Rural-urban differences in meeting physical activity recommendations and health status in cancer survivors in central Pennsylvania

Abstract

Background: This study explored rural-urban differences in meeting physical activity (PA) recommendations and health status in cancer survivors in central Pennsylvania and associations between PA and health status. Methods: Cancer survivors (N=2,463) were identified through a state cancer registry and mailed questionnaires assessing PA and health status. Rural-urban residence was based on county of residence at diagnosis. Participants self-reported frequency and duration of leisure-time PA and were classified as: 1) meeting aerobic recommendations (≥150 minutes/week), 2) muscle-strengthening recommendations (≥2 times/week), 3) both aerobic and muscle-strengthening recommendations, or 4) neither recommendation. Logistic regression models examined associations between rural-urban residence and meeting PA recommendations and associations between PA and health status, adjusting for cancer type, gender and income. Results: Nearly 600 (N=591, 24.0%) cancer survivors returned completed questionnaires (rural 9.5%, urban 90.5%). Half (50.0%) of rural cancer survivors reported no leisure-time PA compared to 35.2% of urban cancer survivors (p=.020), and urban cancer survivors were 2.6 times more likely to meet aerobic PA recommendations (95% CI: 1.1-6.4). Odds of reporting good physical and mental health were 2.3 times higher among survivors who reported meeting aerobic recommendations compared to those who did not meet PA recommendations (95% CI: 1.1-4.5), adjusting for rurality and covariates. Conclusions: Results demonstrate persistent rural-urban differences in meeting PA recommendations in cancer survivors and its association with self-reported health. These findings underscore the need for interventions to increase PA in rural cancer survivors in an effort to improve health status and reduce cancer health disparities in this population. dichotomized poor physical health days (≥7 days vs. <7 days), poor mental health days (≥7 days vs. <7 days), and poor physical or mental health days impeding activities (≥7 days vs. <7 days). Regression analyses included cancer type, gender, and income because they were associated with PA and rural-urban residence. Effect modification by rural-urban differences was assessed. Results Participant Characteristics Of the 2,463 cancer survivors mailed recruitment letters and questionnaires, 591 (24.0%) returned completed questionnaires and participated in this study (Figure 1); the response rate did not significantly differ between rural (19.8%) and urban (24.5%) cancer survivors (χ 2 =3.1, p=.078). Breast cancer survivors were most likely to return completed questionnaires, followed by gynecologic, prostate, and colorectal cancer survivors; lung cancer survivors were least likely to participate. Demographic characteristics, PA, and health status are summarized in Table 1 by rural-urban residence. Rural cancer survivors were significantly more likely to be unemployed (χ 2 =4.9, p=.025) than urban cancer survivors. Half (50.0%) of rural cancer survivors reported being physically inactive (re...

The impact of a hospital-based exercise oncology program on cancer treatment–related side effects among rural cancer survivors

“…Accordingly, rural was defined as a population approximately < 40,000 individuals. This is consistent with previous research that utilized RUCC 1–3 as urban location and RUCC ≥ 4 as rural [ 1 , 9 , 10 , 19 , 20 ].…”

“…Notably, declines in cardiorespiratory fitness are linked with increased mortality among cancer survivors [ 6 – 8 ]. Nationwide, evidence consistently demonstrates lower engagement in leisure time physical activity, or structured exercise, among cancer survivors in rural areas compared with urban areas [ 9 , 10 ]. Access to exercise programs and education related to the importance of exercise for cancer survivorship are postulated as the primary reasons for this disparity [ 1 , 11 ].…”

Stress and Physical Activity in Rural Cancer Survivors: The Moderating Role of Social Support

“…1 Although physical activity reduces the risk of cancer recurrence and comorbidities and improves physical and psychological well-being, 2 rural cancer survivors are less likely to meet physical activity recommendations than urban cancer survivors, contributing to cancer health disparities. 3,4 Elevated psychosocial distress (eg, fear of recurrence, anxiety, depression) is not uncommon among cancer survivors and contributes to physical inactivity and poor quality of life among rural cancer survivors. 3,[5][6][7][8] Geographic isolation, inadequate transportation, and low access to health care and supportive oncology services and resources may contribute to rural-urban differences.…”

Associations Between Physical Activity and Alcohol Consumption in Rural Cancer Survivors

“…Adults residing in rural areas tend to be older, poorer, and sicker ( 12 ) and engage in more health risk behaviors than their urban counterparts ( 13 ). In addition to being less active and more sedentary ( 14 , 15 ), rural adults tend toward extremes of alcohol use compared to their urban counterparts ( 16 ). Although more likely to abstain from alcohol use, rural adults who drink alcohol are more likely to be moderate or heavy drinkers ( 13 ).…”