Closing the Exercise Gap: How We Start to Address Disparities in Physical Activity

It's widely known that nutritious food is too hard to come by for many in this country, particularly in low-income communities. There's even a name for impoverished communities with limited access to affordable, healthy fare: food deserts.

In food deserts, fast-food joints and corner stores provide cheap, convenient fare and fresh produce is harder to come by. And, according to the U.S. Department of Agriculture, in all but the most dense urban areas, the higher the percentage of the minority population (the language used to describe race and ethnicity by the USDA report), the more likely the area is to be a food desert.

Because diet can contribute to shorter lives and chronic conditions such as heart disease and type 2 diabetes, according to the Centers for Disease Control and Prevention (CDC), the importance of addressing equitable access to nutritious food has been increasingly recognized as a matter of public health.

But what about another pillar of health: physical activity? Exercise is also important to living longer and staving off chronic diseases. And not all communities have equal access to the space or means to exercise, either. Should disparities in access to physical activity be treated with the same level of attention and urgency as access to healthy food? Is there such thing as a fitness desert, too?

"We do not have a specific measure for physical activity that mirrors the concept of a food desert, but it is accurate to say that people have unequal access to places to be active," says Geoffrey P. Whitfield, an epidemiologist in the Division of Nutrition, Physical Activity and Obesity (DNPAO) at the CDC. "Regular physical activity is one of the most important things people can do for their health."

Becoming physically active can improve sleep quality, reduce feelings of anxiety and lower high blood pressure in the short term, he says. As the CDC describes, "Over time, it can help prevent or delay the onset of chronic diseases. Getting enough physical activity could prevent 1 in 8 cases of breast cancer, 1 in 8 cases of colorectal cancer, 1 in 12 cases of diabetes and 1 in 15 cases of heart disease."

However, the proportion of sedentary people is especially high in some communities of color: More Hispanic (32 percent), Black (30 percent) and American Indian/Alaska Native (29 percent) adults are physically inactive outside of their jobs, compared with white (23 percent) and Asian adults (20 percent), according to the DNPAO.

"Lack of access to safe and convenient places to be physically active may contribute to these racial and ethnic disparities," Whitfield says.

Given the life-saving benefits of physical activity, why isn't more urgency given to closing these disparities? Chalk it up to a strong societal narrative about personal responsibility, says Sarah Benes, EdD, a Natick, Massachusetts-based associate clinical professor of nutrition and public health at Merrimack and a a board member of the Society of Health and Physical Educators, commonly known as Shape America.

"The discussion is that people should just change their behaviors and be more physically active. There's not as much of a focus on equity and access," she says.

Yet, many people in communities of color and low-income areas face a variety of structural barriers to being more active — obstacles that are shaped by centuries of racism, oppression and social and economic marginalization. They are subject to (as we all are) social determinants of health: "conditions in the places where people live, learn, work and play that affect a wide range of health and quality-of life-risks and outcomes," according to the U.S. Department of Health and Human Services (HHS).

Racism, discrimination, neighborhood safety and access to opportunities for physical activities are just some of the conditions that determine health outcomes.

Having access to physical activity, in particular, is not just about whether you can afford to go to a gym or live across the street from a park. At a basic level, it's about being able to move about under your own power, easily and safely.

For instance, walking briskly for 30 minutes a day, five days a week is one way to satisfy the minimum amount of exercise recommended by the HHS (although more is encouraged). It's something that can be done while running errands, visiting neighbors or walking to and from work. People who get that amount of moderate-intensity exercise have a 33 percent lower risk of dying of any cause than people who don't exercise, according to the CDC.

Sounds straightforward enough, right? It is — assuming your community has sidewalks, and those walkways are not broken, dangerous or hard to navigate. "Activity-friendly" routes to everyday destinations are important so people can be physically active throughout their day, Whitfield says.

Yet safe and activity-friendly routes aren't equally accessible to everyone. Whitfield points to a report from a CDC partner organization, Smart Growth America, which found people walking in low-income communities are more likely to be struck and killed by a motor vehicle than people walking in other areas.

Among the reasons cited in the report: "Low-income communities are significantly less likely than higher-income communities to have sidewalks, marked crosswalks and street design to support safer, slower speeds."

He also cites a Governor's Highway Safety Association report revealing that among pedestrian fatalities, Black and Hispanic folks and members of other marginalized communities were more likely to be struck by motor vehicles than white people.

And that doesn't even take into account access to (or lack thereof) gyms and other fitness facilities. Future research is needed to better understand how the locations and costs of joining these spaces may affect community and public health.

With adequate funding and the right policies in place, communities can be redesigned to address this problem. "Community design can make physical activity more accessible to everyone by connecting sidewalks, trails, bicycle lanes and public transit to destinations such as grocery stores, schools, worksites, libraries, parks or health care facilities," Whitfield says. "This strategy makes it safe and easy to walk, bicycle or wheelchair roll for people of all ages and abilities."

There are provisions in the bipartisan infrastructure law that President Joe Biden signed in late 2021 that can be used in such redesigns. Among them: $1.5 billion — a 50 percent expansion — in funding for Rebuilding American Infrastructure With Sustainability and Equity (RAISE) discretionary grants through the U.S. Department of Transportation. Communities can use these grants to pay for projects relating to transportation and mobility. The program also guarantees $15 million in funding for "Areas of Persistent Poverty and Historically Disadvantaged Communities."

Ninety awards were made in the prior funding cycle, including one to the city of High Point, North Carolina, which received $19.8 million to expand a paved greenway by several miles.

"Lack of access to safe and convenient places to be physically active may contribute to racial and ethnic [health] disparities."

The project will connect low-income and historically marginalized neighborhoods to the city's southwest and downtown commercial districts, plant more trees and construct "complete streets" that are friendly to pedestrians, cyclists and others of all ages and abilities who need to get around. The goal is not only to provide more green space for recreation, but to reduce bicyclist and pedestrian accidents, improve air quality and allow more equitable access to areas where people work, shop and live.

The CDC is addressing physical activity access through its Racial and Ethnic Approaches to Community Health (REACH) program, which funds 40 locations to reduce health disparities among racial and ethnic populations with the highest burden of chronic diseases such as high blood pressure, heart disease, type 2 diabetes and obesity.

In Reading and Lebanon, Pennsylvania, REACH is funding a program by Pennsylvania State University Hershey Medical Center to improve the health of local Latinx residents by, in part, "promoting existing and new walking/bike trails that connect parks, schools, businesses and community facilities; supporting the improvement of cities' recreational infrastructure; and increasing school involvement in physical activity through safe routes and shared-use agreements."

If you're interested in seeing improvements in your own community that make it easier to be physically active, one resource to check out is the American Heart Association's Active Living Support Portal.

Hosted in partnership with the Physical Activity Alliance, it offers fact sheets about complete street policies, templates for developing your own community's policies and a support desk that will provide tips for mobilizing neighbors or even provide a second set of eyes on policy proposals.

Another resource is the CDC's Tools for Action page, which has guides for people in various professions and sectors to promote physical activity, including educators, land use planners, community designers, parks and recreation professionals and those working in public health.

Increasing at-school recreation opportunities for children and teens is an important part of physical activity equity as well, says Teri Shigeno, PhD, an assistant professor and training coordinator with the Adler University Sport and Human Performance Program in Chicago.

However, in the current public education environment, school funding is being prioritized for enabling students to pass science, math and reading tests, she says. In 2016, the median physical education budget for schools in the United States was only $764 per school year for the entire school, ranging from $460 for elementary schools to $1,370 for high schools, according to Shape America.

Also, team sports are becoming more competitive and highly structured, she adds. "It's becoming more and more challenging to get kids especially involved, because of the cost related to it." Furthermore, lower-resourced communities may lack the requisite courts and fields necessary to play them.

All Kids Play, a non-profit in her hometown of Chicago, aims to address the equity gap by providing financial assistance to families and communities to pay for youth sports registration fees, equipment and uniforms. Among the programs being funded is a soccer program for refugee children who have resettled with their families in the U.S.

But, playing organized sports isn't the only way to get exercise, Shigeno adds. "I think schools could do a better job at providing free play opportunities for kids." She sees a lack of "understanding around the importance of kids being able to organize themselves and to be able to play a pick-up basketball game or soccer game and what they could really learn from that."

Shigeno also points out equity extends beyond the necessary work of addressing racism or economic marginalization. "I think there are a lot of social identities that intersect in order to make it really challenging for people to have access to public spaces that they can feel actually feel comfortable exercising in."

For instance, people who must dress conservatively for religious reasons may feel uncomfortable in some exercise settings or gym facilities, she says. For different reasons, a person may feel that a workout space is unsafe for someone of their gender identity.

Both situations could be addressed by having certain hours of the day specifically reserved for certain people or populations, such as having women-only gyms or hours at gyms, or ensuring spaces are comfortable for trans and gender non-conforming people, Shigeno says.

Benes reminds us of the importance of access for people whose bodies don't conform to popular notions of fitness. "I think there are lots of problematic norms around what it means to be fit that don't include or often incorporate, for example, various body sizes," she says. "Fitness can also be very ableist. We think of fitness for people who are able-bodied, and it's not always the most inclusive framing."

Without equitable access to physical activity, "It takes away people's opportunities to flourish and thrive, she says.