Physical Activity in Rural and City-dwelling Low-income Women: Implications for Clinical Practice

Physical inactivity is most prevalent among low-income women, yet a paucity of physical activity research exists with this population. Nurse practitioners can play a critical role in promoting physical activity to decrease adverse health outcomes among low-income women.  The purpose of this study was to compare physical activity patterns, perceived barriers and benefits of rural and city-dwelling low-income women. This study used the Transtheoretical Model (TTM) stages of change, perceived barriers and benefits constructs. Rural (N=55) and city-dwelling (N=122) low-income women were recruited from Midwestern community health clinics. Women completed a self-administered questionnaire to report types and amount of physical activity, TTM Exercise Stage of Change Short Form, TTM Exercise Barriers and Benefits Scales, and demographic data.

Rural women were White (96%), married (73%), with a mean age of 33 years, 11.8 years of education, and annual household incomes below $20,000.  Mothers of pre-school children comprised 42% of the sample, and 64% had school-aged children. Walking was the primary physical activity for those who engaged in exercise (N=24; 44% of sample). Walkers averaged 4 days per week for 40 minutes per session.

City-dwelling women were single (70%), of African-American (44%), White (40%), Latina (11%), Asian (4%) and Native American (1%) ethnicity. The mean age was 30 years, 12.4 years of education, and annual household incomes below $20,000. Mothers of pre-school children comprised 57% of the sample, and 38% had school-aged children. Walking was the primary physical activity (N=80; 66% of sample). Walkers averaged 4 days per week for 40 minutes per session.

Women  in lower stages of change perceived significantly more barriers to physical activity compared to those in higher stages of change: Rural = [F (4, 46) = 4.655, p = .003], City-dwelling = [F (4, 115) = 3.403, p = .011].  For both groups, major barriers included exhaustion, lack of motivation, weather, and self-consciousness; major benefits were improved body image, self-esteem, and confidence.

Nurse practitioners can customize physical activity counseling that emphasizes walking, incorporates strategies to relieve exhaustion and improve body image in this vulnerable population.