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Demographic, cultural, and health correlates of physical activity and sports participation among adults in Kermanshah province, Iran

BMC Public Health volume 25, Article number: 1867 (2025) Cite this article

Abstract

Background

Physical activity (PA) is vital for health but faces gender disparities, particularly in regions like Iran due to cultural and infrastructural barriers. This study examines gender differences in PA and sports participation among adults in Kermanshah Province, focusing on demographics, cultural barriers, and health-related factors, while comparing findings with recent studies across Iran. Addressing these disparities is essential for promoting equitable access to PA opportunities.

Methods

A cross-sectional study was conducted with 392 participants aged 18–60 years, selected through stratified random sampling in Kermanshah Province. Data were collected using an online questionnaire distributed via social media platforms, which included demographic information and physical activity (PA) levels assessed through the International Physical Activity Questionnaire (IPAQ). Statistical analyses included independent t-tests, Pearson’s correlation, and multivariate regression.

Results

Significant gender differences were observed in PA levels, with men reporting a mean PA level of 2,850 MET-minutes/week compared with 1,920 MET-minutes/week for women (p = 0.033). A stronger inverse correlation was found between PA and BMI in men (Rs = -0.485) compared to women (Rs = -0.223). Cultural norms, such as restrictive gender roles and limited access to sports facilities, were identified as major barriers to women’s participation. Additionally, demographic factors such as education level, income, marital status, and social support were significantly associated with PA levels across both genders.

Conclusions

The findings underscore the need for gender-sensitive strategies to tackle physical activity disparities in Kermanshah Province. Recommendations include: (1) creating women-focused programs, such as women-only facilities and community exercise groups; (2) improving sports infrastructure access for underserved populations, especially women; and (3) integrating PA promotion into public health campaigns targeting disadvantaged groups. Further research should explore contributing factors and evaluate targeted interventions.

Peer Review reports

Introduction

Monitoring physical activity (PA) and sports participation across different population subgroups, such as men and women, is essential for understanding health trends and improving public health interventions [1, 2]. PA, defined as any bodily movement produced by skeletal muscles that results in energy expenditure, plays a critical role in preventing chronic diseases, improving mental health, and enhancing overall quality of life [3, 4]. In Iran, where non-communicable diseases (NCDs) account for 76% of all deaths, promoting PA is a public health priority to reduce the burden of conditions such as cardiovascular disease, diabetes, and obesity [5]. However, significant gender disparities in PA levels persist, with men reporting higher participation rates than women [6, 7]. For example, data from the European Union (EU) show that 45% of men engage in exercise or sports at least once a week, compared to only 37% of women [8]. These disparities are further exacerbated in regions like Iran, where cultural norms, limited infrastructure, and restrictive social expectations create unique barriers for women [9, 10].

In Kermanshah Province, these challenges are particularly pronounced due to conservative cultural norms and inadequate access to sports facilities. Women in Kermanshah often face significant obstacles, including a lack of women-only gyms, societal stigma around exercising in public spaces, limited transportation options, and safety concerns [11]. These barriers contribute to lower PA levels among women, perpetuating health disparities and increasing the risk of NCDs. Addressing these issues requires a nuanced understanding of local contexts and the development of culturally sensitive interventions.

Recent studies from other regions of Iran, such as Tehran, Isfahan, and Shiraz, highlight the influence of cultural, gender, and regional factors on PA levels [12, 13]. For instance, research in Shiraz emphasized the role of social support networks in encouraging PA among women, while studies in Tehran identified urban planning and access to public parks as key determinants of PA participation [14, 15]. These findings underscore the importance of tailoring interventions to regional variations and contextual factors.

Technological advancements, such as accelerometers and pedometers, have improved the measurement and assessment of PA patterns [16, 17]. However, challenges remain, including limited access to advanced physical activity monitors (PAMs) and internet connectivity issues in rural areas [18, 19]. Despite these limitations, PAMs remain valuable tools for understanding PA behaviors and informing public health strategies.

Studies consistently demonstrate that men and women differ not only in their levels of PA but also in their motivations for engaging in it [20, 21]. Men are more likely to participate in sports for recreation and socialization, while women are primarily motivated by health concerns [22, 23]. Additionally, traditional gender roles shape exercise settings; men often engage in organized sports clubs, whereas women are more likely to exercise at home or in informal settings [18, 19]. These differences highlight the need for targeted interventions that address the unique barriers faced by women, such as providing safe and accessible spaces for exercise and challenging societal norms that restrict women’s participation.

Objectives

This study aimed to investigate physical activity (PA) levels and sports participation among adults in Kermanshah Province, Iran, with a focus on identifying gender disparities. Specifically, the research sought to examine demographic and cultural factors influencing PA levels, including marital status, number of children, and social support, assess the relationship between PA levels and Body Mass Index (BMI) across genders, and provide evidence-based recommendations for public health initiatives to promote equitable access to PA opportunities in Kermanshah Province. To address identified barriers, potential strategies include establishing women-only sports facilities to provide safe and culturally appropriate exercise spaces, implementing community-based programs such as walking groups or fitness classes tailored to women’s needs, launching public health campaigns to raise awareness about the benefits of PA and challenge restrictive gender norms, and partnering with schools and workplaces to integrate PA into daily routines, particularly for women in low-income and rural areas. By addressing these objectives, this study seeks to enhance understanding of the factors driving PA disparities in Kermanshah Province and inform the development of culturally sensitive interventions to promote equitable access to PA opportunities for all.

Methods

Study design and population

This study is applied research in purpose, aiming to address practical issues related to physical activity (PA) and sports participation, and descriptive, as it seeks to describe patterns and relationships among variables. A cross-sectional design was employed to collect data at a single point in time, aligning with the study’s objectives to examine gender disparities in PA levels and their correlates. The target population consisted of adults aged 18–60 years residing in Kermanshah Province, Iran, stratified into three age groups: 18–30, 31–45, and 46–60 years.

Using Morgan’s table for determining sample size in descriptive studies, a minimum sample size of 384 participants was calculated to ensure statistical reliability. This sample size was chosen because it provides a balance between precision and feasibility while accounting for the large population of Kermanshah Province, estimated to be over 1 million adults. To allow for potential dropouts or incomplete responses, a total of 392 participants were included in the study. Stratified random sampling was used to ensure proportional representation across age groups, enhancing the generalizability of the findings (Fig. 1).

Fig. 1
figure 1

Consort flow diagram for the study

Full size image

Data collection

Data were collected using an online questionnaire distributed through social media platforms, including WhatsApp and Instagram, which are widely used in the region. To encourage participation and address potential biases introduced by the reliance on online data collection, the questionnaire was promoted through targeted posts and shared in local community groups to reach a diverse audience. Participants were incentivized with the opportunity to receive a summary of the study findings upon completion of the survey. Over two months, the questionnaire received 693 views, and 392 responses were completed (137 women and 255 men).

The response rate was calculated as follows: Response Rate = (Number of Completed Responses / Number of Views) × 100, resulting in a response rate of 56.6%. Potential factors affecting the response rate include limited internet access in rural areas, reluctance to participate in online surveys due to privacy concerns, and the voluntary nature of participation. These factors may have introduced some selection bias, potentially underrepresenting individuals from rural or less-educated backgrounds. However, the use of stratified random sampling helped mitigate these biases to some extent.

Inclusion criteria and instruments

Participants were included based on residency in Kermanshah Province, being aged 18 or older, and providing voluntary consent for the online survey. Data were collected using two validated questionnaires: a Demographic Information Questionnaire gathering data on age, height, weight, education level, employment status, marital status, number of children, social support, disabilities, chronic illnesses, and hospitalization history; and the International Physical Activity Questionnaire (IPAQ), assessing PA levels over the past week categorized into walking, moderate-intensity, and vigorous-intensity activities [24]. PA levels were calculated using the Metabolic Equivalent of Task (MET) values, estimating energy expenditure with the formula: Total Physical Activity = (Walking × Minutes × Days) + (Moderate Activity × Minutes × Days) + (Vigorous Activity × Minutes × Days). PA was categorized as Low Activity (< 600 MET minutes/week), Moderate Activity (600–3000 MET minutes/week), and High Activity (> 3000 MET minutes/week). The IPAQ underwent validation through pilot testing on 30 participants in Kermanshah Province to ensure cultural relevance and clarity, with minor adjustments made to improve comprehension of questions related to moderate and vigorous activities, enhancing the credibility of the instruments [24, 25].

Statistical analysis

Data were analyzed using SPSS version 26. The normality of the data distribution was assessed using the Kolmogorov-Smirnov test. Descriptive statistics (means, standard deviations) were calculated for all variables. Inferential statistics included Spearman’s correlation coefficient to examine relationships between PA levels and Body Mass Index (BMI), as BMI data were not normally distributed; Mann–Whitney U test, chosen over t-tests to compare PA levels between men and women due to the non-normal distribution of PA data, ensuring accurate comparisons for skewed data; and independent two-tailed t-test to assess differences in demographic variables between groups, as these variables were normally distributed. Multivariate regression analysis was performed to identify predictors of PA participation, including marital status, number of children, and social support, with justification for statistical test choices based on data distribution and the need for robust and reliable results.

Results

The demographic characteristics of the participants are summarized in Table 1. The average age for male participants was 31.45 ± 11.23 years, and for female participants, it was 29.87 ± 9.00 years. Men had an average body weight of 80.28 ± 7.66 kg, while women had an average height of 165.58 ± 5.88 cm. The mean body mass index (BMI) was 24.07 ± 3.24 kg/m² for men and 22.67 ± 3.09 kg/m² for women. These findings suggest that men, on average, had a slightly higher BMI than women, which may reflect differences in body composition or activity levels.

Table 1 Descriptive characteristics of the participants (392 People)
Full size table

Age distribution

As shown in Table 2, the majority of participants fell within the 18–30 age group, with 92.9% of men and 83.9% of women in this category. In the 31–45 age group, 5.5% of men and 13.1% of women were represented. For participants aged 46–60, the proportions were 1.6% of men and 2.9% of women. Notably, no participants older than 60 years were included in the study. A significant difference in age distribution between genders was observed (p = 0.001), indicating that men and women were not evenly distributed across age groups.

Table 2 Demographic status of participants in the total population
Full size table

Gender differences in BMI, education, occupation, marital status, social support, and physical activity

The Mann-Whitney U test was used to compare BMI, educational levels, occupational status, marital status, social support, and physical activity levels between the genders (Table 3). The results revealed significant gender differences in BMI, with men having a higher mean rank (222.32) than women (182.63; p = 0.001). No significant difference was found in educational levels between the genders (p = 0.502). However, occupational status differed significantly, with men having a higher mean rank (233.91) than women (176.40; p = 0.001). Additionally, men reported higher physical activity levels (mean rank = 211.76) compared with women (mean rank = 188.30; p = 0.033). Marital status and social support were also found to significantly influence PA levels, with married individuals and those reporting higher social support engaging in more PA.

Table 3 U-Mann-Whitney test results for differences between men and women in BMI, educational level, occupational status, and physical activity level
Full size table

Correlations between physical activity and other variables

Table 4 presents the results of the Spearman correlation test, which examined the relationships between physical activity levels and other variables. Among women, a weak inverse correlation was observed between physical activity and BMI (Rs = − 0.223, p < 0.001). For men, this correlation was stronger (Rs = − 0.485, p = 0.001), indicating that a higher BMI was associated with lower physical activity levels, particularly among men. No significant association was found between physical activity and educational level for either gender (women: p = 0.712; men: p = 0.893). However, occupational status showed a weak negative correlation with physical activity for women (Rs = − 0.156, p = 0.013) and a negligible correlation for men (Rs = − 0.020, p = 0.001). Marital status and social support were positively correlated with PA levels for both genders, highlighting their role as facilitators of physical activity.

Table 4 Spearman correlation test results between physical activity levels and other variables (BMI, educational level, and occupational Status) in men and women
Full size table

Summary of the key findings

In summary, this study identified significant gender differences in BMI, occupational status, marital status, social support, and physical activity levels among adults in Kermanshah Province. Men tended to have higher BMI and physical activity levels than women, while marital status and social support played a more significant role in influencing physical activity among women. The weak to moderate correlations between BMI and physical activity highlight the need for targeted interventions to address these disparities. Further research is needed to explore the underlying factors contributing to these differences and to develop strategies for promoting physical activity in this population.

Discussion

The findings of this study demonstrate a significant inverse relationship between BMI and physical activity levels among both men and women in Kermanshah Province. Specifically, higher levels of physical activity were associated with lower BMI, consistent with previous research showing that increased physical activity reduces the risk of overweight and obesity [26, 27]. For example, a cross-sectional study of pre-university students in Malaysia found a weak negative correlation (r = -0.21) between physical activity and BMI, supporting the idea that greater physical activity contributes to weight stabilization [28]. Similar findings have been reported in other regions of Iran, such as Tehran and Isfahan, where studies have consistently shown that higher PA levels are associated with lower BMI [14, 15]. Internationally, research in countries like the United States and the United Kingdom has also confirmed the inverse association between physical activity and BMI, underscoring its global relevance [29, 30]. The regression analyses in this study further suggest that individuals with higher BMIs are less likely to engage in physical activity, potentially leading to a cycle of weight gain and sedentary behavior. This relationship can be attributed to the energy expenditure associated with physical activity, which helps regulate caloric balance and prevent weight gain [31]. However, individuals with higher BMIs often face barriers—such as lack of access to sports facilities or low self-confidence—that discourage participation in physical activity and perpetuate sedentary lifestyles [32, 33]. These findings align with global research, which identifies similar barriers in both developed and developing countries, although the specific challenges may vary by cultural and socioeconomic context [33, 34].

While the study highlights a strong negative correlation between physical activity and BMI, it is important to note that BMI alone is not a comprehensive measure of health. BMI does not distinguish between fat mass and lean mass, which limits its ability to fully capture body composition [35]. For instance, athletes with high muscle mass may have a high BMI despite being physically fit. Future research should consider incorporating additional measures, such as body fat percentage or waist-to-hip ratio, to provide a more nuanced understanding of the relationship between physical activity and health outcomes [36]. This approach has been successfully implemented in studies in Iran and other countries, yielding more accurate insights into the health impacts of physical activity [37, 38].

This study also identified significant gender disparities in physical activity levels, with men reporting higher activity levels than women. This finding aligns with previous studies in Iran, such as those conducted in Shiraz and Mashhad, which have consistently shown that men are more likely to meet the recommended physical activity guidelines than women [22, 23]. Internationally, similar trends have been observed in countries such as India and Saudi Arabia, where cultural norms often restrict women’s participation in physical activities [24, 39, 40]. These differences may be driven by socio-cultural factors, such as limited access to sports facilities for women and societal norms that restrict their participation in certain types of exercise, such as outdoor or team sports [41, 42]. Additionally, lower self-confidence among women may further reduce their engagement in physical activities. Addressing these barriers through targeted interventions could help promote gender equity in physical activity participation.

The inclusion of marital status, number of children, and social support in this study provides critical insights into the individual and environmental determinants of PA. For example, married individuals and those with higher social support were more likely to engage in PA, suggesting that social networks and family dynamics play a crucial role in facilitating or hindering PA participation. These findings highlight the need for mixed-methods approaches that combine quantitative analysis with qualitative research to explore the lived experiences and perceptions of individuals regarding cultural barriers to PA. Such an approach could offer a more nuanced understanding of these barriers and inform more effective policy interventions.

Implications for public health and policy recommendations

The results of this study have important implications for public health initiatives aimed at promoting active lifestyles and reducing obesity rates in Kermanshah Province. To address the identified barriers, the following policy recommendations are proposed:

  1. 1.

    Develop Culturally Tailored Programs: Establish women-only sports facilities and community-based exercise groups to provide safe and culturally appropriate spaces for women to engage in physical activity. These programs should be designed in collaboration with local communities to ensure that they align with cultural norms and preferences.

  2. 2.

    Improve Access to Sports Facilities: Increase investment in sports infrastructure, particularly in underserved and rural areas, to ensure equitable access for all residents. This could include building public parks, gyms, and walking trails that are accessible to women and low-income populations.

  3. 3.

    Integrate PA into Education and Public Health Campaigns: Launch public health campaigns to raise awareness of the benefits of PA and challenge restrictive gender norms. Additionally, integrate physical activity education into school curricula to foster healthy habits from a young age.

  4. 4.

    Promote Workplace Wellness Programs: Partner with employers to implement workplace wellness programs that encourage physical activity, such as on-site fitness classes or incentives for active commuting.

  5. 5.

    Leverage Technology for PA Promotion: Use mobile apps and social media platforms to deliver personalized PA recommendations and track progress, particularly for women who may face barriers to accessing traditional sports facilities.

By implementing these strategies, policymakers and public health officials can address the gender disparities in physical activity and promote healthier lifestyles in Kermanshah Province and beyond. Further research should evaluate the effectiveness of these interventions and explore additional factors influencing physical activity participation in this region.

Limitations

This study has several limitations that should be acknowledged. First, the cross-sectional design prevents the establishment of causal relationships between variables, such as physical activity and BMI. Second, the reliance on self-reported data collected through social media platforms may introduce biases, such as overreporting or underreporting of physical activity levels. Third, while the sample size was sufficient for statistical analysis, it may not fully represent the diversity of Kermanshah Province’s population, particularly among individuals without access to the internet or social media. To address these limitations, future studies should consider longitudinal designs and incorporate objective measures of physical activity, such as accelerometers, to enhance data accuracy and reliability.

Future research directions

Future research should explore the associations between physical activity, BMI, and other health indicators, such as body composition, to provide a more comprehensive understanding of the factors influencing active lifestyles in Iran. Additionally, studies should investigate the social, cultural, and environmental determinants of physical activity among different genders to inform the development of targeted interventions. For example, qualitative research could shed light on the specific barriers women face in accessing sports facilities or participating in physical activities. Finally, longitudinal studies are needed to examine the long-term effects of physical activity on health outcomes and to identify effective strategies for promoting sustained behavior change.

Conclusion

This study highlights the significant relationship between physical activity, BMI, and gender in Kermanshah Province, Iran. The findings underscore the need for tailored interventions to promote physical activity, particularly among women, while addressing the sociocultural barriers that hinder participation. By focusing on factors such as education, BMI, marital status, social support, and access to sports facilities, public health initiatives can help improve physical activity levels and reduce obesity rates in the region.

These findings carry important implications for key stakeholders. Government policymakers are encouraged to invest in infrastructure that supports equitable access to sports facilities, particularly for women, and to integrate physical activity promotion into national health strategies. Healthcare providers can play a critical role by offering personalized guidance on physical activity and BMI management, especially for at-risk populations. Community organizations are well-positioned to implement culturally sensitive programs, such as women-only exercise groups or community-based fitness initiatives, to foster social support and inclusivity.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Abbreviations

PA:

Physical Activity

IPAQ:

International Physical Activity Questionnaire

BMI:

Body Mass Index

MET:

Metabolic Equivalent of Task

BW:

Body Weight

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Acknowledgements

We would like to thank the subjects for their willingness to participate in this study.

Funding

This study was financially supported by the Kermanshah Sports and Youth Department..

Author information

Authors and Affiliations

  1. Department of Exercise Physiology, Faculty of Sport Sciences, Razi University, P.O.Box. 6714414971, Kermanshah, Iran

    Rastegar Hoseini

  2. Faculty of Sport Sciences, Razi University, Kermanshah, Iran

    Zahra Hoseini, Diana Pourahmadi & Ayob Kamangar

Authors
  1. Rastegar Hoseini
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  2. Zahra Hoseini
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  3. Diana Pourahmadi
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  4. Ayob Kamangar
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Contributions

RH contributed to the conception, design, investigation, data analysis, and writing of the manuscript. ZH, DPA, and AK contributed to data acquisition, interpretation, data analysis, and manuscript revision. All authors approved the final version of the manuscript and agreed to be accountable for all aspects of the study.

Corresponding author

Correspondence to Rastegar Hoseini.

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Ethics approval

Not applicable.

Consent to participate

The study received research approval from the Kermanshah Sports and Youth Department Research Committee, which is affiliated with the Kermanshah Sports and Youth Department (approval number: 76886868, dated May 22, 2024). This research was conducted in full compliance with the Declaration of Helsinki. All procedures involving human participants adhered to the ethical standards outlined in the Declaration of Helsinki and applicable national guidelines. Before participation, informed consent was obtained from all individuals involved in the study.

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Not applicable.

Competing interests

The authors declare no competing interests.

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Hoseini, R., Hoseini, Z., Pourahmadi, D. et al. Demographic, cultural, and health correlates of physical activity and sports participation among adults in Kermanshah province, Iran. BMC Public Health 25, 1867 (2025). https://doi.org/10.1186/s12889-025-23083-7

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Keywords

BMC Public Health

ISSN: 1471-2458

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