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State-Specific Changes in Physical Inactivity Among Persons Aged Greater Than or Equal to 65 Years -- United States, 1987-1992

Regular physical activity can provide important health benefits, even when such activities are initiated later in life (1,2). Despite these benefits, most older persons in the United States have sedentary lifestyles (3). One of the national health objectives for the year 2000 is to reduce to 22% the proportion of adults aged greater than or equal to 65 years who engage in no leisure-time physical activity (objective 1.5a) (4). This report uses data from CDC's Behavioral Risk Factor Surveillance System (BRFSS) to summarize state-specific trends during 1987-1992 in the prevalence of physical inactivity during leisure time among persons aged greater than or equal to 65 years and projects state-specific prevalences for 1997.

The BRFSS is a population-based, random-digit-dialed telephone survey of the noninstitutionalized U.S. population. Data were available for 83,858 persons aged greater than or equal to 65 years residing in 49 states and the District of Columbia who participated in the BRFSS during 1987-1992. Of the 50 reporting areas, 32 states and the District of Columbia collected information about physical activity for the entire study period. Respondents were asked specific questions about physical activity, including the type, frequency, and duration of the two leisure-time physical activities in which they participated most frequently during the preceding month. Persons who reported engaging in no physical activity during leisure time were categorized as inactive. Confidence intervals and prevalence estimates were calculated using SUDAAN (5).

For the 33 reporting areas that participated in the BRFSS each year during 1987-1992, the median prevalence of no reported leisure-time physical activity among persons aged greater than or equal to 65 years declined from 43.2% in 1987 to 38.5% in 1992. Consistent decreases (i.e., a decrease from the previous year in at least 4 years) occurred in three states (Maryland, New Mexico, and New York) and the District of Columbia; no state reported consistent increases (i.e., an increase over the previous year in at least 4 years) in physical inactivity Table_1. The largest overall declines in prevalence of inactivity over the 6-year period were reported from Rhode Island (21.5%), Massachusetts (15.0%), Ohio (14.1%), New Mexico (12.7%) and Maryland (10.1%). The largest overall increases in prevalence were reported from Montana (7.2%), West Virginia (4.3%), Maine (3.9%), and Georgia (2.9%).

Two methods, a state-specific method and an aggregate method, were used to project the prevalence of physical inactivity in 1997. The analysis using the state-specific method was limited to data from the 33 reporting areas that collected physical activity information from 1987 through 1992. For each of these reporting areas, the 5-year change (i.e., the 1992 value minus the 1987 value) in the percentage of respondents participating in no leisure-time physical activity was added to that state's 1992 value to project the 1997 prevalence. The analysis using the aggregate method employed the median 5-year change in the prevalence of no leisure-time physical activity during 1987-1992 from the 33 areas reporting throughout the interval. The median 5-year change was then added to the 1992 prevalence for each of the 49 participating states and the District of Columbia to project the 1997 prevalence.

The projected median prevalence of no leisure-time physical activity for 1997 was 35.9% based on the state-specific method and 37.1% based on the aggregate method. Using the state-specific method, three states (Massachusetts, Rhode Island, and Minnesota) are projected in 1997 to meet the year 2000 objective to reduce physical inactivity. Using the aggregate method, the lowest projected prevalence is 24.8% for Washington, followed by 25.3% for Colorado.

Reported by the following BRFSS coordinators: J Durham, Alabama; P Owen, Alaska; B Bender, Arizona; J Senner, PhD, Arkansas; B Davis, PhD, California; M Leff, MSPH, Colorado; M Adams, MPH, Connecticut; F Breukelman, Delaware; C Mitchell, District of Columbia; D McTague, MS, Florida; E Pledger, MPA, Georgia; F Newfield, MPH, Hawaii; C Johnson, MPH, Idaho; B Steiner, MS, Illinois; N Costello, MPA, Indiana; P Busick, Iowa; M Perry, Kansas; K Bramblett, Kentucky; D Hargrove-Roberson, MSW, Louisiana; D Maines, Maine; A Weinstein, MA, Maryland; R Lederman, MPH, Massachusetts; H McGee, MPH, Michigan; N Salem, PhD, Minnesota; E Jones, MS, Mississippi; J Jackson-Thompson, PhD, Missouri; P Smith, Montana; S Huffman, Nebraska; E DeJan, Nevada; K Zaso, MPH, New Hampshire; G Boeselager, MS, New Jersey; P Jaramillo, MPA, New Mexico; C Maylahn, MPH, New York; G Lengerich, VMD, North Carolina; D Young, MS, North Dakota; E Capwell, PhD, Ohio; N Hann, MPH, Oklahoma; J Grant-Worley, MS, Oregon; L Mann, Pennsylvania; J Hesser, PhD, Rhode Island; J Ferguson, DrPH, South Carolina; B Miller, South Dakota; D Ridings, Tennessee; R Diamond, MPH, Texas; R Giles, Utah; R McIntyre, PhD, Vermont; S Carswell, MA, Virginia; K Holm, MPH, Washington; F King, West Virginia; E Cautley, MS, Wisconsin. Statistics Br, and Cardiovascular Health Studies Br, Div of Chronic Disease Control and Community Intervention, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: The findings in this report indicate that in 19 (58%) of the 33 states for which complete data were available, the prevalence of physical inactivity among persons aged greater than or equal to 65 years declined moderately during 1987-1992. This analysis extends findings from a previous analysis of BRFSS data for 1986-1990 (6). However, based on analysis of the data for 1987-1992 by the s prevalence in 1997 is projected to be approximately 36%-37%; if the decline continues at the projected rate, it will be insufficient to achieve the year 2000 objective.

Factors that may be associated with variations among the states in physical inactivity include differences in the age distribution of persons aged greater than or equal to 65 years, perceptions among both health-care providers and the public about the benefits and need for physical activity in older adults, variations in climate, and differences in community-level resources for physical activity (e.g., state funding of facilities and programs to promote physical activity). Community efforts have targeted barriers to participation in physical activity for older adults (e.g., lack of access to age-appropriate activities) by providing transportation to safe and accessible facilities, such as local malls to attend walking programs or to senior centers for low-impact stretching and exercise programs in conjunction with congregate meals.

The findings in this report are subject to at least three limitations. First, because BRFSS data are self-reported, activity levels cannot be validated; however, the categorization of only those persons who report no leisure-time activities as inactive probably reduced the degree of misclassification. Second, some respondents may have been active for other reasons (e.g., occupation or housework) but were misclassified as inactive. Third, the sensitivity of questions to ascertain leisure-time physical activity may vary in relation to the age of respondents.

The health benefits of regular physical activity for persons aged greater than or equal to 65 years include reducing the risks for coronary heart disease and noninsulin-dependent diabetes, preventing osteoporosis, promoting weight loss and weight maintenance, preserving functional capacity, and fostering psychologic well-being (1,2). In 1993, CDC and the American College of Sports Medicine recommended that all adults in the United States participate in greater than or equal to 30 minutes of moderate-intensity physical activity on most, if not all, days of the week (7). Persons who report no leisure-time physical activity are the target population with the greatest potential gain in health benefits as they increase their level of activity (8). Although increases in longevity are diminished compared with younger persons, older adults who begin to participate in regular physical activity can decrease their risks for death and disability and improve their quality of life (9).

References

  1. Caspersen CJ, Kriska AM, Dearwater SR. Physical activity epidemiology as applied to elderly populations. Bailleres Clin Rheumatol 1994;8:7-27.

  2. Elward K, Larson EB. Benefits of exercise for older adults. Clin Geriatr Med 1992;8:35-50.

  3. Siegel PZ, Brackbill RM, Frazier EL, et al. Behavioral risk factor surveillance,1986-1990. In: CDC surveillance summaries (December). MMWR 1991;40(no. SS-4).

  4. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives. Washington DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50213.

  5. Shah BV, Barnwell BG, Hunt PN, LaVange LM. SUDAAN user's manual release 5.50. Research Triangle Park, North Carolina: Research Triangle Institute, 1991.

  6. Caspersen CJ, Merrit RK. Physical activity trends among 26 states, 1986-1990. Med Sci Sports Exerc 1995;27:713-20.

  7. Pate RR, Pratt M, Blair SN, et al. Physical activity and public health: a recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995;273:402-7.

  8. Paffenbarger RS Jr, Hyde RT, Wing AL, Lee I-M, Jung DL, Kampert JB. The association of changes in physical-activity level and other lifestyle characteristics with mortality among men. N Engl J Med 1993;328:538-45.

  9. Paffenbarger RS Jr, Hyde RT, Wing AL, Lee I-M, Kampert JB. Some interrelations of physical activity, physiological fitness, health, and longevity. In: Bopuchard C, Shepard RJ, Stephens T, eds. Physical activity, fitness, and health. Champaign, Illinois: Human Kinetics Publishers, 1994.


Table_1
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TABLE 1. Prevalence of leisure-time physical inactivity among persons aged >=65 years, by state -- United States, Behavioral Risk
Factor Surveillance System, 1987-1992
=============================================================================================================================================================
                                                                                                                                     Projected
                                                                                                                                       1997     Projected
                                                                                                                                     prevalence   1997
                                                                                                                                      based on  prevalence
                      1987 *          1988 +            1989 &         1990 @             1991 **        1992 ++        Change in      state-   based on
                ----------------  --------------  --------------   --------------   ---------------  --------------     prevalence   specific   aggregate
State            %   (95% CI +++)   %   (95% CI)    %   (95% CI)     %   (95% CI)      %   (95% CI)   %      (95% CI)   1987-1992 &&   method @@  method ***
-------------------------------------------------------------------------------------------------------------------------------------------------------------
Alabama         42.7   (+/-7.1)   45.7  (+/-6.7)  45.6  (+/-5.7)   43.6  (+/-5.1)    47.1  (+/-5.7)   44.1   (+/-5.3)       1.4        45.5       42.2
Alaska           NA &&&            NA               NA              NA               48.8  (+/-12.9)  30.2  (+/-12.5)       NA          NA        28.3
Arizona         32.9   (+/-6.5)   28.3  (+/-6.3)  26.8  (+/-5.7)   23.4  (+/-5.3)    31.0  (+/-5.9)   34.4   (+/-5.9)       1.5        35.9       32.5
Arkansas         NA                NA              NA               NA               48.9  (+/-6.3)    NA                   NA          NA         NA
California      27.8   (+/-5.7)   29.1  (+/-5.3)  31.5  (+/-6.5)   30.0  (+/-4.9)    26.7  (+/-4.3)   29.3   (+/-4.1)       1.5        30.8       27.4
Colorado         NA                NA              NA              30.4  (+/-6.3)    26.4  (+/-5.3)   27.2   (+/-6.1)       NA          NA        25.3
Connecticut      NA               53.1  (+/-7.4)  42.7  (+/-7.6)   36.8  (+/-5.9)    42.8  (+/-5.9)   40.9   (+/-5.5)       NA          NA        39.0
Delaware         NA                NA              NA              39.3  (+/-6.1)    47.9  (+/-6.9)   44.8   (+/-6.1)       NA          NA        42.9
District
  of Columbia   59.0   (+/-8.2)   71.2  (+/-7.4)  63.8  (+/-6.1)   62.1  (+/-7.1)    56.6  (+/-6.7)   50.2   (+/-6.9)      -8.8        41.4       48.3
Florida         39.1   (+/-6.1)   30.5  (+/-4.9)  29.7  (+/-4.5)   39.1  (+/-4.5)    30.8  (+/-4.5)   32.0   (+/-3.7)      -7.1        24.9       30.1
Georgia         49.6   (+/-6.9)   54.2  (+/-14.5) 53.6  (+/-7.1)   51.2  (+/-6.9)    53.9  (+/-6.9)   52.5   (+/-6.3)       2.9        55.4       50.6
Hawaii          31.5   (+/-7.6)   36.0  (+/-6.9)  32.6  (+/-6.5)   29.0  (+/-6.3)    23.3  (+/-5.3)   32.6   (+/-6.9)       1.1        33.7       30.7
Idaho           32.9   (+/-5.1)   33.4  (+/-5.1)  43.1  (+/-5.5)   40.8  (+/-5.7)    33.7  (+/-4.9)   30.0   (+/-5.1)      -2.9        27.1       28.1
Illinois        44.5   (+/-5.9)   40.7  (+/-5.9)  42.3  (+/-6.1)   44.6  (+/-6.3)    49.0  (+/-5.5)   44.1   (+/-4.9)      -0.4        43.7       42.2
Indiana         40.4   (+/-5.3)   48.7  (+/-5.1)  47.8  (+/-5.1)   35.7  (+/-4.9)    39.3  (+/-4.9)   38.5   (+/-4.9)      -1.9        36.6       36.6
Iowa             NA               45.7  (+/-7.8)  43.7  (+/-5.7)   46.4  (+/-5.9)    40.1  (+/-5.5)   42.4   (+/-5.1)       NA          NA        40.5
Kansas           NA                NA              NA               NA                NA              38.2   (+/-6.1)       NA          NA        36.3
Kentucky        56.4   (+/-5.3)   54.9  (+/-5.3)  54.3  (+/-5.7)   55.3  (+/-5.3)    56.0  (+/-5.5)   56.5   (+/-5.3)       0.1        56.6       54.6
Lousianna        NA                NA              NA              44.3  (+/-9.4)    45.5  (+/-6.7)   48.7   (+/-6.3)       NA          NA        46.8
Maine           42.4   (+/-6.7)   44.9  (+/-6.3)  60.0  (+/-7.4)   53.1  (+/-7.4)    42.8  (+/-6.7)   46.3   (+/-6.9)       3.9        50.2       44.4
Maryland        52.0   (+/-8.6)   50.7  (+/-7.3)  49.2  (+/-6.3)   43.5  (+/-6.7)    42.3  (+/-6.5)   41.9   (+/-5.5)     -10.1        31.8       40.0
Massachusetts   44.4   (+/-6.9)   48.5  (+/-6.5)  47.3  (+/-7.1)   36.4  (+/-7.4)    39.9  (+/-7.1)   29.4   (+/-6.1)     -15.0        14.4       27.5
Michigan         NA               42.8  (+/-8.4)  44.2  (+/-5.3)   46.6  (+/-5.1)    39.8  (+/-5.1)   35.6   (+/-4.7)       NA          NA        33.7
Minnesota       38.6   (+/-4.1)   37.2  (+/-4.1)  44.5  (+/-4.1)   36.4  (+/-3.9)    36.7  (+/-4.1)   29.6   (+/-3.7)      -9.0        20.6       27.7
Mississippi      NA                NA              NA              50.7  (+/-6.1)    55.3  (+/-6.3)   62.5   (+/-6.3)       NA          NA        60.6
Missouri        46.3   (+/-6.7)   45.5  (+/-6.1)  45.5  (+/-6.7)   38.8  (+/-6.3)    47.8  (+/-5.9)   44.0   (+/-5.7)      -2.3        41.7       42.1
Montana         28.3   (+/-5.5)   30.7  (+/-5.9)  28.9  (+/-5.5)   33.1  (+/-6.3)    32.1  (+/-6.1)   35.5   (+/-6.5)       7.2        42.7       33.6
Nebraska        43.2   (+/-6.5)   47.0  (+/-5.9)  48.6  (+/-5.7)   36.9  (+/-5.1)    40.6  (+/-5.7)   39.2   (+/-5.3)      -4.0        35.2       37.3
Nevada           NA                NA              NA               NA                NA              37.3   (+/-6.3)       NA          NA        35.4
New Hampshire   40.5   (+/-7.6)   42.2  (+/-8.0)  35.5  (+/-6.9)   29.0  (+/-6.3)    35.5  (+/-6.9)   32.0   (+/-6.3)      -8.5        23.5       30.1
New Jersey       NA                NA              NA               NA               45.6  (+/-6.5)   45.1   (+/-6.9)       NA          NA        43.2
New Mexico      51.7   (+/-7.6)   43.4  (+/-8.2)  40.8  (+/-7.4)   37.2  (+/-7.6)    42.4  (+/-8.8)   39.0   (+/-7.1)     -12.7        26.3       37.1
New York        57.2   (+/-6.9)   53.7  (+/-7.3)  48.1  (+/-7.3)   40.6  (+/-6.9)    49.8  (+/-6.1)   47.4   (+/-5.5)      -9.8        37.6       45.5
North Carolina  45.4   (+/-5.5)   52.0  (+/-5.7)  46.6  (+/-5.9)   50.8  (+/-5.5)    47.4  (+/-5.5)   46.7   (+/-5.1)       1.3        48.0       44.8
North Dakota    36.7   (+/-5.1)   36.7  (+/-5.3)  42.8  (+/-5.5)   43.7  (+/-5.5)    42.2  (+/-5.3)   37.7   (+/-5.1)       1.0        38.7       35.8
Ohio            60.1   (+/-5.9)   46.3  (+/-6.5)  51.6  (+/-6.7)   46.3  (+/-6.1)    46.9  (+/-6.7)   46.0   (+/-6.1)     -14.1        31.9       44.1
Oklahoma         NA               40.2  (+/-7.6)  53.9  (+/-6.5)   47.3  (+/-6.5)    49.0  (+/-6.7)   43.9   (+/-6.1)       NA          NA        42.0
Oregon           NA                NA             26.0  (+/-4.7)   28.8  (+/-3.7)    31.6  (+/-3.7)   31.5   (+/-3.7)       NA          NA        29.6
Pennsylvania     NA                NA             46.9  (+/-5.5)   40.1  (+/-4.7)    42.8  (+/-5.1)   35.2   (+/-4.7)       NA          NA        33.3
Rhode Island    59.5   (+/-5.7)   57.8  (+/-5.3)  58.7  (+/-5.5)   37.7  (+/-5.1)    39.3  (+/-5.5)   38.0   (+/-5.3)     -21.5        16.5       36.1
South Carolina  44.7   (+/-6.3)   46.2  (+/-5.9)  58.7  (+/-6.1)   48.7  (+/-5.5)    52.1  (+/-5.5)   46.9   (+/-5.7)       2.2        49.1       45.0
South Dakota    43.2   (+/-6.9)   39.6  (+/-5.9)  42.1  (+/-5.3)   40.2  (+/-5.1)    37.0  (+/-5.3)   38.1   (+/-5.1)      -5.1        33.0       36.2
Tennessee       57.3   (+/-4.9)   57.4  (+/-4.9)  57.3  (+/-4.7)   52.1  (+/-5.1)    50.0  (+/-4.7)   53.9   (+/-5.1)      -3.4        50.5       52.0
Texas           36.7   (+/-7.6)   42.4  (+/-7.8)  40.0  (+/-7.3)   38.0  (+/-6.3)    39.6  (+/-7.1)   31.8   (+/-5.3)      -4.9        26.9       29.9
Utah            31.1   (+/-6.9)   32.7  (+/-6.9)  33.0  (+/-5.5)   31.6  (+/-5.5)    30.4  (+/-5.7)   32.3   (+/-6.1)       1.2        33.5       30.4
Vermont          NA                NA              NA              38.1  (+/-7.4)    45.8  (+/-6.3)   40.3   (+/-5.3)       NA          NA        38.4
Virginia         NA                NA             53.7  (+/-8.6)   41.5  (+/-6.5)    39.0  (+/-7.1)   40.9   (+/-6.7)       NA          NA        39.0
Washington      27.8   (+/-6.5)   30.6  (+/-6.3)  28.8  (+/-5.9)   27.9  (+/-5.1)    24.3  (+/-4.9)   26.7   (+/-4.3)      -1.1        25.6       24.8
West Virginia   48.7   (+/-5.5)   51.1  (+/-5.3)  61.9  (+/-5.3)   55.3  (+/-4.5)    55.8  (+/-4.5)   53.0   (+/-4.7)       4.3        57.3       51.1
Wisconsin       34.5   (+/-6.5)   35.9  (+/-6.5)  40.9  (+/-6.9)   36.0  (+/-6.5)    33.0  (+/-6.3)   35.6   (+/-5.9)       1.1        36.7       33.7
-------------------------------------------------------------------------------------------------------------------------------------------------------------
*   Sample sizes for individual states ranged from 169 to 644 persons aged >=65 years.
+   Sample sizes for individual states ranged from 62 to 636 persons aged >=65 years.
&   Sample sizes for individual states ranged from 199 to 652 persons aged >=65 years.
@   Sample sizes for individual states ranged from 147 to 643 persons aged >=65 years.
**  Sample sizes for individual states ranged from 123 to 665 persons aged >=65 years.
++  Sample sizes for individual states ranged from 122 to 699 persons aged >=65 years.
&&  1992 percentage minus 1987 percentage.
@@  For this analysis, for each of the 33 participating reporting areas, the 5-year change (i.e., the 1992 value minus the 1987 value) in the percentage of
    respondents participating in no leisure-time physical activity was added to that state's 1992 value to project the 1997 prevalence.
*** This analysis employed the median 5-year change (1.9% decrease) in the prevalence of no leisure-time physical activity during 1987-1992 from the 33
    areas reporting throughout the interval. The median 5-year change was then added to the 1992 prevalence for each of the 49 participating states and
    the District of Columbia to project the 1997 prevalence.
+++ Confidence interval.
&&& Not available.
=============================================================================================================================================================



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