1. Introduction

Childhood and adolescence, as the critical stages of life, are marked by rapid physical, neurological, and social development. During this period, behaviors and habits such as physical activity are established ( 1 ). This age range is often described as a “golden opportunity” for the prevention, control, and early detection of diseases through simple yet effective interventions ( 2 ). Physical activity plays a vital role in promoting lifelong health and fostering a healthy lifestyle, making it a key factor in ensuring long-term well-being ( 3 ).

Given its importance, policies aimed at promoting physical activity—which provide a framework for designing and implementing interventions—have gained the attention of policymakers ( 4 , 5 ). The primary goal of these policies is to shift from individual-focused interventions to systemic changes that create supportive environments for the development of programs, infrastructure, and spaces that encourage physical activity ( 6 , 7 ). When effectively implemented, such policies can help individuals adopt and maintain healthy behaviors while reducing sedentary lifestyles. For instance, countries like the United Kingdom and China have successfully reduced the prevalence of insufficient physical activity among children and adolescents through targeted policy development and implementation ( 8 , 9 ).

In Iran, several legal and policy documents have been developed to address physical activity among children and adolescents. However, research showed that most Iranian children and adolescents do not meet the physical activity levels recommended by the World Health Organization ( 10 , 11 ). This suggests that current policies have been ineffective, and that strategies for promoting physical activity in this age group require improved design and implementation.

In Iran, physical activity among children and adolescents has been addressed in several legal and policy documents, including the Fundamental Transformation Document of Education, the Five-Year Development Plans, and the National Physical Activity Program. However, research indicated that most Iranian children and adolescents do not meet the physical activity levels recommended by the World Health Organization (WHO) ( 10 , 11 ). For example, a national study conducted in 2018 found that approximately 26% of adolescents aged 10 to 12 were physically inactive ( 10 ) . Furthermore, a systematic review and meta-analysis showed that only 29.5% of girls and 20.5% of boys achieved the WHO-recommended physical activity levels ( 11 ). This alarming situation suggests that existing planning efforts have been largely ineffective, and that policies and interventions aimed at promoting physical activity among children and adolescents have not been adequately designed or successfully implemented. Several studies identified weaknesses in policy and planning as significant barriers to increasing students’ participation in physical activity ( 12 - 14 ). Moreover, the limited effectiveness of current programs has been attributed to challenges such as inadequate facilities, a shortage of trained physical education teachers, overloaded school curricula, and low levels of parental involvement ( 15 - 17 ).

Accordingly, the present study examined the policymaking landscape related to promoting physical activity among children and adolescents in Iran through a content analysis of policy documents. The present study aimed to provide a comprehensive assessment of the current situation and offer practical recommendations to improve policymaking in this area.

2. Methods

2.1. Design

This study employed a qualitative document analysis approach. The analysis was guided by the four-stage READ framework developed by Dalglish and colleagues ( 18 ), consisting of document preparation, data extraction, data analysis, and presentation of findings.

2.2. Selection and Description of Documents

The documents analyzed in this study consisted of national laws, regulations, policies, and guidelines related to promoting physical activity among children and adolescents in Iran. Documents were identified through:

• Comprehensive searches of official governmental and organizational websites (Appendix 1).

• Consultations with subject-matter experts and correspondence with relevant institutions.

• Searches of domestic scientific databases including the Scientific Information Database (SID), Magiran, and IranDoc.

• Supplementary searches using Google to locate official documents not indexed in other databases.

The search was primarily conducted in Persian, the official language of the documents. A broad range of keywords was used, including: “sports,” “physical activity,” “student,” “school-age,” “children,” “adolescents,” “physical inactivity,” “exercise,” “physical education,” “policy,” “program,” “guideline,” “intervention,” “regulation,” “strategy,” and “action plan.”

Documents dated from 1979 to 2024 were included. References to scientific literature were limited to national sources. A total of 61 documents were initially identified, of which 36 met all inclusion criteria after evaluation.

2.3. Data Collection and Measurements

In the data extraction stage, information such as document title, type, publication year, and content was extracted using a researcher-developed checklist. All documents were assessed using Scott’s four criteria—authenticity, credibility, representativeness, and meaning ( 19 ). Only documents obtained from reliable sources and free of errors or conflicts of interest were included. Those failing to meet the criteria were excluded. Microsoft Excel 2016 was used to organize, record, and manage extracted data.

2.4. Procedure

The qualitative document analysis followed the four steps of the READ framework:

1. Document preparation: Identification and collection of relevant documents through the search strategies described above

2. Data extraction: Extraction of key information using the standardized checklist and evaluation using Scott’s criteria

3. Analysis: Systematic thematic analysis of the included documents

4. Presentation of findings: Organization and reporting of themes using narrative descriptions, tables, and figures

To minimize individual bias, a team-based approach was applied. One researcher performed the initial search, coding, and preliminary analysis, while the other authors reviewed and validated the process through consensus meetings.

2.5. Data Analysis

Data were analyzed using thematic analysis ( 20 ), which included familiarization with the data, generating codes, identifying themes, reviewing and refining themes, and presenting the findings. MAXQDA 10 software was used to support the coding and analysis process. Findings were reported narratively and visually to enhance clarity and comprehensiveness.

3. Results

This study analyzed documents related to promoting physical activity among Iranian children and adolescents. A total of 36 documents were included in the analysis, consisting of two international documents, 12 high-level (upstream) documents, 19 organizational documents, and three executive documents (Table 1). The majority of the documents (n=10) were issued by the Ministry of Health.

Following the document analysis, five key focus areas were identified: (1) school-based approaches, (2) resources and infrastructure, (3) intersectoral collaboration, (4) education and cultural promotion, and (5) monitoring and evaluation (Table 2).

3.1. School-Based Approach

Our results indicated that policymakers recognize schools as the primary setting for promoting physical activity. Nearly all upstream documents emphasized the important role of schools in encouraging physical activity among children and adolescents. Initiatives included programs by the Ministry of Health—such as the Student Health Ambassadors, Weight and Obesity Control Program, and Classroom Stretching Exercises—and by the Ministry of Education, including regular physical education classes and extracurricular activities like morning exercises, the Dynamic School Program, family sports, sports clubs, and School Sports Olympiads. Furthermore, intra- and inter-school sports competitions were organized in collaboration with the Ministry of Sports to motivate and encourage student participation.

3.2. Resources and Infrastructure

Programs and interventions in this area aim to improve both the quantity and quality of physical activity initiatives in schools. Measures include pre-service and in-service training for teachers, hiring qualified physical education instructors, increasing the per capita space for school sports facilities, standardizing and renovating sports infrastructure within schools, raising the school sports budget, and allocating a portion of value-added tax and tobacco tax revenues to support these efforts.

3.3. Intersectoral Collaboration

This area focuses on establishing cooperation agreements between the Ministries of Health, Education, Roads and Urban Development, and Sports to strengthen cross-sector collaboration. These agreements aim to improve students’ access to environments that encourage physical activity before, during, and after school hours.

3.4. Education and Cultural Promotion

Efforts to raise public awareness and foster a culture of physical activity include organizing sports events, competitions, and festivals in collaboration with the Ministry of Sports and the National Broadcasting Organization. These initiatives are designed to motivate and educate the public about the importance and benefits of physical activity.

3.5. Monitoring and Evaluation

The Ministries of Education and Health have developed programs and guidelines to assess the implementation of physical activity initiatives. Evaluation is carried out using tools and indicators specifically designed for this purpose. Examples include the creation of student health and physical activity profiles, the Child Fitness Monitoring Program, physical fitness testing, and data registration in the Integrated Health System (SIB).

4. Discussion

This study is among the first to identify and analyze the current state of policies and programs aimed at promoting physical activity among children and adolescents in Iran. A total of 36 relevant policy documents were reviewed. Analysis of these documents revealed five key focus areas: a school-based approach, provision of resources and infrastructure, intersectoral collaboration, education and awareness-raising, and monitoring and evaluation. The findings indicated that promoting physical activity among children and adolescents has received attention at the policy level, with several measures implemented to develop and execute related policies. However, to fully achieve the desired goals and improve the effectiveness of these policies, significant reforms across multiple areas are needed.

Our findings revealed that various programs— such as the “Dynamic School,” “Koocheh Plan,” “Neshat Plan,” and the “Intra-school Sports Olympiad”— have been designed and implemented to increase students’ physical activity. However, these programs often lack systematic and coordinated connections with each other and tend to follow fragmented and short-term approaches. As supported by previous studies, this fragmentation can hinder comprehensive evaluation and the gradual improvement of programs, ultimately reducing student engagement and the overall effectiveness of interventions ( 21 , 22 ).

Moreover, public policy theories emphasize the importance of developing coherent, long-term, and evidence-based strategies to achieve sustainable health outcomes ( 23 ). For example, the experiences of countries such as China and the United Kingdom have shown that sustainable school-based programs, supported by gradual reforms and long-term policymaking, have been successful in promoting physical activity among children and adolescents ( 8 , 9 ). Accordingly, it is recommended that the development of a comprehensive and sustainable policy be prioritized, with the active involvement of relevant stakeholders.

In addition, given lifestyle changes and the increasing tendency of children and adolescents to engage with virtual environments, policies and programs are expected to place greater emphasis on using technological tools—such as physical activity-related mobile apps, digital movement-based games, and gamification strategies ( 24 ). Among the documents reviewed, only the National Program for the Promotion of Physical Activity briefly addressed this issue. Findings from several studies suggested that insufficient attention to this potential could lead to decreased motivation and participation in physical activity among children and adolescents ( 17 , 25 ).

Although some policy documents identify entities such as the government and philanthropic organizations as funding sources, the majority lack clear and detailed mechanisms for the allocation and provision of financial resources. For example, the Student Sports Olympiad Program was developed without specific financial estimates—a gap that, according to previous studies, has contributed to implementation challenges and threatened the program’s sustainability ( 26 ). Other research also highlighted the uneven and inefficient distribution of financial resources as a major barrier to effective program implementation ( 22 , 25 , 26 ). Therefore, it is recommended that future policy development place particular emphasis on designing transparent, well-documented, and realistic financial mechanisms.

Another underemphasized area in the policy documents is the promotion of active commuting, such as walking and cycling, which research showed that it can be an effective strategy to increase physical activity among children and adolescents ( 27 ). However, the reviewed documents lack concrete operational measures for developing safe routes, motivational programs, and related educational initiatives. Khodanazari and co-workers reported that the rate of active commuting among students is low, at approximately 10% ( 28 ). Additionally, the experience of Scotland’s “Cycling Action Plan” demonstrated that success in this area requires clear operational frameworks, dedicated budget allocations, and targeted intersectoral collaboration ( 29 ). Given the environmental and economic benefits of this strategy, it is recommended that future policy documents place greater emphasis on promoting active commuting.

Although many policy documents emphasize the importance of raising awareness and promoting a culture of physical activity among children and adolescents, they often lack clearly defined learning objectives, measurable key messages, and effective methods for content delivery. Previous studies identified low awareness of the benefits of physical activity as a major factor contributing to low student participation ( 22 , 30 ). Additionally, a study conducted in Poland found that simply disseminating information and holding workshops—without evaluating their quality and effectiveness—resulted in diminished impact of these interventions ( 31 ).

Another significant shortcoming is the underutilization of modern media tools and communication technologies in education and awareness-raising efforts, despite evidence suggesting that such tools can greatly enhance the effectiveness of these initiatives ( 32 ). Therefore, it is recommended that existing educational programs be revised and strengthened, with a focus on behavior-oriented, interactive, and technology-based approaches.

Furthermore, the monitoring and evaluation systems for these programs tend to focus on quantitative and surface-level indicators, such as the number of training sessions held, informational posters distributed, and participation rates. In contrast, qualitative indicators, such as audience satisfaction, actual changes in physical activity levels, and improvements in physical health, have received comparatively little attention. Domestic studies also reported the inefficiency of the evaluation system for physical education in schools ( 25 , 33 ).

Furthermore, the reviewed documents reveal signs of duplicated efforts and a lack of effective coordination between the Ministry of Education and the Ministry of Health in designing and implementing monitoring systems—an issue that may undermine the efficiency and coherence of the evaluation process. Therefore, it is recommended that policymakers work toward developing a comprehensive monitoring and evaluation system based on qualitative and process-oriented indicators, while leveraging digital technologies to enhance the accuracy, transparency, and effectiveness of this system.

Ultimately, although the reviewed policy documents emphasize the need for intersectoral collaboration, such collaboration is often discussed in general and non-operational terms. Responsibilities, coordination mechanisms, and joint action plans are rarely detailed. In many cases, institutional roles are presented simply as lists, without clearly specifying which organization holds primary responsibility for implementation and accountability, an issue previously identified as a major barrier to the success of multisectoral policies ( 34 , 35 ).

In this regard, Khouzani and co-workers also highlighted the importance of addressing financial and infrastructural gaps through strengthened intersectoral collaboration ( 22 ). The development of a national framework for institutional role-sharing was identified in another study as a critical prerequisite for the successful implementation of school-based physical activity initiatives ( 36 ). Furthermore, international experience —for example, in Finland— shows that successful intersectoral policies require clearly defined shared objectives, an independent leadership structure, and a well-designed system for institutional coordination ( 37 ). Based on these insights, it is recommended that a comprehensive intersectoral action plan be developed, with clearly defined roles, mechanisms for joint monitoring and evaluation, and an independent leadership structure, as fundamental prerequisites for effective policymaking.

4.1. Limitations

This study aimed to provide a comprehensive overview of national policies and programs that promote physical activity among children and adolescents in Iran, based on an in-depth document analysis.The findings can serve as a foundation for developing more effective strategies and identifying weaknesses in current policies. However, the study had some limitations that may affect the interpretation of the results. First, despite extensive efforts to access full-text documents, only summaries or secondary reports were available in some cases. Second, the study focused exclusively on national documents, and local or regional policies were not examined. Future research is recommended to evaluate the effectiveness of local policies and analyze the implementation and impact of strategies in various settings.

5. Conclusions

This study analyzed the content of 36 existing policy documents to identify and categorize the main themes related to promoting physical activity among children and adolescents in Iran. The findings indicated that these policies primarily focus on five key areas: a school-based approach, provision of resources and infrastructure, intersectoral collaboration, education and awareness-raising, and monitoring and evaluation. However, the reviewed documents often lacked sufficient coherence, clearly defined operational strategies, and comprehensive evaluation frameworks. Moreover, limited attention was given to institutional coordination and the use of modern technologies. The results of this study provided an important foundation for understanding the current status of physical activity policies in Iran and might serve as a guide for future research and policymaking.

Acknowledgement

This research was extracted from the PhD dissertation of Ms. Somayeh Mostaghim in Health Policy at Iran University of Medical Sciences, Tehran, Iran.

Authors’ Contributions

Somayeh Mostaghim: Contributed significantly to the conception and design of the study, data acquisition, analysis, and interpretation; drafted the manuscript and reviewied it critically for important intellectual content. Mehdi Jafari: Contributed to the conception and design of the study, data collection and analysis; reviewed the mansuript critically for important intellectual content. Ahmad Ahmadi: Contributed to the acquisition and interpretation of data; drafted the manuscript and reviewied it critically for important intellectual content. All authors have read and approved the final manuscript and agree to be accountable for all aspects of the work, such as the questions related to the accuracy or integrity of any part of the work.

Conflict of Interest

None declared.

Funding

None.

Ethical Approval

The Ethics Committee of Iran University of Medical Sciences, Tehran, Iran, approved the present study with the code of IR.IUMS.REC.1401.009. As the study did not involve human participants and relied solely on publicly accessible documents, written informed consent was not required.

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