Urban‐Rural Differences in Aerobic Physical Activity, Muscle Strengthening Exercise, and Screen‐Time Sedentary Behavior

Purpose Compared to their urban counterparts, US residents in rural settings face an increased risk of premature mortality and health problems that have been linked to insufficient physical activity (PA) levels. There is limited literature regarding urban‐rural differences in adherence to national guidelines for all 3 PA‐related behaviors. Methods We investigated urban‐rural differences in aerobic PA, leisure‐time muscle strengthening PA, and leisure screen‐time sedentary behavior in a combined data set of the 2011‐2014 waves (N = 14,188) of the nationally representative National Cancer Institute's Health Information National Trends Survey. Findings We found no evidence of a difference between large urban and rural residents’ aerobic PA levels. The typical number of weekly bouts of leisure‐time muscle strengthening PA was 25% lower for rural residents (incidence rate ratio [IRR] = 0.751, P < .001); this relationship was no longer statistically significant after controlling for potentially confounding covariates. In adjusted models, we found rural residents to engage in 6.6% less daily leisure screen‐time sedentary behavior than their large urban counterparts (IRR = 0.934, P = .031). Conclusions Taken together with previous literature, these results suggest that rural residents may engage in comparable levels of total PA, but less leisure‐time PA, than their urban counterparts.