Hypertension, or high blood pressure, is a serious global health concern and a leading cause of early death. In South Africa, the condition is widespread, especially in rural areas where more than half of adults are affected. Most people depend mainly on medication, but blood pressure control remains poor. Lifestyle changes such as regular physical activity are known to help, yet there is little information about the actual activity levels of adults with hypertension in rural South Africa.

This study was conducted to understand the patterns of physical activity among adults living with hypertension in a rural sub-district of Mpumalanga Province. The aim was to describe the frequency, intensity, duration, and type of activities performed over a seven-day period.

The researchers carried out a cross-sectional study in October 2021. Adults aged 40 years and older who had been diagnosed with hypertension were randomly selected from the Health and Ageing in Africa Longitudinal Study (HAALSI). A total of 429 participants completed the International Physical Activity Questionnaire Long Form (IPAQ-LF) through telephone interviews in their local language. The questionnaire covered five areas: work-related activity, transport, housework and family care, recreation or leisure, and time spent sitting.

The participants’ average age was 65 years. Women made up 58% of the group, and just over half reported having paid or unpaid work. The median total time spent on physical activity in a week was 330 minutes, including walking, moderate, and vigorous activities.

Work-related physical activity showed clear differences between men and women. Men reported more vigorous activity at work, with a median of 240 minutes per day compared to 120 minutes for women. Men also recorded more days per week of vigorous tasks. Women performed fewer vigorous tasks but did more moderate-intensity activities at work.

Transport activity was also important. Both working men and women walked more frequently for transport than non-working participants. The amount of time spent in motor vehicles did not differ between men and women, and cycling was very uncommon across the group.

Household and caregiving activities were mainly performed by women. They reported more days of moderate-intensity tasks such as sweeping, washing, and gardening, both inside and outside the house, compared to men. Men, on the other hand, reported more vigorous household activities such as chopping wood or digging.

Recreation and leisure activities were very low. Both men and women reported almost no time spent on exercise, sports, or other leisure physical activity. This highlights the limited opportunities for recreational exercise in rural areas.

Time spent sitting was another key finding. Non-working men and women sat for longer periods during weekdays (around 180 minutes per day) than their working counterparts (about 120 minutes). Weekend sitting time was slightly higher than weekdays, but there was no significant difference between groups.

Overall, the study found that adults with hypertension in rural South Africa reported enough weekly activity to meet international guidelines, but the type of activity varied. Men were more active in vigorous work-related tasks, while women engaged more in household and caregiving tasks at moderate intensity. Leisure activity was almost non-existent, and sitting time was higher for those not working.

The study concludes that physical activity in rural areas is shaped by gender roles, work status, and social expectations. Men tend to perform more strenuous tasks, while women take on household responsibilities. Non-working adults are more sedentary. These findings suggest that public health interventions should consider these social and cultural factors when promoting physical activity to improve blood pressure control.