The Journal of Primary Prevention

, Volume 34, Issue 1–2, pp 5–15 | Cite as

“Positive Deviants”: A Qualitative Study of Physically Active Adults in Rural Environments

  • Michelle C. Kegler
  • Iris Alcantara
  • Nicole Dubruiel
  • J. K. Veluswamy
  • Hannah Appelbaum
  • Sandy Handwerk
Original Paper


Rural residents, particularly those in the South, are less physically active than their urban counterparts and often live in areas with limited walkability (e.g., no sidewalks) and minimal access to recreational facilities. The purpose of this study was to gain an understanding of what makes certain rural residents physically active despite their environment. Qualitative interviews (N = 29) were conducted with physically active adults who live in rural areas (e.g., outside of town) in southwest Georgia. Participants were 65.5 % male and 24.1 % African American, with a mean age of 55.9 years. Results suggest that physically active adults in rural areas are motivated by their health and perceive their local surroundings as a resource for physical activity. Understanding how these physically active adults take advantage of their living situations to be physically active has the potential to inform interventions that encourage physical activity in this high-risk population.


Physical activity Rural Environments Qualitative 



The authors wish to thank members of the Emory Prevention Research Center’s Community Advisory Board for their guidance in the design and implementation of this research. We also wish to thank our study participants for their valuable contributions to this research. This publication was supported by Cooperative Agreement Number # 5U48DP001909 from the Centers for Disease Control and Prevention. Its contents are solely those of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.


  1. Agency for Healthcare Research and Quality. (2011). 2010 national healthcare disparities report. Rockville, MD: U.S. Department of Health and Human Services.Google Scholar
  2. Bennett, K., Olatosi, B., & Probst, J. (2008). Health disparities: A rural–urban chartbook. Columbia, SC: South Carolina Rural Health Research Center.Google Scholar
  3. Berge, J. M., Larson, N., Bauer, K. W., & Neumark-Sztainer, D. (2011). Are parents of young children practicing healthy nutrition and physical activity behaviors? Pediatrics, 127, 881–887.PubMedCrossRefGoogle Scholar
  4. Boeije, H. (2002). A purposeful approach to the constant comparative method in the analysis of qualitative interviews. Quality & Quantity, 36, 391–409.CrossRefGoogle Scholar
  5. Brownson, R. C., Eyler, A. A., King, A. C., Brown, D. R., Shyu, Y. L., & Sallis, J. F. (2000). Patterns and correlates of physical activity among US women 40 years and older. American Journal of Public Health, 90, 264–270.PubMedCrossRefGoogle Scholar
  6. Centers for Disease Control and Prevention. (2000). Behavioral risk factor surveillance system survey questionnaire. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.Google Scholar
  7. Craig, C. L., Marshall, A. L., Sjöström, M., Bauman, A. E., Booth, M. L., Ainsworth, B. E., et al. (2003). International physical activity questionnaire: 12-country reliability and validity. Medicine and Science in Sports and Exercise, 35, 1381–1395.PubMedCrossRefGoogle Scholar
  8. Dye, C. J., & Wilcox, S. (2006). Beliefs of low-income and rural older women regarding physical activity: You have to want to make your life better. Women and Health, 43, 115–134.CrossRefGoogle Scholar
  9. Eberhardt, M. S., & Pamuk, E. R. (2004). The importance of place of residence: Examining health in rural and nonrural areas. American Journal of Public Health, 94, 1682–1686.PubMedCrossRefGoogle Scholar
  10. Eyler, A. A. (2003). Personal, social, and environmental correlates of physical activity in rural Midwestern white women. American Journal of Preventive Medicine, 25(3 Suppl. 1), 86–92.PubMedCrossRefGoogle Scholar
  11. Frost, S. S., Goins, R. T., Hunter, R. H., Hooker, S. P., Bryant, L. L., Kruger, J., et al. (2010). Effects of the built environment on physical activity of adults living in rural settings. American Journal of Health Promotion, 24, 267–283.PubMedCrossRefGoogle Scholar
  12. Giles-Corti, B., & Donovan, R. J. (2003). Relative influences of individual, social environmental, and physical environmental correlates of walking. American Journal of Public Health, 93, 1583–1589.PubMedCrossRefGoogle Scholar
  13. Hooker, S. P., Wilson, D. K., Griffin, S. F., & Ainsworth, B. E. (2005). Perceptions of environmental supports for physical activity in African American and white adults in a rural county in South Carolina. Preventing Chronic Disease, 2, A11.PubMedGoogle Scholar
  14. Jackson, J. E., Doescher, M. P., Jerant, A. F., & Hart, L. G. (2005). A national study of obesity prevalence and trends by type of rural county. Journal of Rural Health, 21, 140–148.PubMedCrossRefGoogle Scholar
  15. Janney, C. A., Cauley, J. A., Cawthon, P. M., Kriska, A. M., & Osteoporotic Fractures in Men Study Group. (2010). Longitudinal physical activity changes in older men in the osteoporotic fractures in men study. Journal of the American Geriatrics Society, 58, 1128–1133.PubMedCrossRefGoogle Scholar
  16. Jilcott, S. B., Evenson, K. R., Laraia, B. A., & Ammerman, A. S. (2007). Association between physical activity and proximity to physical activity resources among low-income, midlife women. Preventing Chronic Disease, 4, A04.PubMedGoogle Scholar
  17. Kegler, M. C., Swan, D. W., Alcantara, I., Wrensford, L., & Glanz, K. (2012). Environmental influences on physical activity in rural adults: The relative contributions of home, church, and work settings. Journal of Physical Activity & Health, 9, 996–1003.Google Scholar
  18. Kerr, J., Norman, G. J., Sallis, J. F., & Patrick, K. (2008). Exercise aids, neighborhood safety, and physical activity in adolescents and parents. Medicine and Science in Sports and Exercise, 40, 1244–1248.PubMedCrossRefGoogle Scholar
  19. Kesaniemi, Y. K., Danforth, E., Jr, Jensen, M. D., Kopelman, P. G., Lefèbvre, P., & Reeder, B. A. (2001). Dose-response issues concerning physical activity and health: An evidence-based symposium. Medicine and Science in Sports and Exercise, 33(6 Suppl), S351–S358.PubMedGoogle Scholar
  20. Mansfield, C. J., Wilson, J. L., Kobrinski, E. J., & Mitchell, J. (1999). Premature mortality in the United States: The roles of geographic area, socioeconomic status, household type, and availability of medical care. American Journal of Public Health, 89, 893–898.PubMedCrossRefGoogle Scholar
  21. Martin, S. L., Kirkner, G. J., Mayo, K., Matthews, C. E., Durstine, J. L., & Herbert, J. R. (2005). Urban, rural, and regional variations in physical activity. Journal of Rural Health, 21, 239–244.PubMedCrossRefGoogle Scholar
  22. National Advisory Committee on Rural Health and Human Services. (2005). The 2005 Report to the secretary: Rural health and human service issues. Retrieved from’s_report.pdf.Google Scholar
  23. Patterson, P. D., Moore, C. G., Probst, J. C., & Shinogle, J. A. (2004). Obesity and physical inactivity in rural America. Journal of Rural Health, 20, 151–159.PubMedCrossRefGoogle Scholar
  24. Patton, M. Q. (2002). Qualitative research & evaluation methods (3rd ed.). Thousand Oaks, CA: Sage Publications.Google Scholar
  25. Reed, J. A., & Phillips, D. A. (2005). Relationships between physical activity and the proximity of exercise facilities and home exercise equipment used by undergraduate university students. Journal of American College Health, 53, 285–290.PubMedCrossRefGoogle Scholar
  26. Sallis, J. F., Cervero, R. B., Ascher, W., Henderson, K. A., Kraft, M. K., & Kerr, J. (2006). An ecological approach to creating active living communities. Annual Review of Public Health, 27, 297–322.PubMedCrossRefGoogle Scholar
  27. Sallis, J. F., Johnson, M. F., Calfas, K. J., Caparosa, S., & Nichols, J. F. (1997). Assessing perceived physical environmental variables that may influence physical activity. Research Quarterly for Exercise and Sport, 68, 345–351.PubMedCrossRefGoogle Scholar
  28. Salmon, J., Owen, N., Bauman, A., Schmitz, M. K., & Booth, M. (2000). Leisure-time, occupational, and household physical activity among professional, skilled, and less-skilled workers and homemakers. Preventive Medicine, 30, 191–199.PubMedCrossRefGoogle Scholar
  29. Scharff, D. P., Homan, S., Kreuter, M., & Brennan, L. (1999). Factors associated with physical activity in women across the life span: Implications for program development. Women and Health, 29, 115–134.Google Scholar
  30. Shores, K. A., West, S. T., Theriault, D. S., & Davison, E. A. (2009). Extra-individual correlates of physical activity attainment in rural older adults. Journal of Rural Health, 25, 211–218.PubMedCrossRefGoogle Scholar
  31. Smith, B. J., Marshall, A. L., & Huang, N. (2005). Screening for physical activity in family practice: Evaluation of two brief assessment tools. American Journal of Preventive Medicine, 29, 256–264.PubMedCrossRefGoogle Scholar
  32. U.S. Department of Health and Human Services. (2008). 2008 Physical activity guidelines for Americans. Retrieved from
  33. Wilcox, S., Bopp, M., Oberrecht, O., Kammermann, S. K., & McElmurray, C. T. (2003). Psychosocial and perceived environmental correlates of physical activity in rural and older African American and white women. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 58, P329–P337.PubMedCrossRefGoogle Scholar
  34. Yin, R. K. (1993). Applications of case study research. Thousand Oaks, CA: Sage Publications.Google Scholar
  35. Yousefian, A., Hennessy, E., Umstattd, M. R., Economos, C. D., Hallam, J. S., Hyatt, R. R., et al. (2010). Development of the rural active living assessment tools: Measuring rural environments. Preventive Medicine, 50(Suppl. 1), S86–S92.PubMedCrossRefGoogle Scholar
  36. Yousefian, A., Ziller, E., Swartz, J., & Hartley, D. (2009). Active living for rural youth: Addressing physical inactivity in rural communities. Journal of Public Health Management and Practice, 15, 223–231.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Michelle C. Kegler
    • 1
  • Iris Alcantara
    • 1
  • Nicole Dubruiel
    • 1
  • J. K. Veluswamy
    • 2
  • Hannah Appelbaum
    • 1
  • Sandy Handwerk
    • 3
  1. 1.Emory Prevention Research Center, Rollins School of Public HealthEmory UniversityAtlantaUSA
  2. 2.Cancer Coalition of South GeorgiaAlbanyUSA
  3. 3.College of Arts and HumanitiesAlbany State UniversityAlbanyUSA

Personalised recommendations