Physical inactivity prevalence and associated factors among iranian older adults in the 2021 STEPS survey

Physical inactivity is a major, modifiable driver of non-communicable diseases in aging populations. We quantified the prevalence of physical inactivity among Iranian older adults and identified demographic, socioeconomic, and health-related correlates. We analyzed nationally representative 2021 STEPS data from 5,491 adults aged ≥ 60 years. Physical activity was assessed via World Health Organization Global Physical Activity Questionnaire (WHO GPAQ) and categorized as sufficient (≥ 600 MET-min/week) vs. insufficient (< 600). Sedentary time (min/day) was recorded. Complex survey design was accounted for in estimates. Associations with inactivity were examined using sex-stratified generalized linear mixed-effects models adjusting for age, education, marital and employment status, urban or rural residence, wealth tertile, obesity, depressive symptoms, and multimorbidity. Among the participants, mean sedentary time was 288 min/day and mean total activity was 1,326 MET-min/week. Overall, 69.6% (95% CI: 68.3-71.0) were inactive, higher in women (76.8%, 75.0-78.5) than men (62.4%, 60.3-64.4). Inactivity was highest in adults aged ≥ 80 years (80.9%, 77.1-84.7). Urban residence was associated with higher odds of inactivity (adjusted OR [aOR] 1.35, 95% CI: 1.13-1.61) and higher education (≥ 12 years formal education) showed lower odds (aOR 0.73, 0.61-0.88). Obesity and depressive symptoms were each related to higher odds of inactivity (aOR 1.34, 1.08-1.66 and aOR 1.30, 1.12-1.51); odds were progressively higher across multimorbidity categories (e.g., ≥ 3 conditions, aOR 1.26, 1.02-1.55 vs. none). Sex differences were evident. Compared with ages 60-69, adults aged ≥ 80 had higher odds of inactivity in women (aOR 3.20, 95% CI 1.96-5.24) than in men (aOR 1.91, 1.41-2.60). Urban residence and higher wealth were also related to higher odds in women (urban aOR 1.62, 1.25-2.11; wealth Q3 aOR 1.41, 1.14-1.75), while higher wealth was related to lower odds in men (Q3 aOR 0.76, 0.61-0.94). Physical inactivity is highly prevalent among Iranian older adults, especially women, the oldest age groups, urban residents, and those with obesity, depression, or multiple chronic conditions. Findings support gender-responsive, multicomponent strategies-including community programs, primary-care integration, and activity-supportive urban design-to reduce inactivity and advance healthy aging in Iran.