Physical Activity, Health-Related Physical Fitness, Sleep Quality, and Psychological Status Among Saudi Female University Students: A Cross- Sectional Study

Abstract Background University students are particularly vulnerable to unhealthy lifestyle behaviors, including physical inactivity, prolonged sedentary behavior, poor sleep, and psychological distress. These lifestyle factors may negatively influence both physical and mental health, particularly among young women. This study examined the relationships between physical activity, sedentary behavior, body composition, cardiorespiratory fitness, sleep quality, and psychological well-being among Saudi female university students. Methods A cross-sectional study was conducted among 73 female university students (age: 19.6 ± 1.5 years). Body mass index (BMI), body fat percentage (BF%), estimated cardiorespiratory fitness (VO₂max), grip strength, and flexibility were objectively measured. Physical activity and sedentary behavior were assessed using the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), and psychological status was assessed using the Depression Anxiety Stress Scales (DASS-21). Descriptive statistics, Spearman correlations, Mann-Whitney U tests, chi-square tests, and multiple linear regression analyses were performed. Results Body fat percentage was positively correlated with BMI (r = 0.686, p < 0.001) and sitting time (r = 0.237, p = 0.043) and negatively correlated with estimated VO₂max (r = − 0.248, p = 0.035). Sleep quality was positively associated with stress (r = 0.532, p < 0.001), anxiety (r = 0.507, p < 0.001), and depression (r = 0.332, p = 0.004). Multiple linear regression revealed that the overall model significantly predicted sleep quality (R² = 0.473, adjusted R² = 0.388, p < 0.001). Stress was the only significant independent predictor of poorer sleep quality (β = 0.469, p = 0.002). Conclusions Among Saudi female university students, sleep quality was more strongly associated with psychological stress than with physical activity or cardiorespiratory fitness. Lower fitness was associated with less favorable body composition. These findings highlight the importance of integrated lifestyle and mental health interventions targeting sleep hygiene, stress management, and physical health in young women.