Launch

The Health Exchange brings together the perspectives of academics and researchers from the NWU Faculty of Health Sciences, sharing expert insight on health, wellbeing and the issues that matter.
From research and healthcare to the health questions shaping our everyday lives, explore informed perspectives from our Faculty experts.

Opinion piece: Why accurate data matters in modern sport performance

By Dr Cobus Oosthuizen, Acting Deputy Director: Mahikeng Campus | Lecturer: Human Movement Sciences

In modern sport, data has become central to how teams train, compete, and manage athlete performance. From elite rugby to developing athletes, performance tracking technologies such as global positioning systems (GPS) are now widely used to monitor workload, optimise training, and reduce injury risk.

However, as the use of technology grows, an important question emerges. How reliable is the data we rely on to make these decisions?

GPS systems are designed to measure key aspects of player performance, including distance covered, speed, acceleration, and deceleration, to name but a few. These metrics inform decisions that directly influence training intensity, recovery strategies, and match readiness. Yet, not all systems measure these variables in the same way.

Recent research highlights that while different GPS devices may appear similar, their outputs are not always directly comparable. Even when systems operate at the same sampling frequency, differences in hardware, software, and data processing methods can result in meaningful variations in the data they produce. These discrepancies are largely attributed to proprietary filtering applied by each manufacturer, typically withheld due to intellectual property restrictions.

This becomes particularly relevant in environments where teams may transition between systems, or where budget constraints require the use of more cost-effective alternatives. While more affordable technologies are expanding access to performance monitoring, they also introduce new challenges in ensuring data consistency.

For example, findings show that certain performance measures, such as velocity, tend to align reasonably well across different systems. However, other metrics, including distance, acceleration, and deceleration, may vary significantly. These differences are not merely technical. They have practical implications for how training loads are interpreted and managed.

If practitioners assume that data from different systems is interchangeable without adjustment, they risk misinterpreting player performance. This could lead to inappropriate training prescriptions, increased injury risk, or missed opportunities to optimise performance.

The issue is not whether one system is better than another. Rather, it is about understanding the limitations of each system and using the data appropriately. In many cases, different systems can be used effectively, but only if practitioners account for the differences and apply the necessary adjustments.

This highlights a broader shift in sport science. The focus is no longer only on collecting data, but on interpreting it critically. Coaches, sport scientists, and practitioners must engage with the data they use, rather than treating it as inherently accurate or interchangeable.

For institutions and teams, this has important implications. Investment in technology must be matched by investment in knowledge and capacity. Without a clear understanding of how data is generated and what it represents, even the most advanced systems may fall short of their potential.

Ultimately, accurate and reliable data is not simply a technical requirement. It is fundamental to athlete well-being, performance development, and informed decision-making. As sport continues to evolve, the ability to use data responsibly and effectively will remain a defining factor in achieving sustainable performance outcomes.

Opinion piece: Does feeling better always mean moving better after knee replacement surgery?

By Dr Clément N. Gambelli, Dr Tamrin Veldsman, Prof Hanlie (SJ) Moss and Ms Lenthea Kamffer 

Total knee replacement surgery is often described as life-changing for people living with advanced knee osteoarthritis. For many patients, the procedure brings pain relief and improved quality of life after years of discomfort and reduced mobility; however, this is only true in a quarter of the population

But recovery after total knee replacement surgery is not always as straightforward as it seems.

While many patients report feeling better after surgery, research increasingly suggests that perceived recovery and actual physical recovery do not always align. A patient may experience less pain and believe they are functioning well, while objective functional testing still reveals balance difficulties, muscle weakness, or altered walking patterns.

This raises an important question: does feeling better necessarily mean moving better?

At North-West University (NWU), researchers are exploring this question through an ongoing study investigating recovery after total knee replacement surgery. The research examines not only physical recovery, but also how mental health, patient expectations, satisfaction, and quality of life influence the overall rehabilitation experience.

This more holistic approach reflects a growing recognition that recovery cannot be measured through pain relief alone.

Traditionally, outcomes after knee replacement surgery have relied heavily on patient-reported feedback. Patients are often asked how they feel, whether they are experiencing pain, and how satisfied they are with the outcome of the procedure. While these perspectives are important, they do not always provide a complete picture of recovery.

Research shows that as many as one in four patients remain dissatisfied after surgery, despite improvements in pain levels. In many cases, patients may expect to return quickly to normal daily activities, only to find that physical function improves more gradually than anticipated.

This disconnect highlights the importance of objective functional assessment.

The NWU study tracks patients from before surgery to 12 months afterwards, assessing factors such as walking mechanics, muscle strength, balance, mobility, and sit-to-stand performance at multiple stages of recovery. By following patients over time, researchers are able to better understand how recovery evolves.Importantly, the study also integrates mental health into the recovery process.

Recovery after surgery is not only physical. Anxiety, depression, fear of movement, and unmet expectations can all influence how patients experience rehabilitation. Two individuals with similar physical outcomes may report very different levels of satisfaction depending on their expectations, emotional well-being, and ability to return to meaningful activities.

This highlights the need for a more individualised approach to rehabilitation.

Rather than treating recovery as a standardised process, clinicians may need to consider both the physical and psychological factors affecting each patient. Objective functional testing can help identify areas where support is still needed, even when patients report that they feel better, this might not mean their movement improved..

The findings may ultimately help healthcare professionals set more realistic expectations, better track rehabilitation progress, and improve long-term outcomes after surgery.

The broader implication is that success after knee replacement surgery should not be defined by pain relief alone. True recovery involves restoring confidence, mobility, independence, and overall quality of life.

As orthopaedic care continues to evolve, integrating physical function and mental well-being into recovery assessment may become essential for understanding what successful rehabilitation really looks like.

Opinion piece: Why retaining academic talent requires more than better pay

By Mr Marcel Mather, Clinical Programme Leader and Senior Lecturer, School of Nursing

Universities are under increasing pressure to attract and retain skilled academic staff. In South Africa, this challenge is further intensified by resource constraints, growing student enrolments, and rising expectations related to both teaching and research. While remuneration is often presented as the primary solution to staff retention, this perspective oversimplifies a far more complex issue.

Academic staff rarely leave institutions for a single reason. Retention is shaped by a combination of factors that influence how academics experience their work over time. Addressing only one aspect, such as salary, without considering the broader institutional environment, is unlikely to produce meaningful or sustainable results.

Research consistently demonstrates that the academic work environment plays a central role in staff satisfaction and retention. Leadership, organisational culture, and institutional support structures largely determine whether academics feel valued and empowered in their roles. Where leadership is supportive, transparent, and engaged, staff are more likely to remain committed. Conversely, environments characterised by inconsistent or excessive bureaucracy often contribute to disengagement.

Workload is another defining factor. Academic roles increasingly require individuals to balance teaching, research, postgraduate supervision, community engagement, and administrative responsibilities. Over time, these competing demands contribute to sustained pressure and, in many cases, burnout. This does not always present as immediate resignation; rather, it often manifests as gradual disengagement, reduced productivity, and diminished institutional loyalty.

Equally important is the opportunity for professional growth and development. Academics are not merely employees, but contributors to knowledge creation, innovation, and societal advancement. Institutions that invest in mentorship, research support, leadership development, and clear career progression pathways create environments where academic staff can thrive and remain engaged. In the absence of such opportunities, even highly capable and committed individuals may begin to seek alternatives elsewhere.

Recognition also warrants greater attention. While financial compensation remains important, it is sufficient on its own. A sense of professional acknowledgement, whether through recognition of teaching excellence, research contributions, or leadership within the academic community, plays a critical role in sustaining motivation and morale. When recognition is lacking, it can reinforce perceptions that effort and impact are undervalued.

What becomes evident is that staff retention is not driven by isolated interventions, but by the overall institutional experience. Leadership, workload, professional development, and recognition are interconnected factors that collectively shape whether an academic career is experienced as meaningful and sustainable.

For institutions such as the North-West University, this presents both a challenge and an opportunity. Retention strategies must move beyond short-term solutions and focus on cultivating environments where academic staff can perform at their best. This requires intentional leadership, investment in people, and a genuine commitment to supporting both professional and personal well-being.

Retaining academic talent is not simply about maintaining staff numbers. It is about safeguarding the quality of teaching, strengthening research output, and ensuring that universities remain spaces of innovation, critical inquiry, and societal impact. Institutions that recognise this and respond accordingly will be better positioned to sustain excellence in an increasingly demanding higher education landscape.

Opinion piece: Why body mass index (BMI) misclassifies childhood obesity: Practical alternatives for assessing body fatness in children

By Prof Makama Andries Monyeki, Director: PhASRec

For decades, Body Mass Index, or BMI, has been the standard tool for assessing whether a child is underweight, of normal weight, overweight, or obese. It is simple, cost-effective, and widely used in schools, clinics, and research. However, as our understanding of health and body composition evolves, it is becoming increasingly clear that BMI alone does not tell the full story.

BMI is based on a straightforward calculation using height and weight. While this makes it practical, it also means that it cannot distinguish between fat mass and lean mass. In growing children, this distinction is critical. Two children may have the same BMI, yet very different levels of body fat, and therefore very different health risks.

This limitation is particularly concerning in the context of rising childhood obesity. South Africa is facing a growing burden of overweight and obesity, with significant implications for future health outcomes. Yet evidence suggests that BMI may be underestimating the true scale of the problem.

Research conducted among South African children aged six to eight years illustrates this gap clearly. When BMI was used, only a small proportion of children were classified as overweight or obese. However, when a more accurate method for directly measuring body fat was used, the results changed significantly. A much larger percentage of children were found to have excess body fat, despite appearing to fall within a normal weight range.

This phenomenon, often referred to as the “thin–fat” profile, highlights a critical blind spot. Children who appear healthy according to BMI may already be at increased risk of conditions such as type 2 diabetes, hypertension, and cardiovascular disease. If these risks are not identified early, opportunities for prevention may be missed.

The issue is not that BMI has no value. It remains a useful screening tool, particularly in settings where resources are limited. However, relying on BMI alone can lead to an incomplete and, at times, misleading picture of health.

Obesity is defined by excess body fat, not simply excess weight. It is this excess fat that drives long-term health risks. If we are serious about addressing childhood obesity, we need to ensure that our assessment methods reflect this reality.

At the same time, there are practical considerations. Advanced techniques such as MRI or dual-energy X-ray absorptiometry provide highly accurate measurements of body composition, but they are costly and not feasible for routine use in schools or clinics. The challenge, therefore, is to find approaches that are both accurate and accessible.

Encouragingly, research is beginning to offer solutions. Validate methods that estimate body fat tested across a wide range of populations, including high-, low- and middle-income settings using simple measurements, such as height, weight, age, and sex, are showing promise as more accurate alternatives that can be implemented at scale. These approaches bridge the gap between scientific precision and real-world application.

For South Africa, the implications are significant. If childhood obesity is being underestimated, then current prevention and intervention strategies may not be reaching all those at risk. Improving how we measure body fat could allow for earlier identification, more targeted interventions, and ultimately better health outcomes.

Addressing childhood obesity requires more than awareness. It requires accurate information, informed decision-making, and a willingness to adapt long-standing practices. BMI has served an important role, but it is no longer sufficient on its own.

If we are to change the trajectory of childhood health, we must move beyond weight and focus on what truly matters: understanding and addressing excess body fat before its consequences take hold.

Opinion piece: Why sitting all day is a health risk we can no longer ignore

By Associate Professor Mariette Swanepoel (Supervisor), Dr Tamrin Veldsman (Co-Supervisor) and Mrs Shantelle Oelofse (MA Student) - Human Movement Sciences, Biokinetics Programme

For many people, a typical workday involves long hours spent sitting. Meetings, emails, administrative tasks, and screen-based work often keep us seated for most of the day. This has become so normalised that it is rarely questioned. Yet emerging research suggests that prolonged sitting may be one of the most underestimated health risks in modern working environments.

A recent study conducted among employees across multiple campuses of a South African university found that staff spend an average of nearly 13 hours per day seated. During the standard working day alone, more than seven of the eight working hours are spent sitting. Perhaps more concerning is that more than half of the employees assessed were found to be at moderate to high risk of cardiovascular disease.

These findings reflect a broader global trend. As work becomes increasingly desk-based, physical inactivity is no longer limited to leisure time. It is embedded within the structure of the workday itself.

What makes this particularly significant is that sitting time is not simply the opposite of physical activity. Even individuals who meet recommended exercise guidelines may still be at risk if they spend extended periods sitting. In other words, going to the gym does not necessarily offset the effects of sitting for most of the day.

The health implications are both physical and psychological. Prolonged sitting has been associated with increased cardiovascular risk, reduced energy levels, and lower overall quality of life. It may also contribute to an increased risk of Type 2 diabetes, as reduced muscle activity affects energy use, glucose regulation, and insulin sensitivity. In addition, prolonged sitting is commonly associated with lower back pain, poor posture, fatigue, reduced social interaction, and physical discomfort in the workplace.

In academic and administrative environments, these patterns are often intensified by workload demands. Staff are required to balance teaching, research, and administrative responsibilities, frequently under time pressure. This can lead to long, uninterrupted periods of sitting, with limited opportunities to move throughout the day.

The challenge is not simply to encourage more exercise, but to rethink how movement is integrated into the working day. Small, consistent changes can make a meaningful difference. Standing up regularly, taking short walking breaks, and interrupting long periods of sitting are practical strategies that can be implemented without disrupting productivity.

At an institutional level, there is also an opportunity to create environments that support healthier work patterns. This could include promoting active workspaces, encouraging regular movement breaks, and raising awareness about the health risks associated with prolonged sitting.
Importantly, addressing sedentary behaviour is not about drastic lifestyle changes. It is about recognising that health is shaped by daily habits, many of which are influenced by the environments in which people work.

As universities continue to evolve in response to technological and organisational demands, the well-being of staff must remain a priority. Reducing sitting time is a simple but impactful step towards supporting both individual health and overall institutional performance.
 

Opinion piece: The hidden cost of retail “innovation” for time-scarce women

By Dr Minnet du Preez, Dr Neoline Le Roux & Dr Heleen Dreyer

Retail innovation is often associated with creativity, engagement, and enhanced consumer experience. From changing store layouts to introducing new product displays, these strategies are designed to capture attention and encourage exploration.

But for many consumers, particularly employed women, these changes may be having the opposite effect.

As women’s participation in the workforce continues to grow, so too does the complexity of their daily responsibilities. Many are managing full-time employment alongside most household purchasing decisions. In this context, shopping is no longer a leisurely activity. It is a task that must be completed efficiently, often within tight time constraints.

Research exploring the experiences of employed female consumers highlights a consistent and defining challenge: time scarcity. While factors such as financial pressure, caregiving responsibilities, and long working hours all play a role, they ultimately converge into a single constraint. There is simply not enough time.

This has a direct impact on how shopping decisions are made.

Consumers in these contexts develop coping strategies to manage the pressure. Some rely on planning, others outsource tasks where possible, and many are willing to pay a premium for convenience. However, one of the most significant behavioural patterns observed is a strong preference for familiarity.

Time-scarce consumers deliberately choose stores they know. Familiar layouts allow them to move quickly, locate products efficiently, and complete purchases with minimal cognitive effort. In contrast, unfamiliar environments introduce friction. When store layouts change or navigation becomes unclear, even routine shopping can become stressful and time-consuming.

This creates an important tension within retail design.

Frequent layout changes are commonly used as a strategy to increase product exposure and stimulate impulse purchases. While this may be effective for shoppers with time to browse, it can have unintended consequences for those under pressure. What is intended as innovation may instead disrupt efficiency and increase frustration.

For a consumer with limited time, a changed layout is not an opportunity for discovery. It is a barrier.

In practical terms, this can lead to abandoned purchases, reduced store loyalty, or a shift towards alternative options such as online shopping or more predictable competitors. The very consumers who contribute significantly to household spending may be the ones most affected by these design decisions.

This raises a critical question for retailers.

Are current innovation strategies aligned with the realities of modern consumers, or are they based on outdated assumptions about how people shop?

If retailers are to remain relevant, particularly in serving what is often referred to as the “she-conomy”, a shift in approach is required. This does not mean abandoning innovation but rather rethinking how it is implemented.

Consistency, clarity, and ease of navigation should form the foundation of the shopping experience. Where changes are necessary, they should be supported by clear signage, intuitive layouts, and strong wayfinding that allows consumers to adapt quickly. Innovation can then be layered in through visual merchandising, technology, and targeted engagement, without disrupting the store's core structure.

At a broader level, this reflects a need to design for real-world conditions.

Consumer behaviour is shaped by time pressure, mental load, and competing responsibilities. When these factors are not considered, even well-intentioned strategies can create frustration rather than value.

For retailers, the opportunity lies in recognising that efficiency is not the opposite of engagement. For many consumers, it is the foundation of a positive experience.

Understanding this shift is not only about improving consumer satisfaction. It is about aligning retail environments with the realities of modern life, and ensuring that innovation supports, rather than hinders, those navigating it.

Opinion piece: When chaos is creative: what retailers misunderstand about modern female consumers

By Dr Heleen Dreyer, Valentia Mouton & Annemie Niemann

Consumer behaviour is often judged against an ideal of rational, structured decision-making. When shoppers deviate from this ideal, forgetting items, switching brands, or making impulse decisions, their behaviour is frequently labelled as inconsistent or inefficient.

But what if this interpretation is fundamentally flawed?

For many consumers, particularly employed women, shopping is no longer a simple, routine activity. It has become a cognitively demanding task shaped by time pressure, financial constraints, and competing responsibilities. Balancing professional roles alongside household coordination means that even everyday purchases require constant mental effort.

In this context, what appears to be disorganised behaviour may in fact be a rational response to an increasingly complex environment.

Recent research exploring the experiences of employed South African women highlights this shift. The findings suggest that what is often perceived as “chaos” in consumer behaviour reflects a pattern of adaptive decision-making under pressure. Rather than indicating poor judgment, these behaviours can represent efficient coping strategies in high-demand situations.

Traditional models of consumer behaviour assume that individuals have the time and cognitive capacity to carefully evaluate options, compare products, and make deliberate choices. Retail environments are designed accordingly, with structured layouts, extensive product information, and promotions that require active engagement.

However, this model no longer reflects reality.

Many consumers are making decisions under conditions of cognitive overload. They are managing multiple priorities simultaneously, often with limited time and mental energy. In such environments, decision-making becomes fast, fragmented, and highly responsive to immediate needs.

This is where the concept of a Creative-Chaos pattern becomes relevant. It reflects a combination of flexible thinking and reduced reliance on rigid planning, particularly under pressure. While this may lead to behaviours such as deviating from shopping lists or making spontaneous choices, it also enables rapid adaptation.

Consumers operating in this mode are often able to:

• Adjust quickly when products are unavailable
• Make efficient substitutions
• Navigate complex choices without overthinking
• Reduce cognitive effort through intuitive decision-making

In other words, what appears to be inconsistency may be a form of efficiency.

This challenges a long-standing assumption in both research and retail practice. Structured, linear decision-making is not always optimal, particularly in high-pressure environments. Flexibility, speed, and adaptability may be more effective strategies for navigating everyday consumption.

Yet many retail environments are not designed with this in mind.

Supermarkets, online platforms, and product ecosystems often present an overwhelming number of choices, complex information, and layouts that prioritise logic over ease of use. For consumers already under pressure, these environments can increase stress rather than reduce it.

As a result, the problem may not lie with the consumer, but with the system.

If retailers want to better serve modern consumers, particularly those managing multiple roles, they need to rethink how decision environments are designed. This includes simplifying product choices, improving clarity, and supporting faster, more intuitive decision-making.

More importantly, it requires a shift in mindset.

Rather than trying to correct or control consumer behaviour, retailers should aim to understand it. What is often labelled as disorganised behaviour may reflect real-world pressures and adaptive responses to them.

At a broader level, this calls for a more human-centred approach to understanding consumption. Consumer behaviour does not exist in isolation. It is shaped by context, responsibility, and cognitive load.

Recognising this allows for more effective design, not only in retail environments, but in how we think about decision-making more generally.

The “messy” consumer is not a problem to be fixed. It is a signal that the world in which decisions are made has changed. The question is whether our systems are willing to adapt accordingly. And perhaps, in that messiness, there is a form of intelligence we have been too quick to overlook.

Opinion piece: Why specialised clinical training is key to improving rare disease diagnosis in Africa

By Dr Albe Swanepoel & Dr Elne Conradie[AS1.1], Centre for Human Metabolomics

Rare diseases are often described as uncommon, but collectively they affect millions of people worldwide. In Africa, however, these conditions remain largely underdiagnosed and underreported. The challenge is not necessarily that rare diseases are absent, but that the systems required to identify and manage them are still developing. 

One of the most significant barriers is a lack of specialised clinical training. 

In many African countries, healthcare systems understandably focus on addressing high-burden conditions such as infectious diseases. While this focus is essential, it has resulted in limited attention being given to rare diseases. As a result, many clinicians have had little exposure to these conditions during their training, making early identification difficult. 

This has real consequences for patients. 

Rare diseases, including lysosomal storage disorders (LSDs), are often progressive and, in some cases, life-threatening. Without an accurate diagnosis, patients may go years without answers, receiving treatment for symptoms rather than the underlying condition. In many instances, diagnosis may not occur at all. 

Recent work across multiple African countries highlights how targeted clinical training can begin to address this gap. By equipping clinicians with the knowledge to recognise key clinical features, it becomes possible to identify patients who may otherwise be overlooked. 

The results are encouraging. 

In a pilot initiative spanning several sub-Saharan African countries, clinicians who received specialised training were able to identify and refer patients for LSD diagnostic testing. Despite the relatively small number of cases, the diagnostic yield was notably high. This reflects not an increase in disease prevalence, but an improvement in the ability to recognise and investigate these conditions. 

Importantly, the approach did not rely solely on advanced infrastructure. 

Simple and practical tools, such as dried blood spot testing, were used to collect and transport samples across borders for analysis. These methods proved to be both reliable and effective, even in resource-constrained settings. This demonstrates that improving diagnostic capacity does not always require complex systems, but rather coordinated, context-appropriate solutions. 

At the same time, the study highlights ongoing challenges. Delays in sample transport, gaps in referral systems, and environmental factors such as temperature and humidity can all affect the diagnostic process. In some regions, broader logistical and political factors also play a role. 

However, these challenges do not diminish the central finding. They reinforce the need for sustained investment in both training and systems development. 

Another important insight is the value of collaboration. The success of this initiative was built on partnerships between institutions, clinicians, and organisations across multiple countries. This collaborative model enables knowledge sharing, strengthens networks, and creates opportunities for continuous learning. 

For Africa, the implications are significant. 

Improving rare disease diagnosis is not only about identifying individual cases. It is about building a foundation for better healthcare systems. When clinicians are equipped with the right knowledge and tools, they are better able to recognise complex conditions, make informed decisions, and provide appropriate care. 

This also contributes to a more accurate understanding of disease patterns within African populations, which have historically been underrepresented in global research. Without this data, diagnostic criteria and treatment approaches may not fully reflect local realities. 

Ultimately, specialised clinical training is not a luxury. It is a necessary step towards more equitable healthcare. 

By investing in training, strengthening networks, and supporting practical diagnostic approaches, it is possible to improve outcomes for patients with rare diseases across the continent. The progress made so far shows that meaningful change is achievable, provided the right priorities are in place.