Environmental correlates of physical activity among individuals with diabetes in the rural midwest

OBJECTIVE - To determine the relationship between physical and social environment attributes and levels of physical activity in a population-based sample of diabetic individuals living in rural areas. RESEARCH DESIGN AND METHODS - Cross-sectional telephone survey data from rural communities of southeastern Missouri, Tennessee, and Arkansas were used. Logistic regression was used to calculate crude and adjusted prevalence odds ratios (PORs) and 95% CIs. RESULTS - A total of 278 (11%) individuals with diabetes were identified. Almost 37% of this group reported no leisure-time physical activity. Individuals with diabetes who reported regular physical activity were more likely to report better general health status, normal BMI, and no physical impairment. After adjustment, regular activity was positively associated with use of three or more facilities (POR 14.3, 95% CI 3.0-67.3) in the past 30 days, the availability of many nearby places to walk (2.3, 1.1-4.8), the availability of shoulders on streets (2.4, 1.3-4.5), often walking to nearby places (4.1, 2.0-8.3), and rating the community for physical activity as generally pleasant (2.3, 1.1-4.8). Additionally, the regular activity group was more likely to report their physician had helped make a plan to increase physical activity (2.8, 1.3-5.8) and followed up on their plan (2.2, 1.1-4.4). Social environment variables were not associated with physical activity after adjustment. CONCLUSIONS - Physical inactivity is a significant problem in rural diabetic populations. We have identified aspects of the social and physical environment that are positively associated with physical activity. Understanding the role of the environment may result in increased physical activity for individuals with diabetes.