Predictors of exercise participation among Saudi adults attending primary healthcare centers in Riyadh

Background Regular exercise is crucial for preventing chronic diseases. Saudi Arabia, undergoing rapid socioeconomic transformation, faces escalating rates of lifestyle-related illnesses, underscoring the urgent need to understand exercise participation among its residents. This study aims to identify key sociodemographic and health-related predictors of exercise engagement in this unique context, thereby informing targeted public health strategies. Methods This cross-sectional survey was conducted from March to July 2023 across 48 primary healthcare centers in Riyadh, Saudi Arabia, selected via multi-stage cluster sampling. A total of 14,239 adults (aged ≥ 18) completed an electronic, interview-based questionnaire. A rigorously validated and reliable questionnaire collected self-reported data on sociodemographic characteristics, health behaviors and comorbidities. Univariate and multivariate logistic regression were used to identify predictors of exercise participation, with a p-value < 0.05 considered statistically significant in the adjusted model. Results Overall, a substantial 60.7% of participants reported engaging in regular exercise. Male sex was found to be a strong predictor (AOR = 1.14, 95% CI: 1.06–1.22, P = 0.001). Employed individuals were more likely to exercise (AOR = 1.40, 95% CI: 1.30–1.51, P < 0.001) than unemployed Saudi residents. The strongest predictor was health insurance coverage (AOR = 1.61, 95% CI: 1.48–1.75, P < 0.001). Smoking (AOR = 5.42, 95% CI: 4.82–6.08, P < 0.001) and fast-food consumption (AOR = 10.76, 95% CI: 9.77–11.84, P < 0.001) were also associated with higher odds of exercise. Individuals with heart disease showed significantly higher odds of exercising (AOR = 1.85, 95% CI: 1.42–2.41, P < 0.001). Conclusion Our findings underscore the complex interplay of sociodemographic factors, health behaviors, and existing health conditions in shaping exercise participation in Saudi Arabia. The significant influence of male sex, employment, insurance coverage, and the intriguing relationships with smoking, fast-food consumption, and specific health conditions, provide crucial insights. These results highlight key areas for developing tailored public health strategies and interventions to enhance exercise participation in Saudi Arabia.