Background. Physical activity (PA) rates are lower in rural populations, compared to urban and suburban counterparts. Since PA is shown to decrease the risk of cancers and chronic diseases, increasing PA in rural environments is an important disease-prevention strategy. However, in order to develop effective interventions for rural populations, more research is needed. The purpose of the study was to elicit rural residents’ thoughts and perceptions related to PA and walking trail use. Methods. Key informant interviews were conducted via telephone, with 62 adults, living in six rural communities in southeast Missouri, who identified as stakeholders, walking trail users, and nontrail users. Participants were recruited through word of mouth and snowball sampling. Interviews were digitally audio-recorded, transcribed, and qualitatively analyzed. Findings. Analysis revealed variation within the rural population, with each town unique in what constituted barriers and facilitators to PA. Life priorities other than physical health were found to be important motivators to PA and also influenced how PA was obtained. Community size was found to impact community resources and infrastructure, although this was mitigated by poverty rates. Conclusion. Rural communities are distinct from one another with different views and approaches to PA. Future interventions designed to increase PA should be mindful of differences at the individual and town levels and avoid a one-size-fits-all approach. Interventions would benefit from insight and support from community members and stakeholders, to facilitate a tailored approach to increase PA.

Physical activity (PA) has demonstrated a decreased risk in various cancers and other chronic diseases; however, rural residents are less likely to attain recommended levels of PA compared to urban and suburban counterparts. Given rural residents make up 15% of the United States population, there is a need for novel approaches to increase PA among this population. The goal of the present study is to investigate the effectiveness of a multilevel intervention to increase PA rates among rural residents. Guided by an ecological framework, a group-randomized design will be used to evaluate the effects of a three-level intervention for increasing PA among adult residents residing in 6 rural communities (n = 600) along with 6 control communities (n = 600). The intervention includes components at the individual (short message service [SMS] text messages), interpersonal (social support in walking groups), and community levels (events at existing trails). Innovative methods to encourage participation will be employed as well as a focus on life priorities (family, recreation, hobbies) other than health. Aim 1 includes a literature review and key informant interviews to determine the local contexts for intervention adaptation. Aim 2 will employ a set of interventions at the individual, interpersonal, and community-levels to evaluate their impact on moderate-to-vigorous PA as measured by self-reported (telephone survey) and objectively assessed (accelerometry) measures. These data are supplemented by location based on Global Positioning System and community audits, which provide information on recreational amenities, programs/policies, and street segments. This study is among the first of its kind to test a multilevel intervention in a rural setting, address life priorities that compliment health outcomes, and examine moderation between behavioral interventions and the natural environments where people are physically active. Our results will influence the field by enhancing the ability to scale-up innovative, PA interventions with the potential to reach high-risk, rural populations. Clinical Trials NCT03683173 , September 25, 2018.

Physical activity (PA) pre-COVID-19 was lower in rural areas compared to non-rural areas. The purpose of this study was to determine COVID-19’s impact on PA in rural and non-rural residents. A cross-sectional study consisting of a convenience sample of 278 participants (50% rural, 50% non-rural) from 25 states completed an online survey describing their PA behaviors and perceptions during COVID-19. The global physical activity questionnaire was used to determine PA in various domains and summed to determine if the participant met the PA guidelines. Rural participants had a significantly higher body mass index, lower income, and a lower educational attainment. Conversely, non-rural participants reported more barriers to PA. There was no difference in the perception of COVID-19’s impact on PA, specifically; however, rural participants were significantly less likely to meet cardiorespiratory PA recommendations compared to non-rural participants. Conclusions: This study demonstrates the continued disparity in PA between rural and non-rural residents, despite the supposition of COVID-19 being less impactful in rural areas due to sparse populations. Efforts should be pursued to close the PA gap between rural and non-rural residents.

Background: Increasing physical activity (PA) in rural communities is a vital prevention tactic in multiple chronic diseases; however, little is known on the multilevel correlates of PA rural areas. A better understanding of domain-specific PA adds context for promoting PA in rural communities. The current study sought to determine factors associated with domain-specific and overall moderate-vigorous physical activity (MVPA) in rural communities. Methods: Surveys were conducted across 14 rural mid-Western communities, with the final analytical sample including 1241 adults (ages 19–96, M = 57.0 [SD = 16.7], 67.8% female, 83.8% white). Generalized linear models with negative binomial distributions examined the relation between demographics, trail use, and perceptions of the neighborhood environment, with domain-specific and overall MVPA, measured via the Global Physical Activity Questionnaire. Results: Rural residents reported an average of 617 total minutes of weekly MVPA (SD = 1141), with 58.5% meeting MVPA guidelines. Higher age, female gender, and higher educated individuals had lower levels of overall and occupational MVPA. Females, higher education, and perceived indoor recreational access were associated with lower levels of transportation-related MVPA, while trail use was associated with increased transportation MVPA. Higher age and female gender respondents had lower levels of recreational MVPA, while trail users and those who perceived favorable indoor recreational access had higher levels of recreational MVPA. Conclusions: PA primarily occurred in the occupational domain among this sample of rural mid-Western adults. Findings highlight the need for multilevel interventions to address PA across multiple domains in rural communities, especially among females and older adults.

The purpose of this study was to capture the perceptions of COVID-19 mitigations’ efficacy of rural and non-rural participants, using the health belief model (HBM), as well as to describe where public health nursing may be able to fill behavior gaps in rural communities. Rural and non-rural participants completed electronic surveys. Surveys collected demographic information and perceptions of various mitigation strategies’ effectiveness. Rurality was significantly associated with perceptions of the effectiveness of public health mitigation strategies including wearing facemasks, limiting time indoors, avoiding gatherings, non-essential business closure, and staying home. Our findings suggest people in rural areas perceive mitigations to be effective. Other researchers have consistently shown rural residents are least likely to partake in the same mitigations. Rural public health nurses on the front line serve as the key to closing the aforementioned gap. Understanding where their community’s perceptions lie is pivotal in creating educational programs to continue mitigation efforts as we embark on the second year of this pandemic.

Purpose: We investigated associations of intrapersonal and environmental factors with objectively assessed weekly moderate to vigorous physical activity (MVPA) minutes, and their interactions in rural adults. Design: Cross-sectional. Setting: 14 rural towns participating in a multilevel intervention to promote physical activity. Sample: Baseline data from 241 rural community members (19% losses due to missing data). Measures: Self-reported demographics, behavioral factors, and neighborhood environment perceptions. Weekly MVPA minutes were assessed using accelerometry data. Analysis: Generalized linear models using a negative binomial distribution examined associations of and interactions between intrapersonal and environmental correlates with weekly MVPA. Results: Older age (β = −1.37; P= .025) and identifying as a woman (β = −.71; p= <.001) were inversely associated with MVPA. Self-efficacy (β = .34; p = <.001) and trail use (β = .44; P-value = .003) were directly associated with MVPA. Further, among women, perceived safety from traffic was inversely associated with MVPA (β = −.37; P = .003), while indoor recreational facility access was directly associated with MVPA (β = .24; P = .045). Conclusions: Rural residents, especially women, face disproportionately lower MVPA levels. Improving recreational access and self-efficacy may be effective strategies for increasing MVPA.