Physical activity (PA) is any body movement that raises energy expenditure above the resting metabolic rate through muscle contraction (1). Globally, non-communicable diseases (NCDs) such as cancer, cardiovascular diseases, diabetes, and common mental disorders (CMDs) like depression and anxiety are endemic (2, 3). Also, NCDs are increasingly becoming the leading cause of mortality in sub-Saharan Africa, accounting for 37% of the mortality burden (4). The burden is eve n greater in low-income countries like Zimbabwe, where the NCD-related mortality is 39% (5). Further, the magnitude of mental disorders in Zimbabwe as is globally, is growing exponentially, with anxiety and depressive disorders affecting 2.8% and 4.0% of the Zimbabwean population, respectively (6). Unfortunately, a massive mental healthcare treatment gap (discrepancy between people in need of care against available care resources) exists globally, with low-resourced countries disproportionally affected (7). Given the high mental healthcare treatment gap in low-income countries, it is essential to explore multiple treatment strategies, including physical-activity interventions. The numerous health benefits of regular PA engagement include the prevention and management of NCDs is uncontested (8, 9). Unfortunately, PA is slowly being replaced by a more sedentary lifestyle in the modernised population. For instance, about 27.5% of the adult global population (10) are sufficiently physically active. Further, 23% and 31% of Zimbabwean males and females are physically active compared to 22.1% of the African region’s adult population (11, 12). University students are no exception; for example, the estimated prevalence of physical inactivity in European and Sub-Saharan African university students is approximately in the ranges of 60%–91% and 37.1–62.5%, respectively (13–16). Low PA levels in young adults are concerning as PA engagement behaviours persist throughout the lifespan. For example, physically inactive people in adolescence and young adulthood are unlikely to achieve ideal PA levels in adulthood (17). Thus, it is vital to intervene early and promote healthy lifestyles anchored on increasing PA levels among adolescents and young adults, particularly university students.

The Health Belief Model (HBM) is one of the leading models for understanding health behaviours, and designing and evaluation of interventions to increase positive health behaviours (18, 19). The HBM model posits that health-related behaviours are influenced by perceived; barriers, benefits, severity, self-efficacy, and susceptibility (20). For example, if individuals perceive a negative health outcome to be severe, perceive themselves to be susceptible to it, perceive the benefits of behaviours that reduce the likelihood of that outcome to be high, and perceive the barriers to adopting those behaviours to be low, then the individual is likely to engage in positive health-seeking behaviour(s) (21). Given the high burden of physical inactivity, it is essential to apply the HBM as a conceptual framework to understand the multiple factors that may influence the rate of physical activity engagement among university students. For example, past studies have demonstrated that internal factors (e.g., perceived barriers and benefits) and external/environmental factors (e.g., availability of exercise facilities) predict PA engagement behaviours and patterns among university students and other populations (22, 23). Commonly perceived benefits to exercise among university students include; enhanced vitality, social interaction, recreation, and better sleep quality (14, 17, 24, 25). Inversely, ubiquitous perceived barriers to exercise engagement include negative experiences at school during physical education, personal factors (e.g., motivation, self-consciousness about appearance), lack of social support, time constraints, physical exertion and lack of safe spaces to engage in physical activity (17, 25–27). Although there is a fair understanding of the common benefits and barriers to exercise engagement among university students, the variations in settings, behaviours and cultural norms warrant contextualised epidemiological data. Further, most of the information has been from high-income countries and may have limited applicability in low-income countries due to context differences (28). Also, a granular understanding of the context-specific perceived benefits to exercise is crucial to understanding and developing bespoke interventions targeting university students (29).

As the global burden of CMDs continues to rise, there is a great propensity to explore alternative and complementary non-pharmacological and transdiagnostic therapeutic options for managing CMDs (9). Physical activity is widely recognised as a valid treatment for anxiety and depression (8, 30, 31). A meta-analysis of prospective cohort studies revealed that people with high self-reported PA (vs. low PA) were at reduced odds of developing anxiety (adjusted odds ratio = 0.748 95%CI = 0.629, 0.889; p-value = 0.001) and depression (adjusted odds ratio = 0.83, 95%CI = 0.79, 0.88; p < 0.0001) (30, 32). Further, a systematic review to investigate the feasibility and efficacy of exercise therapy for patients with depression found that moderate-intensity exercise reduces depressive symptoms, with higher-dose exercise associated with greater overall functioning and well-being (33). For university students, greater perceived benefits of exercise are associated with greater physical engagement and higher physical activity levels, positively affecting mental health and health-related quality of life (HRQoL) (14). Several studies have shown HRQoL gains attributed to physical activity across different populations (34–36). However, there is a paucity of published evidence regarding physical activity levels and factors affecting exercise engagement among university students in the Sub-Saharan region. Of the few studies available, Kgokong and Parker (14) conducted a cross-sectional study among South African physiotherapy students, N = 296 to describe the levels of PA and benefits and barriers to exercise for undergraduate physiotherapy students attending university in the Western Cape of South Africa. This study suggests that undergraduate physiotherapy students in the Western Cape universities do not engage in adequate PA. In this group of students, benefits associated with high PA related to physical performance and barriers associated with low levels of PA related to physical exertion. However, the study only recruited physiotherapy students, who are more likely to be knowledgeable about exercise benefits and barriers, thus creating selection bias. It is essential to understand exercise behaviours across all healthcare programs. Also, participants were drawn from one province, a threat to the study’s internal and external validity. Further, South Africa is an upper-middle income country, and comparability of the study to other Sub-Saharan countries could be limited. Given the research gaps, and need for contextualised data, this paper primarily sought to investigate the barriers and facilitators to physical activity engagement in Zimbabwean undergraduate students. We also sought to determine correlates of perceived barriers and benefits to; physical activity engagement, mental health disorders and perceived HRQoL. Results from this study can aid in developing bespoke and contextual solutions to promoting physical activity to improve health and well-being among university students from low-income countries.

This study evaluated the perceived barriers and facilitators to physical activity in Zimbabwean university students and associated factors. Overall, our study outcomes show that university students were strongly knowledgeable of the benefits of exercising with physical performance, life enhancement and psychological impacts cited as major benefits. Time constraints, physical exertion, and lack of exercise infrastructure were major barriers to exercise. Also, a higher quality of life was associated with an increased perception of benefits. Last, lower socio-economic status and poor mental health were associated with increased barriers to exercise.

Participants scored highly on the benefits subscale, i.e., a mean of 95 ± 11.4. Our results are comparable to studies done on American and Saudi Arabian university students, which yielded mean EBBS benefits subscale scores of 94 ± 11 and 95 ± 10, respectively (27, 44). University students are likely to have high health literacy, contributing to the high perception of the benefits of exercise (14). A high educational level is linked to increased positive health-information-seeking behaviours and high health literacy, which may be invariably linked to favourable perceptions of physical activity's health benefits (14, 45). Also, university students are exposed to various health promotional activities, such as campus-wide health expos and educational talks, which may increase their knowledge of the benefits of exercise (46). At the sub-domain level, university students highly endorsed the positive effects of exercise on physical performance, life enhancement and psychological impacts. Elsewhere, South African physiotherapy students (N = 296) highly ranked the physical performance and psychological impacts of exercise (14). This was attributable to the advanced health education in the physiotherapy training curriculum (14). Other studies have shown that preventive health, physical performance and life enhancement are high motivators of exercise engagement among university students (24, 27). For instance, university students are likely to engage in physical activity as a stress-coping mechanism (24, 27).

In this study, university students experienced moderate barriers to exercising, with a mean barriers’ subscale of 28.6 ± 5.4. These results are comparable to studies done on American and Indian university students, which yielded mean EBBS barriers subscales of 28.5 ± 6.7 and 29.5 ± 7, respectively (44, 47). The high comparability suggests that barriers to exercise among university students are universal across socio-economic contexts. At the subscale level, the most perceived barriers to exercising were time constraints, physical exertion, and exercise infrastructure. Most students perceived exercise as taking too much time from studies and family responsibilities. This finding was similarly reported in Spanish (48), Saudi Arabian (49) and German students (50), who reported that they would instead use their free time to prepare for exams or socialising than engage in physical exercise. As noted in a systematic review (51), our outcomes show that physical exertion is a barrier to exercising by students. Exercise can be physically and cognitively demanding, and if not addressed, perpetual fatigue may lead to decreased PA engagement. A South African also showed that time constraints and physical exertion are substantial barriers (38). Also, the lack of exercise facilities was a significant barrier to exercise engagement in this study. This was unsurprising as there are few to no state-subsidized on-campus exercise facilities in Zimbabwe. Elsewhere, 75% of Saudi university students cited the lack of public exercise facilities as a barrier to exercising (52). In contrast, in a study on German students (N = 689), only 2.9% perceived the availability of facilities/programs as a barrier to exercise as the university sports program is offered at low to no cost (50).

Most participants were classified as having moderate to high PA levels. These reported levels of PA engagement may be attributed to structural challenges university students face in this context. In a study to document objective PA trajectories in students in the USA (N = 805), participants were more active during structured days (i.e., school days); this finding was expected because most students had to walk to or around campus during weekdays similar to the setting in our study (53). Further, a study among Indian university students (N = 255) showed that the high to moderate physical activity levels among university students might be due to environmental factors, including lack of access to reliable on-campus transportation. Consequently, students tend to be more physically active when reliant on active transportation, such as cycling or walking to and around campus (54). No association was found between PA levels and barriers or benefits to exercise. Other factors may have influenced physical activity levels in students in this sample.

Unadjusted odds ratios from the univariate analysis suggests that poor mental health and low socio-economic status are salient barriers to PA engagement in university students. Although these unadjusted outcomes are subject to confounding and co-variation biases, our study findings showed a high burden of CMDs in university students. Also, poor mental health was associated with an increased likelihood of perceived barriers to exercise. Poor mental health functioning is related to a lack of energy and motivation for PA engagement, creating a vicious cycle of poor physical and mental health (55, 56). A systematic review by Sheldon et al. (57) reported similar findings: negative exercise perceptions were associated with an increased risk of CMDs in international undergraduates. Also, participants with chronic conditions reported more exercise barriers. Chronic illness is associated with lethargy, bodily pain and fatigue, contributing to reduced physical endurance; thus, participants would perceive more barriers to physical activity engagement (30). Notably, a chronic condition, such as CMDs, acts as a stress inducer, adding to the pre-existing academic stress in students, which may exacerbate exercise-avoidance behaviours (55, 56).

University students of lower socioeconomic status were likelier to experience significant exercise barriers. Studies have shown that reduced physical activity engagement among the low SES population is due to a lack of resources, low motivation, fatigue and lack of energy and financial restrictions (58–61). In our context, students may not afford monthly off-campus gym facilities subscriptions due to the prevailing socio-economic challenges. Lastly, our study also shows that university students with a higher self-assessed HRQoL were likelier to perceive exercise benefits. Other studies have indicated that perceived benefits to physical activity were associated with an increased compulsion to greater physical engagement. Increased PA engagement then leads to reductions in the risk of NCDs, leading to increased HRQoL overall (14, 62, 63).

Our study shows that university students strongly perceive the benefits of exercise with an associated higher HRQoL. Also, poor mental health, low socio-economic status, chronic illness, a lack of exercise infrastructure, time constraints and physical exertion were significant barriers to exercise in this setting. Zimbabwean universities are encouraged to invest in several initiatives to increase PA in university students. For instance, considerations should be made to promote the use of non-conventional exercise spaces like open spaces with adequate security and lighting, allowing students access at any time. Significantly, health promotion activities, including physical activity counselling and education, may increase awareness of the health benefits of PA, including dispelling the perceived myths and barriers around regular physical activity engagement.