Associations between active travel and physical multi-morbidity in six low- and middle-income countries among community-dwelling older adults: A cross-sectional study

BACKGROUND: There is little evidence on the potential health benefits of active travel in low- and middle-income countries (LMICs). The aim of this study was to assess the association between levels of active travel and physical multi-morbidity (i.e., two or more chronic physical conditions) and individual physical conditions among community-dwelling adults aged 65 or older in six LMICs. METHODS: Data were analyzed from the World Health Organization’s Study on Global Ageing and Adult Health (China, Ghana, India, Mexico, Russia, South Africa). Active travel (minutes / week) was assessed with questions of the Global Physical Activity Questionnaire (GPAQ) and presented in tertiles. Eleven chronic conditions (angina, arthritis, asthma, chronic back pain, chronic lung disease, diabetes, edentulism, hearing problems, hypertension, stroke, visual impairment) were assessed by self-report of diagnosis, symptoms, or blood pressure measurement. Multivariable logistic regression analysis was conducted to assess the association between levels of active travel, physical conditions and physical multi-morbidity. RESULTS: The final sample consisted of 14,585 individuals aged ≥65 years (mean age = 72.6±0.1 years; 54.9% female). In the fully adjusted model, compared to the highest tertile, those in the lowest tertile of active travel had a 1.28 (95%CI = 1.06–1.54) times higher odds for physical multi-morbidity. The association between active travel and physical multi-morbidity was significantly mediated by affect (14.4%) and cognition (9.7%). With regard to individual conditions, hearing problems, hypertension, stroke, and visual impairment were particularly strongly associated with less active travel. CONCLUSION: The current data suggest that lower levels of active travel are associated with the presence of physical health conditions and physical multi-morbidity. This multi-national study offers potentially valuable insight for a number of hypotheses which may influence this relationship, although testing with longitudinal studies is needed.