Associations Between Obesity, Rural-Urban Continuum Codes, And Physical Activity Program Preferences Among Breast Cancer Survivors

Abstract

PURPOSE: Many cancer survivors in rural areas with obesity fail to meet the American College of Sports Medicine physical activity (PA) guidelines. PA promotion programs are needed for these populations. This study examined the associations between obesity, rural-urban continuum (RUCC) codes, and PA program preferences. METHODS: Physically inactive breast cancer survivors (N=222) completed the baseline assessment for a randomized controlled PA trial including surveys to assess PA program preferences (i.e., location, exercise counseling source, exercise counseling delivery, exercise type [walking vs yoga], program type [aerobic vs resistance training], supervised vs unsupervised exercise, individual vs group exercise, flexible vs scheduled, amount willing to pay for exercise program, distance willing to travel, and distance willing to travel if gas costs were covered). Chi-Square analyses using dichotomized variables were conducted. Obesity was defined as body mass index ≥ 30. RUCC codes were classified as metro [RUCC=1 and3] vs non-metro [RUCC=6]. RESULTS: Participants were primarily white (85%), non-Hispanic (98%), and employed (71%) with an average age of 54.4 ± 8.5 years; half (51%) were obese. Most resided in metro areas with <250,000 population (RUCC=3; 73.6%) while the remaining resided in metro areas with >1 million population (RUCC=1; 22%) or nonmetro with 2,500-19,999 population (RUCC=6, 5%). When compared with non-obese, survivors with obesity were more likely to prefer exercise counseling from a personal trainer rather than a cancer exercise specialist, health club exercise specialist, or other cancer survivor (44% of non-obese vs. 57% of obese, p=.03). RUCC was associated with the farthest distance willing to travel (≥16 miles acceptable to 95% of RUCC 1 and 3 vs. 5% of RUCC 6, p<.001) and farthest distance willing to travel if gas costs were covered (≥16 miles acceptable to 42% of RUCC 1 and 3 vs 4% of RUCC 6, p=.027). No other preferences were associated with obesity or RUCC. CONCLUSIONS: Exercise counseling source and distance traveled are preferences associated with obesity or metro vs. nonmetro residency. Future PA programs should consider these factors along with potential reach and access concerns when targeting breast cancer survivors with obesity or living in nonmetro areas.