Intrapersonal, interpersonal, and community factors are associated with adherence to physical activity, sedentary behavior, and sleep recommendations in adolescents, with only approximately 1.8% of adolescents meeting all three recommendations simultaneously.
Key Findings
Results
Only approximately 1.8% of the 576 adolescents met all three recommendations (physical activity, sedentary behavior, and sleep) simultaneously.
Study sample consisted of 576 adolescents aged 14 to 17 years from public schools in the Metropolitan Region of Recife, Pernambuco, Brazil.
The three recommendations assessed were for physical activity, sedentary behavior, and sleep.
This cross-sectional study used an adapted version of the Global School-based Student Health Survey.
Robust Poisson regressions were performed to analyze associations.
Results
Enjoying physical activity was strongly associated with combined adherence to physical activity and sedentary behavior recommendations.
Prevalence ratio (PR) of 11.62 (95% CI 1.50–89.75) for enjoying physical activity.
This represents an intrapersonal-level factor within the Social Ecological Model.
The wide confidence interval suggests variability in this estimate, though the association remained statistically significant.
Results
Having two or more friends and participating in physical education classes were associated with lower probabilities of non-compliance with physical activity and sedentary behavior recommendations.
Having two or more friends: PR 0.38 (95% CI 0.18–0.76) for non-compliance.
Participating in one physical education class per week: PR 0.39 (95% CI 0.20–0.78) for non-compliance.
Participating in two physical education classes per week: PR 0.43 (95% CI 0.20–0.92) for non-compliance.
These represent interpersonal and community-level factors within the Social Ecological Model.
Results
Self-rated good sleep quality was associated with higher prevalence of meeting the combined recommendations for sedentary behavior and sleep.
PR of 2.49 (95% CI 1.09–5.67) for meeting combined sedentary behavior and sleep recommendations among those rating their sleep quality as good.
Self-rated sleep quality as good was also associated with higher likelihood of meeting combined physical activity and sleep recommendations (PR 3.11; 95% CI 1.36–7.10).
This factor represents an intrapersonal-level variable.
Results
Being male was associated with lower prevalence of not meeting sedentary behavior and sleep recommendations and with higher likelihood of meeting combined physical activity and sleep recommendations.
Being male was associated with lower prevalence of not meeting sedentary behavior and sleep recommendations: PR 0.48 (95% CI 0.23–0.97).
Being male was associated with higher likelihood of meeting combined physical activity and sleep recommendations: PR 2.10 (95% CI 1.14–3.87).
Sex represents an intrapersonal-level factor in the Social Ecological Model.
Results
Participating in one physical education class per week was associated with lower prevalence of not meeting sedentary behavior and sleep recommendations.
PR 0.40 (95% CI 0.16–0.99) for not meeting sedentary behavior and sleep recommendations among those attending one physical education class per week.
This community-level factor was significant for this specific combination of recommendations.
Physical education class attendance also showed associations with physical activity and sedentary behavior recommendation compliance.
Results
Actively commuting to school was associated with a lower likelihood of not meeting the combined physical activity and sleep recommendations.
PR 0.48 (95% CI 0.27–0.83) for not meeting physical activity and sleep recommendations among active commuters.
Active commuting to school represents a community-level factor within the Social Ecological Model.
This finding highlights transportation behavior as a relevant factor in adolescent health recommendation adherence.
Conclusions
The study applied the Social Ecological Model framework, identifying intrapersonal, interpersonal, and community factors as associated with combined adherence to health behavior recommendations.
The Social Ecological Model was used to categorize associated factors across multiple levels of influence.
Intrapersonal factors identified included enjoying physical activity, self-rated sleep quality, and sex.
Interpersonal factors included having two or more friends.
Community factors included physical education class participation and active commuting to school.
The study used a cross-sectional design, limiting causal inference.
What This Means
This research suggests that very few adolescents in Brazil are meeting the recommended guidelines for physical activity, sedentary behavior, and sleep all at once — only about 1 in 55 students in this study did so. The researchers surveyed 576 teenagers aged 14 to 17 attending public schools in the Recife metropolitan region, examining which personal, social, and community-level factors were linked to whether students met these health recommendations in various combinations.
The study found that personal factors like enjoying physical activity and rating one's own sleep as good, as well as being male, were linked to better adherence to multiple health behavior recommendations. Social factors also mattered: teenagers who had two or more friends were more likely to meet the combined physical activity and sedentary behavior guidelines. At the community level, attending physical education classes at school and actively commuting to school (e.g., walking or cycling) were associated with better compliance with various recommendation combinations.
This research suggests that efforts to improve adolescent health behaviors should address multiple levels simultaneously — from individual attitudes and sleep habits, to friendships and social support, to school programs like physical education and safe routes for active commuting. The extremely low rate of adolescents meeting all three recommendations at once highlights the difficulty of achieving comprehensive healthy behavior patterns during adolescence and points to the need for multi-faceted interventions.
Rocha K, Feitosa S, Wanderley Junior R, Costa A, Barbosa Filho V, Barros M, et al.. (2026). Factors associated with meeting the recommendations for physical activity, sedentary behavior, and sleep in adolescents: a cross-sectional study.. Revista paulista de pediatria : orgao oficial da Sociedade de Pediatria de Sao Paulo. https://doi.org/10.1590/1984-0462/2026/44/2025027