Comparative Evaluation of Blood Pressure, Central Adiposity, and Physical Activity Patterns Between Wheelchair Users and Ambulatory Adults in a Rural South African Settings: A Cross-Sectional Study Protocol

Background Hypertension is a major modifiable driver of cardiovascular disease in low- and middle-income countries, heavily driven by central adiposity and physical inactivity. Wheelchair users represent a structurally marginalized population facing heightened exposure to prolonged sitting and altered body composition. However, context-specific epidemiological data comparing cardiovascular risk profiles by mobility status in rural South Africa remain scarce. Objective This study aims to compare blood pressure profiles, central adiposity (waist circumference), physical activity levels, and sedentary behavior between wheelchair users and ambulatory adults in the Thulamela Municipality, Limpopo Province, and to determine if mobility status is independently associated with hypertension. Methods This study utilizes an analytical, community-based cross-sectional design. A sample of N = 210 adults (n = 70 wheelchair users; n = 140 ambulatory controls) will be recruited using purposive and convenience sampling strategies within rural networks. Assessments will feature seated blood pressure measurements and seated waist circumference metrics to standardize data collection across both groups. Physical activity and sedentary durations will be quantified using the Leisure Time Physical Activity Questionnaire for Spinal Cord Injury (LTPAQ-SCI) and the International Physical Activity Questionnaire Short Form (IPAQ-SF). Outcomes will be mathematically harmonized into weekly minutes of moderate-to-vigorous physical activity (MVPA). Analysis Inter-group variations will be assessed using independent samples t-tests or Mann-Whitney U tests. Multivariate binary logistic regression models will isolate the independent association between mobility status and hypertension, controlling for confounding clinical and demographic factors.