Physical inactivity prevalence and associated factors among iranian older adults in the 2021 STEPS survey

Abstract Physical inactivity is a major, modifiable driver of non-communicable diseases in aging populations. We quantified the prevalence of physical inactivity among Iranian older adults and identified demographic, socioeconomic, and health-related correlates. We analyzed nationally representative 2021 STEPS data from 5,491 adults aged ≥ 60 years. Physical activity was assessed via World Health Organization Global Physical Activity Questionnaire (WHO GPAQ) and categorized as sufficient (≥ 600 MET-min/week) vs. insufficient (< 600). Sedentary time (min/day) was recorded. Complex survey design was accounted for in estimates. Associations with inactivity were examined using sex-stratified generalized linear mixed-effects models adjusting for age, education, marital and employment status, urban or rural residence, wealth tertile, obesity, depressive symptoms, and multimorbidity. Among the participants, mean sedentary time was 288 min/day and mean total activity was 1,326 MET-min/week. Overall, 69.6% (95% CI: 68.3–71.0) were inactive, higher in women (76.8%, 75.0–78.5) than men (62.4%, 60.3–64.4). Inactivity was highest in adults aged ≥ 80 years (80.9%, 77.1–84.7). Urban residence was associated with higher odds of inactivity (adjusted OR aOR 1.35, 95% CI: 1.13–1.61) and higher education (≥ 12 years formal education) showed lower odds (aOR 0.73, 0.61–0.88). Obesity and depressive symptoms were each related to higher odds of inactivity (aOR 1.34, 1.08–1.66 and aOR 1.30, 1.12–1.51); odds were progressively higher across multimorbidity categories (e.g., ≥ 3 conditions, aOR 1.26, 1.02–1.55 vs. none). Sex differences were evident. Compared with ages 60–69, adults aged ≥ 80 had higher odds of inactivity in women (aOR 3.20, 95% CI 1.96–5.24) than in men (aOR 1.91, 1.41–2.60). Urban residence and higher wealth were also related to higher odds in women (urban aOR 1.62, 1.25–2.11; wealth Q3 aOR 1.41, 1.14–1.75), while higher wealth was related to lower odds in men (Q3 aOR 0.76, 0.61–0.94). Physical inactivity is highly prevalent among Iranian older adults, especially women, the oldest age groups, urban residents, and those with obesity, depression, or multiple chronic conditions. Findings support gender-responsive, multicomponent strategies—including community programs, primary-care integration, and activity-supportive urban design—to reduce inactivity and advance healthy aging in Iran.