Effect of telemedicine-delivered lifestyle interventions in older adults during the COVID-19 pandemic: a nationwide two-arm randomized trial (PROACTIVE-19)

Abstract Older adults are at increased risk of severe COVID-19 outcomes, yet randomized evidence on structured lifestyle interventions in this context remains limited. We aimed to evaluate the effects of a personalized lifestyle intervention on health-related behaviors and adverse outcomes among adults aged ≥ 60 years during the COVID-19 pandemic. PROACTIVE-19 was a nationwide, open-label, randomized trial initiated in Hungary in March 2020, during the first wave of the COVID-19 pandemic. Participants aged ≥ 60 years were randomly assigned (1:1) to general (group A) or personalized (group B) lifestyle counselling delivered via telephone, targeting mental health, smoking, physical activity, diet, and alcohol consumption. The primary planned endpoint was a composite of COVID-19 severity outcomes; however, due to infection rates, all-cause mortality was assessed. Longitudinal lifestyle changes were evaluated using linear mixed-effects models with bootstrap 95% confidence intervals (CIs) in a modified intention-to-treat population. A total of 441 participants were analyzed (214 group A; 227 group B). All-cause mortality did not differ significantly between groups (HR = 0.66, 95% CI 0.28–1.53). Significant overall time effects were observed for fruit and vegetable consumption ( β = 0.052, CI 0.026–0.074), smoking reduction among current smokers ( β = − 0.372, CI − 0.528 to − 0.222), and psychological variables. A significantly greater reduction in estimated alcohol consumption was observed in group B among baseline drinkers compared with group A ( β = − 1.357, CI − 2.425 to − 0.187), particularly in women. However, BMI among participants with obesity increased in group B ( β = 0.068, CI 0.013–0.119). Seasonal and pandemic-wave effects significantly influenced physical activity and psychological distress. The personalized intervention was not associated with a significant reduction in all-cause mortality. Several lifestyle behaviors improved over time; however, the additional benefit of personalization was limited (Supported by the Semmelweis University Research, Development and Innovation Fund, ClinicalTrials.gov number, NCT04321928).

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Publication Details

Journal
GeroScience
Published
2026-10-19
DOI
https://doi.org/10.1007/s11357-026-02585-1
Primary Topic
Telemedicine and Telehealth Implementation
Type
article
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article

Effect of telemedicine-delivered lifestyle interventions in older adults during the COVID-19 pandemic: a nationwide two-arm randomized trial (PROACTIVE-19)

András Varró, Fanni Dembrovszky, Szilárd Váncsa, Eszter Hegyi et al.
GeroScience
Telemedicine and Telehealth Implementation
article

Effect of telemedicine-delivered lifestyle interventions in older adults during the COVID-19 pandemic: a nationwide two-arm randomized trial (PROACTIVE-19)

András Varró, Fanni Dembrovszky, Szilárd Váncsa, Eszter Hegyi, Anett Szakolczai, Nóra Vörhendi, Szabolcs Kiss, Noémi Zádori, Tamás Habon, Zoltán Péterfi, Zsolt Molnár, Klementina Ocskay, Márk Félix Juhász, Árpád Csathó, Béla Birkás, Borbála Zsigmond, Piroska Pázmány, István Kiss, Zsuzsanna Helyes, Andrea Sárközi, Anna Hegyi, Andrea Szentesi, László Czopf, Zsolt Szakács, Andrea Párniczky, Anna Kanjo, Zsolt Abonyi‐Tóth, Anikó Vargáné Nagy, Dóra Czapári, Dalma Dobszai, Erika Pintér, Gábor Pethö, Nelli Farkas, Roland Molontay, Mária Földi, Attila Márta, Lajos Szakó, Katalin Márta, Dominika Tóth, P ter Hegyi, Emőke Miklós, Zsanett Macht-Szalai, Antal Zemplenyi, Péter Jenő Hegyi, Bálint Erőss, Judit Hegyi, PROACTIVE-19 Trial Contributors, Richárd Farkas
article en

Abstract

Abstract Older adults are at increased risk of severe COVID-19 outcomes, yet randomized evidence on structured lifestyle interventions in this context remains limited. We aimed to evaluate the effects of a personalized lifestyle intervention on health-related behaviors and adverse outcomes among adults aged ≥ 60 years during the COVID-19 pandemic. PROACTIVE-19 was a nationwide, open-label, randomized trial initiated in Hungary in March 2020, during the first wave of the COVID-19 pandemic. Participants aged ≥ 60 years were randomly assigned (1:1) to general (group A) or personalized (group B) lifestyle counselling delivered via telephone, targeting mental health, smoking, physical activity, diet, and alcohol consumption. The primary planned endpoint was a composite of COVID-19 severity outcomes; however, due to infection rates, all-cause mortality was assessed. Longitudinal lifestyle changes were evaluated using linear mixed-effects models with bootstrap 95% confidence intervals (CIs) in a modified intention-to-treat population. A total of 441 participants were analyzed (214 group A; 227 group B). All-cause mortality did not differ significantly between groups (HR = 0.66, 95% CI 0.28–1.53). Significant overall time effects were observed for fruit and vegetable consumption ( β = 0.052, CI 0.026–0.074), smoking reduction among current smokers ( β = − 0.372, CI − 0.528 to − 0.222), and psychological variables. A significantly greater reduction in estimated alcohol consumption was observed in group B among baseline drinkers compared with group A ( β = − 1.357, CI − 2.425 to − 0.187), particularly in women. However, BMI among participants with obesity increased in group B ( β = 0.068, CI 0.013–0.119). Seasonal and pandemic-wave effects significantly influenced physical activity and psychological distress. The personalized intervention was not associated with a significant reduction in all-cause mortality. Several lifestyle behaviors improved over time; however, the additional benefit of personalization was limited (Supported by the Semmelweis University Research, Development and Innovation Fund, ClinicalTrials.gov number, NCT04321928).

GeroScience
Semmelweis University (HU), University of Szeged (HU), Budapest University of Technology and Economics (HU), Heim Pál Országos Gyermekgyógyászati Intézet (HU), University of Pecs (HU)
Openalex Percentile: Top 10%
Telemedicine and Telehealth Implementation
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