Community-Based Physical Activity Approaches to Hypertension Management in South Africa: A Narrative Review

BACKGROUND: Non-communicable diseases represent a critical public health challenge in South Africa, with hypertension serving as a major driver of cardiovascular morbidity and premature mortality. Despite the effectiveness of lifestyle modification, access to sustainable community-based physical activity (PA) opportunities remains uneven in resource-constrained settings. OBJECTIVE: This narrative review synthesises evidence on community-based PA approaches for hypertension prevention and management in South Africa, with specific attention to the four levels of the Social-Ecological Model (SEM), implementation barriers and policy translation. METHODS: A structured narrative synthesis was undertaken using literature published between 2006 and June 2026 and identified through PubMed/MEDLINE, Scopus, Web of Science and the Cochrane Library. Evidence was organised using the Popay narrative-synthesis framework and the SEM. A PRISMA 2020-informed flow diagram was used to improve reporting transparency. RESULTS: Evidence was organised across individual, interpersonal, community and policy/health-system levels. Community health worker, faith-based and structured physical-activity approaches showed potential for improving blood-pressure control and health behaviours, although effects varied by study design, intervention intensity and context. Comparative evidence from Kenya, India and Brazil supports the potential value of community delivery while highlighting differences in implementation and health-system context. CONCLUSION: Community-based PA interventions offer a culturally relevant and potentially scalable component of hypertension management in South Africa. Their effectiveness is most likely when individual behaviour support is combined with social support, safe environments, primary-healthcare integration and policy support.