Physical inactivity prevalence and associated cardiometabolic risk factors among Saudi adults: A cross-sectional analysis of national survey data

Background: Physical inactivity is a leading modifiable risk factor for noncommunicable diseases (NCDs) globally. Saudi Arabia faces a dual burden of elevated physical inactivity prevalence and rising cardiometabolic disease, yet nationally comprehensive analyses characterizing inactivity patterns and their cross-sectional associations with cardiometabolic outcomes across all administrative regions remain limited. Objectives: To determine the national prevalence of physical inactivity among Saudi adults, characterize sociodemographic and geographic variations, and describe cross-sectional associations with key cardiometabolic risk factors. Materials and Methods: This cross-sectional descriptive study analyzed secondary data from the 2018 Saudi Health Interview Survey ( n = 11,231 adults aged≥18 years), supplemented by World Health Organization (WHO) STEPwise Approach to NCD Risk Factor Surveillance data and Saudi Ministry of Health Annual Statistical Yearbooks (2016–2023). Physical activity was assessed using the Global Physical Activity Questionnaire, with physical inactivity defined as accumulating <600 metabolic equivalent of task-minutes per week, equivalent to <150 min of moderate-intensity aerobic activity per week per WHO recommendations. Cardiometabolic outcomes included obesity, hypertension, type 2 diabetes mellitus, hypercholesterolemia, and metabolic syndrome. Descriptive statistics, proportions with 95% confidence intervals (CIs), and crude odds ratios (ORs) were calculated to characterize unadjusted associations. WHO Global Action Plan on Physical Activity (GAPA) 2018–2030 targets were used as benchmarks. Results: Overall physical inactivity prevalence was 53.2% (95% CI: 52.3%–54.1%), with substantial sex disparities (males 41.8%; females 65.8%). Inactivity increased monotonically with age, from 47.3% (18–29 years) to 63.4% (≥60 years), and demonstrated an inverse educational gradient. Regional prevalence ranged from 49.8% (Southern region) to 55.1% (Central region). In unadjusted cross-sectional analysis, physically inactive adults had significantly higher prevalence of obesity (38.7% vs. 24.1%), hypertension (28.4% vs. 18.3%), type 2 diabetes mellitus (22.6% vs. 14.2%), and metabolic syndrome (35.4% vs. 19.8%) compared to active counterparts, with crude ORs ranging from 1.67 to 2.20. Only 46.8% of Saudi adults met the WHO aerobic activity recommendations. Conclusions: Physical inactivity affects more than half of Saudi adults, with pronounced disparities by sex, age, and educational attainment. Cross-sectional associations with cardiometabolic risk factors highlight the need for evidence-based, multi-sectoral physical activity promotion strategies aligned with Saudi Vision 2030 health transformation objectives and WHO GAPA 2018–2030 targets. Given the cross-sectional design, causal inferences cannot be drawn from these findings.