Labour-Type Physical Activity, Alcohol Use and Hypertension in Rural Older Adults in Northeast China

Yongheng Zhao^1,2Gaixia Hou¹YIMENG GU^2,3Zhuangzhuang Guo^1,2Dehui Zhang⁴Xuefeng Xi^1*Limeng Liu^5*Lizhen Ning^1,2,6*

• ¹School of Wushu, Henan University, Kaifeng, China
• ²Kyungil University, Gyeongsan-si, Republic of Korea
• ³School of Martial Arts, Henan University, Kaifeng, China
• ⁴Dongcheng Community Health Service Center, Wangkui County, Heilongjiang, China
• ⁵School of Physical Education and Health Sciences, Mudanjiang Normal University, Mudanjiang, China
• ⁶School of Physical Education, Suihua University, Suihua, China

Background: Hypertension is highly prevalent in older adults, yet evidence from resource-limited rural settings remains limited. In Northeast China, older residents are chronically exposed to cold-climate stress, labour-intensive agricultural routines, and entrenched social drinking norms, which may shape blood pressure risk profiles differently from urban cohorts. Methods: We analyzed data from the 2025 Rural Elderly Health Examination Program in Wangkui County, Heilongjiang, using a community-based cross-sectional design. Participants aged ≥65 years (N = 2,270) completed standardized examinations including bilateral blood pressure measurement, anthropometrics, and questionnaires assessing workload-related physical activity frequency—dominated by farming and domestic labour in this setting (hereafter termed occupational/labour-type physical activity, OPA; sessions/week)—and alcohol drinking frequency (occasions/week). Hypertension was defined as higher-arm SBP ≥140 mmHg and/or DBP ≥90 mmHg. Associations were estimated using multivariable logistic regression with HC3 robust standard errors, adjusting for age, sex, body mass index, haemoglobin concentration, and winsorized resting heart rate (complete-case N = 2,194). Results: Higher OPA frequency and alcohol drinking frequency were independently associated with greater odds of hypertension. Each additional OPA session per week was associated with a 23% higher odds of hypertension (adjusted OR [aOR] = 1.23, 95% CI: 1.16–1.32), and each additional drinking occasion per week was associated with a 20% higher odds (aOR = 1.20, 95% CI: 1.04–1.40). Estimated population-attributable fractions suggested a substantial potential burden associated with high-frequency OPA (≥3 sessions/week; 34.8%) and a smaller burden associated with any weekly drinking (>0/week; 4.7%); these estimates were interpreted cautiously given the cross-sectional design and the use of odds ratios for a common outcome. Sensitivity analyses using alternative hypertension definitions and continuous SBP/DBP models yielded directionally consistent findings, with steeper OPA gradients at older ages. Conclusions: In this rural older-adult cohort, workload-related physical activity—reflecting largely non-volitional labour rather than leisure-time exercise— and alcohol use were associated with higher hypertension likelihood. Prevention strategies in cold-climate rural communities may benefit from workload-modification and recovery-protection approaches, safer organization of labour tasks, and targeted reduction of weekly alcohol use.