Beyond the Guidelines: Exploring the Prevalence and Correlates of No-to-Low Moderate to Vigorous Physical Activity Among US Adolescents

Background: Although many studies examine adolescent physical activity (PA) guideline adherence, few focus on the lowest end of the PA spectrum—engaging in no-to-low moderate to vigorous PA (MVPA). Methods: This study characterized cross-sectional and longitudinal patterns of device-measured no-to-low MVPA among a cohort of US adolescents and examined sociodemographic and neighborhood-level correlates. This secondary analysis used data from years 2 and 4 of the Adolescent Brain Cognitive Development Study. Participants wore a Fitbit Charge HR 2 on their nondominant wrist 24 hours per day for 3 weeks to assess daily MVPA. No-to-low MVPA was defined as <8.57 minutes per day of MVPA (<1 d/wk meeting PA recommendations). Neighborhood conditions were captured using the Child Opportunity Index 2.0. Survey-weighted logistic regression models examined sociodemographic and neighborhood-level correlates of no-to-low MVPA, adjusted for covariates. A total of 5786 adolescents (49% female; mean = 11.99 [0.65] y) had complete data at year 2, with 1348 (51% female) providing data at both years. Results: The prevalence of no-to-low MVPA was 17% at year 2, 15% at year 4, and 7.3% across both years, with 10% of adolescents transitioning into and 63% transitioning out of no-to-low MVPA between time points. Females and adolescents from low-income households had higher odds of engaging in no-to-low MVPA at both time points. Adolescents in higher opportunity neighborhoods had lower odds of no-to-low MVPA. Conclusions: This study addresses a critical PA surveillance gap by using device-based measures to quantify no-to-low MVPA among US adolescents. Findings identify at-risk groups and underscore the need for targeted interventions to reduce disparities and improve MVPA engagement.