Advisor(s)

Raymond Jones

Committee Member(s)

Erin Dooley
Harshvardhan Singh
Stephen Clarkson
Suzanne Judd

Document Type

Dissertation

Date of Award

6-1-2026

Degree Name

Doctor of Philosophy (PhD)

School

School of Health Professions

Department

Physical Therapy

Abstract

Rural populations in the United States experience a disproportionate burden of cardiovas-cular disease, yet how rural‑urban context shapes physical activity (PA) and vascular health is not fully understood. Because vascular dysfunction links PA to cardiovascular risk, rural‑urban differences in movement may help explain disparities in cardiovascular health. Rurality is often treated as a static, binary exposure, which may obscure meaning-ful geographic variation and accumulated life course influences. The overarching goal of this dissertation was to examine associations among rural‑urban exposure, objectively measured PA, and vascular health using national cohort data and a pilot study. This dissertation begins with a conceptual commentary establishing Rural‑Urban Com-muting Area (RUCA) codes as a more granular measure of rurality. Building on this framework, Aim 1 examined cross‑sectional rural‑urban differences in accelerome-ter‑measured PA within the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort using a four‑category RUCA classification. After adjustment for demographic, socioeconomic, seasonal, and clinical factors, adults residing in rural areas accumulated significantly more light‑intensity physical activity (LIPA) and less sedentary behavior (SB) than urban residents, while moderate‑to‑vigorous physical activity (MVPA) was uniformly low across all groups. Interaction analyses indicated that the association between rurality and LIPA varied by educational attainment, suggesting that socioeco-nomic context modifies how geographic exposure shapes movement behaviors. Aim 2 evaluated whether long‑term rural exposure across adulthood was associated with PA and arterial stiffness (AS) in later life using data from the Physical Activity and Vas-cular Health in Elders (PAVE) pilot study. A novel 26‑year Cumulative Rurality Scale derived from RUCA codes was applied alongside accelerometer‑measured PA and carot-id‑femoral pulse wave velocity. Cumulative rurality was not associated with PA engage-ment or AS in this exploratory sample. Age was the primary determinant of AS, while income was the only variable associated with PA engagement. Together, these findings demonstrate that cross‑sectional rurality captures meaningful dif-ferences in lower‑intensity movement behaviors, whereas cumulative rural exposure did not predict PA or AS in an older, highly urban pilot sample. This dissertation advances rural health research by refining rurality measurement and clarifying how socioeconomic context and aging influence rural‑urban differences in PA and vascular health.

Keywords

aging;arterial stiffness;cardiovascular health;physical activity;rural-urban disparities;rurality measurement

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