self-reported height and weight, and stan- dard sociodemographic information was ..... Dannenberg AL, Keller JB, Wilson PF,. Castelli WP. Leisure time physical ...
Self-Reported Physical Activity in a Rural County: A New York County Health Census
Charles B. Eaton, MD, MS, Anne N. Nafziger, MD, MHS, David S. Strogatz, PhD, and Thomas A. Pearson, MD, PhD, MPH
Intodution For public health programs to be targeted appropriately, information on the types and frequency of physical activity in various groups, such as rural populations, needs to be obtained. Most previous community studies have been performed in urban or suburban settings, not in rural ones.l 4 Larger national studies have been conducted,5-11 but only two5,6 have been analyzed comparing urban vs rural location. Data on risk factors such as physical activity may help explain the usual advantage of rural areas in urban-rural comparisons of coronary heart disease mortality and trends in coronary heart disease mortality over time.12-15 This paper describes the frequency, types, and correlates of physical activity in a rural population in New York State.
Methods Door-to-door collection and assistance with completing a private census form led to a 86.6% level of participation rate representing 17 144 out of 19 800 households. The section of the census form giving data about physical activity, self-reported height and weight, and standard sociodemographic information was completed by 33 428 individuals aged 17 years or older. To assess levels of physical activity, respondents were asked, "At least once a week, do you engage in any regular activitylike briskwalking, jogging, bicycling, etc. long enough to work up a sweat? (No, Yes) If yes, how many times ." a week? __ Activity This question, which was derived from Paffenbarger et al.'s16 original physical activity questionnaire, has been validated by Siconolfi et al.,17 Kohl et al.,18 and Washburn et al.19 and shows correla-
tions with measures of cardiovascular fitness (maximal oxygen consumption [VO2 max])17,18 and high-density lipoprotein cholesterol19 that are the same as or better than longer questionnaires. The reliability of this question ranges from r = .60 to r = .71 in women and from r = .26 to r = .36 in men.20 An answer of no to the physical activity question was used to define sedentaly behavior; an answer of yes defined nonsedentary behavior. The single activity associated with sweat-related physical activity was categorized into one of 18 types: walking, weight lifting, aerobics/
calisthenics, jogging/running, swimming, cycling, gardening, team sports, racquet sports, other aerobics, skiing, dancing, nonaerobic sports, work related, outdoors, farm related, chopping wood, and miscellaneous. Cigarette smoking was evaluated by self-report comparing present vs past smoking or never smoked. Physical activitywas evaluated both as the mean number of times per week participants were involved in "sweat activity" and as the percentage of the population labeled sedentary. Analysis of covariance was used to derive least square means to determine the mean number of times per week of sweat activity, and F tests were Charles B. Eaton, Anne N. Nafziger, and Thomas A. Pearson are with the Department of Medicine/Epidemiology at Columbia University's Mary Imogene Bassett Research Institute, Cooperstown, NY. David S. Strogatz is with the Department of Epidemiology, State University of New York at Albany and the New York State Health Department's School of Public Health. Requests for reprints should be sent to Charles B. Eaton, MD, MS, Department of Family Medicine, Brown University/Memorial Hospital of Rhode Island, 111 Brewster St, Pawtucket, RI 02860. This paper was accepted June 29, 1993.
American Journal of Public Health 29
Eaton et aL
Types of Physical Activy As descnibed in Table 2, walking was the most popular activity for men and women in all age groups. For those aged 18 to 35 and 36 to 65, other prevalent types of activity for men were work related and jogging while women chose aerobics. In the oldest age group (65 to 89), men preferred gardening, work-related activity, and nonaerobic activity while women preferred gardening and cycling.
Correlates of Physical Actvity Table 3 reveals the odds ratios and 95% confidence intervals of the multivariable logistic regression for men and women comparing sedentary levels of activity with nonsedentary levels. The correlates of sedentary activity varied with age and gender.
Icussion
used to determine differences in activity by race, gender, age, marital status, location, level of education, and occupation. A logistic model comparing sedentary with nonsedentary activity was evaluated separately for men and women stratified by age group (young = 17 to 35, middle age = 36 to 65, old = 65 to 89) using dichotomous predictor variables of smokn, having a
blue-coliar job, being married, and having less than a high school education, with the quetelet index (kgi2) evaluated as a continuous variable. All analyses were done using the SAS statistical package.
Resuk Levels of Physical Activity Table 1 categorizes subjects as sedentary and nonsedentary and describes 30 American Journal of Public Health
the mean number of times per week participants engage in sweat activity for each sociodemographic descriptor. In this study, 46.2% were sedentary and 53.8% were nonsedentary. Excluding work and examining only leisure-time physical activity reveals that 48.8% were sedentary. Comparisons of the mean number of times per week participants were involved in sweat activity revealed differences by age, marital status, gender, education (in all cases, P < .001), and occupation (P < .01) but no differences by race or location. Farmers demonstrated an increased amount of sweat activity compared with persons in most other occupations but had the same percentage of sedentary behavior, suggesting a bimodal distribution.
This study demonstrates that a large proportion (46.2%) of residents of this rural county were sedentary. Levels of sedentary behavior are higher in this study than both the New York State Behavioral Risk Factor Surveillance System2l estimates in 1986 (28.4%) and 1987 (38.2%) and the national Behavioral Risk Factor Survey' estimates in 1982 (36%). However, the fact that our study questionnaire asked about sweat-related physical activity and not about less intense activity may have overestimated sedentary levels. Demographic factors such as age, gender, educational attainment, and marital status; behavioral factors such as cigarette smoking; and physiologic factors such as quetelet index are predicative of sedentary activity compared with nonsedentary activity in this rural population and are consistent with studies in other set-
tings.-122 The single type of activity reported in this study is difficult to compare against the multiple activities recorded by other national surveys.5-" Nevertheless, walking (49.4%) is clearly the most popular activity in this study, as it is in other surveys,5-11 and jogging, aerobics, and cycling (approximately 6%) are of similar rank order compared with their standing in national surveys.5-11 The high level of physical activity found in this rural county may reflect a more active life-style associated with rural living. This appears particularly true for male farmers, of whom 46.4% were involved four or more times per week in sweat-related activity, which contnbuted
January 1994, Vol. 84, No. 1
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statistical analysis and Irene Reis for her assistance in the preparation of the manuscript.
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1. White CC, Powell KE, Hogelin GC, Gently EM, Forman MR. The behavioral risk factor surveys: IV. the descriptive epidemiology of exercise.AmJPrevMeiL 1987; 3:304-310. 2. MontoyeJH.PhysicalActvityandHeatkh An Epidemiolgic Swdy ofan Entire Community. Englewood Cliffs, NJ: Prentice Hall; 1975:13-27. 3. Folsom AR, Caspersen CJ, Taylor HL, et al. Leisure time physical activity and its relationship to coronary risk factors in a 0 0.3 00 1) 0* 12 Ok~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~....... population-based sample: the Minnesota Ok 00 0.101 IA~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~...... Heart Survey. AmJ EpidemioL 1985;121: 10 0* 0.11k 570-579. 34~~~~~~~~~~~~~~~~~~~~~~~...... 62 17* 198 0.1 4. Dannenberg AL, Keller JB, Wilson PF, 4146 *7 * 6* ~~~~7 Castelli WP. Leisure time physical activity 90 0? 0*............. ' 02 8* 02.~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~..... 1* 4* 4500 in the Framingham, Offspring Study: deVwm ~ 0.1S:S 0$R 4.3 ~ ~ Oo'0' scription, seasonal variation, and risk fac9*08 12 as 1* 1* o'qit tor correlates. Am JEpidemioL 1989;129: 76-88. 5. Stephens T, Jacobs DR, White CC. A descriptive epidemiology of leisure-time physical activity. Public Health Rep. 1985; 100:147-158. 6. President's Council on Physical Fitness and Sports. National adult physical fitness survey. Phys Fitness Res Digest. 1974;4: 1-27. 7. Exercise and participation in sports among persons 20 years of age and over, United States, 1975. Adv Data Vital Health Stat. 1978; no. 19. 8. The Pemer Study: Fitness in America. '................. New York, NY: Perrier-Great Waters of ORUO'^ 1 ''~~~~~1O ' Xt10 France, Inc; 1979. 9. H htsfromwave I of the National Survey of Personal Health Practices and Consequences: United States, 1979. Vital 0A4 14 Healh Stat [15]. 1981;1. DHHS publication PHS 81-1162. ..........1..U...a 10. Canada Fitness Suwvey. Fitness and Lifestyle in Canada. Ottawa, Canada: Canada Survey; May 1983. 11. The Miller Lite Report on American Attitudes toward Sports. Milwaukee, Wis: Miller Brewing Co; 1983. 12. Enterline PE, Rikli AE, Sauer H, Hyman 0023 th4 i M. Death rates for coronary heart disease in metropolitan and other areas. Public Health Rep. 1960;75:759-766. 13. Miller MK, Stokes CS, Clifford WB. A comparison of rural-urban mortality differential for deaths from all causes, cardiovasMey~~~~~~~ 1S2S1* X eA--S ' ss 3is7S -e cular disease and cancer. J Rural Health 1987;3:23-34. 14. Ingram DD, Gillum RF. Regional and urbanization differentials in coronary heart disease mortality in the United States, 1968-1985. J Clin EpidemioL 1989;42:857(43%) and a high percentage (46.4%) into an average of 1 more sweat day of ac868. in week per tines or more four volved with compared tivity per week in fanming 15. Najem GR, Hutcheon DE, Feuerman M. sweat activity should be explored in future other occupations. Changing patterns of ischemic heart disstudies. [l The high frequency of walking and ease mortality in New Jersey 1968-1982, and the relationship with urbanization. Int the gender differences in both levels and
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choice of activity suggest that further research and public policy recommendations focus on these issues. The health impacts of the bimodal distribution of farmers' activity patterns with a large percentage involved in sedentary behavior January 1994, Vol. 84, No. 1
Acknowledgments Partial support for this research was supplied by the Public Health Service, National Service Research Award 5T32HL07642-04. The authors gratefully acknowledge Benjamin Rybicki for his assistance in the early
JEpiderioL 1990;19:26-31.
16. Paffenbarger RS, Wing AI, Hyde RT. Physical activity and index of heart attack risk in college alusmni. Am J EpidemnioL 1978;108:161-175. 17. Siconolfi SF, Lasater TM, Snow RC, Carleton RA. Self-reported physical activ-
American Journal of Public Health 31
Eato et aL
ity compared with maximal oxygen uptake. Am JEpidemioL 1985;122:101-105. 18. Kohl HW, Blair SN, Paffenbarger RS, Macera CA, Kronenfeld JJ. A mail survey of physical activity habits as related to measured physical fitness. Am J Epidemioi 1988;127:1228-1239. 19. Washbum RA, Goldfield SR, Smith KW, McKinlay JB. The validity of self-reported
exercise-induced sweating as a measure of physical activity. Am J EpidemioL 1990; 132:107-113. 20. Nafziger AN, Eaton CB, Jenkins PL, Bolin SJ, Pearson TA. Marked gender differences in the reliability and validity of self-reported physical activity ascertained by mafl surveys, physician inteIview and phone survey. Am JEpidenioi 1992;136:992.
21. Bzduch H. Physical activity and exercise. New York State Behavioral Risk Factor Surveillance System 1986 and 1987. Albany, NY: New York State Department of Health; January 1990;23:59-67. New York State Department of Health Monographs. 22. DishmanRK, SallisJR, Orenstein DR. The determinants of physical activity and exercise. Public HealthRep. 1985;100:158-170.
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32 American Journal of Public Health
January 1994, Vol. 84, No. 1
