Physical education class participation is associated with physical activity among adolescents in 65 countries.

In this study we examined the associations of physical education class participation with physical activity among adolescents. We analysed the Global School-based Student Health Survey data from 65 countries (N = 206,417; 11-17 years; 49% girls) collected between 2007 and 2016. We defined sufficient physical activity as achieving physical activities ≥ 60 min/day, and grouped physical education classes as '0 day/week', '1-2 days/week', and ' ≥ 3 days/week' participation. We used multivariable logistic regression to obtain country-level estimates, and meta-analysis to obtain pooled estimates. Compared to those who did not take any physical education classes, those who took classes ≥ 3 days/week had double the odds of being sufficiently active (OR 2.05, 95% CI 1.84-2.28) with no apparent gender/age group differences. The association estimates decreased with higher levels of country's income with OR 2.37 (1.51-3.73) for low-income and OR 1.85 (1.52-2.37) for high-income countries. Adolescents who participated in physical education classes 1-2 days/week had 26% higher odds of being sufficiently active with relatively higher odds for boys (30%) than girls (15%). Attending physical education classes was positively associated with physical activity among adolescents regardless of sex or age group. Quality physical education should be encouraged to promote physical activity of children and adolescents.