Introduction
Regular physical activity is a key determinant of physical and mental health across all stages of life [1]. Evidence shows that engaging in adequate moderate-to-vigorous activity reduces the risk of chronic conditions such as cardiovascular disease, type 2 diabetes, obesity, and several forms of cancer [2]. In adolescents, physical activity supports healthy growth and development, enhances cardiorespiratory and muscular fitness, and contributes to improved cognitive functioning and academic performance [3,4]. It also plays an essential role in mental well-being, with studies reporting reduced symptoms of depression, anxiety, and stress among more active youth [5]. Given these wide-ranging benefits, promoting physical activity in adolescence is considered a critical public health priority [6].
In Central Europe, and particularly within the Visegrad Group (V4) countries (the Czech Republic, Hungary, Poland, and Slovakia), adolescent physical activity patterns have become a growing public health concern. Although all four countries participate in large international surveillance systems such as HBSC, the available data typically rely on single-item or short physical activity indicators, offering only limited insight into domain-specific or context-specific behavior [7,8].
Furthermore, chronic insufficient physical activity remains a critical public health issue, with patterns observed in the Central European context aligning with global trends [9]. Evidence consistently indicates that a higher proportion of boys achieve recommended physical activity levels compared to girls, underscoring the need for comprehensive strategies aimed at increasing overall youth engagement in sports and exercise.
Coordinated research conducted across the Visegrad region has generated comprehensive evidence on youth physical activity patterns [10]. Comparative analyses indicate that young people in the four countries typically achieve insufficient levels of physical activity, with substantial gender differences, whereby boys report higher levels of moderate-to-vigorous physical activity than girls [11,12]. High levels of sedentary behavior have also been reported across all V4 countries, affecting both secondary-school and university students and frequently co-occurring with low physical activity levels [13]. Further evidence suggests a clear association between body weight and physical activity, with overweight and obese adolescents in the V4 region reporting significantly lower physical activity than their normal-weight peers [14]. Additionally, notable disparities between countries have been documented, highlighting the importance of social and environmental factors, such as access to facilities and cultural attitudes towards sport, in shaping physical activity levels [15].
According to review focused on physical activity in the Visegrad region from 2021, the need for enhanced physical activity among adolescents is pressing, as the prevalence of insufficient physical activity is alarming across the Visegrad countries. For instance, girls consistently reported lower engagement in physical activities compared to boys, underscoring persistent gender disparities that affect exercise participation. In Hungary, approximately 85.8% of girls did not meet the recommended levels of physical activity, while the figures for Poland, the Czech Republic, and Slovakia were similarly high, with 84.2%, 82.0%, and 77.8%, respectively, of girls reporting insufficient activity. Such results imply a clear need for targeted interventions to promote physical activity, especially among girls [16].
A more recent study compared physical activity levels post-COVID-19 pandemic across the Czech Republic, Slovakia, and Poland. This study specifically highlighted differences in metabolic equivalent (MET) minutes per week, revealing Slovakia’s adolescents as the most active, followed by those in the Czech Republic and Poland. The post hoc analysis indicated significant differences in activity levels among these countries, informing potential regional policy initiatives aimed at enhancing youth engagement in physical activities post-pandemic [17].
Aim of the work
Although earlier research provided an important foundation for understanding youth movement behavior in Central Europe, most available studies from the Visegrad region were conducted more than five years ago, and some date back nearly a decade. As a result, the region still lacks recent, harmonized evidence that captures the current patterns of adolescent physical activity across multiple behavioral domains. This creates a persisting monitoring gap and underscores the need for updated, standardized comparisons across the Czech Republic, Hungary, Poland, and Slovakia.
In response to this gap, the present study aimed to generate a contemporary, multi-domain assessment of adolescent physical activity and sedentary behavior in the four Visegrad countries, using unified IPAQ-based methodology and consistent data-collection procedures.
By examining gender and country differences across school/work-related, transport, household, leisure-time, total physical activity, and sitting time, the study provides new, comparable evidence that can support targeted public health actions in the region.
Material and methods
Study design and setting
This cross-sectional study was conducted between March and May 2025 among adolescents from four Central European countries: the Czech Republic, Hungary, Poland, and Slovakia. Data collection was carried out within the framework project titled “Physical activity patterns among high school and university students in the V4 countries – a comparative study”, which examines adolescent physical activity and contextual factors using harmonized protocols. Participating sites included secondary schools located in four municipalities corresponding to the collaborating academic institutions: University of Pécs (Hungary), John Paul II University in Biała Podlaska (Poland), Pavol Jozef Šafárik University in Košice (Slovakia), and University of South Bohemia in České Budějovice (the Czech Republic). Schools were randomly selected within these municipalities to ensure a diverse representation of students. Data were collected during regular school lessons, with students completing the questionnaire in a supervised classroom environment using standardized procedures across all participating sites.
Participants
A total of 2,006 secondary school students participated in the study, with a mean age of 17.03 years (SD=1.37; age range: 14-18 years). The sample included 1,379 females (mean age 17.01; SD 1.34; age range: 14-18 years) and 627 males (mean age 17.07; SD 1.43; age range: 14-18 years). The participants attended vocational schools (27.4%), grammar schools (44.0%), and technical/specialized secondary schools (28.6%), of which 1.0% were sports schools. Most participants were classified as having a normal BMI (76.9%), while 3.9% were underweight, 9.8% overweight, and 9.4% obese (Table 1). Individuals were eligible if they were enrolled in secondary school and provided complete IPAQ data. Missing or inconsistent entries were handled according to IPAQ scoring guidelines.
Table 1
Age and BMI classification of adolescents by gender and country
[i] Notes: BMI categories were derived from age- and gender-specific international cut-offs. Percentages refer to the proportion of participants within each BMI category. Age is presented as mean and standard deviation (SD). Total values represent combined samples across all four participating countries (the Czech Republic, Hungary, Poland, Slovakia).
Measures
Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ, long form). Students reported the duration and frequency of activities across all standard IPAQ domains, and weekly energy expenditure was calculated in MET-minutes per week according to official scoring guidelines. Sedentary behavior was measured using two items capturing average daily sitting time on weekdays and weekends. All responses were screened and processed following IPAQ data-cleaning recommendations.
Statistical analysis
Descriptive statistics included median, mean, and mean rank for each domain. Gender differences were examined using the Mann-Whitney U test, given the non-normal distribution of IPAQ data. Effect sizes were expressed as r = |Z| / √N. Country differences (the Czech Republic, Hungary, Poland, Slovakia) were analyzed using the Kruskal-Wallis test, with effect sizes calculated using η2 = (H − k + 1) / (N − 1), where k = 4 groups. A significance level of p<0.05 was applied. The collected data were analyzed using IBM SPSS Statistics version 29.0 (IBM Corp., Armonk, NY, USA).
Results
Gender comparison
The comparison of physical activity levels between female and male adolescents revealed statistically significant differences; however, the observed effect sizes were generally small, indicating modest gender-related differences rather than pronounced patterns (Table 2). Overall, boys accumulated more weekly physical activity than girls, driven largely by higher recreation, sport, and leisure participation.
Table 2
Gender comparison of IPAQ domains and sitting time among adolescents
Median weekly leisure-time activity among boys was 522 MET-min/week compared with 420 MET-min/ week in girls, a difference that was statistically significant (p=0.002) and represented the largest gender discrepancy in the dataset. Boys also reported higher total physical activity, with a median of 2,790 METmin/week versus 2,575 MET-min/week in girls (p=0.013). School/work-related activity was likewise higher among boys (920 vs. 800 MET-min/week; p=0.018), although the effect size remained small. In contrast, transport-related physical activity and active transport did not differ significantly by gender, and median values were very similar (780 vs. 780 MET-min/week for transport physical activity; 360 vs. 350 MET-min/ week for active transport), suggesting comparable mobility patterns for commuting among adolescent boys and girls. Household-related activity showed a tendency toward higher values in males (322 vs. 270 METmin/week), but the difference was not significant (p=0.190). Patterns in sedentary behavior differed by gender: girls reported substantially more weekday sitting time than boys (median 420 vs. 360 minutes/ day; p<0.001), representing the strongest gender effect across all variables. Weekend sitting time, however, did not differ between boys and girls (median 300 minutes/day for both; p=0.203). Overall, the results indicate that boys reported higher levels of leisure-time and total physical activity. Regarding sedentary behavior, higher weekday sitting time was observed among girls.
Country comparison – females
Among female adolescents, levels of physical activity varied markedly across the four participating countries, as shown in Table 3. Polish girls consistently showed the highest activity levels in several domains, particularly in school/work-related (median 960 MET-min/week, mean rank 779.7) and transport-related physical activity (median 890 MET-min/week, mean rank 740.9), where they surpassed their peers from the Czech Republic, Hungary, and Slovakia. In contrast, Slovak girls generally reported the lowest physical activity levels, especially in transport physical activity (median 540 MET-min/week, mean rank 568.8) and active transport, where their median of 135 MET-min/week was far below that of the other countries. Active transport was the domain with the most pronounced cross-country difference (H=132.49, p<0.001), driven by very low levels in Slovakia compared with consistently higher values elsewhere. Leisure-time activity also showed meaningful variation: Polish girls again reported the highest levels (median 450 MET-min/week), whereas Slovak girls displayed much lower participation (median 315 MET-min/week), reflected in significantly different mean ranks (709.3 vs. 603.9). Total physical activity followed a similar pattern, with Polish girls accumulating more weekly activity overall (median 2,930 MET-min/week, mean rank 766.0), while Slovak girls reported substantially lower totals (median 1,950 MET-min/week). Sitting behavior, by contrast, showed a different pattern. Slovak and Hungarian girls reported higher weekday and weekend sitting times than their Czech and Polish counterparts, and the differences were statistically significant (weekday H=20.59, weekend H=39.10; both p<0.001). Taken together, these findings highlight cross-country contrasts among girls, with Poland tending toward the most active profile and Slovakia consistently showing the lowest activity across several key IPAQ domains.
Table 3
IPAQ-based physical activity domains across the V4 countries in females
Country comparison – males
Among male adolescents, cross-country differences were also evident, though generally smaller in magnitude than among females. Polish boys were the most active group across several domains, most notably in school/work-related activity (median 1,157 MET-min/week, mean rank 368.6) and total physical activity (median 3,630 MET-min/week), where they exceeded their peers from the Czech Republic, Hungary, and Slovakia. Active transport showed the strongest country effect among boys (H=45.78, p<0.001), with Polish boys again reporting the highest values (median 480 MET-min/week) and Slovak boys the lowest (median 180 MET-min/week), mirroring the pattern observed among girls. Transport-related physical activity also differed significantly across countries (H=18.95, p<0.001), with Czech boys showing relatively high medians (880 MET-min/week) while Slovak boys reported lower levels (660 MET-min/week). Leisure-time physical activity followed the same pattern, with Polish boys (median 660 MET-min/week) more active than those in other countries, particularly Slovak boys (median 450 MET-min/week). In most physical activity domains, Hungary and the Czech Republic typically occupied intermediate positions between Poland and Slovakia. Sedentary behavior showed minimal variation across countries: neither weekday nor weekend sitting time differed significantly among boys (p=0.434 and p=0.729, respectively), and medians were nearly identical across settings. Overall, Polish boys tended to have the highest activity across domains, Slovak boys the lowest, and Czech and Hungarian boys were clustered in the middle, with only modest differences in sedentary time (Table 4).
Table 4
IPAQ-based physical activity domains across V4 countries in males
Discussion
This study provides the most recent harmonized comparison of adolescent physical activity and sedentary behavior across the Visegrad region and directly addresses the monitoring gap identified in prior research [10].
In our dataset, clear gender disparities in physical activity were observed, with boys accumulating more total and leisure-time physical activity than girls, with the largest differences evident in the recreation and sport domain. These findings are consistent with earlier reports from Central Europe and longstanding patterns documented in HBSC surveillance and other V4 studies, which similarly reported higher moderate-to-vigorous physical activity among boys and persistently lower engagement among girls [15, 17-19]. Together, this reinforces previous observations that adolescent girls remain a key target group for physical activity interventions [17], supported by HBSC evidence demonstrating that active commuting to school, especially cycling, is associated with significantly lower levels of somatic and psychological health complaints, underscoring the health relevance of interventions promoting everyday physical activity [19]. In parallel, long-term HBSC trend analyses demonstrate that opportunities for integrating physical activity into daily routines, such as active transport to school, have been steadily diminishing over time, further strengthening the case for targeted, routine-based interventions [20].
Our study confirms and more clearly quantifies cross-country differences previously reported in the V4 region. Consistent with previous regional observations, Polish adolescents in our sample showed the highest levels of physical activity across several domains, whereas Slovak adolescents were the least active, especially in transport-related and active transport activity. These patterns mirror previous findings from V4 and international studies, which have repeatedly reported higher overall activity levels among Polish youth and comparatively lower engagement in active transport and daily movement among Slovak adolescents, underscoring the persistence of country-specific differences in physical activity behavior [10,21]. By providing harmonized, domain-specific data for all four countries, this study extends earlier V4 research, which typically reported low overall activity but did not offer comparable multi-domain analyses. The particularly low levels of active transport observed among Slovak youth represent a notable and previously underreported finding that warrants further attention.
Our results showed that girls demonstrated substantially higher weekday sitting time, while weekend sitting time showed little gender difference. The gender differences in sedentary behavior patterns identified in our study are consistent with earlier findings from the Visegrad region. Prior research reported that adolescent girls tend to accumulate more sedentary time than boys and that this imbalance coexists with lower physical activity in girls [18,22]. Similar trends were also described by Šimůnek et al., who found high levels of sitting among Czech and Slovak adolescents, with girls spending more time in sedentary activities than boys [13]. Junger et al. similarly observed that sedentary behavior was prevalent across V4 youth and showed weaker country-level variation compared with physical activity indicators [23].
In our findings, boys in the Visegrad countries accumulated more total and leisure-time activity than girls, whereas girls reported higher sedentary time during school days. These patterns are broadly consistent with international evidence on adolescent physical activity. Global surveillance data, including the WHO reports and repeated HBSC cycles, consistently show that the majority of adolescents worldwide do not meet recommended levels of moderate-to-vigorous physical activity, with girls being less active than boys in nearly all regions [6, 24-26].
Cross-country differences within the V4 region also reflect broader international variation reported in large multinational datasets. International comparisons frequently demonstrate that active transport, recreation, and sport participation differ substantially between countries, influenced by cultural norms, school policies, and the built environment [2]. The markedly lower active transport levels observed among Slovak adolescents, compared with their peers in the Czech Republic, Hungary, and Poland, align with global observations that walking and cycling to school are highly context-dependent and vary widely across settings [6,25]. Recent school-based evidence from the Czech Republic and Poland further indicates a significant post-pandemic decline in transport-related physical activity to and from school, suggesting that disruptions of school-day routines may have contributed to persistently lower levels of active commuting in some countries [27]. These differences are further contextualized by long-term HBSC evidence showing a substantial decline in active school transport over the past two decades. For example, nationally representative HBSC data from Czech adolescents indicate that the prevalence of walking or cycling to school declined by more than 15 percentage points between 2006 and 2022, suggesting that the low levels of active transport observed in some V4 countries may reflect longer-term structural trends rather than short-term behavioral change [20].
Overall, the present results fit within the established international picture of low global adolescent activity, persistent gender inequalities, and strong environmental influences on movement behaviors, while providing new region-specific evidence for Central Europe.
Our study has several strengths and limitations that need to be acknowledged when interpreting the results. One important limitation is related to the sampling strategy. The study sample was drawn from selected secondary schools located in four university cities and is therefore not nationally representative. Consequently, the generalizability of the findings to the national adolescent population may be limited, particularly for students attending schools in non-university cities or rural areas.
Another limitation is the cross-sectional design of the study, which does not allow causal inferences to be drawn. In addition, physical activity and sedentary behavior were assessed using the self-reported IPAQLF. Self-reported measures are subject to recall bias and may lead to overestimation of physical activity levels, particularly in older adolescents. Furthermore, sedentary behavior assessment using the IPAQ-LF was based on overall sitting time on weekdays and weekends, which does not allow for differentiation between specific sedentary activities (e.g. screen-based, educational, or leisure-time sitting).
Finally, the gender imbalance in the sample, with a higher proportion of female participants, should be considered when interpreting gender-specific findings.
A key strength is the use of a harmonized methodological approach across all four Visegrad countries, which enabled direct cross-country comparisons of adolescent physical activity within a single analytical framework. Unlike much of the earlier V4 research, which often relied on country-specific analyses or aggregated indicators, this study provides domain-specific insights into total, leisure-time, and transport-related physical activity, allowing for a more nuanced interpretation of movement behaviors.
Another strength is the focus on multiple physical activity domains, which strengthens the interpretation of gender- and country-level differences by identifying where disparities are most pronounced. By situating the findings within established HBSC and international surveillance evidence, this study contributes updated, region-specific data that help to address the documented monitoring gap in Central Europe and provide a relevant evidence base for targeted public health and school-based interventions.
Conclusions
This study aimed to provide an updated, harmonized comparison of physical activity and sedentary behavior among adolescents in the four Visegrad countries and to examine how these patterns differ by gender and country. The findings show gender differences: boys engaged in more total and leisure-time physical activity, while girls accumulated substantially more weekday sitting time. A marked cross-country variation was also observed, particularly among girls, with Polish adolescents reporting the highest levels of activity across several domains, and Slovak adolescents the lowest. Among boys, the differences between countries were smaller but followed a similar pattern. Sedentary behavior showed limited variation across countries, indicating that sitting time is a widespread issue in the region regardless of national context.
Taken together, the results highlight inequalities in adolescent movement behavior within the Visegrad region and emphasize the need for targeted, context-specific strategies to support physical activity and reduce sedentary time, particularly for girls and for adolescents in countries with the lowest reported activity levels.
Disclosures and acknowledgements
The authors declare no conflicts of interest with respect to the research, authorship, and/or publication of this article.
The research was funded by the project “Physical activity patterns among high school and university students in the V4 countries – a comparative study” co-financed by the International Visegrad Fund under the Visegrad Grants program (Agreement number 22420149).
The study was conducted in accordance with the principles of the Declaration of Helsinki. All the participants provided written informed consent to participate in the study. They were informed about its purpose and procedures prior to participation. The Bioethics Committees of the respective universities approved the study protocols: Medical Research Council of Hungary, Hungary, January 3rd, 2025, No. BM/1652-1/2025; Bioethics Committee of John Paul II University in Biała Podlaska, Poland, January 29th, 2025, No. 1/2025; Research Ethics Committee of the Faculty of Health and Social Studies, University of South Bohemia in České Budějovice, the Czech Republic, February 18th, 2025, No. 002/2025; Human Research Ethics Committee of Pavol Jozef Šafárik University in Košice, Slovakia, April 7th, 2025, No. 5/2025.
The authors would like to acknowledge the use of an AI-based tool (ChatGPT, OpenAI) for initial basic grammar and formatting checks. All the scientific and intellectual content was solely developed by the authors.
