Physical Activity According to Diabetes and Metropolitan Status, U.S., 2020 and 2022

Introduction Physical activity can reduce morbidity and mortality among adults with diabetes. Although rural disparities in physical activity exist among the general population, it is not known how these disparities manifest among adults with diabetes. Methods Data from the 2020 and 2022 National Health Interview Survey were analyzed in 2023 to assess the prevalence of meeting aerobic and muscle-strengthening recommendations according to the 2018 Physical Activity Guidelines for Americans during leisure time. Physical activity prevalence was computed by diabetes status, type of physical activity, and urban/rural residence (large central metropolitan, large fringe metropolitan, medium/small metropolitan, and nonmetropolitan). Logistic regression models were used to estimate prevalence and prevalence ratios of meeting physical activity recommendations by urban/rural residence across diabetes status. Results Among adults with diabetes in nonmetropolitan counties, only 23.8% met aerobic, 10.9% met muscle-strengthening, and 6.2% met both physical activity recommendations. By contrast, among adults with diabetes in large fringe metropolitan counties, 32.1% met aerobic, 19.7% met strengthening, and 12.0% met both guidelines. Multivariable adjusted prevalence of meeting muscle-strengthening recommendations was higher among participants with diabetes in large fringe metropolitan than among large central metropolitan counties (prevalence ratio=1.27; 95% CI=1.03, 1.56). Among those without diabetes, adjusted prevalence of meeting each recommendation or both was lower in nonmetropolitan and small/medium metropolitan than in large central metropolitan counties. Conclusions Adults with diabetes are less likely to meet the physical activity recommendations than those without, and differences exist according to urban/rural status. Improving physical activity among rural residents with diabetes may mitigate disparities in diabetes-related mortality.