Skip to main content

Community SES, Perceived Environment, and Physical Activity During Home-Based Cardiac Rehabilitation: Is There a Need to Consider the Urban vs. Rural Distinction?


Physical activity (MVPA) levels during home-based cardiac rehabilitation (CR) remain problematic. Consequently, the present study examined the association between MVPA and urban vs. rural residential status and the perceived environment in patients attending home-based CR. A total of 280 patients completed a questionnaire assessing demographic, clinical, MVPA, and perceived environmental variables measured at baseline and 3 months later. Patient addresses were geocoded and linked to the 2006 Canadian census to establish the urban/rural distinction. Results showed that urban and rural patients had similar baseline MVPA and improvements in MVPA by 3 months. Several perceived environmental variables were significantly related to MVPA throughout home-based CR that were common and urban/rural-specific. Therefore, although there does not appear to be an urban vs. rural advantage in MVPA levels during home-based CR, there does appear to be environmental/MVPA-specific relationships specific to urban and rural patients that may warrant attention.

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



  1. 1.

    Arthur HM, Smith KM, Kodis J, McKelvie R. A controlled trial of hospital versus home-based exercise in cardiac patients. Med Sci Sports Exerc. 2002; 34(10): 1544–1550.

    PubMed  Article  Google Scholar 

  2. 2.

    Smith KM, Arthur HM, McKelvie RS, Kodis J. Differences in sustainability of exercise and health-related quality of life outcomes following home or hospital-based cardiac rehabilitation. Eur J Cardiovasc Prev Rehabil. 2004; 11(4): 313–319.

    PubMed  Article  Google Scholar 

  3. 3.

    Blanchard C, Reid R, Morrin L, et al. Demographic and clinical determinants of moderate to vigorous physical activity during home-based cardiac rehabilitation: the home-based determinants of exercise (HOME) study. J Cardpulm Rehabil. 2010; 30(4): 240–245.

    Google Scholar 

  4. 4.

    Petter M, Blanchard C, Kemp K, Mazoff A, Ferrier S. Correlates of exercise among coronary heart diseaes patients: review, implications, and future directions. Eur J Cardiovasc Prev Rehabil. 2009; 16(5): 515–526.

    PubMed  Article  Google Scholar 

  5. 5.

    Sallis J, Owen N. Ecological models. In: Glanz K, Lewis F, Rimer B, eds. Health Behavior and Health Education: Theory, Research, and Practice. San Francisco, CA: Jossey Bass; 1999: 403–424.

    Google Scholar 

  6. 6.

    Parks S, Housemann R, Brownson RC. Differential correlates of physical activity in urban and rural adults of various socioeconomic backgrounds in the United States. J Epidemiol Community. 2003; 57: 29–35.

    Article  CAS  Google Scholar 

  7. 7.

    Wilcox S, Castro C, King A, Housemann R, Brownson R. Determinants of leisure time physical activity in rural compared with urban older and ethnically diverse women in the United States. J Epidemiol Community. 2000; 54: 667–672.

    Article  CAS  Google Scholar 

  8. 8.

    Tucker-Seeley R, Subramanian S, Sorensen G. Neighborhood safety, socioeconomic status, and physical activity in older adults. Am J Prev Med. 2009; 37(3): 207–213.

    PubMed  Article  Google Scholar 

  9. 9.

    Wilson D, Kirtland K, Ainsworth B, Addy C. Socioeconomic status and perceptions of access and safety for physical activity. Ann Beh Med. 2004; 28(1): 20–28.

    Article  Google Scholar 

  10. 10.

    Jakicic J, Wing R, Butler B, Jeffrey R. The relationship between presence of exercise equipment in the home and physical activity. Am J Health Promot. 1997; 11(5): 363–365.

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Sallis J, Johnson M, Calfas K, Caparosa S, Nichols J. Assessing perceived physical environmental variables that may influence physical activity. Res Q Exerc Sport. 1997; 68(4): 345–351.

    PubMed  CAS  Google Scholar 

  12. 12.

    Humpel N, Owen N, Leslie E. Environmental factors associated with adults’ perception in physical activity. Am J Prev Med. 2002; 22(3): 188–199.

    PubMed  Article  Google Scholar 

  13. 13.

    Saelens B, Handy S. Built environment correlates of walking: a review. Med Sci Sports Exerc. 2008; 40: S550–S566.

    PubMed  Article  Google Scholar 

  14. 14.

    INTERXVENT, CANADA. 12-week mentored health program. Accessed January 2, 2010.

  15. 15.

    Godin G, Shepard RJ. A simple method to assess exercise behavior in the community. Can J Appl Sport Sci. 1985; 10: 141–146.

    PubMed  CAS  Google Scholar 

  16. 16.

    Jacobs DR, Ainsworth BE, Hartman TJ, Leon AS. A simultaneous evaluation of ten commonly used physical activity questionnaires. Med Sci Sports Exerc. 1993; 25: 81–89.

    PubMed  Article  Google Scholar 

  17. 17.

    International, Physical, Activity, Prevalence, Study. Self-administered environmental module. Accessed January 1, 2006

  18. 18.

    Land Information Ontario. Ontario Road Net Element File. Ontario, Canada: Ministry of Natural Resources; 2010.

  19. 19.

    Bollman R. Rural and small town canada analysis bulletin. Statistics Canada. Accessed January 2, 2010.

  20. 20.

    Demissie K, Hanley J, Menzies D, Joseph L, Ernst P. Agreement in measuring socio-economic status: area-based versus individual measures. Accessed January 2, 2010.

  21. 21.

    Oliver L, Schuurman N, Hall A. Comparing circular and network buffers to examine the influence of land use on walking for leisure and errands. Int J Health Geographics. 2007; 6(41): 1–11.

    Google Scholar 

  22. 22.

    Raudenbush SW, Bryk TA. Hierarchical Linear Model: Applications and Data Analysis Methods. 2nd ed. Thousand Oaks, CA: 2002.

    Google Scholar 

  23. 23.

    Giles-Corti B, Donovan R. Socioeconomic status differences in recreational physical activity levels and real and perceived access to a supportive physical environment. Prev Med. 2002; 35: 601–611.

    PubMed  Article  Google Scholar 

  24. 24.

    Cohen A. A power primer. Psychol Bull. 1992; 112: 155–159.

    PubMed  Article  CAS  Google Scholar 

Download references


This research was supported by the Social Sciences and Humanities Research Council of Canada. Dr. Blanchard is supported by the Canada Research Chairs program.

Author information



Corresponding author

Correspondence to Chris Blanchard.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Blanchard, C., Rainham, D., McSweeney, J. et al. Community SES, Perceived Environment, and Physical Activity During Home-Based Cardiac Rehabilitation: Is There a Need to Consider the Urban vs. Rural Distinction?. J Urban Health 89, 285–295 (2012).

Download citation


  • Physical activity
  • Home-Based cardiac rehabilitation
  • Urban
  • Rural
  • Community SES
  • Perceived Environment