Some weeks ago, the Ministry for Health and Active Ageing launched the Strategy for Health-Enhancing Physical Activity (HEPA) 2025-2030 to promote physical activity among the various sectors of the Maltese population.
The strategy adopts a whole of society, systemic approach, including sectors like health, education, transport, environment and urban planning, in a collaborative effort to encourage children, young people and adults alike to reduce their sedentary behaviours and increase their physical activity up to the standards recommended by the World Health Organisation (WHO).
Physical activity (PA) has not only the apparent well-documented physical health benefits, but it also promotes mental health and well-being as recent research has been increasingly showing us. In the case of children and adolescents, it has clear benefits for their physical health, emotional regulation, academic learning and achievement, social competence and relationships, and mental health and well-being.
One of the key recommendations of the HEPA strategy for children and adolescents is that they do at least one hour of moderate to vigorous physical activity per day, particularly aerobic activity, while reducing the amount of sedentary time.
It is ironic that despite their high energy level, as well as the various central and local government initiatives and school-based campaigns to encourage PA among children and adolescents, adolescents engage in less PA than that recommended for their health and well-being. Their sedentary behaviour, such as long hours of screen time (from six to nine hours every day), has become a cause of serious concern and has been linked to various psychological and mental health issues.
The latest HBSC study by WHO, including adolescents from about 50 countries, reported that when compared with international peers, Maltese adolescents spend less time on physical activity and sports, and more time on the screen, particularly recreational screen time. They have one of the highest rates of problematic use of the internet when compared with peers from other European countries, with girls at higher risk.
In a study we have published last month in the international journal Children − Paediatric Mental Health, we examined the relationship between PA and well-being among 399,794 15-year-old adolescents from 64 high- and middle-income countries around the world, including Malta.
The study made use of latest dataset from the Programme for International Student Assessment (PISA), the world’s largest comparative education survey of adolescents. As expected, we found that, after controlling for individual, family and school factors, PA is positively and significantly associated with life satisfaction and well-being. This finding holds for the pooled sample, as well as across the 64 countries analysed. However, the overall average rate of 4.53 hours of PA per week falls short of the 60 minutes of daily moderate to vigorous physical activity recommended by WHO.
We also found that male adolescents have higher levels of well-being and PA than females, the difference being particularly striking in PA. Males engage in more weekly PA than females, while PA is considerably below average for females.
“Their sedentary behaviour, such as long hours of screen time, has become a cause of serious concern and has been linked to various psychological and mental health issues”
This pattern is reflected also in the Maltese sample, but another notable finding is that Maltese female adolescents have the lowest rate of PA among the 64 countries in the study, with less than two hours of PA per week. This is particularly concerning as Maltese 15-year-old females are not only experiencing lower levels of well-being and life satisfaction but, at the same time, they are deprived of the potential protective benefits of PA for their well-being and mental health.
Other current research among European adolescents, including Malta, shows that over the last 20 years, there has been a notable decline in the well-being of female adolescents, putting them at risk of mental health issues. The latest HBSC study by WHO (2024) shows that Maltese 15-year-old girls are particularly vulnerable to both physical and psychological health symptoms. The newly released ESPAD study reported higher substance use (cigarettes, alcohol, cannabis and prescribed tranquilisers) and use of social media by 15- to 16-year-old Maltese girls when compared to males.
These findings clearly underline that within the universal HEPA strategy, we also need to have a strategic focus on particular groups who may be at risk, such as female adolescents. We need to examine what is keeping our female adolescents away from regular and daily PA, such as the hold and addiction of social media, academic pressure and societal attitudes towards female participation in exercise and sports and the availability of resources and support for female engagement in PA.
The first step in a strategic focus on PA among female adolescents, is to engage with female adolescents themselves to explore what are the obstacles (individual, systemic, societal) which may be preventing them from engaging in more daily PA and what may help them to increase their PA.
Working with the adolescent girls themselves to remove potential barriers and make it easier for them to engage more regularly in PA within the various systems in their lives, such as the family, school and community, while providing adequate resources, is an important step forward in addressing this issue.
This could be part of a broader five-year strategy to promote and protect the well-being and mental health of adolescent girls in Malta. Today’s adolescents are the parents of tomorrow’s children, and investing in their health and well-being today, is an investment in an upcoming healthier generation in line with the Malta Vision 2050.
Carmel Cefai is head of the WHO Collaborating Centre on the Promotion and Protection of Mental Health in Schools at the University of Malta.
References
Cefai, C., Barrado, B., Gimenez, G., & Cavioni, V. (2025). Adolescents’ Life Satisfaction, Physical Activity and the Moderating Role of Gender: A Cross-Country, Multilevel Analysis in 64 Countries. Children, 12(10), 1375.