Rural exercise rose faster and is still five points behind

The 2008 Physical Activity Guidelines for Americans ask adults for two things,
and meeting the guidelines means meeting both:

What changed in ten years

Rural areas improved by half again as much, proportionally. And **rural in
2017 (19.6%) is still below urban in 2008 (19.4%'s near neighbour)** — the gap
of about six points barely moved, because a faster rise from a lower base
takes a long time to close anything.

The headline both ways: **only one in four urban residents and one in five
rural residents met the combined guidelines.** Three-quarters and four-fifths
did not.

The subgroups are where the story is

**Among urban residents, every single demographic subgroup and every census
region was higher in 2016–2017 than in 2008–2009.** No exceptions.

Among rural residents, three groups showed no increase:

• Hispanic adults
• Adults with a college education
• Adults living in the South

The third is the one that compounds: the South also has the highest obesity
prevalence and the widest rural/urban obesity gap. A decade of national
progress did not reach rural Southern adults, and their exposure to the
chronic diseases physical activity protects against — **coronary heart
disease, stroke, obesity, type 2 diabetes** — is among the highest.

What the data is

National Health Interview Survey, 2008–2017, a multistage probability
sample of US households. Sample sizes from 21,781 (2008) to 36,697 (2014);
response rates from 53.0% (2017) to 66.3% (2011). Activity is
self-reported leisure-time activity, with vigorous minutes doubled and
added to moderate ones to compare against the 150-minute threshold.

Two things follow from that definition and are worth holding. It counts
leisure-time activity, so physically demanding work does not appear — which
matters when comparing places with different kinds of jobs. And the trend is
measured against a falling response rate, from 66% to 53%.

Increases for several groups were not consistent year to year, which is why
the comparison is made between the pooled first two years and the pooled last
two rather than end points.

What communities can do

The listed approaches are structural rather than exhortative: **improved
community design**, **better access to indoor and outdoor recreation
facilities**, social support programmes, and community-wide campaigns —
all aimed at making physical activity **the safe and easy choice for people of
all ages and abilities.**

And the line addressed to the three rural subgroups that did not move:
**incorporating culturally appropriate strategies into local programmes might
help address differences across subgroups.** What worked nationally did not
work for them, and doing more of it is not the answer.

Source: Centers for Disease Control and Prevention, MMWR.