Abstract
Purpose
This study aimed to investigate the knowledge, attitudes, and practices (KAP) of healthcare practitioners and community members regarding physical activity prescription (PAP), filling a crucial gap in existing research.
Methods
A national-level assessment of KAP regarding physical activity (PA) and PAP within Saudi primary healthcare centres (PHCs) was conducted using two structured surveys: one targeting the Saudi community and one targeting healthcare practitioners. A cross-sectional, quantitative web-based survey design involved 1323 participants (396 healthcare practitioners and 927 community members.
Results
The study indicates that both practitioners and the community have positive attitudes and knowledge about PA and PAP. However, significant gaps exist between this knowledge and actual practice, particularly in the integration of PAP into healthcare. Practitioners recognise PA guidelines and support PAP but face barriers such as time constraints and unclear roles, leading to infrequent prescriptions. Meanwhile, the community demonstrates trust in healthcare providers but lacks sufficient guidance on PA, highlighting an unmet need for structured PA counselling.
Conclusion
These insights emphasize the urgent need to standardize PAP implementation through tailored guidelines, training, and tools, with coordinated efforts across health authorities. Addressing systemic barriers and utilizing PHCs as frontline agents of behaviour change, Saudi Arabia can advance PAP as a key public health strategy, fostering a more active, healthier society aligned with Vision 2030.
Keywords: community, healthcare practitioners, physical activity, prescription, delivery of health care, Saudi Arabia
Introduction
Physical activity (PA) is defined as bodily movement produced by skeletal muscles that results in energy expenditure (Caspersen et al, 1985). It is widely recognised as a cornerstone of public health, playing a significant role in promoting general health and well-being across all age groups. PA is particularly important for slowing the aging process and preserving cognitive function as well as for the prevention and management of non-communicable diseases such as diabetes mellitus, hypertension, and obesity. Beyond physical health, PA is linked to improved mental health outcomes by alleviating symptoms of anxiety and depression.1–3 Furthermore, PA is associated with enhanced cognitive function and reduced risk of cognitive decline among older populations, emphasising its importance across the lifespan.4 On the contrary, physical inactivity contributes to the rising prevalence of obesity and non-communicable diseases in the community.5 Sedentary behaviours, particularly among youth and children, are exacerbated by prolonged screen time.6 Globally, these diseases impose an escalating burden on governments, compromising the quality of life for affected individuals and their families. The World Health Organization (WHO) underscores the role of PA in decreasing the prevalence of non-communicable diseases, such as cardiovascular diseases, diabetes mellitus, and certain cancers, which are increasingly common in Saudi Arabia due to shifts in lifestyle and dietary habits.7
Addressing these public health challenges necessitates multisectoral interventions involving healthcare professionals, policymakers, and community stakeholders to create environments encouraging active lifestyles. Saudi Arabia has made substantial efforts to improve public health and quality of life through initiatives to promote PA, prominently featured within the “Living Healthy, Being Healthy” domain of Vision 2030.8,9 The Saudi Sports for All Federation, under the Ministry of Sport, aims to enhance physical activity across all demographic groups by organizing events, programs, and campaigns that ensure accessible participation for various ages and genders, with a particular emphasis on inclusivity for marginalized groups and a focus on women.10 These campaigns and events raise awareness about PA’s health benefits and promote mass participation in sport.11 Currently, the Saudi General Authority for Statistics (GASTAT) reported that 59.1% of adults in the country meet the recommended levels of PA.12 Several barriers hinder the full implementation of PA initiatives, including financial constraints, limited time and resources, and sociocultural factors.13
One of the current strategies for mitigating individual inactivity in communities is the utilization of physical activity prescriptions (PAP) as a therapeutic intervention analogous to pharmacological prescriptions.14 Globally, PAP was first utilised in health systems in the 1990s in Europe, the USA, Canada, New Zealand, and Australia.14 Evidence indicates that PAPs enhance health outcomes, making them a form of preventive medicine. They facilitate the early identification and referral of sedentary individuals to appropriate interventions, effectively reducing the spread of lifestyle-related diseases and their complications.15 While primary health care centres (PHCs) serve as essential platforms for integrating PAP into clinical management protocols for various health conditions, these centres function as the initial interface between individuals and the healthcare system and encompass essential health services delivered at the community level.16,17 In Saudi Arabia, PHCs serving as the initial interface between the Ministry of Health and the Saudi population play a pivotal role in promoting PA, yet, there is a lack of a structured PAP to be prescribed by healthcare practitioners. Healthcare providers in PHCs in implementing targeted services aimed at enhancing PA and mitigating sedentary behaviours and facilitating referrals to community-based programmes, such as structured exercise classes and walking groups, providing organised opportunities for PA engagement. These services include assessing patients’ PA levels, offering personalised counselling, and providing tailored guidance for integrating regular exercise into daily routines. Additionally, regular follow-up appointments monitor progress and ensure continued support.18 These efforts collectively underscore the critical role of PHCs in addressing PA and its associated health risks. Currently, despite the healthcare practitioners’ individual efforts to promote PA in PHCs in Saudi Arabia,19 PAP is not yet formally integrated into the Saudi health system. Therefore, integrating PAP into PHCs in Saudi Arabia is vital for addressing the rising burden of disease and promoting public health while supporting the current effort to achieve Vision 2030. By providing PAP in PHCs, local customised guidelines, trained healthcare practitioners, and coordinated efforts, the healthcare system can effectively encourage active living.14 Collaborative strategies involving government agencies, healthcare providers, and community organisations are crucial in creating an environment that promotes PA and prioritises a healthy lifestyle. However, there is a paucity of research focusing on both healthcare practitioners and individuals in the Saudi community regarding providing PAP in PHCs. Therefore, this study aims to explore the knowledge, attitudes, and practices (KAP) of healthcare practitioners and individuals in the Saudi community regarding the integration of PAP into PHCs.
Integrating PAP into PHCs in Saudi Arabia is essential for addressing the increasing prevalence of lifestyle-related diseases and aligns with the Vision 2030 initiative to enhance public health. Despite strong global evidence of PAP’s effectiveness in improving community health outcomes,14,15 its formal implementation in Saudi PHCs remains lacking. This study aims to investigate the knowledge, attitudes, and practices (KAP) of healthcare practitioners and community members regarding PAP, filling a crucial gap in existing research. The findings will help develop collaborative strategies that foster a culture of active living, making a vital contribution to the health of the Saudi population.
Materials and Methods
Study Design
This study employed a cross-sectional, quantitative web-based survey. The study collected data from various regions of Saudi Arabia by administering an online survey from May 2025 to December 2025.
Study Participants
The participants were recruited through convenience sampling from healthcare centres across different regions in Saudi Arabia. The sample included healthcare practitioners (eg, physicians, nurses, and physical therapists) currently working in healthcare centres in Saudi Arabia, as well as adult community members (aged 18 and above) who receive services from PHCs in Saudi Arabia. Participants who failed to meet these inclusion criteria were excluded.
The sample sizes for the Saudi community and healthcare practitioners in Saudi Arabia were calculated using a 95% confidence level and a 5% margin of error, yielding target sample sizes of 385 and 384, respectively. A total of 1323 respondents were recruited for the study, comprising 396 healthcare practitioners and 927 individuals in the Saudi Arabian community, enrolled through convenience sampling.
Data Collection
The data collection phase took place between May and December 2025 via an online survey to collect information from healthcare practitioners and the community about implementing PAP in PHCs in Saudi Arabia. The survey was distributed to relevant authorities and targeted groups by the Saudi Public Health Authority, Health Holding Company, and the Saudi Sports for All Federation, as well as through social connections and social media.
Surveys
Two surveys were created. The first targeted healthcare practitioners, and the second targeted individuals in the Saudi community. The survey was provided in both Arabic and English language for the Saudi community and only in English for health practitioners (Supplementary files 1–3). The surveys were developed by an expert in PA with a PhD in physiotherapy to explore KAP regarding the integration of PAP into PHCs in Saudi Arabia. The development process was informed by the frameworks established in Sharma20 and Andrade et al,21 which guided the formulation of questionnaire items, scoring methodologies, and response scales.
The questions in both surveys were tested through expert revision and piloting. Five experts in PA and public health reviewed the survey. The validation process, via expert review and pre-testing, involved circulating the questionnaire to five experts, who independently rated each item, provided justifications, and suggested revisions. The questionnaire was then updated and circulated again for approval. Then, the survey was piloted with a small group from the target population (n=10) to assess clarity, identify potential issues and gather suggestions for improvement, which were incorporated into the final instrument. To assess the internal consistency of the 5-point Likert scale items in the “Attitude” and “Practice” sections, Cronbach’s alpha was 0.837 for 11 questions among healthcare practitioners and 0.676 for 2 questions among community participants. To reduce self-selection and the social desirability bias inherent in convenience sampling, we applied clear criteria, diverse recruitment methods (email, social media, text messages) and anonymous survey designs, strengthening the validity and generalizability of our findings.
Survey for Health Practitioners
This survey targeted health practitioners and was composed of four sections. First, the Demographic characteristics section included age, gender, health profession, years of experience, highest degree earned, location of the respondent’s community health centre, and the type of healthcare centre in which healthcare practitioners work.
The second section was the knowledge, which comprised two questions about healthcare practitioners’ knowledge of (1) international PA guidelines and (2) the minimum recommended dose of PA per week for adults.
The third section included eight questions exploring health practitioners’ attitudes towards (1) prescribing PA for chronic diseases, (2) support for Vision 2030, (3) the development of PA guidelines for the Saudi population, (4) the provision of PAP in PHCs, (5) the role of ready-to-use PAP in enhancing consistency, (6) training to prescribe PA to patients, and (7) the need for further training in PAP and PA guidelines. The responses to these seven questions were rated on a 5-point Likert scale (strongly agree to strongly disagree). The eighth question aimed to explore the preferred format of the training.
Finally, the fourth section, which had seven questions, was about practice. The first four addressed the healthcare practitioners’ perceived practice towards (1) advising patients to practise PA regularly, (2) prescribing PA to patients as part of routine practice, (3) prescribing PA to patients as a scope of practice, and (4) discussing PA with patients during routine consultations, measured by a 5-point Likert scale (strongly agree to strongly disagree). Question (5) concerned the frequency with which healthcare practitioners recommended PA to patients using a 4-point frequency scale, and questions (6) and (7) were multiple-choice questions identifying current obstacles to PAP and the recommended conditions for it.
Survey for Individuals in the Saudi Community
This survey targeted the Saudi community and was composed of three sections. The first was the demographic characteristics section, which included questions about age, gender, region of residence, nationality, and occupation. The second section comprised six questions to assess the Saudi community’s practice and attitude towards PA and PAP in PHCs. Four attitude questions about (1) PA motivating factors, with a multiple-choice answer, (2) belief in healthcare practitioners as qualified providers of PAP with dichotomous answers (yes, no), and two questions rated on a 5-point Likert scale (strongly agree to strongly disagree) on (3) receiving PA information and (4) having PAP as a routine in PHCs. The practice section included two questions concerning whether Saudi community respondents had (1) visited PHCs and (2) received a PAP, with dichotomous answers (yes, no).
Scoring and Categorisation of KAP of Healthcare Practitioners and the Saudi Community
The total score for each response was calculated by summing each participant’s item scores for each answer option of the question. This process was repeated for all KAP sections. Questions with dichotomous answers were scored as 1 for yes or correct responses and 0 for no or incorrect responses. We utilised a 5-point Likert scale to evaluate attitudes and practices among healthcare practitioners and the Saudi community. On this scale, a score of 1 represents strong agreement, while a score of 5 indicates strong disagreement. To maintain consistency across responses, reverse scoring was applied so that higher scores reflect more positive outcomes. For healthcare practitioners, seven attitude questions were assessed, with total scores ranging from 7 (most negative) to 35 (most positive), and four practice questions were evaluated, ranging from 4 to 20. In the Saudi community, two attitude questions were measured, with scores ranging from 2 (most negative) to 10 (most positive). The total score for each response was calculated by summing the scores earned by all participants for that response.
Categorisation of participants’ scores using a 60% cut-off was employed in previous healthcare research assessing KAP towards PA in Saudi Arabia.22 Using more than 60% cut-off may categorise most individuals as having poor knowledge, negative attitudes, and unsatisfactory practices, as formal PAP is not yet integrated into the current health system. This limitation affects knowledge, attitudes, and perceived practices related to PA, including its health benefits, guidelines, and training. Therefore, a 60% threshold provides a better distinction between “moderate” and “low” levels. Furthermore, the 60% threshold was used in previous healthcare research assessing KAP towards PA in Saudi Arabia.22
We defined poor knowledge, a negative attitude, and unsatisfactory practice among healthcare practitioners as participants who scored below 60% of the highest score in knowledge and attitude, whereas those with scores of 60% or above were considered to have good knowledge, a positive attitude, and satisfactory practice. For the Saudi community, only attitude questions were categorised as negative (below 60%) or positive (60% or above).
Ethical Considerations
Ethics approval for the study was obtained from the ethics committee of King Abdullah Bin Abdulaziz University Hospital in Riyadh, Saudi Arabia (HA-01-R-104), in accordance with the Helsinki Declaration on ethical standards in human research. All the respondents provided informed consent before completing the survey. All the methods described below were performed in accordance with the relevant institutional review board and regulatory requirements. Participation was voluntary, and the respondents were informed that they could withdraw at any time without consequences.
Data Analysis
Descriptive and inferential statistics were employed using Microsoft Excel. Descriptive statistics (frequencies and percentages) were used to summarise variables. Inferential analyses, including the Spearman correlation test, were used to test the relationship between the ordinal data of the non-parametric variables. Statistical significance was set at p < 0.001.
Results
The Health Practitioners’ Results
Healthcare Practitioners Demographics and KAP Scores
The largest single group among the health practitioner respondents was aged 35–44, with equal numbers of males (50%) and females (50%). While physicians constituted the largest health profession among the respondents (45%), followed by nurses (31%), many reported themselves as allied health professionals under the category of “other” (15%) (Table 1). About half of the respondents held bachelor’s degrees, followed by diploma and bachelor’s (19%), while PhD constituted 10% of the respondents. Two-thirds of them had more than 10 years of experience, while 21% had 6–10 years, 13% had 1–5 years, and only 2% had less than 1 year of experience. Most healthcare practitioners work at PHCs (59%), 29% at secondary healthcare centres, and 15% at tertiary healthcare centres.
Table 1.
Demographic and Professional Background of Health Practitioners (n=927)
| Age | Count | % |
|---|---|---|
| 18–24 | 3 | 0% |
| 25–34 | 203 | 22% |
| 35–44 | 455 | 49% |
| 45–54 | 197 | 21% |
| 55 or older | 69 | 7% |
| Health profession: | ||
| Physician | 417 | 45% |
| Nurse | 284 | 31% |
| Physiotherapist | 41 | 4% |
| Public Health Specialist | 46 | 5% |
| Other | 139 | 15% |
| Location of Community Health Centre: | ||
| Central Region | 223 | 24% |
| Western Region | 187 | 20% |
| Eastern Region | 224 | 24% |
| Northern Region | 86 | 9% |
| Southern Region | 207 | 22% |
Regarding KAP Scores of Healthcare Practitioners, two-thirds of the health practitioners showed good knowledge, while 80% had a positive attitude, and 73% had satisfactory PA practice (Figure 1).
Figure 1.
Percentages of scores for knowledge, attitude, and practice towards PAP among PHCs.
PA Guidelines
The most reported resource for PA guidelines was the WHO Global Guidelines on PA (72%), followed by the 24-hour movement guidelines for Saudi Arabia by the Saudi Public Health Authority (36%), the Center for Disease Control and Prevention PA Guidelines (26%), and finally, the American College of Sports Medicine Guidelines (12%). Regarding the development of customised PA guidelines for the Saudi population, 72% agreed or strongly agreed that such guidance would be more applicable than international PA guidelines, while only 3% disagreed and strongly disagreed (Figure 2).
Figure 2.
Percentages of healthcare practitioners’ knowledge, attitudes and practices towards PA and PAP.
PA and PAP in PHCs
Most of the health practitioners believe that regular PA plays a significant role in preventing and managing chronic diseases and that having a PAP in PHCs would benefit patients. This result may support the aim of Vision 2030 to improve the quality of life for citizens and residents. Moreover, 87% of the healthcare practitioners agreed that having a ready-to-use PAP would improve consistency in advising patients about PA and further reported that they agree or strongly agree to advise, prescribe, and discuss practising PA with their patients as part of their routine perceived practice (Figure 2). Despite this, about half never prescribe or recommend PA to their patients in current practice (Table 2), and they agreed or strongly agreed that prescribing or recommending PA is outside the scope of their practice (Figure 2).
Table 2.
Physical Activity Recommendation Frequency by Healthcare Practitioners in the Current Practice (n=927)
| Always | 44 | 5% |
| Often | 41 | 4% |
| Sometimes | 160 | 17% |
| Rarely | 259 | 28% |
| Never | 423 | 46% |
The healthcare practitioner respondents reported that the conditions and populations for which PA is most recommended are diabetes (86%), obesity or being overweight (85%), hypertension (78%), the healthy or general population (66%), and the elderly (63%). The most reported barriers that healthcare practitioners currently face in prescribing PA were lack of time (53%), lack of patient interest or compliance (50%), and lack of training or knowledge (34%).
Using a Spearman correlation test, significant (p<0.001) positive correlations were found between health practitioners’ attitude towards the statement that “having a PAP in PHCs as a standard practice is beneficial for patients” and their knowledge and positive attitude towards international PA guidelines (r= +0.25, p<0.001), PA in the prevention and management of chronic diseases guidelines (r= +0.66, p<0.001), PAP in improving the quality of life guidelines (r= +0.73, p<0.001), the consistency of prescribed PA guidelines (r= +0.77, p<0.001), and the practice of prescribing and discussing PA with patients guidelines (r= +0.40, p<0.001), (Table 3). However, the variable regarding PAP, which is outside the scope of health practitioners’ practice, showed no significant relationship, with a very small negative correlation observed (Table 3).
Table 3.
Spearman Correlation Test Results of Healthcare Practitioners Having PAP in PHCs Results with Knowledge, Attitude and Practice Among Healthcare Practitioners
| Knowledge, Attitude and Practice Among Healthcare Practitioners | Correlation (r) | p |
|---|---|---|
| Understanding of the international PA guidelines | +0.254 | <0.001 |
| Developing customised PA guidelines for the Saudi population will be more applicable than international PA guidelines. | +0.446 | <0.001 |
| Regular PA plays a significant role in the prevention and management of chronic diseases | +0.66 | <0.001 |
| PAP may support the Saudi 2030 vision to improve the quality of life for our citizens and residents. | +0.729 | <0.001 |
| Having a PAP ready to use will improve consistency in advising patients about PA. | +0.771 | <0.001 |
| I am adequately trained to prescribe PA to patients. | +0.285 | <0.001 |
| I am interested in receiving further training in exercise prescription and PA | +0.576 | <0.001 |
| I advised my patients to practice PA generally. | +0.535 | <0.001 |
| I prescribe or recommend PA to my patients as part of my routine practice. | +0.462 | <0.001 |
| Prescribing or recommending PA to my patients is outside the scope of my practice | −0.0235 | 0.476 |
| Frequency of recommending PA to patients | +0.287 | <0.001 |
| I discuss PA with my patients during routine consultations. | +0.402 | <0.001 |
Note: *p < 0.001.
Abbreviations: PAP, physical activity prescription; PA, physical activity; PHCs, primary healthcare centres.
Health Practitioner Training
Although about half of the health practitioners felt adequately trained to prescribe exercise to patients, 85% were interested in receiving further training in PAP and PA guidelines (Figure 2). Their preference for this training was mainly in-person workshops, followed by online courses, on-the-job training, and other methods (37%, 40%, 22%, and 1%, respectively).
The Saudi Community Survey Results
The Saudi Community Demographics and Scores
The largest group of respondents (39%) was aged 35–44 years old and lived in the central region (Table 4). A majority were Saudis (87%), with nearly equal numbers of males (55%) and females (45%).
Table 4.
Demographic Information of Saudi Community Respondents
| Age: | N | % |
|---|---|---|
| 18–24 | 16 | 4% |
| 25–34 | 74 | 19% |
| 35–44 | 153 | 39% |
| 45–54 | 116 | 29% |
| 55 or older | 37 | 9% |
| Region of Residence: | ||
| Central Region | 153 | 39% |
| Western Region | 71 | 18% |
| Eastern Region | 109 | 28% |
| Northern Region | 19 | 5% |
| Southern Region | 44 | 11% |
| Occupation: | ||
| Student | 10 | 3% |
| Employee | 310 | 78% |
| Self-employed | 16 | 4% |
| Unemployed | 31 | 8% |
| Retired | 27 | 7% |
| Other | 2 | 1% |
PA and PAP in PHCs
The most motivating factors for Saudi community respondents to undertake PA were health condition (68%) and weight management (66%), followed by stress relief (55%). More than half of the respondents (58%) reported visiting PHCs in the last 12 months, while 73% reported never receiving a PAP recommendation from healthcare practitioners (Table 5). The majority of community respondents believe that healthcare providers are qualified to provide PAP and would like to receive PAP as part of their routine healthcare services. They are also interested in receiving more information about PA from PHCs (Table 5).
Table 5.
Saudi Community Respondents’ Practice and Attitude Toward PA and PAP
| Practice and Attitude Among Saudi Community | Yes | No | |||
|---|---|---|---|---|---|
| I have visited PHCs in the past 12 months | 58% | 42% | |||
| I have received PA recommendation as a medical prescription (PAP) by healthcare providers | 27% | 73% | |||
| Healthcare providers are qualified to provide effective advice on PA | 83% | 17% | |||
| Strongly agree | Agree | Neutral | Disagree | Strongly disagree | |
| I would like to receive a PA prescription as part of my routine healthcare services. | 55% | 36% | 9% | 0% | 0% |
| I am interested in receiving more information about PA from PHCs | 52% | 39% | 7% | 1% | 1% |
Abbreviations: PAP, physical activity prescription; PA, physical activity; PHCs, primary healthcare centres.
Using a Spearman correlation test, respondents from the Saudi community demonstrated a significant moderate positive relationship (r=+0.513, p<0.001) between their agreement to receive a PA prescription as part of routine healthcare services and their agreement to receive more information about PA from PHCs.
Discussion
This national cross-sectional survey demonstrates strong attitudinal readiness for PAP among both healthcare practitioners and the Saudi community, but substantial gaps remain in routine implementation. Among healthcare practitioners, approximately two-thirds demonstrated good knowledge of physical activity (PA) guidelines (60%), and 80% had a positive attitude towards PAP. However, this positive attitude did not consistently translate into practice, with 46% reporting that they never prescribe or recommend PA to patients. Although just over half of practitioners agreed that PAP fell within their scope of practice, 31% disagreed or strongly disagreed, highlighting uncertainty regarding professional roles. Within the community, 91% expressed positive attitudes towards receiving PAP, yet 73% reported never having received a PA prescription from a healthcare provider. These findings illustrate a substantial knowledge-to-practice gap and an unmet opportunity for preventive healthcare delivery in Saudi PHCs.
Our findings are consistent with previous literature describing barriers to integrating PA promotion into routine healthcare practice. Al-Baker et al23 similarly reported that PHC physicians recognised the importance of PA but encountered practical constraints such as limited consultation time and competing clinical priorities. International evidence also highlights similar challenges, including uncertainty regarding professional responsibilities, limited confidence, and insufficient organisational support.18 The positive correlations observed in our study between favourable attitudes towards PAP and routine counselling behaviours may suggest that improving system-level support could help translate positive beliefs into consistent clinical practice. However, it is important to interpret these correlations cautiously, as they do not necessarily imply direct causation.
The findings also support evidence favouring structured and standardised PAP approaches. A substantial majority of healthcare practitioners supported the development of Saudi-specific PA guidelines (72%), while 87% agreed that ready-to-use PAP tools would improve consistency when advising patients. These findings align with systematic reviews demonstrating that standardised prescription pathways, clear referral mechanisms, and structured follow-up improve implementation and patient engagement.14,15 Experience from Sweden similarly suggests that formalised PAP systems increase consistency and improve matching of physical activity recommendations to patient needs.24
Community findings further reinforce the need for systematic implementation of PAP within PHCs. Although the Saudi General Authority for Statistics data indicate that 59.1% of Saudi adults achieve recommended PA levels,12 these national surveillance data are external to the present study and suggest that a substantial minority remain insufficiently active. Within our study, community respondents demonstrated strong confidence in healthcare practitioners as qualified providers of PAP (83%), with over 90% agreeing that PAP should form part of routine healthcare services and expressing interest in receiving more PA information from PHCs. However, the low proportion of participants reporting prior exposure to PAP indicates that current service delivery does not meet this demand.
Taken together, our findings suggest that the principal challenge is not acceptance of PAP but its operational implementation. Three practical priorities emerge from the data. First, PAP should be formally integrated into PHC practice. The uncertainty regarding whether PAP falls within practitioners’ scope of practice suggests that national policy and organisational guidance should clearly define professional responsibilities and embed PAP within routine clinical pathways.17 Policy endorsement should be paired with electronic medical record (EMR) integrated prompts and order sets to minimise cognitive load, in line with implementation facilitators noted by AuYoung et al.25
Second, healthcare practitioners require competency-based training and continuing professional development. While about half felt adequately trained, 85% sought further education. Structured training covering exercise prescription (frequency, intensity, type, and time), contraindications, motivational interviewing, and brief action planning can close skill gaps, an approach supported by clinician-perception data from Woodhead et al18 and programmatic lessons from Arsenijevic and Groot14 and Albert (2020). Given the preferences in our sample, a blended model (workshops, online micro modules, and on-the-job mentoring) is likely to be acceptable and scalable.
Third, standardised and culturally adapted PAP tools should be developed. Strong practitioner support for customised Saudi guidelines (72%) and ready-to-use PAP resources (87%) argues for the development of a Saudi-specific PAP toolkit rather than relying solely on international guidance: concise adult and condition-specific algorithms (eg, diabetes, obesity, hypertension), pre-authorised community referral directories, Arabic patient handouts, and automated follow-up templates. This finding aligns with calls for coherent national coordination of PA policies and initiatives8,26 and would help translate positive attitudes into consistent action.
The findings also align closely with Saudi Vision 2030 and current national public health priorities. PHCs provide an important platform for integrating preventive healthcare with community-based physical activity initiatives. Rather than requiring entirely new structures, strengthening PAP implementation through clear guidelines, practitioner training, standardised tools, and digital integration could leverage existing healthcare infrastructure to promote healthier lifestyles and reduce the burden of chronic disease.15
Systems and Policy Alignment
Saudi Arabia has accelerated PA promotion through cross-sector initiatives,8 yet stakeholders describe fragmentation and the need for stronger coordination.26 PHCs are an ideal operational nexus where policy signals meet clinical workflows and community assets.
We recommend:
First, institutionalising PAP in PHC workflows by embedding PAP prompts and templates into EMR systems; assigning PA champions within PHCs to support implementation, incorporating PAP delivery into PHC key performance indicators (KPIs), and providing tiered referral networks connecting PHCs to municipal facilities and community programs, with feedback mechanisms to prescribers, features associated with greater program functionality.14,15
Second, developing and implementing national PA and PAP guidelines is supported by the finding that 72% of practitioners favored customised Saudi guidelines. These guidelines should align with PHC workflows and be developed collaboratively with the Saudi Public Health Authority and SFA. They could include clear protocols, dosage recommendations, safety considerations, and dissemination through official and digital platforms.
Third, building healthcare practitioner capacity is justified by the finding that 85% of practitioners expressed interest in further PAP training. This could include mandatory PAP education through the Saudi Public Health Authority Academy, the Saudi Commission for Health Specialties, medical colleges, and residency programs, supplemented by short courses, e-learning, competency assessments, culturally tailored patient materials, and digital follow-up tools.
Fourth, allocating time for PA counselling in clinical schedules; equipping PHCs with practical PAP resources, quick-reference guides, and digital prescribing tools; and enhancing cross-sector collaboration among the Ministry of Health, Health Holding Company, and Saudi Sport for All Federation.
Fifth, enhancing public awareness and health literacy through national campaigns promoting the benefits of PA and the availability of PAP in PHCs, while reinforcing healthcare practitioners as trusted PA advisors and supporting broader PA education initiatives.
Sixth, ensuring ongoing monitoring and evaluation by establishing national indicators for PAP implementation and outcomes, conducting regular assessments of system and training needs, and supporting collaborative implementation research.
Strengths and Limitations
This national study provides one of the first broad examinations of PAP across multiple regions of Saudi Arabia and is strengthened by the inclusion of both healthcare practitioner and community perspectives, offering a comprehensive understanding of the opportunities and challenges associated with PAP implementation in primary healthcare. However, the findings should be interpreted in light of several limitations, including the cross-sectional design, reliance on self-reported data, and convenience sampling through predominantly digital recruitment methods, which may introduce selection and social desirability bias and limit the generalisability of the findings. In addition, the cross-sectional nature of the study precludes causal inference between knowledge, attitudes, and practice. Nevertheless, the consistency of our findings with previous Saudi and international studies18,23 supports their credibility and relevance for policy and practice.
Future Directions
Future research should build on the strong practitioner and community support for PAP demonstrated in this study by evaluating implementation strategies within Saudi PHCs. Prospective studies should test implementation packages, including practitioner training, EMR integration, standardised PAP tools, and structured referral pathways, using hybrid effectiveness–implementation designs. Future evaluations should measure patient-level outcomes, including physical activity participation, blood pressure, body mass index, and mental health indicators, while assessing cost-effectiveness to inform wider scale-up. Given national surveillance data,7,10,12 focusing on high-burden conditions such as diabetes, obesity, and hypertension, as well as priority populations including older adults and insufficiently active individuals, may maximise the public health impact of PAP implementation.
Conclusion
This national study provides important evidence regarding the integration of PAP within Saudi primary healthcare centres by examining both healthcare practitioner and community perspectives. The study’s novelty lies in its dual coverage of practitioners and community members at a national level, providing evidence on knowledge and practice gaps and training needs. This is valuable for advancing PAP policies and designing future interventions in Saudi Arabia. Approximately two-thirds of healthcare practitioners demonstrated good knowledge of PA guidelines (60%), while 80% reported positive attitudes towards PAP. However, almost half (46%) reported never prescribing PA in routine practice, despite recognising its clinical value. Similarly, community respondents showed strong support for PAP, with 91% expressing positive attitudes and 83% trusting healthcare practitioners as qualified providers of PA advice, yet 73% had never received a PA prescription during healthcare visits. Although external national GASTAT data indicate that a substantial minority of Saudi adults remain insufficiently active, our findings highlight an important opportunity for PHCs to strengthen preventive healthcare through routine PAP delivery.
The findings suggest that improving PAP implementation requires practical system-level solutions rather than changing attitudes alone. Healthcare practitioners demonstrated strong support for Saudi-specific PA guidelines (72%), widespread agreement that ready-to-use PAP tools would improve consistency (87%), and substantial interest in additional training (85%). These results support the development of national PAP guidelines, structured practitioner education, standardised prescribing tools, and the integration of PAP into routine PHC workflows and electronic medical record systems.
The study should also be interpreted in light of its limitations, including the cross-sectional design, convenience sampling, and reliance on self-reported responses, which may affect causal interpretation and generalisability. Despite these limitations, the findings provide a strong evidence base for strengthening PAP implementation within Saudi PHCs and support ongoing national efforts under Vision 2030 to promote active lifestyles and improve population health.
Acknowledgments
This work was funded by the Princess Nourah bint Abdulrahman University Researchers Supporting Project (PNURSP2026R267), Princess Nourah bint Abdulrahman University (PO Box 84428, Riyadh 11671, Saudi Arabia).
Funding Statement
This work was funded by the Princess Nourah bint Abdulrahman University Researchers Supporting Project (PNURSP2026R267), Princess Nourah bint Abdulrahman University (PO Box 84428, Riyadh 11671, Saudi Arabia).
Abbreviations
KAP, knowledge, attitudes, and practices; PAP, physical activity prescription; PA, physical activity; PHCs, primary healthcare centres.
Disclosure
The authors declared no potential conflicts of interest in this work.
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