Smartwatch adoption and physical activity levels in Saudi Arabia: implications for digital health interventions

<p><strong>Background:</strong> Wearable devices such as smartwatches are increasingly used for self-monitoring of physical activity; however, evidence regarding their association with physical activity levels in Middle Eastern settings remains limited. This study examined the relationship between smartwatch use and physical activity among adults in Saudi Arabia, using the World Health Organization Global Physical Activity Questionnaire.<br /><strong>Methods:</strong> A cross-sectional online survey was conducted between August 2024 and February 2025 among Saudi adults aged &ge;18 years (n = 1,082), recruited through social media platforms. Data collected included sociodemographic characteristics, smartwatch ownership and usage patterns, and physical activity quantified as metabolic equivalent task minutes per week (MET-minute/week). Multivariable linear regression models were used to identify factors independently associated with physical activity level.<br /><strong>Results:</strong> The mean participant age was 27 &plusmn; 11 years, and 51% were female. Overall, 56% reported smartwatch use, with Apple Watch being the most commonly reported device (40.8%). Smartwatch users had higher physical activity levels compared with non-users (5,284 &plusmn; 7,821 vs. 4,098 &plusmn; 6,987 MET-minute/week; p = 0.014) and were more likely to meet WHO physical activity recommendations (71.5% vs. 63.3%; p = 0.008). Activity tracking was the most frequently reported smartwatch function (47%) and was associated with higher activity levels. In multivariable analyses, male sex (&beta; = 2,563.65; p &lt; 0.001), employment status (&beta; = 1,663.97; p = 0.044), and smartwatch use for general health monitoring (&beta; = 1,439.03; p = 0.037) were independently associated with higher physical activity.<br /><strong>Conclusion:</strong> Smartwatch use was associated with higher physical activity in this convenience sample of Saudi adults; the findings may not be generalizable to older, rural, or less technology-engaged populations.&nbsp;</p>