Short- and Long-Term Effect of Multidomain Lifestyle Intervention on Frailty: Post Hoc Analysis of an RCT

Abstract

Background: The prevalence of frailty is increasing as the population ages. Lifestyle interventions have shown potential in frailty prevention. Intervention studies have been generally limited by short interventions and follow-ups or by focusing on single-domain approaches. We aimed to investigate whether a 2-year multidomain lifestyle intervention prevents phenotypic pre-frailty or frailty and whether baseline factors predict phenotypic pre-frailty or frailty.

Methods: A total of 1259 participants (aged 60-77 years) in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) were randomized to a multidomain intervention group or to a regular health advice group for 2 years. Frailty was defined by modified Fried phenotype. Pre-frail and frail participants were grouped for analyses. The prevalence of pre-frailty/frailty at baseline and at 2, 7, and 11 years, the change in prevalence from baseline, and the difference in these changes between intervention and control groups were estimated using a mixed-effects logistic regression model.

Results: The intervention reduced the risk of pre-frailty/frailty up to 7 years. The prevalence decreased in the intervention group from baseline (47%) to 2 years (42%), while it increased in the control group (45% to 49%), resulting in a -9.6-percentage point difference in the change (p = 0.007). After the active intervention period, the prevalence began to increase in both groups, but the difference in the change remained in favor of the intervention group at 7 years (-6.2 percentage points, p = 0.049). The beneficial effect was no longer evident at 11 years. Older age, lower protein intake, and a higher number of chronic diseases were strongly associated with pre-frailty/frailty.

Conclusions: A 2-year multimodal lifestyle intervention effectively prevented phenotypic pre-frailty/frailty, with sustained benefits observed up to 7 years. Continuous support for a healthy lifestyle may be necessary to prevent late-life pre-frailty or frailty.

Keywords: frailty; multidomain lifestyle intervention; pre‐frailty; protein intake.

FIGURE 1

A Sankey diagram illustrating the flow of participants from baseline frailty status to each follow‐up assessment. Missing frailty status data after baseline are also shown. The diagram shows a decrease in the robust group and an increase in the pre‐frail/frail group. The missing data group was the largest at the final follow‐up. Data represent numbers of participants observed in each group.

FIGURE 2

A graph of estimated mean prevalences (range of proportions 0.00–1.00) of pre‐frail/frail participants in randomization groups. The estimates are from the best‐fitting adjusted mixed‐effects logistic regression model, where time was non‐linear, split into two linear periods of 0–2 years and 2–11 years, including an interaction between randomization group (intervention vs. control) and time. P‐values indicate the difference in the prevalence change between the intervention and control groups from baseline to each follow‐up. Error bars depict 95% confidence intervals.