Despite the temperate climate, surrounded by pristine oceans, children in the Maldives do not meet the minimum daily physical activity (PA) requirements. Maldives is a resource inhibited country within the Indian rim. Generalist teachers are required to deliver primary physical education (PE). There is a paucity of information about Maldivian PE, and comprehensive studies of children's engagement in PA levels in this, and similar contexts are limited. Therefore, this study examined PA levels of fifth-grade students (N = 30 classes) during PE lessons from four schools in the capital city of Male'. The Health Optimising PE model conceptually framed the work. Teachers' (N = 20) perceptions of implementation barriers were reported during semi-structured interviews. Students' PA levels, lesson context and PA promotion were assessed during PE lessons with the System for Observing Fitness Instruction Time. The students averaged 31.05% (7.95 min) of PE time in moderate to vigorous PA. During 26.56% of lesson time teachers focused on skill and knowledge development, while for 10.31% of PE lesson time children were encouraged to be active during and outside of class. Programme implementation, according to the teachers, was impacted by a lack of teacher knowledge and confidence, teacher attire and perceived lack of infrastructure, resources and equipment. Recommendations to improve PE outcomes include interventions and continuous professional development aimed at enhancing teachers' knowledge and confidence towards PE, in conjunction with promotion of effective teaching strategies. Maldivian PE programmes and student health-related outcomes could be improved by addressing these barriers.