Physical activity, sedentary time, and anthropometric differences in Saudi children with cerebral palsy compared to typically developing peers: an activPAL-based study

Abstract Children with cerebral palsy (CP) typically accumulate less physical activity (PA) and more sedentary time than typically developing (TD) peers, but evidence from Middle Eastern settings is limited. This study compared objectively measured PA, sedentary behavior, and anthropometric profiles between Saudi children with CP and TD peers. In a cross-sectional comparative study, school-aged children with CP (GMFCS I-II, n = 14) and age-matched TD peers ( n = 15) wore an activPAL inclinometer continuously for seven days. Anthropometric measures included height, weight, and BMI percentiles. activPAL outcomes comprised time spent sitting/lying, standing, and stepping; sit-to-stand transitions; sedentary bout characteristics; and reciprocal leg movement (RLM) epochs. Between-group differences were assessed using Mann-Whitney U tests; daily stepping time was the pre-specified primary outcome, and all remaining activPAL variables were treated as secondary exploratory outcomes. Associations between anthropometry and activity were examined using Spearman correlations. Complementary multiple linear regression models adjusted for BMI percentile were run as sensitivity analyses. Children with CP demonstrated significantly lower body weight (median [IQR]: 21.65 [18.25–29.90] vs. 33.00 [27.35–37.40], p = 0.02) and markedly lower BMI percentiles (6 [2–59.25] vs. 87 [70–96.95], p = 0.002). Compared with TD peers, the CP group accumulated 2.66 more hours/day sedentary (median 692.1 vs. 532.3 min; Δ = +159.8 min), spent 0.46 fewer hours/day upright when combining stepping and standing time (median 254.5 vs. 282.0 min; Δ = −27.5 min), accumulated 0.7% fewer daily steps (median 7582.4 vs. 7639.3), and performed 11.2% fewer sit-to-stand transitions (median 93.5 vs. 105.3). Sedentary behavior in children with CP also tended to be accumulated in longer bouts, with ~ 1.18 more hours/day spent in prolonged sedentary periods (≥ 30 min; median 296.39 vs. 225.37 min), although this between-group difference was not statistically significant ( p = 0.13). RLM epochs count (10 s–1 min) were ~ 1.9% lower in the CP group (median 5883 vs. 5995.33), but this difference was not statistically significant ( p = 0.29). Saudi children with CP exhibited distinct anthropometric profiles, with significantly lower body weight and BMI percentiles. While descriptive trends suggested greater sedentary accumulation, fewer sit-to-stand transitions, and reduced stepping time, these between-group differences did not reach statistical significance in the primary analyses. In complementary regression analyses, CP group was associated with fewer sit-to-stand transitions and fewer short-duration upright bouts after adjustment for BMI percentile. Given the small sample size and exploratory nature of secondary analyses, findings should be interpreted cautiously and require replication in larger samples. The activPAL provided clinically actionable metrics for rehabilitation planning, and these findings may inform intervention strategies aimed at interrupting prolonged sitting, increasing stepping opportunities, and integrating nutritional support with physical activity promotion.