Healthy Exercise in the States

Earlier this year, the U.S. Centers for Disease Control published a document called “State Indicator Report on Physical Activity, 2010. I know, it sounds like a real page turner, doesn’t it. Ok, I’ll admit that, but the report had some interesting statistics on variations in measures of exercise and physical activity infrastructure among the states. In the following chart, you will see the extremes: those states with the highest proportion of adults with no leisure time exercise, lead by Mississippi, and those states with the lowest proportion, lead by Minnesota. This is irrelevant to health professionals with a clinical perspective, because if you have a patient or client who is not getting exercise, it would be an individual challenge to find ways to get her to be more active.

In public health and health promotion, the big patterns matter. The “active” states do much better than the national average, while the group of “inactive” states does far worse. Notice that sedentary adults in Mississippi outnumber those in Minnesota by almost two to one. Why should this be true? The reasons are many, but might give us clues to how to bring activity levels in more sedentary states to the levels found in the more active states, and to do it through community rather than individual processes.

The first thing you should understand about the chart is that the percents are not adjusted for gender, age, or race and ethnicity. In one sense that doesn’t matter. If you have about 1/3 of adults in your state or community not exercising, it doesn’t matter whether they are red, yellow, black, white, young, old, female or transgendered, it is still a problem. On the other hand, if the percent of the population in one state consists of 20% over the age of 65 while in another state that percent is only 11%, the comparison would be considered misleading. These populations are very different. It might turn out that if you compared physical activity by age group in each of the states, those percents could be very comparable. This is a technical point of no interest to anyone unless you are designing health promotion solutions.

Another point to make is that the sedentary states tend to be rural, poor, or both, whereas the more active states tend to be more urban and affluent. The rural dimension is surprising, but it turns out that people living in the country often are quite sedentary. Remember that most people living in rural communities are not farmers or farm workers, but instead work in small businesses servicing the farms or general retail, such as Wal-Mart. Other rural residents are employed by local government and the school system. Often there isn’t much else. These communities usually don’t have a lot of convenient places for people to be active. Most people drive everywhere because typical destinations are not nearby. Roads are not designed for pedestrians: they have no shoulders or sidewalks, and often visibility threatens safety. Finally, these communities usually don’t have public or private fitness facilities.

The CDC state report also looked at resources to facilitate more active lifestyles. Two of the measures were the percent of census tracts within 1) ½ mile of a park and 2) ½ mile of a fitness center. Once again there was a wide range. Some states, such as California, Connecticut, Maryland and Massachusetts, are very well endowed with these resources, while others, such as Mississippi, Montana, and North Dakota, have very few. When you look at the entire list, it looks very much like blue states versus red states. This is very political, and I don’t want this blog to be about partisan politics. However, the point is that those states (usually politically blue) which believe in public investment in things like parks and fitness centers, tend to have a more active population, while those states (usually politically red) which resist public investments like those, tend to have more sedentary citizens.

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