International Journal of Environmental Research and Public Health · 3 authors, 2 centres
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This cross-sectional study of 402 Saudi adolescents found that 45.77% reported physical activity-related injuries in the past year, with boys at 3.52 times higher risk than girls. Higher specific knowledge about injuries was protective (β = −0.136; p = 0.001), while increased sedentary behavior was a significant risk factor (β = 0.358; p = 0.023). The findings highlight the need for injury prevention education alongside physical activity promotion in school-aged adolescents.
**Background:** Physical activity (PA) is essential for adolescent health, but increased participation may elevate the risk of PA-related injuries. Previous research indicates that PA-related injuries are a significant burden in school-aged populations, contributing to medical consultations, hospitalization, and dropout from sports. Identifying modifiable risk factors—such as knowledge about injuries, sedentary behaviors, and physical fitness—is critical for developing effective prevention strategies. This study aimed to assess the frequency, location, type, and severity of PA-related injuries among Saudi adolescents aged 13–18 years and to investigate associations with gender, age, BMI, knowledge of PA-related injuries, sedentary behaviors (SB), and weekly PA levels.
**Methods:** A cross-sectional study was conducted between September and November 2022 in Al-Ahsa governorate, Saudi Arabia. From a total population of 94,384 students, a minimum sample of 500 was targeted; 402 students (206 boys, mean age 15.87 ± 1.69 years; 196 girls, mean age 15.83 ± 1.70 years) were included after exclusions. Anthropometric measurements (height, weight, BMI, fat percentage, fat-free mass) were taken using a stadiometer and bioelectrical impedance. PA-related injuries were assessed using a validated Arabic questionnaire (30 items) covering injury occurrence, frequency, type, body location, and need for urgent medical attention over the past year. Knowledge was assessed with 25 Likert-scale questions (score range 1–25; poor ≤8, intermediate 9–16, good ≥17). PA levels were measured using the Arabic version of the Physical Activity Questionnaire for Adolescents (PAQ-A; 9 items, score 1–5). SB was evaluated using the NSW Schools Physical Activity and Nutrition Survey (4 items, score 1–5, higher = more sedentary). Statistical analyses included t-tests, one-way ANOVA with Tukey–Kramer post hoc, binary logistic regression, and multinomial logistic regression (SPSS V.26; p < 0.05).
**Key Results:** Overall, 184 participants (45.77%) reported PA-related injuries in the past year (57.28% of boys, 33.67% of girls). Among injured students, 93 suffered one injury, 54 suffered two, and 37 suffered three or more. Bruises (29 cases) and strains (27 cases) were most common in boys; bruises (16 cases) and fractures (10 cases) were most common in girls. Limbs were the most injured body parts in boys (79 lower limb, 18 upper limb); head (12 cases) and lower limbs (34 cases) were most vulnerable in girls. Only 43 cases (23.37% of injuries; 33 boys, 10 girls) required urgent medical attention. Mean knowledge score was 10.31 ± 3.68 (boys 10.57 ± 3.97; girls 10.03 ± 3.34); 33.3% had low, 61.7% intermediate, and only 5% good competence. Mean SB score was 2.716 ± 0.61 (boys 2.79 ± 0.596; girls 2.64 ± 0.67; p = 0.011). Mean PA score was 2.45 ± 0.86 (boys 2.32 ± 0.9; girls 2.58 ± 0.8), indicating inactive to moderately active levels. Logistic regression showed boys were 3.52 times more likely to have PA-related injuries than girls. Increased knowledge was associated with lower odds of injury (β = −0.136; p = 0.001), while increased SB was associated with higher odds (β = 0.358; p = 0.023). For injuries requiring medical attention, boys were 2929 times more likely to need emergency intervention than girls, and increased SB increased this likelihood. Multinomial regression revealed that gender, knowledge, and SB were overall associated with sustaining 1, 2, or ≥3 injuries; gender, fat-free mass, knowledge, and SB were associated with specific injury types (bruises, strains, fractures, sprains, concussions, and ≥2 types). Reduced lean body mass increased risk of bruising (Exp(B) = 0.933) and fractures (Exp(B) = 0.883); increased SB raised risk of strains (Exp(B) = 2.001), concussions (Exp(B) = 3.936), and ≥2 injury types (Exp(B) = 1.666). Reduced knowledge increased risk of bruises (Exp(B) = 0.837), sprains (Exp(B) = 0.854), concussions (Exp(B) = 0.793), and ≥2 injury types (Exp(B) = 0.869).
**Clinical Implications:** This study demonstrates that PA-related injuries are common among Saudi adolescents, particularly in boys, and that modifiable factors—knowledge about injuries and sedentary behavior—are significant predictors. The findings support integrating injury prevention education into school physical activity programs, especially given the low knowledge levels observed (only 5% with good competence). The strong association between higher sedentary behavior and increased injury risk (including strains and concussions) suggests that reducing screen time and recreational sedentary activities may be an important component of injury prevention. The high proportion of injuries requiring medical attention (23.37%) underscores the clinical burden. Limitations include reliance on self-reported data (recall bias), lack of direct PA/SB measurement, and potential missing data. Future research should incorporate objective measures and longitudinal designs to establish causality.