Racial/Ethnic Differences in Leisure-Time Physical Activity Among United States Adults With and Without Diabetes

Background: Physical activity (PA) is a key lifestyle recommendation for diabetes mellitus (DM) prevention and management. The purpose of this study was to describe the patterns of leisure-time, aerobic & muscle-strengthening PAs across races/ethnicities and DM status. Methods: We included 91,386 adults ≥18 years from the 2011–2018 National Health Interview Surveys who were able to participate in light-moderate PA. Aerobic PA was classified per 2008 guidelines as inactive (0 minutes/week [min/wk] of moderate or vigorous activity), insufficiently active (0–150 moderate-equivalent min/wk, defined as sum of moderate-level and 2*vigorous-level PA), sufficiently active (150–300 moderate-equivalent min/wk), and highly active (>300 min/wk of moderate-level PA, >150 min/wk of vigorous-level PA, or >300 moderate-equivalent min/wk). We also classified aerobic PA continuously in terms of metabolic equivalents (METs; 4 METs for moderate and 8 METs for vigorous PA). Muscle-strengthening PA was dichotomized into ≥3 times/wk (adequate) and <3 times/wk (inadequate). Race/ethnicity was categorized as non-Hispanic White (NHW), non-Hispanic Black (NHB), Asian Indian (AI), Other Asian (OA), and Hispanic/Other (H/O). We used self-reported DM-stratified multivariable logistic and linear regression to assess racial/ethnic differences in PA. All analyses accounted for the survey design and weights to obtain nationally representative estimates. Results: Among the 91,386 participants, 45,676 (53%) were male, 11,835 (10%) were ≥65 years, and 5,106 (5.2%) had DM. Asian groups had lower adequate muscle-strengthening PA than others (%[SE]: NHW, 35[0.3]%; NHB, 35[0.7]%; AI, 27[1.6]%; OA, 30[1.3]%; H/O, 34[0.8]%; p<0.0001). AIs also had a lower proportion of ‘highly active’ individuals (%[SE]: NHW, 67[0.2]%; NHB, 65[0.7]%; AI, 57[1.8]%; OA, 61[1.5]%; H/O, 67[0.8]%; p<0.0001). Non-DM AIs had mean (SE) 622 (133) lower METs than NHWs (covariate adjusted mean METs [SE]: NHW, 3,568 [305]; NHB, 3,873 [309]; AI, 2,946 [333]; OA, 3,107 [321]; H/O, 3,736 [325]; p<0.001). This difference was also present in those with DM (adjusted mean METs [SE]: NHW, 2,231 [314]; NHB, 2,231 [379]; AI, 1,366 [456]; OA, 1,847 [495]; H/O, 2,454 [401]; p=0.013). Non-DM AIs and OAs had ~30% lower odds of being at least ‘sufficiently active’ relative to NHWs (aOR [95% CI]: AI, 0.70 [0.56, 0.87]; OA, 0.72 [0.61, 0.85]). All races/ethnicities had lower odds of adequate muscle-strengthening PA compared to NHWs (aOR [95% CI]: NHB, 0.94 [0.90, 0.99]; AI, 0.68 [0.60, 0.79]; OA, 0.75 [0.68, 0.84]; H/O, 0.73 [0.69, 0.77]). These inverse associations persisted in DM-diagnosed OAs, but not AIs. Conclusion: Among those with and without DM, there exist racial/ethnic differences in strength-related and aerobic activities. Asian groups may benefit from aggressive counseling and PA interventions to both prevent and manage DM.