Walking is central to independence, work and daily life, but new PHRI study found that people in low-income countries are losing that ability much earlier than those in high-income countries, thus revealing a major global gap in healthy aging.
The study, published in The Lancet Healthy Longevity on May 11, 2026, used data from the PHRI Prospective Urban Rural Epidemiology study (PURE), which has followed people in communities across a wide range of countries and income levels for more than two decades.
The analysis included 150,221 adults from 25 countries who did not report walking limitations when they joined the study. Participants were between 35 and 70 years old at the start and followed for an average of 14.5 years. Some were followed for as long as 24 years.
Researchers found that walking limitations developed earlier and more often in low-income countries. By age 64, about one in three people in low-income countries had developed a walking limitation. In high-income countries, that same point was reached at age 76.
Raed Joundi
The 12-year gap matters because walking is central to daily life. It helps people work, care for themselves, take part in family and community activities, and remain independent as they age.
“Walking ability is a key part of healthy aging” said Raed Joundi, first author of the study and PHRI scientist. “These findings show that many people in lower-income settings are facing mobility decline much earlier in life, during years when they may still be working and supporting families.”
Among 122,538 participants who had follow-up data on walking ability, 26,156 developed a new walking limitation during the study.
The proportion was highest in low-income countries, where 42.2 per cent of participants developed a walking limitation. That compared with 22 per cent in other middle-income countries, 18.7 per cent in high-income countries and 8.6 per cent in China.
Even after researchers accounted for differences in age and sex, people in low-income countries developed walking limitations at a much higher rate than those in high-income countries.
Women were more likely than men to develop walking limitations. Also, people living in rural communities also had a higher rate than those in urban communities.
The study also looked at other activity limitations, including difficulty bending, grasping, seeing and hearing. Motor and vision limitations were also more common in low-income countries.
Many of the risk factors can be changed
The study found that walking limitation and death share many of the same risk factors.
Lower levels of education, low recreational physical activity, poor diet and high blood pressure were among the leading factors linked to both outcomes. Obesity, diabetes, depression, smoking, previous stroke, coronary heart disease, and lower grip strength were also associated with a higher risk of developing walking limitations.
Stroke stood out as a particularly strong risk factor. Participants who had a stroke during follow-up had more than three times the risk of developing a walking limitation.
At the population level, low education accounted for the largest share of risk for walking limitation, at 11.1 per cent. Obesity accounted for 5.2 per cent, low recreational physical activity for 4.3 per cent and high blood pressure for 3.6 per cent.
Together, the potentially modifiable risk factors studied accounted for about one-third of the population-level risk of walking limitations and nearly half of the risk of death.
Joundi said the overlap is important because it suggests that some prevention efforts could help people live longer while also helping them live with fewer limitations.
“Healthy aging is not only about surviving longer,” he said. “It is also about helping people maintain function, mobility and quality of life.”
The findings suggest that efforts to prevent mobility loss should begin in midlife, before walking limitations appear.
This may include better prevention and treatment of high blood pressure and diabetes, support for regular physical activity, healthier diets, smoking prevention and cessation, and improved access to education and health care.
The researchers note that the reasons for earlier walking limitation in low-income countries are likely complex. They may include lifelong social and economic disadvantage, physically demanding work, environmental risks, limited access to preventive care and rehabilitation, and other factors not fully captured in the study.
Longer lives, healthier lives
The new analysis builds on earlier PURE findings published in 2024, which showed that activity limitations were more common in low- and middle-income countries than in high-income countries. That earlier work also found that people in lower-income countries were less likely to use assistive devices such as canes, walkers, glasses and hearing aids.
The recently published study goes further by looking at when walking limitations develop and what factors may contribute to them. The study concludes that walking limitations are potentially preventable and that action is needed to reduce the burden of mobility loss, especially in countries where people are experiencing these limitations earlier in life.
