Disparities in adherence to physical activity guidelines among US adults: A population-based study

Abstract

The objective of this study was to determine adherence to national guidelines for aerobic and muscle-strengthening physical activity among United States (US) adults and identify factors associated with guideline nonadherence. The 2022 National Health Interview Survey data were analyzed to evaluate self-reported physical activity among 26,494 US adults. Adherence to national guidelines was defined as engaging in ≥150 minutes moderate-intensity or ≥75 minutes vigorous-intensity aerobic activity/week, and muscle-strengthening activity ≥2 days/week. A multivariable logistic regression model evaluated associations between 24 sociodemographic and health variables with nonadherence to physical activity guidelines. Shapley Additive Explanations were used to assess the relative importance of each factor in the model. The population-weighted analysis revealed that only 24.3% of US adults met both the aerobic and muscle-strengthening activity guidelines. The regression model identified 17 factors significantly associated with nonadherence. When evaluating the relative importance of these variables, older age, lower educational attainment, and lower household income emerged as the primary determinants of nonadherence. Guideline adherence was lowest among subgroups with multiple risk factors, with only 6.5% of older adults with lower income and education meeting the guidelines. In contrast, adherence was 42.7% in younger respondents with higher incomes and educational attainment. In conclusion, physical activity rates among US adults remain below public health targets, with significant disparities among sociodemographic groups. Expanded outreach efforts targeting higher-risk populations are urgently needed to address barriers, promote physical activity engagement, and achieve health equity.

1. Introduction

Regular physical activity offers substantial health benefits that greatly outweigh the risks for most adults.^[1] These benefits include a reduced risk of all-cause mortality, cardiometabolic conditions (e.g., heart disease, stroke), cancer, and excessive weight gain. Additionally, physical activity promotes brain health, including decreased risks of dementia, depression, and anxiety, while improving cognitive function and sleep quality.^[2] Despite these well-established benefits, many Americans fail to engage in sufficient physical activity to meet the recommended guidelines for aerobic and muscle-strengthening activities.^[3–5] Recent estimates indicate that only about half of United States (US) adults meet aerobic activity recommendations, and only a quarter adhere to both aerobic and muscle-strengthening guidelines.^[5,6]

As part of the Healthy People 2030 public health initiative, which aims to improve population health over the next decade, targets have been set to increase the proportion of adults 18 years and older meeting both activity guidelines to 29.7%.^[6] However, recent national surveys demonstrate adherence rates falling below this target, particularly among racial minorities and women.^[3–5] Examining disparities in guideline adherence based on sociodemographic and health characteristics may reveal population subsets facing disproportionate risks from physical inactivity. While selected determinants of physical activity adherence have been studied,^[3–5] a comprehensive analysis of sociodemographic and physical health factors is warranted to identify the most significant barriers and inform targeted interventions.

To address this need, our study utilized the most recent self-reported physical activity data for US adults from the 2022 National Health Interview Survey (NHIS), an annual nationwide survey of healthcare and health behaviors.^[7] Therefore, this study had 2 primary objectives. The first was determining adherence to aerobic and muscle-strengthening activity guidelines among US adults. The second was identifying the key sociodemographic and health determinants of nonadherence.

2. Methods

2.1. Study design and participants

This cross-sectional study utilized data from the 2022 NHIS, an annual household interview survey that provides health information on the US civilian population and is a major surveillance tool for monitoring adult physical activity.^[7] The NHIS employs a multistage probability cluster sampling approach with geographic stratification to randomly select US households. One adult aged 18 years or older was randomly chosen to participate from each sampled household. The survey excluded active-duty military personnel, civilians living on military bases, institutionalized individuals, and those without a fixed household address. Interviews for the 2022 NHIS were conducted between January 1 and December 31, 2022 using in-person computer-assisted personal interviews, supplemented by telephone when needed or requested by the participant. A total of 27,651 adults completed interviews, representing a response rate of 47.7%. All participants provided informed consent under protocols approved by the National Centers for Health Statistics Ethics Review Committee. This study design and reporting adhered to the Strengthening the Reporting of Observational Studies in Epidemiology reporting guideline^[8] and the Preferred Reporting Items for Complex Sample Survey Analysis.^[9]

2.2. Outcomes

The primary outcome of this study was self-reported adherence to aerobic and muscle-strengthening physical activity guidelines in a typical week. Aerobic minutes per week were calculated by multiplying self-reported frequency and duration for moderate and vigorous activities separately. Adherence to national recommendations was based on the 2018 Physical Activity Guidelines for Americans, which recommend at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic activity per week (or an equivalent combination), plus muscle-strengthening activity on at least 2 days per week.^[10] Adherence to recommendations was categorized into 4 groups: “Meets neither” for individuals not meeting aerobic or strength guidelines; “Strength only” for those meeting only the muscle-strengthening guideline of 2 + days/week; “Aerobic only” for those meeting only the aerobic guideline of 150 + minutes moderate or 75 + minutes vigorous activity per week; and “Meets both” for individuals fulfilling both aerobic and strength recommendations.

Sociodemographic characteristics included geographic region and urban–rural classification,^[11] age, sex, body mass index, race/ethnicity (Asian, Black, White, Hispanic, American Indian/Alaska Native, Other/multirace), education attainment, marital status, and household income as a percentage of federal poverty guidelines. Physical health factors included self-reported history of diabetes, cancer, lung disease, coronary heart disease, myocardial infarction, angina, hypertension, arthritis, stroke, disability as determined by the Washington Group Short Set Composite Disability Indicator,^[12] chronic fatigue syndrome, asthma, depression, anxiety, and smoking history.

2.3. Statistical analysis

A complex sample analysis incorporated sampling weights, strata, and cluster variables to generate nationally representative estimates. Sampling weights were calculated as the inverse selection probability, with adjustments made for survey nonresponse. Variance estimates using Taylor series expansion accounted for the multistage stratified cluster design of the survey. Multivariable logistic regression models were used to examine associations of sociodemographic and physical health variables with nonadherence to physical activity guidelines. The associations were reported as odds ratios with corresponding 95% confidence intervals. Because trivial statistically significant associations are common in population-based studies, Shapley Additive Explanations (SHAP) were also used to assess the relative importance of each variable when accounting for all possible interactions. This machine-learning approach decomposes the model output by calculating SHAP values derived from all possible variable subsets, indicating the explanatory contribution of each variable, ranging from 0% to 100%.^[13] A SHAP value threshold ≥12.5% was set to identify the most influential variables, reflecting only the variables with at least 3 times the expected average predictive contribution. Variables achieving both statistical significance (P < .05) and sufficient relative importance (SHAP > 12.5%) were considered primary determinants^[14] and were subsequently evaluated in a subgroup analysis to explore their association with physical activity guideline adherence. All statistical analyses were performed using Stata (v18).

3. Results

Physical activity status was reported for 26,494 (95.8%) participants. The median participant age was 54 years, and 54.6% were female. Adherence to physical activity guidelines was lower among older adults, females, and those with obesity, less education, and lower household income (Table 1). Additionally, for each physical comorbidity evaluated, physical activity adherence was lower in those with the condition than those without, most notably for diabetes, lung disease, and disability (Table 2).

Table 1.

Sociodemographic characteristics of 26,494 adults in the 2022 National Health Interview Survey by adherence to aerobic and muscle-strengthening activity guidelines.^*

Variable	Sample frequency (%)	Adherence to activity guidelines (%)
		Meets neither	Strength only	Aerobic only	Meets both
Overall sample	100	47.1	6.5	23.1	23.3
Household region
Northeast	16.4	47.4	6.5	23.5	22.6
Midwest	21.9	47.5	6.6	23.6	22.2
West	25.0	41.4	6.5	24.8	27.4
South	36.7	50.6	6.6	21.6	21.3
Urban–rural county classification
Large central metro	29.9	43.7	6.6	22.2	27.4
Large fringe metro	23.4	44.4	7.1	22.9	25.6
Medium & small metro	31.0	48.4	6.2	24.0	21.5
Nonmetropolitan	15.7	55.0	6.3	23.5	15.2
Age (years)
18–34	20.8	36.9	6.5	21.8	34.8
35–64	47.2	46.6	6.3	23.5	23.6
≥65	32.0	54.4	6.9	23.5	15.2
Sex
Female	54.6	51.6	6.5	22.2	19.7
Male	45.4	41.6	6.6	24.3	27.5
Body mass index
Underweight	1.6	47.8	8.4	22.8	20.9
Healthy weight	31.4	39.2	6.5	24.5	29.8
Overweight	34.3	43.5	6.6	24.3	25.6
Obese	32.7	57.3	6.4	20.8	15.4
Race/ethnicity
Asian	6.1	44.3	6.5	25.3	24.0
White	66.3	45.4	6.4	24.6	23.5
AIAN	0.7	52.3	7.4	23.9	16.5
Other/multirace	1.8	42.4	6.7	22.8	28.2
Black	10.9	52.3	8.1	17.9	21.6
Hispanic	14.2	52.5	5.8	19.2	22.5
Highest education level
Less than high school	10.7	65.7	5.1	19.8	9.4
High school	51.1	52.0	6.7	22.6	18.7
Bachelor’s degree	23.0	36.1	7.0	24.4	32.5
Master’s degree	11.2	34.2	6.4	25.1	34.3
Professional degree	4.0	32.4	6.3	25.9	35.4
Marital status
Married	46.4	45.5	6.1	24.9	23.5
Unmarried	53.6	48.5	6.9	21.6	23.0
Household income
<200% FPG	27.3	59.5	6.3	20.8	13.4
200–399% FPG	28.8	50.3	6.5	22.6	20.6
≥400% FPG	43.8	37.2	6.7	24.9	31.2

AIAN = American Indian and Alaskan Native, FPG = federal poverty guidelines.

^* Values are unweighted descriptive statistics from the study sample.

Table 2.

Health and lifestyle characteristics of 26,494 adults in the 2022 National Health Interview Survey by adherence to aerobic and muscle-strengthening activity guidelines.^*

Variable	Sample frequency (%)	Adherence to activity guidelines (%)
		Meets neither	Strength only	Aerobic only	Meets both
Overall sample	100	47.1	6.5	23.1	23.3
Diabetes
Yes	10.6	65.6	5.9	18.9	9.6
No	89.4	44.9	6.6	23.6	24.9
Cancer
Yes	12.5	51.9	7.1	23.6	17.4
No	87.5	46.4	6.5	23.1	24.1
Lung disease
Yes	5.5	70.9	6.1	14.7	8.2
No	94.5	45.7	6.6	23.6	24.1
Coronary heart disease
Yes	6.3	64.5	5.5	18.4	11.7
No	93.7	45.9	6.6	23.4	24.1
Myocardial infarction
Yes	3.6	64.7	5.9	18.0	11.3
No	96.4	46.4	6.6	23.3	23.7
Angina
Yes	1.9	63.7	6.6	17.6	12.1
No	98.1	46.7	6.5	23.2	23.5
Hypertension
Yes	36.8	56.9	7.1	21.1	14.9
No	63.2	41.3	6.2	24.3	28.1
Arthritis
Yes	26.5	57.9	7.1	20.8	14.1
No	73.5	43.2	6.3	23.9	26.6
Stroke
Yes	3.6	67.6	7.0	15.2	10.2
No	96.4	46.3	6.5	23.4	23.7
Disabled
Yes	10.4	72.3	6.8	13.6	7.3
No	89.6	44.2	6.5	24.2	25.1
Chronic fatigue syndrome
Yes	2.1	68.4	6.6	14.9	10.1
No	97.9	46.6	6.6	23.3	23.5
Asthma
Yes	14.2	50.6	7.0	20.4	22.0
No	85.8	46.5	6.5	23.6	23.5
Depression
Yes	19.0	56.3	6.6	20.3	16.8
No	81.0	44.9	6.5	23.8	24.8
Anxiety
Yes	17.6	54.1	6.6	21.2	18.1
No	82.4	45.6	6.5	23.5	24.4
Smoking
Yes	36.6	51.4	6.1	23.8	18.7
No	63.4	44.6	6.8	22.7	25.9

^* Values are unweighted descriptive statistics from the study sample.

In the population-weighted analysis, 75.7% of adults failed to meet physical activity guidelines. This included 22.9% who met the aerobic activity guidelines only, 6.3% who met the strengthening activity guidelines only, and 46.5% who met neither guideline. Overall, adherence to both physical activity guidelines was 24.3% overall, falling short of the 29.7% Healthy People 2030 target.^[6] Among those reporting adherence to these guidelines, the proportions varied by sex and across age categories. The proportion of adherent men exceeded 29.7% until ages 45 to 49, whereas for women, except for the 18 to 24 age group, all age groups were below target (Fig. 1).

Figure 1.

Adherence to aerobic and muscle-strengthening activity guidelines by sex and age group among adults in the 2022 National Health Interview Survey. Values are weighted and nationally representative of the US adult population.

The logistic regression analysis identified 17 factors that were statistically associated with nonadherence to guidelines, whereas 7 additional comorbidity factors failed to show a statistical association (Table 3). However, when further evaluating the relative explanatory importance of the variables using SHAP, only 3 of these 24 characteristics met the dual P-value and SHAP value criteria for predicting physical activity guidance nonadherence: older age, less education, and lower household income (Fig. 2). The subgroup analysis based on these 3 determinants highlighted the disparities in adherence rates. Among adults aged 65 years and older, only those with the highest education and income levels reached the target adherence. Similar trends were observed among adults aged 35 to 64, but with higher adherence overall. Among those aged 18 to 34 years, only the lowest income group fell below the target. Strikingly, adults with all 3 risk factors (older age, less education, and lower household income) had an adherence rate of only 6.5%, in contrast to the 42.7% adherence rate observed in younger adults with more education and higher income (Table 4).

Table 3.

Multivariable logistic regression of factors associated with nonadherence to aerobic and muscle-strengthening activity guidelines among adults in the 2022 National Health Interview Survey.^*

Variable	Unit of measure	Odds ratio	95% CI	P-value
Household region	West	1 [ref.]	–	<.001
	Midwest	1.25	1.12, 1.41
	South	1.27	1.14, 1.42
	Northeast	1.44	1.26, 1.64
Urban–rural county classification	Large fringe metro	1 [ref.]	–	<.001
	Large central	1.06	0.96, 1.17
	Medium & small metro	1.15	1.03, 1.28
	Nonmetropolitan	1.40	1.20, 1.62
Age (years)	18–34	1 [ref.]	–	<.001
	35–64	1.50	1.37, 1.64
	≥65	2.06	1.81, 2.33
Sex	Female vs male	1.55	1.44, 1.66	<.001
Body mass index	Healthy weight	1 [ref.]	–	<.001
	Overweight	1.16	1.06, 1.27
	Underweight	1.29	0.93, 1.79
	Obese	1.79	1.61, 1.99
Race/ethnicity	Black	1 [ref.]	–	<.001
	Other/multirace	1.03	0.79, 1.34
	White	1.14	0.99, 1.31
	Hispanic	1.24	1.06, 1.44
	Asian	2.03	1.67, 2.47
Highest education level	Professional degree	1 [ref.]	–	<.001
	Master’s degree	0.91	0.77, 1.07
	Bachelor’s degree	1.07	0.91, 1.27
	High school	1.63	1.39, 1.92
	Less than high school	2.84	2.28, 3.53
Marital status	Married vs unmarried	1.19	1.10, 1.28	<.001
Household income	≥400% FPG	1 [ref.]	–	<.001
	200–399% FPG	1.32	1.20, 1.46
	<200% FPG	1.77	1.60, 1.97
Diabetes	Yes vs no	1.57	1.34, 1.85	<.001
Cancer	Yes vs no	1.09	0.96, 1.23	.18
Lung disease	Yes vs no	1.38	1.07, 1.77	.01
Coronary heart disease	Yes vs no	1.27	1.04, 1.55	.02
Myocardial infarction	Yes vs no	1.19	0.91, 1.55	.21
Angina	No vs yes	1.16	0.83, 1.64	.38
Hypertension	Yes vs no	1.20	1.09, 1.33	<.001
Arthritis	Yes vs no	1.14	1.03, 1.26	.02
Stroke	Yes vs no	1.21	0.93, 1.57	.16
Disabled	Yes vs no	1.82	1.50, 2.21	<.001
Chronic fatigue syndrome	Yes vs no	1.29	0.93, 1.79	.13
Asthma	No vs yes	1.07	0.96, 1.20	.23
Depression	Yes vs no	1.25	1.09, 1.44	.002
Anxiety	Yes vs no	1.09	0.95, 1.25	.21
Smoking	Yes vs no	1.18	1.09, 1.28	<.001

AIAN = American Indian and Alaskan Native, CI = confidence interval, FPG = federal poverty guidelines.

^* Values are weighted and nationally representative of the US adult population.

Figure 2.

Relative importance of covariates in a multivariable logistic regression model to predict nonadherence to aerobic and muscle-strengthening activity guidelines among adults in the 2022 National Health Interview Survey. BMI = body mass index; CFS = chronic fatigue syndrome; CHD = coronary heart disease; HTN = hypertension; MI = myocardial infarction; SHAP = SHapley Additive exPlanations.

Table 4.

Adherence to aerobic and muscle-strengthening activity guidelines across risk groups in the 2022 National Health Interview Survey.^*

Age	Household income	Educational attainment†
		Low	Medium	High
≥65	<200% FPG	6.5	13.6	19.0
	200–399% FPG	8.1	20.4	24.6
	≥400 FPG	15.1	25.9	33.1
35–64	<200% FPG	10.1	16.3	29.1
	200–399% FPG	17.0	28.3	30.4
	≥400 FPG	23.6	35.2	37.0
18–34	<200% FPG	24.4	38.3	24.6
	200–399% FPG	31.2	37.0	32.6
	≥400 FPG	39.2	46.7	42.7

FPG = federal poverty guidelines.

^* Values are weighted and nationally representative of the US adult population. The weighted population adherence to aerobic and muscle-strengthening activity guidelines was 24.3%.

^† High educational attainment includes Master’s, doctorate, or professional degree; Medium includes Bachelor’s degree; Low includes less than Bachelor’s degree.

4. Discussion

The results of this nationally representative analysis of US adults in 2022 reveal that only 24.3% of the population met the recommended guidelines for both aerobic and muscle-strengthening activity, which are key Leading Health Indicators outlined in the Healthy People 2030 public health initiative.^[6] This finding highlights a substantial gap between current physical activity levels and established public health goals. Further examination of the data revealed major disparities in meeting activity guidelines among certain sociodemographic subgroups. Specifically, older age, low household income, and less education emerged as critical determinants associated with reduced levels of adequate physical activity. The most striking disparity was among older adults with low income and education, with only 6.5% of this subgroup meeting the full activity guidelines. These findings underscore the urgent need for expanded public health initiatives that promote physical activity engagement and address the specific obstacles to participation among higher-risk populations. Such targeted efforts are critical for achieving health equity and realizing the overarching public health goals for physical activity levels not only for the population, but also among diverse sociodemographic groups.

In addition to the overall adherence rate, the analysis revealed that 22.9% of adults met only the aerobic activity guidelines, 6.3% met only the strengthening activity guidelines, and 46.5% failed to meet either guideline. This indicates that while 47.2% of US adults performed adequate aerobic activity for substantial health benefits (independent of muscle-strengthening frequency), only 30.6% engaged in the minimum recommended muscle-strengthening frequency (independent of aerobic activity adherence). Despite evidence showing an increase in muscle-strengthening guideline adherence from 19.8% in 1997 to 27.2% in 2018,^[5] nonadherence to strength training recommendations remains a critical limiter in achieving Healthy People 2030 targets. The considerable gap between aerobic and muscle-strengthening participation warrants prioritization to align population behaviors with full activity recommendations. Muscular strength training confers dose-dependent benefits at any age, but may be especially impactful for maintaining independence, mitigating fall risk, and protecting against chronic conditions in older adults.^[2] Therefore, explicitly addressing the under-participation in muscle-strengthening activities through targeted public health awareness and engagement initiatives represents an opportunity to meaningfully advance population activity guidelines adherence toward the Healthy People 2030 target.

Population-based studies frequently cite lack of time, health issues, and lack of motivation as top contributors to insufficient exercise.^[15] Furthermore, certain barriers disproportionately affect specific subgroups, including older adults, those with less education, and those with lower incomes. For example, a study found that the negative effect of older age on physical activity was moderated by barriers such as fear of injury, time constraints, and perceived skill deficits.^[16] Additionally, research suggests that many older adults view physical activity as recreation rather than a health intervention,^[17] potentially reflecting health literacy challenges. Older adults may also negatively perceive common exercise-associated symptoms like shortness of breath, sweating, and muscle soreness as harmful.^[17] However, it is important to emphasize that the national physical activity guidelines apply to all adults regardless of age, even those with chronic conditions or disabilities absent clear contraindications.^[10] Therefore, most older adults should still strive to achieve recommended activity levels as they stand to benefit substantially from the associated reduced risk of falls, fall-related injuries, and improved physical function conferred by physical activity.^[2] The relatively lower impact of physical health factors on guideline adherence suggests that sociodemographic factors may present more immediate barriers.

Lower education and income levels also demonstrated substantial independent inverse effects on exercise adherence, which may be interrelated through mechanisms such as reduced health literacy. Individuals with lower health literacy may face difficulties accessing, comprehending, and applying health information needed to engage in appropriate physical activity behaviors. Since health literacy is intricately tied to overall literacy and education levels, these factors may exacerbate common physical activity barriers among groups with lower income or education. Collectively, these findings suggest a complex interplay of barriers related to physical limitations, time scarcity, access difficulties, and knowledge gaps that appear to interact and contribute to reduced physical activity participation across subgroups.

Attempts have been made to translate the 2018 Physical Activity Guidelines for Americans into actionable public health messaging through the Move Your Way campaign.^[18] While this campaign intends to communicate exercise benefits and recommendations in plain language, it fails to address common barriers the public faces in initiating and maintaining physical activity programs. Furthermore, despite the widespread availability of online Move Your Way resources, overall public awareness of this program remains low. A survey of individuals contemplating exercise found that only 10% were aware of the Move Your Way campaign.^[19] Moreover, only 2% of individuals were aware of the exercise dose corresponding to moderate-intensity, and just 22% were aware of the 2018 Physical Activity Guidelines for Americans; however, greater familiarity was observed among individuals with higher education and income.^[20] Considering those findings in comparison with the present study’s results, inadequate health literacy appears to contribute to disparities in guideline adherence, since health literacy is intricately tied to overall literacy, education level, and income status. Given that exposure to the Move Your Way campaign confers 40% higher odds of meeting both aerobic and muscle-strengthening activity recommendations,^[19] enhanced public health programming that targets awareness and utilization could improve activity engagement across underserved sociodemographic groups, as well as in the overall population.

Another major initiative aimed explicitly at overcoming barriers to physical activity engagement is Active People, Healthy Nation.^[21] This program intends to help 27 million Americans become more physically active by 2027, aiming to improve overall health and quality of life while reducing healthcare costs. Active People, Healthy Nation promotes strategies aligned with the 2018 Physical Activity Guidelines for Americans and the Community Preventive Services Task Force recommendations to make physical activity accessible, safe, and enjoyable for diverse populations. As part of this initiative, community leaders work directly with traditionally less active groups to codesign and implement culturally relevant solutions to reduce disparities. Considering that only ~20 to 25% of adults have met physical activity guidelines each year since 1998,^[4] substantially greater awareness and improved national implementation of synergistic programs like Move Your Way (addressing health literacy) and Active People, Healthy Nation (removing access barriers) will be essential to promote positive shifts in physical activity behaviors across the population, which has remained largely stagnant for the past 25 years. Our findings suggest these programs could enhance their impact by refining their strategies to more effectively engage older adults, individuals with lower educational attainment, and lower-income households: groups demonstrating the lowest adherence rates in our analysis.

This nationally representative, population-based study has several notable strengths that reinforce the validity and importance of the findings. The sampling methodology enabled the generalization of conclusions to the noninstitutionalized US adult population. Additionally, surveying large numbers of diverse sociodemographic groups facilitated analysis of health characteristics not possible in smaller studies. Determining the relative predictive importance of covariates for nonadherence overcame the limitations of traditional statistical methods in large population-based studies, where variables with minimal effect sizes often reach statistical significance.^[13] Machine-learning algorithms facilitated the identification of the strongest predictors of nonadherence, thereby allowing practical interpretation of the results and providing clear targets for interventions aimed at improving population-level physical activity adherence. Finally, aligning study objectives with Healthy People 2030 goals^[6] underscores the societal relevance of these results, as inadequate physical activity levels are responsible for 16% of premature deaths,^[22] and over $117 billion in annual US healthcare costs.^[23] However, some limitations of the study should be acknowledged. First, the cross-sectional design precluded drawing causal conclusions between participant factors and exercise adherence. Second, self-reported physical activity data may be influenced by recall bias. Third, the NHIS did not collect data on potential residual confounders like attitudinal factors influencing exercise decisions or physical contraindications to activity. Thus, while key target groups for intervention were identified, further qualitative research should investigate opinions and values influencing exercise hesitancy among these subgroups to determine barriers. Finally, this analysis excluded the assessment of nonleisure time physical activity or alternative activities like tai-chi or yoga that may still positively impact health. Thus, some individuals classified as nonadherent may be engaging in sufficient physical activity for at least modest health benefits.

5. Conclusion

This nationally representative study reveals that physical activity rates among US adults remain below public health targets, with significant disparities observed among certain sociodemographic groups. Notably, lower adherence was most prevalent among older adults and those with less education and income. These findings underscore the urgent need for a multipronged approach to meaningfully improve population activity levels. To achieve this goal, persistent public health messaging about physical activity guidelines is essential to raise awareness and promote engagement, in addition to policy initiatives aimed at eliminating obstacles and improving health literacy, particularly among the most vulnerable subgroups.

Author contributions

Conceptualization: Mehul Bhattacharyya, Larry E Miller.

Data curation: Larry E Miller.

Formal analysis: Larry E Miller.

Investigation: Mehul Bhattacharyya, Larry E Miller, Anna L Miller, Ruemon Bhattacharyya, William G Herbert.

Methodology: Mehul Bhattacharyya, Larry E Miller, Anna L Miller, Ruemon Bhattacharyya, William G Herbert.

Project administration: Larry E Miller.

Resources: Anna L Miller, Ruemon Bhattacharyya.

Supervision: Larry E Miller.

Writing – original draft: Larry E Miller.

Writing – review & editing: Mehul Bhattacharyya, Anna L Miller, Ruemon Bhattacharyya, William G Herbert.