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

INTRODUCTION: 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. METHODS: 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). RESULTS: 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). CONCLUSIONS: 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.