In a recent article by the University of Michigan, first expanded upon by research from the U-M Institute for Social Research Survey Research Center, it was found that both urban and suburban neighborhoods may bolster and preserve an older individual’s cognitive health if they provide opportunities for socialization, physical activity, and intellectual stimulation.

These opportunities are especially important in helping protect against the onset of dementia or Alzheimer’s. Research has found that cognitive impairment was associated with elevated risk for all-cause and cardiovascular disease mortality. Other research has also found that nearby green space was related to higher self-rated overall health, and the finding was especially robust for the elderly population.

This current analysis further investigated one of those aforementioned variables, physical activity, and its relationship with premature death across rural and urban counties. Rurality data was collected from the United States Department of Agriculture’s Rural Urban Continuum Codes in order to categorize and compare rural and urban counties.

Data for premature death was collected from the University of Wisconsin Population Health Institute’s County Health Rankings (CHR). Premature death is calculated as the number of years of life lost before the age of 75, this number is then calculated at the per-capita level. For example, a person that passes away at the age of 70 has 5 years of potential life lost.

Access to exercises opportunities was also included in the analysis, defined by CHR as the percentage of individuals who reside near a park or other type of recreational facility, such as a gym. To be considered as one who lives close to an exercise facility one has to reside in either 1) a census block within half a mile to a park, 2) an urban census block close to a recreational facility or 3) a rural census block within three miles of a recreational facility.

Access to exercise opportunities was categorized into quartiles to better compare rural and urban counties and visualize the results. The category breakdown was 0-25.00% = Low, 25.01%-50.00% = Low-Mid, 50.01-75.00% = Mid-High, 75.01-100.00% = High.

Finally, age data was also collected from CHR, specifically the percent of a county that was 65 years or older to control for that variable.

Though physical activity was the focus, access to exercise opportunities as measured by the CHR can also provide locales for people to socialize and engage in intellectual stimulation. For example, people with access to such opportunities may wish to walk in a nearby park and engage in conversation with friends or family or they may also enjoy the outdoor space as a place to read or enjoy an intellectual game with friends such as chess or checkers. Aside from outdoor parks, many gyms also offer group activities and classes where people can socialize and participate in physical activity. Nature is also a place that provides people with a plethora of sensory and social information which may help overall cognition, especially for those individuals with dementia.

For this analysis, the linear model investigated was defined as:

Premature Death = Rural or Urban + Access to Exercise Opportunities + Percent Aged 65 Plus + Rural or Urban * Access to Exercise Opportunities

The interaction of Rural or Urban * Access to Exercise Opportunities was significant, F (1, 3066) = 5.47, p = .001. R Squared = .133, qualifying all lower order main effects.

Follow-up analyses found that the largest difference between rural and urban counties was within the high access group at a mean difference of 1218.75, p < .001. This signifies that at the highest levels of access to parks and recreational facilities, urban residents had a far lower premature death rate compared to rural residents. At the highest level of access, rural residents had similar premature death rates as urban residents in the third quartile of access. At the lowest level of access, there was no significant difference in premature death rates between rural and urban counties.

With each successive access level, the rural-urban difference in premature deaths grew. This may signify that urban environments experience more benefit from access to exercise opportunities, especially parks, and green spaces, as urban areas tend to have less natural green spaces relative to rural areas.

Regardless, the effect of access to exercise opportunities can be easily seen in the graph above, and both rural and urban environments benefit greatly from having these types of environments so that residents can enhance their physical, mental, and social health. For both rural and urban residents, as access to exercise opportunities become more abundant, premature death decreases.

In short, access to exercise opportunities are one piece of the puzzle in promoting the health and well-being of both rural and urban communities. And with rural residents having less access to healthcare systems in general, utilizing green spaces and exercise facilities may be one way to enhance health in a preventive manner and to safeguard against certain ailments like Alzheimer’s or cardiovascular disease.