Lancet Healthy Longevity最新文献

{"title":"Remote, lower-intensity, multidomain lifestyle intervention for subjective cognitive decline or mild cognitive impairment (APPLE-Tree): a multicentre, single-masked, randomised controlled trial.","authors":"Harriet Demnitz-King, Mariam Adeleke, Julie A Barber, Michaela Poppe, Jessica Budgett, Sweedal Alberts, Larisa Duffy, Anne-Marie Minihane, Rachel Gillings, Hannah Chapman, Rosario Isabel Espinoza Jeraldo, Oliver Kelsey, Malvika Muralidhar, Sedigheh Zabihi, Elisa Aguirre, Nicholas Bass, Anna Betz, Henry Brodaty, Alexandra Burton, Paul Higgs, Rachael Maree Hunter, Jonathan Huntley, Helen C Kales, Iain Lang, Natalie L Marchant, Sarah Morgan-Trimmer, Penny Rapaport, Miguel Rio, Irene Petersen, Zuzana Walker, Kate Walters, Sube Banerjee, Joanne Rodda, Marina Palomo, Claudia Cooper","doi":"10.1016/j.lanhl.2025.100777","DOIUrl":"https://doi.org/10.1016/j.lanhl.2025.100777","url":null,"abstract":"<p><strong>Background: </strong>Trials of high-intensity, multidomain interventions show that modifying lifestyle and psychological risk factors can slow cognitive decline. We aimed to evaluate the effectiveness of a lower-intensity, personally-tailored dementia prevention programme in improving cognition in adults with subjective cognitive decline or mild cognitive impairment.</p><p><strong>Methods: </strong>We conducted a single-masked, multisite, randomised controlled clinical trial recruiting older adults with subjective cognitive decline or mild cognitive impairment across 11 sites in England. Participants were randomly assigned (1:1) to the 12-month Active Prevention in People at Risk of Dementia through Lifestyle, Behaviour Change and Technology to build Resilience (APPLE-Tree) intervention or to the control condition (usual care plus brief written information about dementia prevention). Randomisation was blocked and stratified by site, with allocations assigned via a remote web-based system. The intervention promoted healthy lifestyles, social connections, enjoyable activities, and self-management of long-term conditions. It comprised ten 1-h group video-call sessions over 6 months, supplemented with alternating, informal, 40-min video-call sessions (termed tea breaks) and individual goal-setting calls between sessions. From months 6 to 12, participants continued with monthly online tea breaks. The primary outcome was cognition (Neuropsychological Test Battery [NTB] score) at 24 months, analysed using an intention-to-treat approach. This trial was pre-registered with the ISRCTN Registry (ISRCTN17325135); further analyses are ongoing.</p><p><strong>Findings: </strong>Between Oct 5, 2020, and Dec 31, 2022, we screened 1287 individuals for eligibility and randomly assigned 746 to the APPLE-Tree intervention (n=374) or control treatment (n=372). There were 177 (47%) women and 194 (52%) men in the intervention group and 173 (47%) women and 198 (53%) men in the control group. The primary outcome analysis included 635 (85%) of 746 participants. Mean NTB scores increased in both groups over time, with greater improvement in the intervention group than in the control group (mean 24-month NTB 0·33 [SD 0·67] vs 0·21 [0·75]; adjusted mean difference 0·06 [95% CI -0·001 to 0·128]; p=0·055). Serious adverse events occurred in 35 (9%) participants in the intervention group and 30 (8%) participants in the control group; none were intervention-related.</p><p><strong>Interpretation: </strong>APPLE-Tree is an accessible intervention associated with small improvements in cognition, although these results were not statistically significant. Low-intensity interventions that can be delivered remotely by non-clinical facilitators have the potential for wide-scale implementation to support adults with memory concerns. However, further work is needed to optimise the intervention for delivery in routine settings.</p><p><strong>Funding: </strong>Economic and Social ","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":" ","pages":"100777"},"PeriodicalIF":14.6,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145356260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Care beyond caregivers: a wider spectrum of social support for older adults.","authors":"Shahmir H Ali","doi":"10.1016/j.lanhl.2025.100782","DOIUrl":"https://doi.org/10.1016/j.lanhl.2025.100782","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":" ","pages":"100782"},"PeriodicalIF":14.6,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145348939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimising polypharmacy management in primary care through general practitioner-pharmacist collaboration, informatics, and enhancing clinician engagement: the IMPPP cluster-randomised trial.","authors":"Rupert A Payne, Peter S Blair, Barbara Caddick, Carolyn A Chew-Graham, Tobias Dreischulte, Lorna J Duncan, Bruce Guthrie, Cindy Mann, Roxanne M Parslow, Jeff Round, Chris Salisbury, Katrina M Turner, Nicholas L Turner, Deborah McCahon","doi":"10.1016/j.lanhl.2025.100774","DOIUrl":"https://doi.org/10.1016/j.lanhl.2025.100774","url":null,"abstract":"<p><strong>Background: </strong>Polypharmacy is a major and growing challenge for patient safety and health outcomes, and associated with inefficient use of resources. Management requires balancing therapeutic benefits and risks, aligned with clinical and patient priorities. High-quality evidence supporting current guidance for the management of polypharmacy is scarce. The aim of the Improving Medicines use in People with Polypharmacy in Primary Care (IMPPP) study was to examine whether a complex intervention could reduce potentially inappropriate prescribing among patients experiencing polypharmacy in primary care.</p><p><strong>Methods: </strong>A pragmatic, open-label, two-arm, parallel cluster-randomised trial was conducted in UK general practices providing National Health Service primary medical care. Practices were required to use the EMIS electronic health records system and have more than 4000 registered patients. For inclusion in the study, participants were required to be aged 18 years or older, prescribed at least five regular medications (ie, medicines recorded in the clinical system as repeat prescriptions, and thus available for recurrent ordering by patients without having to see a clinician) irrespective of when the drug was last issued, and with at least one indicator of potentially inappropriate prescribing identified by an informatics tool. Practices were randomly allocated to deliver the polypharmacy intervention or continue usual care. The complex intervention comprised a structured, collaborative, and patient-centred approach to medication review, supported by informatics, clinician training, performance feedback, and financial incentivisation. In each practice, adults receiving five or more regular medications, with at least one indicator of potentially inappropriate prescribing, were reviewed over a 6-month period. The primary outcome was number of indicators of potentially inappropriate prescribing at 26 weeks' follow-up, analysed on an intention-to-treat basis. The trial was registered with the ISRCTN registry (90146150) and is complete.</p><p><strong>Findings: </strong>Between Jan 26, 2022, and June 20, 2022, 37 general practices were recruited. 33 745 patients were potentially eligible, and 11 022 of these were randomly sampled for study inclusion. 1471 were excluded after general practitioner screening, 9551 were invited to participate, and 1950 provided consent and were randomly assigned (944 patients from 18 practices assigned to usual care and 1006 patients from 19 practices assigned to the intervention). 1727 participants were enrolled in the trial (836 in the usual care group and 891 in the intervention group). Participants' median age was 73 years (IQR 66-79), 881 (51%) were male and 846 (49%) were female, and they had a median of four long-term conditions and a median of eight medications. There was no evidence of a difference in the primary outcome of number of potentially inappropriate prescribing indicators ","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":" ","pages":"100774"},"PeriodicalIF":14.6,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145330076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Making time for brain health: recognising temporal inequity in dementia risk reduction.","authors":"Susanne Röhr, Simone Reppermund, Annabel Matison, Suraj Samtani, Perminder S Sachdev","doi":"10.1016/j.lanhl.2025.100768","DOIUrl":"https://doi.org/10.1016/j.lanhl.2025.100768","url":null,"abstract":"<p><p>Time is an under-recognised social determinant of brain health, and is potentially as important as education or income for dementia risk. Temporal inequity refers to the unequal distribution of discretionary time owing to structural conditions shaping daily life. Temporal inequity encompasses insufficient time for rest, misaligned biological rhythms, fragmented leisure, and the encroachment of work or digital demands into personal time. Time poverty is a measurable manifestation, denoting insufficient time for brain health, disproportionately affecting structurally disadvantaged populations and exacerbated by performance-driven cultures. Although evidence for modifiable risk factors of dementia, such as sleep, physical activity, nutrition, and social engagement, is strong, adopting healthy behaviours requires time. In this Personal View, we integrate insights from epidemiology, neuroscience, and time-use research to argue that addressing temporal inequity is essential for brain health and dementia risk reduction. We call for temporal justice through research and policies that recognise time as both a resource and a site of inequity in ageing and dementia. Accordingly, we outline future research directions, including the development of metrics for temporal inequity, longitudinal studies linking time-use patterns to brain health outcomes, and intervention research to evaluate policies that expand equitable access to time.</p>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":" ","pages":"100768"},"PeriodicalIF":14.6,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145309369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ageing in Africa","authors":"The Lancet Healthy Longevity","doi":"10.1016/j.lanhl.2025.100779","DOIUrl":"10.1016/j.lanhl.2025.100779","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 9","pages":"Article 100779"},"PeriodicalIF":14.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145309348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-specific population attributable fractions for frailty, functional disability, and hospitalisation in Chinese older people: an ICOPE-based prospective cohort study","authors":"Ruby Yu PhD ,&nbsp;Derek Lai MSc ,&nbsp;Grace Leung MSc ,&nbsp;Lok-yan Tam BNurs ,&nbsp;Clara Cheng MASSM ,&nbsp;Sara Kong BSc ,&nbsp;Cecilia Tong MSc ,&nbsp;Matthew Yu BSc ,&nbsp;Prof Jean Woo MD","doi":"10.1016/j.lanhl.2025.100757","DOIUrl":"10.1016/j.lanhl.2025.100757","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Declines in intrinsic capacity have been associated with increased risks of frailty, disability, and hospitalisation. We estimated population attributable fractions (PAFs) for these outcomes with respect to intrinsic capacity-related conditions and traditional modifiable risk factors in different age groups.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We analysed data from a territory-wide, multicentre, community-based, prospective cohort study (2023–24) in Hong Kong. Among 22 237 Chinese adults aged 60 years and older with follow-up data, we calculated age-specific PAFs for incident frailty, instrumental activities of daily living (IADL) disability, and hospitalisation associated with 13 modifiable risk factors. These risk factors included intrinsic capacity conditions, cardiometabolic conditions, and socioeconomic and lifestyle factors, and combinations of these.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Between March 21, 2023, and Dec 31, 2024, 47 776 participants were recruited to the study. 41 226 (86·3%) had complete baseline data for all intrinsic capacity conditions, cardiometabolic conditions, socioeconomic and lifestyle factors, demographic covariates, and outcome variables and were therefore included in our study sample. 22 237 (53·9%) of 41 226 participants completed follow-up assessments at least 6 months after baseline with a mean follow-up of 360·4 days (SD 71·6, median 348·0, IQR 307·0–399·0), 1398 (7·1%) of 19 777 participants had incident frailty, 1152 (6·0%) of 19 171 participants had incident IADL disability, and 2068 (11·1%) of 18 622 participants were hospitalised. Limited mobility was the leading risk factor associated across all outcomes (PAFs 9·8–25·3%). Depressive symptoms were a strong risk factor associated with frailty (PAF 19·1%). Age-stratified analyses revealed that limited mobility had the highest PAFs in adults aged 80 years and older, whereas depressive symptoms showed peak PAFs in those aged 60–69 years in most cases. Hypertension contributed to all outcomes (PAFs 8·4–19·6%) only in adults younger than 80 years. In adults aged 60–69 years physical activity was the predominant risk factor associated with frailty (PAF 21·9%) and disability (PAF 22·3%). The attributable risk of lower education with frailty increased with age, reaching its peak in adults aged 80 years and older (PAF 20·2%). Regarding the joint effects of the risk factors, intrinsic capacity decline was the factor associated with the highest overall attributable risk for all outcomes, exceeding the impact of cardiometabolic diseases and socioeconomic and lifestyle risk.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;Our findings provide insights into age-specific risk factors for frailty, disability, and hospitalisation in older people, underlining the importance of targeted prevention strategies across age groups. Our findings further support a shift towards prioritising intrinsic capacity to better support healthy ageing at the popu","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 9","pages":"Article 100757"},"PeriodicalIF":14.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aspirin and healthy lifespan in older people: main outcome of the ASPREE-XT observational study","authors":"Raj C Shah MD ,&nbsp;Prof Joanne Ryan PhD ,&nbsp;Katherine L Webb MA ,&nbsp;Prof Rory Wolfe PhD ,&nbsp;Prof Andrew Chan MD ,&nbsp;Trevor T-J Chong MBBS ,&nbsp;Prof Michael E Ernst PharmD ,&nbsp;Prof Sara E Espinoza MD ,&nbsp;Olivia Flynn BMed ,&nbsp;Song Yuin Lee MBBS ,&nbsp;John McNeil MBBS ,&nbsp;Prof Mark R Nelson MBBS ,&nbsp;Suzanne G Orchard PhD ,&nbsp;Prof Christopher M Reid PhD ,&nbsp;Kerry Sheets MD ,&nbsp;Prof Nigel P Stocks MBBS ,&nbsp;Prof Nilakshi S Weerasinghe MBBS ,&nbsp;Michelle E Wilson PhD ,&nbsp;Robyn L Woods PhD ,&nbsp;Prof Anne M Murray MD","doi":"10.1016/j.lanhl.2025.100764","DOIUrl":"10.1016/j.lanhl.2025.100764","url":null,"abstract":"<div><h3>Background</h3><div>In the Aspirin in Reducing Events in the Elderly (ASPREE) clinical trial, low-dose aspirin was not associated with survival free of dementia and persistent physical disability (a measure of a healthy lifespan); however, there was a small increased risk of death. Given the long pre-clinical phase of many ageing conditions, we aimed to examine the legacy effect (post-trial) and the longer-term effect of aspirin versus placebo through extended follow-up in the ASPREE-XT observational study.</div></div><div><h3>Methods</h3><div>Between March 10, 2010, and Dec 24, 2014, 19 114 community-dwelling people in Australia and the USA, aged predominantly 70 years and older, were randomly assigned to low-dose aspirin or placebo for a median of 4·7 years as part of the ASPREE trial. Post-trial observational follow-up continued for a median of 4·3 years (IQR 4·1–4·6). All components of the primary endpoint (ie, incident dementia, persistent physical disability, and death) were adjudicated by masked expert panels. Analyses used Cox proportional hazards models with intention-to-treat.</div></div><div><h3>Findings</h3><div>15 633 participants (8836 [56·5%] were women, 6797 [43·5%] were men; 981 [6·3%] were not White) were eligible for and agreed to observational follow-up. There was no effect of randomisation to aspirin (34·37 events per 1000 person-years) versus placebo (33·68 per 1000 person-years) on the primary endpoint (hazard ratio [HR] 1·02; 95% CI 0·94–1·11; p=0·63) in the ASPREE-XT period. Similarly, over the period of both ASPREE and ASPREE-XT, no long-term effect of aspirin versus placebo was observed on the composite outcome of death, dementia, or persistent physical disability over almost a decade of follow-up (HR 1·01; 95% CI 0·95–1·08; p=0·65), including no long-term effect on deaths (1·06; 0·99–1·14; p=0·10). No effect of aspirin on incident major haemorrhagic events as compared with placebo was found in ASPREE-XT; however, aspirin was associated with an increased hazard for incident major haemorrhagic events across both ASPREE and ASPREE-XT (1·24; 1·10–1·39).</div></div><div><h3>Interpretation</h3><div>Low-dose aspirin does not appear to be effective in promoting a healthy lifespan in initially healthy, community-dwelling older people.</div></div><div><h3>Funding</h3><div>National Institute on Aging and the National Cancer Institute (USA).</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 9","pages":"Article 100764"},"PeriodicalIF":14.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating exercise and medication management in geriatric care: a holistic strategy to enhance health outcomes and reduce polypharmacy","authors":"Prof Mikel Izquierdo PhD ,&nbsp;Robinsón Ramírez-Vélez PhD ,&nbsp;Prof Maria A Fiatarone Singh MD FRACP","doi":"10.1016/j.lanhl.2025.100763","DOIUrl":"10.1016/j.lanhl.2025.100763","url":null,"abstract":"<div><div>Integrating exercise prescriptions with medication management represents a novel approach for enhancing health and function, optimising medication effectiveness, and reducing adverse drug reactions and polypharmacy in older adults (ie, those aged ≥60 years). This Personal View highlights the need for a comprehensive assessment of lifestyle, diagnoses, geriatric syndromes, and medications with an emphasis on fully incorporating exercise treatment into geriatric care. Exercise is an alternative to less effective or unsafe medications for many conditions, including depression, anxiety, insomnia, osteoarthritis, and dementia. Exercise is an important adjunct to pharmacotherapy for many common chronic conditions such as coronary artery disease, heart failure, diabetes, osteoporosis, cancer, and chronic obstructive pulmonary disease. Adding exercise to drug management can mitigate adverse drug reactions, enhance medication compliance, and reduce the adverse effects of sedentary behaviour and ageing processes on chronic disease expression. Targeted exercise programmes have also been shown to ameliorate drug-induced side-effects, including anorexia, falls, sarcopenia, osteoporosis, and orthostatic hypotension, and to overcome constraints such as reduced aerobic fitness, balance impairment, and muscle atrophy due to some medications. Health-care professionals require additional training and support to ensure that exercise assumes a key, central role in older adults with multimorbidity and polypharmacy, as supported by the current literature. This Personal View describes practical approaches to incorporating exercise into clinical practice as a step towards an integrated geriatric care model, with the ultimate aim of increasing health span and minimising disability.</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 9","pages":"Article 100763"},"PeriodicalIF":14.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to Lancet Healthy Longev 2023; 4: e83–90","authors":"","doi":"10.1016/j.lanhl.2025.100754","DOIUrl":"10.1016/j.lanhl.2025.100754","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 9","pages":"Article 100754"},"PeriodicalIF":14.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bone quality response to lifestyle intervention in older adults with obesity (LIMB-Q trial): a randomised controlled trial","authors":"Giulia Gregori MS ,&nbsp;Sanjay Mediwala MD ,&nbsp;Michael Liebschner PhD ,&nbsp;Daeseung Kim PhD ,&nbsp;Mon S Bryant PhD PT ,&nbsp;Nina Klonis BS ,&nbsp;Prof Reina Armamento-Villareal MD ,&nbsp;Prof Clifford Qualls PhD ,&nbsp;Prof Dennis T Villareal MD","doi":"10.1016/j.lanhl.2025.100761","DOIUrl":"10.1016/j.lanhl.2025.100761","url":null,"abstract":"<div><h3>Background</h3><div>Lifestyle interventions for weight loss might exacerbate age-related bone loss and osteoporosis. However, there is limited knowledge about their effects on bone quality. We examined whether lifestyle intervention can preserve or enhance bone quality, despite reductions in bone mineral density.</div></div><div><h3>Methods</h3><div>The Lifestyle Intervention to Improve Bone Quality (LIMB-Q) study was a randomised controlled trial conducted at Baylor College of Medicine and the Michael E DeBakey VA Medical Center (Houston, TX, USA) including older adults (aged 65–85 years) with obesity (BMI ≥30 kg/m²). Participants were randomly assigned to receive either an intensive lifestyle intervention (intensive lifestyle group, consisting of weight management plus exercise training) or healthy lifestyle (healthy lifestyle group, consisting of educational sessions on healthy diets). The co-primary outcomes were 12-month changes in (1) distal tibia cortical thickness, measured using high-resolution peripheral quantitative CT, and (2) hip bone strength (failure load), assessed via finite element analysis of CT scans. The primary endpoint was analysed by intention to treat (all randomly assigned patients). This trial is registered with <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>, <span><span>NCT03329963</span><svg><path></path></svg></span> (completed).</div></div><div><h3>Findings</h3><div>Of 138 participants assessed for eligibility in person between Nov 9, 2017, and Nov 8, 2021, 120 were included in this study (mean age 71·4 years [SD 4·6]; 63 [53%] male and 57 [47%] female). At 12 months, weight loss was greater in the intensive lifestyle group than in the healthy lifestyle group (–11·6 kg [SE 0·5] <em>vs</em> –1·2 kg [0·5]). No group differences were noted in the change in distal tibia cortical thickness between the intensive lifestyle group (–0·013 mm [SE 0·026]) and the healthy lifestyle group (–0·002 mm [0·025]; between-group difference 0·027 [95% CI –0·066 to 0·120], p=0·40). The change in hip failure load at 12 months did not differ between the intensive lifestyle group (13 N [SE 25]) and the healthy lifestyle group (3 N [26]; between-group difference –6.9 N [95% CI –108 to 95], p=0·89). Exercise-related adverse events in the intensive lifestyle group included a small number of musculoskeletal events (falls [one participant], neck pain [two], and foot, shoulder, back, and leg pain [one each]).</div></div><div><h3>Interpretation</h3><div>Lifestyle intervention preserved bone quality in older adults with obesity during weight loss. Further research is needed to determine whether lifestyle interventions can reduce fracture risk in older adults with obesity.</div></div><div><h3>Funding</h3><div>National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and US Department of Veterans Affairs.</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 9","pages":"Article 100761"},"PeriodicalIF":14.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}