First Physical Activity Report Card for Children and Youth in Lebanon Patrick Abi Nader, Lina Majed, Susan Sayegh, Lama Mattar, Ruba Hadla, Marie Claire Chamieh, Carla Habib Mourad, Elie-Jacques Fares, Zeina Hawa, and Mathieu Bélanger Background: Evidence on physical activity (PA) indicators for children and youth at a national level is necessary to improve multilevel support for PA behaviors. Lebanon’s first Physical Activity Report Card for children and youth (2018) aimed to fill this gap. Methods: In line with the recommended methods of “Global Matrix 3.0,” nationally representative data were retrieved from peer-reviewed manuscripts, national surveys, and government reports. In addition to adopting the 10 indicators of “Global Matrix 3.0,” publications that discussed weight status were also retained. A grade was assigned for each indicator using a standard rubric: A = 80% to 100%, B = 60% to 79%, C = 40% to 59%, D = 20% to 39%, F = <20%, and INC = incomplete data. Results: Four indicators (active play, family and peers, community and environment, and physical fitness) received an “INC.” Three indicators (overall PA, active transportation, and school) received a “D.” Sedentary behaviors received a “C-.” Weight status received a “C.” Government received a “C+.” Organized sport received an “F.” Conclusions: PA participation among Lebanese children and youth is low. Stakeholders should aim to improve low PA indicators grades. Gaps in the literature also need to be filled to inform on the status of all indicators. Keywords: active transport, obesity, sport, sedentary behavior, recreation In light of the international childhood obesity crisis 1 and the prevailing low proportions (20%) of children and youth who meet the physical activity (PA) guidelines of 60 minutes per day of moderate- to vigorous-intensity PA, 2 an international alliance of researchers was created. 3 In 2014, Active Healthy Kids Canada and subsequently the Active Healthy Kids Global Alliance led interna- tional efforts to implement country-specific PA report cards to assess how successful a nation is at promoting and providing PA opportunities for its children and youth. 4,5 Country-specific report cards were combined into “Global Matrix 1.0” 4 and “Global Matrix 2.0.” 5 Results from global matrices were to foster collaborations between international stakeholders and open up a platform where different countries learn from the successes and failures of other countries. 3 Results from the first 2 iterations of the “Global Matrix” may not be generalizable to all countries. The Republic of Lebanon, a small country (10,452 km 2 ) in the Middle East, has had a very politically unstable history, 6 and most recently has been one of the 3 primary countries to host the largest number of Syrian refugees. 7 Among Middle Eastern countries, Lebanon is considered a high developing country (high development index = 0.763) and uses 3.0% of its total gross domestic product on public health expendi- ture. 7 By 2020, Lebanon is expected to have a population greater than 6 million, a population density of 588 persons/km 2 , and a vast majority (88.8%) of its residents living in urban dwellings. 8 In “Global Matrix 1.0,” there were no countries representing the Middle East. 4 Two countries (Qatar and the United Arab Emirates) represented the Middle East in “Global Matrix 2.0.” However, Qatar and the United Arab Emirates are considered as very high developing countries and their profiles are different from Lebanon’s. 7,8 Previously published report cards are not applicable to the unique Lebanese context. In addition, there have been very few published studies discussing the status of childhood obesity and physical inactivity in this country. In 2003, Sibai et al 9 reported that 18.6% and 4.8% of Lebanese youth (3–19 y old) were overweight and obese, respectively. The authors also found that lack of PA was associated with greater odds of obesity. 9 Since then, there has been only one other nationally representative study that evaluated the weight status of Lebanese youth. 10 In this most recent study, authors found that 34.8% and 13.2% of Lebanese youth were overweight and obese, respectively. 10 Furthermore, both studies reported participation in PA using 3 weekly frequency cutoffs (did not participate in any PA during the week, participated in 1–2 session of PA per week, and participated in more than 2 sessions of PA per week). 9,10 This method of classifying PA participation does not allow the evaluation of whether or not Lebanese youth are meeting PA guidelines. Finally, to date, there have been no national efforts to synthesize and grade available data on the 10 common PA indicators that were adopted by the “Global Matrix 3.0” and weight status. 11 Aiming to support PA advocacy efforts in Lebanon, the purpose of this study was to synthesize and grade currently available evidence on the performance of Lebanon on 11 indicators (the 10 PA indicators as recommended by “Global Matrix 3.0” 11 Abi Nader and Bélanger are with the Centre de formation médicale du Nouveau- Brunswick, Moncton, New Brunswick, Canada. Abi Nader is also with the Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada. Majed is with Sport Science Program, College of Arts and Sciences, Qatar University, Doha, Qatar. Sayegh is with Exercise is Medicine Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar. Mattar and Hadla are with Nutrition Program, Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon. Chamieh, Habib Mourad, and Fares are with the Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon. Hawa is with The Chain Effect, Beirut, Lebanon. Bélanger is also with the Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Canada; and the Office of Research Services, Vitalité Health Network, Moncton, New Brunswick, Canada. Abi Nader (Patrick.abi.nader@umoncton.ca) is corresponding author. 1 Journal of Physical Activity and Health, (Ahead of Print) https://doi.org/10.1123/jpah.2018-0473 © 2019 Human Kinetics, Inc. ORIGINAL RESEARCH