Skip to main content

Rural-urban differences in meeting physical activity recommendations and health status in cancer survivors in central Pennsylvania

Supportive Care in Cancer volume 28, pages 5013–5022 (2020)Cite this article

Abstract

Purpose

This study explored rural-urban differences in meeting physical activity (PA) recommendations and health status in cancer survivors in central Pennsylvania and associations between PA and health status.

Methods

Cancer survivors (N = 2463) were identified through a state cancer registry and mailed questionnaires assessing PA and health status. Rural-urban residence was based on county of residence at diagnosis. Participants self-reported frequency and duration of leisure-time PA and were classified as meeting: (1) aerobic recommendations (≥ 150 min/week), (2) muscle-strengthening recommendations (≥ 2 times/week), (3) both aerobic and muscle-strengthening recommendations, or (4) neither recommendation. Logistic regression models examined associations between rural-urban residence and meeting PA recommendations and associations between PA and health status, adjusting for age, cancer type, gender, and income.

Results

Nearly 600 (N = 591, 24.0%) cancer survivors returned completed questionnaires (rural 9.5%, urban 90.5%). Half (50.0%) of rural cancer survivors reported no leisure-time PA compared to 35.2% of urban cancer survivors (p = 0.020), and urban cancer survivors were 2.6 times more likely to meet aerobic PA recommendations (95% CI 1.1–6.4). Odds of reporting good physical and mental health were 2.3 times higher among survivors who reported meeting aerobic recommendations compared to those who did not meet PA recommendations (95% CI 1.1–4.5), adjusting for rurality and covariates.

Conclusions

Results demonstrate persistent rural-urban differences in meeting PA recommendations in cancer survivors and its association with self-reported health.

Implications for cancer survivors

Findings underscore the need for interventions to increase PA in rural cancer survivors in an effort to improve health status and reduce cancer health disparities.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Weaver KE, Geiger AM, Lu L, Case LD (2013) Rural-urban disparities in health status among US cancer survivors. Cancer. 119(5):1050–1057

    Article  Google Scholar 

  2. American Cancer Society (2016) Cancer treatment & survivorship facts & figures 2016–2017. American Cancer Society, Atlanta

    Google Scholar 

  3. Blake KD, Moss JL, Gaysynsky A, Srinivasan S, Croyle RT (2017) Making the case for investment in rural cancer control: an analysis of rural cancer incidence, mortality, and funding trends. Cancer Epidemiol Biomark Prev 26(7):992–997

    Article  Google Scholar 

  4. Weaver KE, Palmer N, Lu L, Case LD, Geiger AM (2013) Rural-urban differences in health behaviors and implications for health status among US cancer survivors. Cancer Causes Control 24(8):1481–1490

    Article  Google Scholar 

  5. Polite BN, Adams-Campbell LL, Brawley OW, Bickell N, Carethers JM, Flowers CR et al (2017) Charting the future of cancer health disparities research: a position statement from the American Association for Cancer Research, the American Cancer Society, the American Society of Clinical Oncology, and the National Cancer Institute. CA Cancer J Clin

  6. Lahart IM, Metsios GS, Nevill AM, Carmichael AR (2015) Physical activity, risk of death and recurrence in breast cancer survivors: a systematic review and meta-analysis of epidemiological studies. Acta Oncol 54(5):635–654

    Article  Google Scholar 

  7. Doyle C, Kushi LH, Byers T, Courneya KS, Demark-Wahnefried W, Grant B et al (2006) Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices. CA Cancer J Clin 56(6):323–353

    Article  Google Scholar 

  8. Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL et al (2012) Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin 62(4):243–274

    Article  Google Scholar 

  9. Cormie P, Zopf EM, Zhang X, Schmitz KH (2017) The impact of exercise on cancer mortality, recurrence, and treatment-related adverse effects. Epidemiol Rev 39(1):71–92

    Article  Google Scholar 

  10. Mishra SI, Scherer RW, Geigle PM, Berlanstein DR, Topaloglu O, Gotay CC et al (2012) Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database Syst Rev 8:CD007566

    Google Scholar 

  11. Mishra SI, Scherer RW, Snyder C, Geigle PM, Berlanstein DR, Topaloglu O (2012) Exercise interventions on health-related quality of life for people with cancer during active treatment. Cochrane Database Syst Rev 8:CD008465

    Google Scholar 

  12. Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvao DA, Pinto BM et al (2010) American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc 42(7):1409–1426

    Article  Google Scholar 

  13. U.S. Department of Health and Human Services (2018) Physical Activity Guidelines for Americans, 2nd edn. U.S. Department of Health and Human Services, Washington, DC

    Google Scholar 

  14. Campbell KL, Winters-Stone KM, Wiskemann J, May AM, Schwartz AL, Courneya KS et al (2019) Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Med Sci Sports Exerc 51(11):2375–2390

    Article  Google Scholar 

  15. Irwin ML, McTiernan A, Bernstein L, Gilliland FD, Baumgartner R, Baumgartner K et al (2004) Physical activity levels among breast cancer survivors. Med Sci Sports Exerc 36(9):1484–1491

    PubMed  PubMed Central  Google Scholar 

  16. Paskett ED (2015) Breast cancer among special populations: disparities in care across the cancer control continuum. Adv Exp Med Biol 862:39–52

    Article  Google Scholar 

  17. Vallerand JR, Rhodes RE, Walker GJ, Courneya KS (2017) Correlates of meeting the combined and independent aerobic and strength exercise guidelines in hematologic cancer survivors. Int J Behav Nutr Phys Act 14(1):44

    Article  Google Scholar 

  18. Trinh L, Strom DA, Wong JN, Courneya KS (2018) Modality-specific exercise guidelines and quality of life in kidney cancer survivors: a cross-sectional study. Psychooncology. 27(10):2419–2426

    Article  Google Scholar 

  19. Tabaczynski A, Strom DA, Wong JN, McAuley E, Larsen K, Faulkner GE et al (2020) Demographic, medical, social-cognitive, and environmental correlates of meeting independent and combined physical activity guidelines in kidney cancer survivors. Support Care Cancer 28(1):43–54

    Article  Google Scholar 

  20. Crawford JJ, Holt NL, Vallance JK, Courneya KS (2016) A new paradigm for examining the correlates of aerobic, strength, and combined exercise: an application to gynecologic cancer survivors. Support Care Cancer 24(8):3533–3541

    Article  Google Scholar 

  21. Rogers LQ, Markwell SJ, Verhulst S, McAuley E, Courneya KS (2009) Rural breast cancer survivors: exercise preferences and their determinants. Psychooncology. 18(4):412–421

    Article  Google Scholar 

  22. Vallance J, Lavallee C, Culos-Reed N, Trudeau M (2013) Rural and small town breast cancer survivors' preferences for physical activity. Int J Behav Med 20(4):522–528

    Article  Google Scholar 

  23. United States Department of Agriculture (USDA). Rural-Urban Continuum Codes: USDA Economic Research Service; [updated October 12, 2016]. Available from: https://www.ers.usda.gov/data-products/rural-urban-continuum-codes/

  24. Centers for Disease Control and Prevention (CDC). BRFSS Questions: Behavioral Risk Factor Surveilliance System (BRFSS); 2017 [updated August 25, 2017]. Available from: https://www.cdc.gov/brfss/questionnaires/index.htm

  25. Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett DR Jr, Tudor-Locke C et al (2011) 2011 Compendium of physical activities: a second update of codes and MET values. Med Sci Sports Exerc 43(8):1575–1581

    Article  Google Scholar 

  26. Centers for Disease Control and Prevention. A data users guide to the BRFSS Physical Activity Questions: how to assess the 2008 Physical Activity Guidelines for Americans: Centers for Disease Control and Prevention; Available from: https://www.cdc.gov/brfss/pdf/PA%20RotatingCore_BRFSSGuide_508Comp_07252013FINAL.pdf

  27. Smith WA, Nolan VG, Robison LL, Hudson MM, Ness KK (2011) Physical activity among cancer survivors and those with no history of cancer—a report from the National Health and Nutrition Examination Survey 2003-2006. Am J Transl Res 3(4):342–350

    PubMed  PubMed Central  Google Scholar 

  28. Vallance J, Basen-Engquist K, Rogers LQ, Alfano C (2019) Distance-based physical activity trials for cancer survivors: current evidence, novel interventions, and future directions. Ann Behav Med 53(Suppl 1):S195–S1S7

    Google Scholar 

  29. Cohen SA, Cook SK, Kelley L, Foutz JD, Sando TA (2017) A closer look at rural-urban health disparities: associations between obesity and rurality vary by geospatial and sociodemographic factors. J Rural Health 33(2):167–179

    Article  Google Scholar 

  30. Long AS, Hanlon AL, Pellegrin KL (2018) Socioeconomic variables explain rural disparities in US mortality rates: implications for rural health research and policy. SSM Popul Health 6:72–74

    Article  Google Scholar 

  31. James CV, Moonesinghe R, Wilson-Frederick SM, Hall JE, Penman-Aguilar A, Bouye K (2017) Racial/ethnic health disparities among rural adults—United States, 2012-2015. MMWR Surveill Summ 66(23):1–9

    Article  Google Scholar 

  32. Dwyer-Lindgren L, Mackenbach JP, van Lenthe FJ, Mokdad AH (2017) Self-reported general health, physical distress, mental distress, and activity limitation by US county, 1995-2012. Popul Health Metrics 15:16

    Article  Google Scholar 

  33. Garcia DO, Thomson CA (2014) Physical activity and cancer survivorship. Nutr Clin Pract 29(6):768–779

    Article  Google Scholar 

  34. Phillips SM, McAuley E (2014) Physical activity and quality of life in breast cancer survivors: the role of self-efficacy and health status. Psychooncology. 23(1):27–34

    Article  Google Scholar 

  35. Lee HY, Kim J, Merighi JR (2015) Physical activity and self-rated health status among older adult cancer survivors: does intensity of activity play a role? Oncol Nurs Forum 42(6):614–624

    Article  Google Scholar 

  36. Smith AW, Alfano CM, Reeve BB, Irwin ML, Bernstein L, Baumgartner K et al (2009) Race/ethnicity, physical activity, and quality of life in breast cancer survivors. Cancer Epidemiol Biomark Prev 18(2):656–663

    Article  Google Scholar 

  37. Courneya KS, Friedenreich CM (1999) Physical exercise and quality of life following cancer diagnosis: a literature review. Ann Behav Med 21(2):171–179

    CAS  Article  Google Scholar 

  38. Blanchard CM, Courneya KS, Stein K (2008) American Cancer Society’s SCS, II. Cancer survivors’ adherence to lifestyle behavior recommendations and associations with health-related quality of life: results from the American Cancer Society’s SCS-II. J Clin Oncol 26(13):2198–2204

    Article  Google Scholar 

  39. United States Department of Agriculture (USDA). Rural-Urban Commuting Area Codes: USDA Economic Research Service; [updated October 12, 2016; cited 2018]. Available from: https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes.aspx

  40. Rural Urban Definitions [Internet]. 2014. Available from: http://www.rural.palegislature.us/demographics_rural_urban.html

  41. Lee RE, Mama SK, Medina AV, Reese-Smith JY, Banda JA, Layne CS et al (2011) Multiple measures of physical activity, dietary habits and weight status in African American and Hispanic or Latina women. J Community Health 36(6):1011–1023

    Article  Google Scholar 

  42. Scherezade KM, Heather JL, Erica GS, Rebecca EL (2016) Improved physical activity screening enhances intervention effectiveness in ethnic minority women. Health Promot Pract 18(1):54–61

  43. Pietilainen KH, Korkeila M, Bogl LH, Westerterp KR, Yki-Jarvinen H, Kaprio J et al (2010) Inaccuracies in food and physical activity diaries of obese subjects: complementary evidence from doubly labeled water and co-twin assessments. Int J Obes 34(3):437–445

    CAS  Article  Google Scholar 

Download references

Acknowledgments

The authors appreciate the cancer survivors who responded to surveys and participated in this study. We also acknowledge the assistance of the Community Sciences and Health Outcomes Shared Resource of the Penn State Cancer Institute in generating the sampling strategy for this study. These data were supplied by the Bureau of Health Statistics & Registries, Pennsylvania Department of Health, Harrisburg, Pennsylvania. The Pennsylvania Department of Health specifically disclaims responsibility for any analyses, interpretations, or conclusions.

Funding sources

Scherezade Mama is supported by a career development award from the National Institutes of Health National Cancer Institute (K07 CA222335-02). Shirley Bluethmann is supported by a Mentored Research Scholar Grant in Applied and Clinical Research from the American Cancer Society (MSRG-18-136-01).

Author information

Affiliations

  1. Department of Kinesiology, The Pennsylvania State University, 268J Recreation Building, University Park, PA, 16802, USA

    Scherezade K. Mama & Nishat Bhuiyan

  2. Penn State Cancer Institute, Hershey, PA, USA

    Scherezade K. Mama, Wayne Foo, Joel E. Segel, Shirley M. Bluethmann, William A. Calo, Eugene J. Lengerich & Kathryn H. Schmitz

  3. Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA

    Wayne Foo, Joel E. Segel, Shirley M. Bluethmann, Renate M. Winkels, Joachim Wiskemann, William A. Calo, Eugene J. Lengerich & Kathryn H. Schmitz

  4. Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA, USA

    Joel E. Segel

  5. Human Nutrition & Health, Wageningen University & Research, Wageningen, The Netherlands

    Renate M. Winkels

  6. Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany

    Joachim Wiskemann

Authors
  1. Scherezade K. Mama
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nishat Bhuiyan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wayne Foo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joel E. Segel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shirley M. Bluethmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Renate M. Winkels
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Joachim Wiskemann
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. William A. Calo
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Eugene J. Lengerich
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kathryn H. Schmitz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Scherezade K. Mama.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Mama, S.K., Bhuiyan, N., Foo, W. et al. Rural-urban differences in meeting physical activity recommendations and health status in cancer survivors in central Pennsylvania. Support Care Cancer 28, 5013–5022 (2020). https://doi.org/10.1007/s00520-020-05342-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-020-05342-y

Keywords

  • Exercise
  • Health behavior
  • Rural health
  • Rural population
  • Health status disparities
  • Cancer survivors