If you live in South Africa, you are likely to develop walking difficulties earlier than people living in countries such as Canada or Sweden, according to a major international study conducted across 25 countries.

Indicator

Walking ability is widely regarded as one of the most important indicators of healthy ageing, because it enables people to remain independent, maintain social connections, and enjoy a better quality of life. Until now, little has been known about how walking limitations develop across countries at different income levels.

In a new study published in The Lancet, researchers found that people living in middle-income countries, including South Africa, and low-income countries lose their mobility earlier than those in wealthier nations, with those in the poorest countries developing walking limitations up to 12 years earlier — highlighting stark global inequalities in healthy ageing.

UWC researcher Prof Rina Swart, Head of the Department of Dietetics and Nutrition, was among the international team of researchers who contributed to the study. Prof Thandi Puoane from the School of Public Health started the Prospective Urban Rural Epidemiology (PURE) research at UWC in 2009.

The research followed more than 122 000 adults over more than 15 years and analysed data from the international PURE study, which tracks how modern environments — such as dietary shifts, changes in physical activity, and environmental factors — affect health outcomes, including the development of chronic diseases such as obesity and diabetes across income levels in different countries. South Africa has four participating sites: one urban and one rural site in the North West Province, one urban site in Langa, Western Cape, and one rural site in Mount Frere, Eastern Cape.

Walking limitations

Participants were asked whether they experienced any difficulty with everyday functions such as walking, grasping objects, bending, seeing up close or at a distance, or hearing. Focusing on walking limitations, researchers found that these were highest in low-income countries (Bangladesh, India, Pakistan, Tanzania, and Zimbabwe), with 3.34 new cases per 100 person-years. This means about three to four people out of every 100 developed a walking limitation each year. This figure was almost twice the rate seen in middle-income countries such as South Africa, Brazil, Russia, and Argentina, where 1.80 new walking limitations per 100 person-years were recorded.

High-income countries that were part of the study — such as Canada, Sweden, the UAE, and Saudi Arabia — recorded fewer cases of walking limitations, at approximately 1.31 cases per 100 person-years. China had the lowest incidence, at 0.58 cases per 100 person-years. The study found that lower educational attainment, lower income, hypertension, disabling health events such as stroke, and a greater burden of chronic diseases were all associated with an earlier onset of walking difficulties. In middle- and low-income countries, limited recreational physical activity and poor neighbourhood walkability — such as a lack of pavements, uneven roads, and unsafe environments — were also linked to reduced mobility.

By contrast, obesity was the leading contributor to walking difficulties in high-income countries. Many of the same factors that increased the risk of walking limitations also increased the risk of premature death.

Prevention

Researchers estimated that nearly one-third of walking limitations and almost half of premature deaths could potentially be prevented by addressing modifiable risk factors, such as improving education, encouraging physical activity, promoting healthier diets, and better controlling hypertension. They argue that these findings strengthen the case for investing in preventive health measures long before old age.

Rather than treating disability and premature death as separate challenges, they suggest that integrated strategies promoting healthy lifestyles and better cardiovascular health during mid-life could substantially improve both mobility and survival. “Because walking and other limitations are potentially preventable, targeted global and region-specific strategies can be developed to promote healthy, limitation-free ageing during mid-life and older adulthood,” the researchers concluded.

ALSO READ: UWC positions itself on the forefront of digital transformation