Background: We report the prevalence of recommended physical activity levels (RPALs) and examine the correlates
of achieving RPALs in rural South Asian children and analyse its association with anthropometric outcomes.
Methods: This analysis on rural South Asian children aged 5–14 years (n = 564) is a part of the Chronic Disease Risk
Factor study conducted at three sites in India (Chennai n = 146; Goa n = 218) and Bangladesh (Matlab; n = 200). Data
on socio-demographic and lifestyle factors (physical activity (PA); diet) were collected using an interviewer-administered
questionnaires, along with objective anthropometric measurements. Multivariate logistic regression models were used to
examine whether RPALs (active travel to school (yes/no); leisure-time PA ≥ 1 h/day; sedentary-activity ≤ 2 h/day) were
associated with socio-demographic factors, diet and other forms of PA. Multivariate linear regression models were used
to investigate associations between RPALs and anthropometrics (BMI- and waist z-scores).
Results: The majority of children (71.8 %) belonged to households where a parent had at least a secondary education.
Two-thirds (66.7 %) actively travelled to school; 74.6 % reported ≥1 h/day of leisure-time PA and 55.7 % had
≤2 h/day of sedentary-activity; 25.2 % of children reported RPALs in all three dimensions. Older (10–14 years,
OR = 2.0; 95 % CI: 1.3, 3.0) and female (OR = 1.7; 95 % CI: 1.1, 2.5) children were more likely to travel actively
to school. Leisure-time PA ≥ 1 h/day was more common among boys (OR = 2.5; 95 % CI: 1.5, 4.0), children in
Matlab, Bangladesh (OR = 3.0; 95 % CI: 1.6, 5.5), and those with higher processed-food consumption (OR = 2.3;
95 % CI: 1.2, 4.1). Sedentary activity ≤ 2 h/day was associated with younger children (5–9 years, OR = 1.6; 95 % CI: 1.1, 2.
4), children of Goa (OR = 3.5; 95 % CI: 2.1, 6.1) and Chennai (OR = 2.5; 95 % CI: 1.5, 4.3) and low household education
(OR = 2.1; 95 % CI: 1.1, 4.1). In multivariate analyses, sedentary activity ≤ 2 h/day was associated with lower BMI-z-scores
(β = −0.3; 95 % CI: −0.5, −0.08) and lower waist-z-scores (β = −1.1; 95 % CI: −2.2, −0.07).
Conclusion: Only one quarter of children in these rural areas achieved RPAL in active travel, leisure and sedentary
activity. Improved understanding of RPAL in rural South Asian children is important due to rapid socio-economic
transition.