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Bradley and colleagues (2013) reviewed 13 studies
on the relationship between physical inactivity and
academic achievement in youth. They reported
that more than two-thirds of the studies found an
inverse relationship between physical inactivity and
academic achievement. 49 Furthermore, four studies
showed no negative impact on standardized test
scores when additional instruction time was spent in
physical education. 49 Moderate to vigorous physical
activity has been positively associated with higher
grade point average 61 and higher SAT scores. 7
Built Environment
Participation in physical activity is not just a matter
of biological factors, social determinants, and
personal choice. Much discussion on inadequate
physical activity, especially its causality in obesity,
has centered on the “built” environment. By
definition, this includes characteristics of one’s
surroundings, such as sidewalks, parks, riding
trails, recreational facilities, street lights and safe
neighborhoods. In a 2012 review of the literature
on physical activity and the built environment,
Ferdinand and colleagues reported that 173 of
the 194 studies examined reported a beneficial
relationship between the built environment and
physical activity; 62 however, studies with objective
measures of physical activity were less likely to find
a direct relationship.
Research has shown that the environmental
correlates to physical activity differ significantly
between rural and urban areas. 15,27 In a 2006 study,
Boehmer and colleagues described the environmental
characteristics of rural communities that impede
physical activity and healthy nutrition. 3 Most notably,
43 percent of their subjects reported feeling unsafe
from traffic while walking or biking. This finding
was more prevalent in rural communities than in
urban, likely due to fewer sidewalks. The study, in
agreement with others, 63,64 also reported that further
distance to recreational facilities was associated with
increased odds of obesity and inactivity.
In a California study, only one in four adolescents
reported access to a safe park. 65 Access was
positively associated with regular physical activity
for adolescents in urban areas, but not for those in
rural areas. 65 Investigators studying the potential link
between the presence of neighborhood parks and
physical activity, did not find an association between
parks and youth meeting minimum physical activity
guidelines. 54 They reported that just 48.3 percent of
urban youth in their study had achieved the minimum
physical activity requirements, compared to 55.7
percent in isolated rural areas. 54
VARIATIONS BY RURAL REGION
Our physical environment, both natural and manmade,
varies greatly across the 50 states, contributing
to regional differences in the physical activity levels
of Americans. In the broadest generalization, the
percent of U.S. residents living in rural areas is
greater in the South and Midwest. Rural residence,
especially in the southern states, has been associated
with low levels of physical activity. 4,19 Mier and
colleagues (2013) reported that the physical
activity of children living in colonias, which are
impoverished neighborhoods along the Texas-Mexico
border, was significantly influenced by neighborhood
characteristics. The Hispanic youth in her study,
eight to 13 years of age, cited litter, speeding cars,
unleashed dogs and unlit streets as deterrents to
physical activity. 66
The Appalachian states also have a disproportionate
burden of low physical activity. North Carolina,
with the second most rural population in the U.S.,
has reported one of the highest rates of obesity in
school-age children. 67 In a survey on extracurricular
sports and facilities at North Carolina schools, it was
reported that rural schools had far fewer facilities
and sports programs than urban schools. (Two-thirds
of the rural schools had no extracurricular physical
activity programs other than interschool sports. 67 )
Also in North Carolina, Jilcott and colleagues
reported that physical activity was positively
associated with a natural amenities scale, which
is a “measure of the physical characteristics of a
county area that enhance the location as a place to
live.” 68 However, no rural-urban comparisons were
made. 69 Swanson et al (2012) reported that Kentucky
residents, particularly in the Appalachian region, had
significantly lower physical activity levels compared
to the national average. 70
In Minnesota and North Dakota, a study reported that
women were more likely than men to be inactive or
have low levels of physical activity. 20
VARIATIONS BY RACE AND ETHNICITY
Although a significant percentage of Americans are
physically inactive, 1,71 an even higher percentage of
African Americans have not met the recommended
guidelines for physical activity. 72 In a 2008 Centers
for Disease Control (CDC) report, whites were
more likely than African Americans (67.5 percent
98