Women are at greater risk of declining physical activity. They engage in less physical activity than men of all ages. Therefore, women are more susceptible to osteoporosis, from which physical activity can offer some protection [23]. Research has shown that this is influenced by contextual factors such as the design of the environment in which women live, as women who live in more walkable neighborhoods will have less physical activity decline than those who live in less walkable neighborhoods [8, 24]. Additionally, cultural issues, safety and a safe environment for women to be outside, and the restriction of freedom of movement by society have important impacts on women’s greater levels of inactivity [25].
Studies have revealed major differences in the prevalence of physical inactivity among different countries [8]. For example, in Arab countries, an alarming situation was reached due to increased body mass index from physical inactivity and adverse health consequences [26]. This study assessed the prevalence, patterns, and determinants of physical activity, leisure-time physical exercise, and high levels of sedentary behavior among Erbil women.
The current study showed that the overall prevalence of meeting the physical activity guidelines among the studied women was 31.5%. A study on Saudi women revealed that 20.2% of women were highly active (420 or more minutes of total physical activity per week) [27]. Another study of medical students at Peruvian public universities revealed that the prevalence of high physical activity among girls was only 15% [28]. The women in the current study, in apposition to women in high-income settings, are less physically active. In another study conducted on the French population between 2014 and 2016, 52.7% of women reported achieving the recommendations for conducting physical activities. Furthermore, a study conducted among multiethnic Asian populations revealed that 82.4% of women are sufficiently active [29]. In addition, a study conducted in Armenia has shown that 79.4% of women have met the WHO recommendations on physical activity [30].
In the current study, meeting physical activity guidelines among women was significantly associated with their employment status. More than 40% of the nonmanual, manual skilled, or unskilled workers met the physical activity guidelines compared to 30.7% of the students, 27.9% of the unemployed, and 23.3% of those with high professional jobs. In a study conducted among women aged 18–60 years in the United States, 44% of employed women, compared to 35% of homemakers, engaged in moderate-vigorous physical activity [31]. The women in the current study, in apposition to women in high-income settings, are less physically active the more educated they are, although they should have more resources. In apposition to this study, unemployed and less educated women in high-income settings are usually less physically active [32]. The low physical activity in the current study could be related to the sedentary nature of professional jobs and students, the use of cars rather than active transportation, and the lack of leisure-time physical exercise due to different barriers related to the context of this region.
In terms of residence, 52.1% of women from outside the city met the physical activity guidelines, while 29.5% of those living inside the city met the physical activity guidelines; this difference was statistically significant. A study conducted on Armenian adults also revealed a significant association between the area of residence and meeting WHO recommendations for physical activity, as 85.2% of rural adults, including women, met the WHO recommendations for physical activity compared to 79.7% of those residing in urban settings [30]. Erbil has an unfavorable environment for physical activity. One cannot run, bike, or even walk. Public transportation is nonexistent, and green areas are rare [33]. All these factors contributed to the low prevalence of physical exercise in our study population.
The current study revealed another significant association between meeting physical activity guidelines and the presence of chronic diseases. More than 38% of those women with chronic diseases met physical activity guidelines, compared to 29.1% of those without chronic diseases. In contrast, a study on Canadian adults revealed that women who did not meet physical activity guidelines were at a significantly greater risk of obesity, hypertension, diabetes, and poor health [34].
The prevalence of leisure-time physical exercise among the participants in the current study was 14.8%, which was markedly lower than that in high-income and middle-income countries. In a study conducted on young Europeans from 21 countries, the overall prevalence of leisure-time physical exercise among women was 68.3%, with the highest prevalence in Hungary (95%) [35] and the lowest in Greece (29%) [36]. A study conducted on multiethnic Asian populations revealed that the prevalence of sufficiently active women was 82.4% [29]. The prevalence of moderate physical activity among girls in Peruvian public universities was 50% [28].
The current study also showed that 33% of the participants had highly sedentary behavior (sitting at least eight hours daily). This finding was close to what was reported from a study conducted in Peruvian public universities, which revealed that the prevalence of low physical activity among female students was 35% [28]. This percentage was higher than that reported in a study on Australian women (22.5%) [37]. However, a study conducted in Singapore showed that the prevalence of sedentary behavior among women is 45.6% [10]. Another study from Armenia reported a significantly lower prevalence of sedentary lifestyles (sitting more than eight hours per day) of 10.6% [30]. On the other hand, 60.5% of Saudi women were classified as inactive because they spent less than 210 minutes per week conducting different physical activities [27].
The study revealed a significant statistical association between a high level of sedentary behavior among women and younger (18–30 years) age group (41.2%), being single (47.3%), having a high school education or below (45.2%), being a student (52.8%), having a high professional job (30.1%), and having an average or below average economic status (35.8%). The very high level of sedentary activities among students and young age groups is alarming. These are shaping periods of life, and urging universities to use resources for students (predominantly female students) to access safe and available areas for exercise must be a high priority. Similar findings have been reported in other settings. For example, a study from Brazil showed a significantly greater prevalence of sedentary life among unemployed women (61.9%), while there was no significant association with age, marital status, or education level [38].