Rural-Urban Differences in Accelerometer-Measured Physical Activity Among US Adults: Findings From the REGARDS Study

Previous studies show rural populations face elevated chronic disease risk and barriers to physical activity (PA). We examined how PA varies across rurality using the Rural Urban Commuting Area (RUCA) 4-category system.

Accelerometer data from Black participants and White participants in the REasons for Geographic and Racial Differences in Stroke cohort study were analyzed across RUCA classification: isolated, small rural, large rural, and urban. PA was categorized into 3 intensities based on counts per minute (CPM): sedentary behavior (SB, <50 CPM), light-intensity physical activity (LIPA, 50-1064 CPM), and moderate-to-vigorous intensity physical activity (≥1065 CPM).

Data were from 7317 participants (age 63.5 [8.5] y, 46% men, 32% Black, 79% urban). Urban participants engaged in the most SB (690.6 [117.6] min/d) and the least LIPA (187.5 [78.1] min/d). Rural residents engaged in significantly more LIPA and less SB than urban residents in fully adjusted models. Moderate-to-vigorous intensity physical activity was low across RUCA groups (mean 13.1 [17.6] min/d). A significant interaction was observed between education and RUCA category for LIPA (P = .03). Individuals in small rural areas with less than a high school education engaged in 46.7 more minutes per day of LIPA than urban residents with a college education (P = .001).

Moderate-to-vigorous intensity physical activity was low across RUCA categories with rural-urban differences in PA driven by LIPA and SB. Educational attainment modified the association between rurality and LIPA, suggesting education may play a role in rural-urban differences in PA. Shared barriers contributing to low moderate-to-vigorous intensity physical activity need further exploration.