Rural–Urban Differences in Objective and Subjective Measures of Physical Activity: Findings From the National Health and Nutrition Examination Survey (NHANES) 2003–2006

Abstract

IntroductionLower levels of physical activity among rural relative to urban residents have been suggested as an important contributor to rural–urban health disparity; however, empirical evidence is sparse.MethodsWe examined rural–urban differences in 4 objective physical activity measures (2 intensity thresholds by 2 bout lengths) and 4 subjective measures (total, leisure, household, and transportation) in a nationally representative sample of participants in the National Health and Nutrition Examination Survey (NHANES) 2003–2006. The sample comprised 5,056 adults aged 20 to 75 years. Rural-Urban Commuting Area (RUCA) codes were matched with NHANES subjects to identify urban status and 2 types of rural status. Rural–urban and within–rural differences in physical activity were estimated without and with controls for demographic and socioeconomic variables.ResultsRural residents were less active than urban residents in high-intensity long bout (2,020 counts per minute threshold and 10 miniutes or longer bout length) accelerometer-measured physical activity (42.5 ± 6.2 min/wk vs 55.9 ± 2.8 min/wk) but the difference disappeared with a lower-intensity threshold (760 counts per minute). Rural residents reported more total physical activity than urban residents (438.3 ± 35.3min/wk vs 371.2 ± 12.5 min/wk), with differences primarily attributable to household physical activity. Within rural areas, micropolitan residents were less active than residents in smaller rural areas. Controlling for other variables reduced the size of the differences.ConclusionThe direction and significance of rural–urban difference in physical activity varied by the method of physical activity measurement, likely related to rural residents spending more time in low-intensity household physical activity but less time in high-intensity physical activity. Micropolitan residents were substantially less active than residents in smaller rural areas, indicating that physical activity did not vary unidirectionally with degree of urbanization.

Urban‐Rural Differences in Aerobic Physical Activity, Muscle Strengthening Exercise, and Screen‐Time Sedentary Behavior

“…The items used to measure aerobic PA in this study, however, had participants more broadly consider “any physical activity or exercise,” and it thus reflects total aerobic PA. Indeed, the findings of this study are in agreement with a study by Fan et al, in which the authors examined urban‐rural differences in PA using accelerometer and survey measures . In their analysis of accelerometer data, these researchers found no evidence for differences between urban and rural residents when using a low‐intensity cut‐off point to measure total aerobic PA.…”

“…21,22 Using accelerometer data of a nationally representative sample, Fan and associates found no difference between urban and rural residents' total aerobic PA levels; these authors did note that PA patterns differed such that rural residents engaged in less vigorousintensity PA, and they suggested that urban-rural health disparities may be attributable in part to this difference, or, alternatively, due to differences in other PA-related behaviors. 23 Limited literature has investigated differences in the other PA-related behaviors corresponding to national guidelines. One study conducted by Trivedi and colleagues found US rural residents to be slightly more likely to engage in 4 hours or more of leisure screen-time sedentary behavior (this is a subset of total sedentary behavior that may be particularly health-compromising).…”

An ecological analysis of environmental correlates of active commuting in urban U.S.

“…In addition, educational attainment is also associated with more awareness of the health benefits of AC and a stronger concern about environmental problems resulting from motorized transportation, which may facilitate the adoption of AC (Dietz et al, 1998). Past studies have found college graduates engage in more leisure time PA than individuals with lower levels of education (Cerin et al, 2009, Fan et al, 2014b, Fan et al, 2014c). Apparently, this association extends to the transportation domain of PA as well.…”

Built environment and obesity by urbanicity in the U.S.

“…Unless there is evidence of different behavior in food and beverage intakes or different metabolism, one may question the reliability of PI (a subjective assessment loosely defined) in comparison to OB (a rather more objective measure based on BMI) (Wang et al 2013: 10–11). Also see Fan, Wen and Kowaleski-Jones (2014) for the difference in subjective and objective PI measures. We will keep this in mind, and hereafter focus more on the MLM results on obesity.…”