A scoping review on the impact of the COVID-19 pandemic on physical activity and sedentary behavior in Saudi Arabia

**Background:** The COVID-19 pandemic led to stay-at-home orders in Saudi Arabia from March 15–23, 2020, with curfews extending until May 28, 2020. Physical activity is a priority of Saudi Arabia's Vision 2030, and pre-pandemic inactivity prevalence ranged from 55–96% among children/adolescents and 50–85% among adults. This scoping review aimed to systematically describe changes in physical activity and sedentary behavior associated with the lockdown timing.

**Methods:** Six databases (Cochrane Library, Global Health [EBSCO], PubMed, Scopus, SPORTDiscus [EBSCO], and WHO Global Index Medicus) were searched on March 3, 2022. Eligible studies were published in English or Arabic between March 1, 2020 and March 3, 2022, reported data from Saudi Arabia for any age, and measured physical activity or sedentary behavior. Two authors independently screened records; one rater abstracted data and a second checked it. Quality was assessed using a modified Joanna Briggs Institute Prevalence Critical Appraisal Tool.

**Key Results:** Of 286 records, 19 studies (all in English) were included. Fifteen were cross-sectional and four were prospective cohorts. Three studies included children/adolescents (age 2–18 years) and 16 included adults (age 15–99 years). Median analytic sample size was 363 (IQR 262–640). Data collection periods were ≤5 months; 17 studies collected data in 2020 only.

*Children/adolescents:* All three studies found physical activity was lower during/following lockdown than before. Almugti et al. reported MVPA ≥1 h/day dropped from 71% to 51% (p=0.001). Hanbazaza et al. found physically active children decreased from 19.3% to 16.1% (p=0.30). Al Agha et al. reported decreased PA for 66.1% of participants. Screen time >2 h/day increased from 63% to 87% (p=0.001); video games ≥3 h/day rose from 40.4% to 75.4% (p<0.001); TV ≥4 h/day rose from 21.1% to 43.6% (p<0.001).

*Adults:* All 16 studies found physical activity declined. BinDhim et al. (n=30,134) showed acceptable PA levels fell from 41.0% in Q1 2020 to 26.5% in Q2, 24.6% in Q3, and 24.6% in Q4 (all p<0.001). Al Fagih et al. used accelerometry in 82 cardiac patients and found median PA declined from 2.4 h/day pre-lockdown to 1.8 h/day during lockdown (27.1% decline). Barwais et al. reported mean MET-min/week dropped from 903 (SD 755.6) to 387 (SD 397.8) (p=0.001, d=0.89). Six studies assessed sedentary behavior: sitting time increased by 33.5 min/day (Al-Musharaf) and 69.1 min/day (Jalal). The proportion with >6 h/day sitting/screen time increased by 20.5–24.0 percentage points.

Quality assessment revealed that only 1 study had an appropriate sampling frame, 4 used appropriate sampling, 4 assessed behaviors both pre- and post-lockdown, and 3 reported adequate response rates.

**Clinical Implications:** The consistent decline in physical activity and rise in sedentary behavior across all age groups during the COVID-19 lockdown in Saudi Arabia is concerning given the country's high baseline inactivity and rising obesity/diabetes rates. These changes may have long-term health consequences, including increased risk of cardiovascular disease, type 2 diabetes, and all-cause mortality. The findings support the need for continued post-pandemic surveillance, identification of subpopulations that have not returned to pre-pandemic levels, and targeted interventions—particularly given Saudi Arabia's Vision 2030 goal to reduce physical inactivity by 30% in adults by 2030. The review also highlights methodological limitations in the current evidence base, including reliance on cross-sectional designs, convenience sampling via social media, and heterogeneous non-standardized questionnaires, underscoring the need for prospective studies with valid, reliable measurement tools.