Beyond the Guidelines: Exploring the Prevalence and Correlates of No-to-Low Moderate-to-Vigorous Physical Activity among U.S. Adolescents

Purpose: While many studies examine adolescent physical activity (PA) guideline adherence, few focus exclusively on the lowest end of the PA spectrum – engaging in no-to-low moderate-to-vigorous PA (MVPA). This study characterized cross-sectional and longitudinal patterns of device-measured no-to-low MVPA among a diverse cohort of U.S. adolescents and examined sociodemographic and neighborhood-level correlates. Methods: This secondary analysis used data from two waves (Year 2 and Year 4 follow-up) of the Adolescent Brain Cognitive Development Study. Participants wore a Fitbit Charge HR on their non-dominant wrist 24h/day for three weeks to assess daily MVPA. No-to-low MVPA was defined as <8.57 min/day of MVPA (<1 day/week meeting PA recommendations). The Child Opportunity Index 2.0 was linked to participants’ data. Survey-weighted logistic regression models examined sociodemographic and neighborhood-level correlates of no-to-low MVPA, adjusted for abdominal obesity.Results: A total of 5,793 adolescents (49% female; M = 9.50 ± 0.50 years at baseline) had complete data at Year 2, with 1,348 (51% female) providing data at both time points. The prevalence of no-to-low MVPA was 17% at Year 2, 15% at Year 4, and 7.3% across both years. Girls and adolescents from low-income households had significantly higher odds of engaging in no-to-low MVPA at both time points. Adolescents living in higher-opportunity neighborhoods had significantly lower odds of no-to-low MVPA.Conclusions: This study fills a critical gap in PA surveillance by using device-based measures to quantify no-to-low MVPA among U.S. adolescents. Findings highlight at-risk groups – girls and low-income adolescents – and emphasize the role of neighborhood conditions in shaping PA engagement. Given the disproportionate health benefits of even small increases in MVPA at this level, targeted interventions are essential to reduce disparities.