Association between Life's Essential 8 and Self-reported Walking Difficulty in Community-dwelling Middle-aged and Older Adults

Background: Self-reported walking difficulty (SrWD) is a key indicator of health and functional decline across the lifespan. Life’s Essential 8 (LE8) evaluates cardiovascular health through metrics including diet, physical activity (PA), body mass index (BMI), blood pressure (BP), cholesterol, glucose, nicotine exposure, and sleep. This retrospective cross-sectional study explores the association between SrWD and LE8 score in community-dwelling middle-aged (40–65 years) and older adults (≥ 65 years) from the Longevity Check-up (Lookup) 8+ cohort. Methods: Lookup 8+ is an ongoing initiative started in June 2015, conducted in unconventional settings across Italy (e.g., malls, exhibitions) to promote healthy lifestyles in the general population. SrWD was assessed with a single question: “Do you have any difficulty in walking 400 meters?”. LE8 components were evaluated using a diet and lifestyle questionnaire, and a brief assessment including point-of-care serum cholesterol and blood glucose testing. Results: By October 2024, 7064 participants aged ≥40 years were enrolled (mean age 60.1 ± 11.2, 33.7% aged ≥ 65 years; 53.5% women; mean LE8 score 65.0 ± 12.7). They were grouped into low (n = 863), moderate (n = 5288), and high (n = 913) LE8 score. The low group was older, had lower muscle mass, and greater dynapenia. SrWD was highest in the low group (31.4%), followed by moderate (14.1%) and high (4.8%) (p < 0.001). 10.3% of those aged 40–65 reported SrWD, increasing across age groups (p for trend < 0.001). Logistic regression revealed an inverse association between SrWD and LE8 scores, with moderate and high groups having 64% and 89% lower odds of SrWD than the low group, respectively Random forest identified PA, BP, and BMI as top predictors overall and for ages 40–65, with diet replacing BMI in those ≥65. Logistic regression showed PA, BMI, sleep, and diet (only ≥ 65 years) were significantly linked to SrWD, while BP, cholesterol, glucose, and smoking showed weaker or no associations after adjustments. Conclusions: LE8 score was inversely associated with SrWD in middle-aged and older adults. These findings highlight the importance of cardiovascular health and prevention to maintain mobility and independence.