Abstract

Introduction: Physical inactivity in environmentally challenged cities represents a critical public health concern, particularly in regions experiencing extreme environmental conditions. While research has documented correlations between environmental conditions and physical activity levels, limited attention has been paid to how communities experience and adapt to environmental barriers, especially in non-Western contexts. This study aims to explore how residents in Ahvaz, Iran—one of the world's most polluted cities and highest level of insufficient physical activity in Iran—perceive and respond to barriers to physical activity, with particular focus on environmental justice implications.

Methods: This qualitative study employed an exploratory design utilising in-depth semi-structured interviews with physically inactive adults in Ahvaz from May to July 2024. Eligibility was determined using the International Physical Activity Questionnaire (IPAQ) short form. Purposive maximum variation sampling ensured diverse representation across socioeconomic status, gender, age, and educational backgrounds. The interview protocol underwent iterative refinement, including pilot testing with five community members to ensure cultural appropriateness and question clarity. All interviews were conducted in Persian, audio-recorded using dual devices with comprehensive field notes documenting contextual factors. Verbatim transcription in Persian was followed by member checking with 15 participants (46.8%) before professional translation to English. Data saturation was determined through iterative analysis. The analytical process employed Naeem et al.'s six-phase thematic analysis approach. Initial coding frameworks were iteratively refined through constant comparison techniques and team-based interpretive validation. Trustworthiness was established through Lincoln and Guba's criteria, including prolonged field engagement, triangulation through multiple data sources, team debriefing sessions, and cultural consultation with internationally diverse co-investigators from Jundishapur University and Kyoto University.

Results: Analysis of data from 32 participants (53.1% female, aged 19-59 years) revealed three interrelated themes: Environmental and Infrastructure Barriers (characterised by extreme climate conditions exceeding 50°C, frequent dust storms with PM2.5 concentrations surpassing safety thresholds, and severely inadequate public recreational facilities); Sociocultural and Individual Dynamics (manifesting as gender-specific constraints particularly affecting women's outdoor activities, internalised resignation towards environmental limitations, and community-wide psychological adaptations including normalised physical inactivity); and Economic and Access Issues (encompassing direct financial barriers to access private facilities, socioeconomic disparities in residential proximity to limited green spaces, and structural inequities in resource allocation). Participants consistently expressed environmental injustice through comparative references to better-resourced urban areas and perceptions of governmental neglect. Significant behavioural adaptations included the development of indoor activity alternatives (primarily unhealthy) and altered daily routines to cope with environmental constraints, often accompanied by expressions of pessimism regarding the potential for environmental improvement. 

Conclusion: This study reveals the intricate interplay between environmental stressors, sociocultural factors, and economic constraints that influence physical activity behaviours in environmentally challenged contexts. The findings contribute to a theoretical understanding of how issues of environmental justice affect health behaviours and inform practical interventions that address physical inactivity in similar settings globally.

Implications: The findings underscore the necessity for context-specific interventions, including climate-adaptive infrastructure (shaded exercise spaces), culturally responsive programming, and policy reforms that address environmental inequities. This research offers actionable insights for addressing health disparities in rapidly urbanising regions facing environmental challenges.