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More than 60 years after "I look up as I walk," known worldwide as "Sukiyaki," became Japan's most famous song about walking, a new study finds that as walkers look up, their predicted health care costs come down. In addition, how steeply the costs descend changes dramatically with age.

Physical activity has long been associated with lower health care costs, but most studies have relied on self-reported questionnaires and linear models. This has left the actual shape of the relationship, and how it evolves across the lifespan, largely hidden.

To uncover the connection between these variables, Associate Professor Haruka Kato at Osaka Metropolitan University's Graduate School of Human Life and Ecology analyzed a linked data set combining objective step counts from "A-Smile," Osaka Prefecture's official mobile health app, with administrative health insurance claims. The findings were published in SSM—Population Health.

The study covered 20,950 long-term app users aged 40 and over, which amounted to 338,706 person-months in total from 2020 to 2023. Generalized additive models, a statistical technique that estimates flexible curves rather than assuming straight lines, were used to map the data.

The results revealed a strikingly age-dependent landscape. Visualized as a three-dimensional surface of predicted costs across age and daily steps, the relationship was nearly flat for middle-aged adults aged 40–64. This group's health care costs appeared to be driven by factors other than walking.

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