 uninterrupted minutes 5 days a week, followed by gym, bodybuilding, or football. The majority of the students participated in VIA for an average of 1.5 hours per day, 3 days per week. The top 3 goals among students were weight control, mood improvement, and fitness, respectively. The majority of students who were physically inactive attributed their lack of physical activity to a lack of time, followed by a lack of willingness and access to facilities.

In comparison to earlier studies conducted in Poland,^[19,20] Malaysia,^[21] Southern Thailand,^[22] Iran,^[23] Nigeria,^[24] and Saudi Arabia,^[25,26] this study findings regarding physical activity were more favorable. These findings, however, were not as strong as those of recent research from Saudi Arabia^[16] and Spain.^[27] The prevalence of physical activity may vary from study to study as a result of being influenced by a number of factors, including the study technique, types of respondents, and colleges or institutions’ environment. This could be 1 explanation for the inconsistent results. For instance, a selection bias brought on by attrition (which is unavoidable in longitudinal research) and the recruitment process, which was primarily conducted online, led to an excess of individuals who fit certain criteria.^[28] However, due to an increasingly sedentary lifestyle, physical inactivity is said to be a frequent practice among students in both developed and developing countries, especially during pandemics in the academic arena.^[29]

Similar to the results from the present study, medical students were less active overall and were more sedentary during the lockdown caused by the COVID-19 pandemic.^[30] In addition, there was a decrease in walking time and an increase in vigorous exercise. Students also slept more than the permitted 7 hours per night under lockdown. Contrary to these findings, the majority of students engaged in more physical activity, but they also sat down for more than 8 hours each day and gained <5.0 kg of body weight throughout the pandemic.^[31] However, because it enhances the health of students, faculty, and patients, institutions should emphasize instruction in physical activity and sleep. Thus, keeping an adequate amount of physical exercise and decreasing sedentary time can be crucial in aiding individuals in coping with a significant life event, especially in the case of repeated lockdowns due to a pandemic outbreak.^[28]

A recent study^[16] that examined the prevalence of physical activity among emergency medical students at the Prince Sultan College for Emergency Medical Services at King Saud University, Riyadh, Saudi Arabia, reported findings that were not similar to those of this study. The findings showed that almost 70% of their students (n = 123) engaged in physical activity, with running coming in third, followed by gym or bodybuilding. Students enjoyed their time in MIA, VIA, and VISFRA, which resulted in significant increases in respiration or heart rate for at least 10 minutes continuously. However, similar to our findings, students from several levels reported engaging in sedentary behavior, such as spending a daily average of 7 hours sitting immobile. It is worth noting that despite these similarities, there are notable differences between our college, the College of Applied Medical Sciences, and their college, including the location and nature of study. Unlike our college, which is located on the main campus of King Saud University, their college is situated off campus. Furthermore, while both colleges cater to students of similar age, background, and overall academic performance, the specific disciplinary focus on emergency medical services may introduce unique factors that could influence the prevalence of physical activity among students. Acknowledging these differences allows for a comprehensive understanding of the factors influencing physical activity levels among undergraduate students in Saudi Arabia. By considering the broader context and comparing findings across various colleges and disciplines, we can gain valuable insights into the prevalence of physical activity and potentially identify strategies to promote and enhance physical activity engagement among students.

According to a recent study,^[27] the majority of the participants engaged in physical activity at work and in their leisure time. The percentage of physical activity related to employment was 18.3%, according to a prior study in Saudi Arabia.^[32] However, despite being aware of the negative effects of inactivity, a recent study^[33] found that Saudi people continue to engage in excessively sedentary behavior and physical inactivity. A thorough evaluation found that young Saudis were significantly more likely than older Saudis to be physically inactive.^[34] Although earlier research revealed that medical professionals were less physically active than other demographics.^[26]

The results of this study did not agree with those of a more recent study in terms of the importance of weight management goals.^[35] In that study, a meta-analysis of data from individual participants revealed that goal-setting-induced weight loss was explained by improved eating but not by physical activity. However, through lowering anxiety, depression, and depressive symptoms, physical activity has been shown to have a positive impact on mood improvement.^[36] According to a prior study,^[37] attending regular group fitness sessions could help medical students reduce their stress and improve their emotional health. Overall, it has been suggested that setting goals for weight management, mood enhancement, and fitness can improve academic performance.^[38]

Similar complaints about the lack of time for physical activity among medical students have been made in the past by residents of Prince Sultan Military Medical City in Riyadh and Southwestern Saudi Arabia.^[39,40] Lack of social support was cited as another recent study^[27] potential barrier that affected students’ physical activity. According to studies,^[27,41] environmental, social, psychological, and cultural factors mostly support students’ physical activity. Additionally, a recent study^[42] conducted in the United States looked at the sociodemographic, lifestyle variables, and sedentary behavior of college students. According to the findings, students said they were sedentary for an average of more than 12 hours every day. Poorer sleep was substantially linked with all sedentary time categories and body mass index.

Adults in Brazil who reported engaging in at least 75 minutes per week of VIA or at least 150 minutes per week of MIA were regarded to be physically active during their free time. The findings showed that men, young people, and people with high levels of education had the highest incidence of leisure-time physical activity.^[43] Unsurprisingly, the current study found lower engagement among CAMS undergraduates. This might be due to the fact that the healthcare students in the current study spent a lot of their leisure time engaging in study-related activities and spending a lot of time in hospitals performing clinical rotations or practical cessations. Maintaining adequate knowledge and awareness of physical activity in current study participants who are viewed as future professionals would aid in providing counseling services to their patients. Knowing the scope of physical activity would aid in the development of policies to promote it regularly among people living in Saudi Arabia.

It would help future professionals provide counseling services to their patients if current study participants, who are thought of as future professionals, maintained appropriate knowledge and awareness of physical exercise. Despite engaging in physical activity, the majority of students did not fully comprehend the value and effectiveness of physical exercise approaches as recommended by the WHO.^[1] In order to increase their understanding of physical activity strategies, it is also crucial to integrate teaching about physical activity programs or enhance their awareness of physical activity into their academic lives.

The primary benefit of this study is that physical activity was measured using a valid and reliable GPAQ scale designed by the WHO. Adequate sample size is another strength of this study. The study has several limitations. First, the research cross-sectional, self-reported online survey design may have made our findings less trustworthy. However, one can trust that physical activity status was accurately captured, given that the survey was anonymous and entirely voluntary. Second, because the results were derived from a self-administered questionnaire, biases such as social desirability bias and recollection bias may have been more likely to exist. Third, because just one health college of university students was studied, the findings cannot be applied to all Saudi Arabian students studying health-related sciences, pharmacy, nursing, or medicine.

5. Conclusions

The objective of the current study was to determine how frequently students and interns in the CAMS departments at KSU in Riyadh, Saudi Arabia, engage in physical activity. The findings showed that the majority of students perform physical activity regularly, walking for 10 continuous minutes 5 days a week. On average, students participated in VIA 3 days a week for 1.5 hours per day. The top 3 objectives among students were, in order, weight management, mood enhancement, and fitness. A lack of time was cited as the primary reason for inactivity by most students.

To promote physical activity among healthcare students, academicians, and policymakers should propose time-efficient initiatives that do not overwhelm their busy schedules. These initiatives could include incorporating physical activity breaks during long study sessions, providing unlimited access to on-campus fitness facilities, or organizing group exercise classes via student clubs/organizations that can be scheduled around their academic commitments. Encouraging healthcare students to prioritize physical activity and providing them with opportunities to incorporate it into their daily routines can have numerous benefits for their health, well-being, and academic performance.

Acknowledgments

The authors extended their appreciation to the Deputyship for Research and Innovation, “Ministry of Education” in Saudi Arabia for funding this research (IFKSUR3-280-1).

Author contributions

Conceptualization: Saad A. Alhammad, Khalid S. Alwadeai.

Formal analysis: Saad A. Alhammad, Faisal M. Almutairi, Abdulaziz S. Bajsair.

Funding acquisition: Saad A. Alhammad.

Investigation: Saad A. Alhammad, Faisal M. Almutairi, Abdulaziz S. Bajsair, Waleed M. Alshehri, Khalid S. Alwadeai.

Methodology: Saad A. Alhammad, Faisal M. Almutairi, Abdulaziz S. Bajsair, Waleed M. Alshehri.

Project administration: Saad A. Alhammad, Faisal M. Almutairi, Mishal M. Aldaihan.

Resources: Saad A. Alhammad, Waleed M. Alshehri, Khalid S. Alwadeai.

Supervision: Saad A. Alhammad.

Visualization: Faisal M. Almutairi, Abdulaziz S. Bajsair, Abdulrahman S. Alghamdi, Fahad S. Algarni.

Validation: Abdulrahman S. Alghamdi, Fahad S. Algarni, Mishal M. Aldaihan.

Writing – original draft: Saad A. Alhammad, Faisal M. Almutairi.

Writing – review & editing: Abdulaziz S. Bajsair, Abdulrahman S. Alghamdi, Fahad S. Algarni, Mishal M. Aldaihan, Waleed M. Alshehri, Khalid S. Alwadeai.