Trends in Meeting Physical Activity Guidelines Among Urban and Rural Dwelling Adults — United States, 2008–2017

Geoffrey P. Whitfield, PhD; Susan A. Carlson, PhD; Emily N. Ussery, PhD; Janet E. Fulton, PhD; Deborah A. Galuska, PhD; Ruth Petersen, MD

Disclosures

Morbidity and Mortality Weekly Report. 2019;68(23):513-518. 

In This Article

Abstract and Introduction

Introduction

Since the release of the 2008 Physical Activity Guidelines for Americans (https://health.gov/paguidelines/2008/pdf/paguide.pdf), the age-adjusted percentage of adults meeting the combined aerobic and muscle-strengthening guidelines increased from 18.2% to 24.3% in 2017.[1] Trends in urban and rural areas, across demographic subgroups, and among subgroups within urban and rural areas have not been reported. CDC analyzed 2008–2017 National Health Interview Survey (NHIS) data to examine trends in the age-standardized prevalence of meeting physical activity guidelines among adults aged ≥18 years living in urban and rural areas. Among urban and rural residents, prevalence increased from 19.4% to 25.3% and from 13.3% to 19.6%, respectively. Nationally, all demographic subgroups and regions experienced increases over this period; increases for several groups were not consistent year-to-year. Among urban residents, the prevalence was higher during 2016–2017 than during 2008–2009 for all demographic subgroups and regions. During the same period, prevalence was higher across all rural-dwelling subgroups except Hispanics, adults with a college education, and those living in the South U.S. Census region. Urban and rural communities can implement evidence-based approaches, including improved community design, improved access to indoor and outdoor recreation facilities, social support programs, and community-wide campaigns to make physical activity the safe and easy choice for persons of all ages and abilities.[2–4] Incorporating culturally appropriate strategies into local programs might help address differences across subgroups.

Physical activity can lower a person's risk for several chronic diseases, including coronary heart disease, stroke, obesity, and type 2 diabetes.[3] To attain substantial health benefits, federal physical activity guidelines recommend that adults perform at least 150–300 minutes of moderate-intensity, or 75–150 minutes of vigorous-intensity aerobic physical activity per week, or an equivalent combination of moderate- and vigorous-intensity aerobic physical activity (i.e., the aerobic guideline).[3] In addition, adults should do muscle-strengthening activities of at least moderate intensity that involve all major muscle groups on ≥2 days per week (i.e., the muscle-strengthening guideline).[3]

NHIS is an annual, multistage probability sample of U.S. households designed to be representative of the civilian, noninstitutionalized U.S. population.* Among sampled adults, sample sizes ranged from 21,781 (2008) to 36,697 (2014); response rates ranged from 53.0% (2017) to 66.3% (2011). Adults reported the frequency and duration of vigorous- and light- or moderate-intensity leisure-time physical activities. The number of weekly minutes was calculated as the product of frequency (occurrences per week) and duration (minutes per occurrence). To match guidelines, the number of weekly minutes of vigorous-intensity physical activity was doubled and added to the number of weekly minutes of light- or moderate-intensity activity.[3] Participants were classified as meeting the aerobic guideline if this total was at least 150 minutes per week. Adults also reported muscle-strengthening activities§ and were classified as meeting the muscle-strengthening guideline if they reported such activity on ≥2 days per week. Participants were classified as meeting the combined aerobic and muscle-strengthening guidelines if they met both the aerobic and muscle-strengthening guidelines as defined.

The annual, age-standardized prevalence of meeting the combined guidelines was calculated for each year. Results were stratified by demographic characteristics (self-reported sex, age, race/ethnicity, and level of educational attainment), Census region of residence, and urban or rural residence (classified according to the U.S. Census Bureau definition).[5] Results for the racial/ethnic group "non-Hispanic other" are presented for reference purposes but were not interpreted because multiple races were combined and the sample sizes were small. Trends were assessed using age-adjusted logistic regression and orthogonal polynomial contrasts. When trends deviated from linearity, the best-fitting model was identified using sequential permutation tests in JoinPoint (version 4.7.0.0; National Cancer Institute)**; slopes from the selected model provided annual percentage point changes. To quantify doubly stratified changes over the period, the first 2 and last 2 years of data (i.e., 2008–2009 and 2016–2017) were combined, and prevalence of meeting the combined guidelines was estimated separately for urban and rural residents, stratified by demographic characteristics and region. Differences between periods were tested using adjusted Wald tests. Results with p-values <0.05 were considered statistically significant. Weighted analyses were performed in Stata (version 15; StataCorp) following NHIS analytic guidelines.

From 2008 to 2017, the age-standardized prevalence of meeting the combined physical activity guidelines increased 30.4% among urban residents (from 19.4% to 25.3%) and 47.4% among rural residents (from 13.3% to 19.6%) (Figure). The prevalence increased across all demographic subgroups, among residents of urban and rural areas, and in all Census regions (Table 1). The overall average annual percentage point change ranged from 0.3 (adults aged 45–64 years and those with some college education) to 0.7 (adults aged 25–34 years and those residing in the Northeast). Increases stalled in middle years overall and for several subgroups (women, adults aged 25–34 years, non-Hispanic whites, adults with at least some college education, urban residents, and adults in the Midwest and West). For example, among urban residents, the prevalence increased 1.1 percentage points per year from 2008 to 2010 (95% confidence interval [CI] = 0.3–2.0), followed by a nonsignificant 0.1 percentage point increase per year from 2010 to 2015 (95% CI = −0.2–0.4), then increased 1.6 percentage points per year from 2015 to 2017 (95% CI = 0.8–2.4).

Figure.

Age-standardized prevalence (with 95% confidence interval) of meeting the combined aerobic and muscle-strengthening physical activity guidelines among adults, by urban and rural residence — National Health Interview Survey, United States, 2008–2017

Among residents of urban areas, the prevalence of meeting the combined physical activity guidelines was higher overall during 2016–2017 (24.4%) than during 2008–2009 (19.8%), as well as across all demographic subgroups and in all Census regions (Table 2). Among rural residents, the prevalence increased across all demographic and regional subgroups except Hispanics (2008–2009 prevalence = 11.0%; 2016–2017 prevalence = 12.4%), adults with a college education (25.5%; 28.0%), and adults residing in the South Census region (13.2%; 14.7%).

* https://www.cdc.gov/nchs/nhis/index.htm.
Leisure-time physical activity prompt: "The next questions are about physical activities (exercise, sports, physically active hobbies…) that you may do in your LEISURE time." Frequency of vigorous-intensity activity: "How often do you do vigorous leisure-time physical activities for at least 10 minutes that cause heavy sweating or large increases in breathing or heart rate?" Duration: "About how long do you do these vigorous leisure-time physical activities each time?" Frequency of light to moderate intensity activity: "How often do you do light or moderate leisure-time physical activities for at least 10 minutes that cause only light sweating or a slight to moderate increase in breathing or heart rate?" Duration: "About how long do you do these light or moderate leisure-time physical activities each time?"
§ Frequency of muscle-strengthening activity: "How often do you do leisure-time physical activities specifically designed to strengthen your muscles such as lifting weights or doing calisthenics?"
Estimates were age-adjusted using the 2000 U.S. population as the standard population and using five age groups: 18–24, 25–34, 35–44, 45–64, and ≥65 years.
** https://surveillance.cancer.gov/joinpoint/.

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