Income Creates a Fitness Gap
The 1996 Surgeon General's report on "Physical Activity and Health" found that more than 60 percent of American adults are not sufficiently active. Worse, one out of four adults is not physically active at all.
Physical inactivity is more common among women, minority groups, older Americans and the disabled, according to the Surgeon General's report. But for both men and women in every major ethnic group--whites, blacks and Hispanics--the lower the income, the higher the prevalence of a sedentary lifestyle.
Such figures suggest that physical inactivity is yet another health risk associated with being poor in the United States.
Regular physical activity reduces the risk of dying from coronary heart disease as well as the risk of developing high blood pressure, colon cancer and diabetes, according to the Surgeon General's report. It helps control weight and reduce body fat; keeps bones, muscles and joints healthy; and can reduce symptoms of anxiety and depression while improving mood.
Yet survey after survey shows a consistent pattern: Higher-income people with more education tend to take exercise more seriously and see inactivity as more of a risk.
"There's a huge difference in participation in physical activity between income classes and between education classes," said Michael Pratt, acting chief of the physical activity and health branch of the federal Centers for Disease Control and Prevention.
Adults who did not complete high school are three times as likely as college graduates to engage in no significant physical activity during leisure, according to the CDC.
A similar pattern holds for income. Some 18 percent of people with household incomes over $50,000 are sedentary or inactive, compared with 40 percent of those with incomes under $20,000 and 43 percent of those with incomes under $10,000.
Narrowing the fitness gap is "a classic public health issue" that needs to be faced on a broad social scale, through education and improved access to recreation facilities, Pratt said. "It's too big a problem to take on one person at a time."
For all the rhetoric about fitness and shaping up America, whether or not people stay active on a day-to-day level often comes down to practical matters and infrastructure: sidewalks, bus lines, bike paths, safe streets and playgrounds.
"It's not just a matter of attitude or lifestyle choice," said H. Jack Geiger, emeritus professor of community health and social medicine at City University of New York Medical School. "It's environmental factors"--access to parks and gymnasiums, physical education classes and public transportation.
"Even an activity as simple as walking depends on the availability of safe and attractive places to walk," Pratt wrote last month in the Journal of the American Medical Association.
Crowded cities often present what Steven Blair, director of epidemiology for the Cooper Institute for Aerobic Research in Dallas, calls an "environment that is toxic to physical activity."
"Here in affluent North Dallas, it's [having] no sidewalks," said Blair, who was also senior scientific editor of the Surgeon General's report on physical activity. "In the urban ghettos, it's the lack of facilities and unsafe streets."
Affluent city dwellers overcome the difficulty of jogging or walking outside by joining a health club or buying treadmills--an approach that the poor cannot afford.
"If you're worried about paying the rent and putting food on the table," Geiger said, "you're not going to join a health club or buy Nike shoes."
Only 4 percent of people with family incomes of less than $25,000 a year are members of a health club, according to American Sports Data Inc., a firm specializing in sports and fitness research. By contrast, 17 percent of those with incomes above $75,000 have joined a health club or fitness center.
California leads the nation in percentage of residents who are members of a health club. Virginia (ranked fifth) and Maryland (ranked seventh) are also in the top ten, according to the Boston-based International Health, Racquet and Sportsclub Association. Most of the 8 percent growth in health club membership during 1997 came in commercial health clubs and corporate fitness centers, which are unlikely to locate in underserved neighborhoods.
"For people who are single parents and running from job to job to make ends meet, physical fitness becomes a luxury instead of a necessity," said Roger Ralph, president of Bel Air Athletic Club in Bel Air, Md. "Executives are better able to find the time."
A national Yankelovich poll, commissioned by Shape Up America, the nonprofit campaign founded by former Surgeon General C. Everett Koop, recently identified barriers that make it more difficult for urban Americans to exercise regularly. Among them:
A shift in the labor market also is a factor. With mechanization and the rise of the service economy, there are fewer "muscle jobs" in construction and farming and, overall, a less physically active labor force. More workers sit at a desk, fewer dig ditches or load furniture.
Most federal surveys of physical activity measure activity away from the job, during leisure. Some experts worry that the term "leisure" is off-putting or irrelevant to many people, particularly the working poor. They also note that some jobs--such as housecleaning, trash collection and delivery service--entail considerable physical activity.
While the exercise gap among low-income Americans is a real and worrisome phenomenon, the Cooper Institute's Blair cautioned that "there are lots of sedentary people in every demographic group you can identify." It would be a mistake, he said, for fitness campaigns to target only those groups with above-average prevalence of a sedentary lifestyle.
"Physical activity is good for you," Blair said, "no matter who you are--young or old, rich or poor, black or white, Hispanic or Native American, smoker or non, fat or thin."
© Copyright 1999 The Washington Post Company