Degree Name

Doctor of Philosophy


School of Health and Society


Background: In Arabic countries, such as Saudi Arabia, no known studies have examined associations between 24-hour movement behaviours (sleep, sedentary behaviour (SB) and physical activity (PA)) and health among school-aged children. Most studies have assessed the relationship of each of these movement behaviours in isolation. Due to the high and increasing levels of obesity and physical inactivity among Saudi Arabian children, it is important to understand how movement behaviours are associated with health, and how to promote healthy levels of these movement behaviours, especially as the country moves on from the COVID-19 pandemic.

Aim: The original purpose of this doctoral research was to investigate the longitudinal associations between 24-hour movement behaviours and health and development among school-aged children in Saudi Arabia.

Methods: This doctoral thesis was designed to comprise a systematic review and a longitudinal study to be commenced in February 2020, with data collection at two time points (baseline and 12-month follow-up) targeting children enrolled in their second year of primary school (Grade 2; 7 years old), from urban (Riyadh city) and rural (Al Jubaylah town) schools in Saudi Arabia. Due to the COVID-19 pandemic in Saudi Arabia, baseline data collection for the longitudinal study was suspended in March, 2020 and schools remained closed until January, 2022. This suspension occurred two weeks after data collection commenced. As such, the following adjustments to this thesis were made:

1- Two online cross-sectional studies focusing on changes in movement behaviours due to COVID-19 was undertaken as an alternative to the longitudinal study.
2- Data that had been collected from baseline data collection were written up as a small cross-sectional study.

This doctoral thesis was revised to comprise a systematic review followed by three studies. The systematic review investigated the associations between 24-hour movement behaviours and health indicators in school-aged children in Arabic countries. Following this, a cross-sectional study was conducted to examine the impact of the COVID-19 outbreak on 24-hour movement behaviours among children in Saudi Arabia (Time 1) (October, 2020). A follow-up to this study assessed the impact of COVID-19 restrictions on movement behaviours of Saudi children (Time 2) (March, 2021) and compared the results to the initial study conducted at Time 1 (October, 2020). The final study used the baseline data collected from the first two weeks of the original longitudinal study to assess the associations between gross motor skills, adiposity and bone mineral density (BMD) among school-aged Saudi children.

Results: The systematic review included 16 studies from nine Arabic countries. The results showed that low levels of PA, sleep and high SB were unfavourably associated with adiposity outcomes, behavioural problems, depression and low self-esteem among children. The online survey (Time 1) included 1021 school-aged children, 6-12 years of age (60% girls), from across Saudi Arabia and found that only 3.4% of Saudi children met all components of 24-hour movement guidelines. Compared with before COVID-19, children’s PA levels declined, they slept more, and their use of electronic screen devices significantly increased. The follow-up online survey (Time 2) included 1045 school-aged children, 6-12 years of age (51% girls), from across Saudi Arabia and found that only 1.8% of Saudi children met all components of the 24-hour movement guidelines, compared to 3.4% in Time 1. Boys slept more than girls, and girls spent more days per week participating in moderate- to vigorous-intensity physical activity (MVPA) ≥60 minutes than boys. The cross-sectional study included 48 school-aged children (7.80±0.62 year, boys only) and found that non-overweight and overweight/obese boys did not significantly differ in their locomotor standard scores (p=0.093), object control standard scores (p=0.876) and BMD radius z-score (p=0.343). BMI was moderately and negatively correlated with locomotor standard scores (r = -0.32, p = 0.025), while BMD radius z-scores were not associated with BMI (r = -0.245), p > 0.05).

Conclusion: The findings from this thesis provides new evidence to advance the understanding of the associations between 24-hour movement behaviours (sleep, sedentary behaviour and physical activity) and health among children in the Kingdom of Saudi Arabia, with particular reference to the period encompassing the COVID-19 pandemic. Further studies to address the dearth of literature from Arab-speaking countries on 24-hour movement behaviours and health across childhood are needed. Longitudinal studies with larger sample sizes are recommended to better understand how gross motor skills, adiposity and BMD may be associated with weight status among children. The COVID-19 pandemic unfavourably affected Saudi children’s movement behaviours. Policies that support the promotion of healthy levels of PA, SB and sleep by encouraging outdoor PA (where possible), minimizing children’s use of screen devices when sedentary, educating parents about the importance of meeting movement behaviour guidelines will help to ameliorate the long-term effects of the COVID-19 and better prepare for future pandemics to lessen their impact on children’s movement behaviours in Saudi Arabia. Finally, girls’ physical education classes were only introduced in 2018, as a part of the Kingdom’s vision (The Quality-of-Life Program). Therefore, more of a focus on promoting PA for girls is recommended as it is associated with better health outcomes.


Thesis by compilation

FoR codes (2008)

110602 Exercise Physiology, 110699 Human Movement and Sports Science not elsewhere classified, 111799 Public Health and Health Services not elsewhere classified, 130102 Early Childhood Education (excl. Maori)



Unless otherwise indicated, the views expressed in this thesis are those of the author and do not necessarily represent the views of the University of Wollongong.