Levati Elena, Zazzara Maria Beatrice, Iurlaro Angela, Marzetti Emanuele, Calvani Riccardo, Pahor Marco, Picca Anna, Tosato Matteo, Landi Francesco, Bernabei Roberto, Onder Graziano
Department of Aging, Orthopaedics and Rheumatological Sciences, Università Cattolica del Sacro Cuore, 00168, Rome, Italy.
Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy.
Eur Geriatr Med. 2025 Jul 15. doi: 10.1007/s41999-025-01266-0.
Polypharmacy is a growing public health problem and implementing strategies to reduce its prevalence is considered a research and clinical priority. Healthy lifestyle impacts the onset and progression of chronic conditions. Yet, there is limited understanding of how this effect influences medication use. The aim of the study was to assess the impact of lifestyle interventions on use of medications for treatment of common chronic conditions.
We performed a secondary analyses from two randomized clinical trials: the Lifestyle Interventions and Independence for Elders Study (LIFE) and the Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies (SPRINTT) trials. LIFE study enrolled community-dwelling men and women aged 70 to 89 years old who were physically inactive and had reduced physical function recruited in eight centers in the United States. SPRINTT enrolled community-dwelling men and women aged 70 years or older with physical frailty and sarcopenia recruited in 16 clinical sites in Europe. Active intervention groups consisted of a physical activity program in LIFE and a multicomponent intervention based on physical activity with technological support and nutritional counselling/dietary intervention in SPRINTT. The main outcome measure was the change in cardiovascular, diabetes, mood and anxiety, and chronic pain medication use as measured by daily dose per day (DDD/day).
A total of 1519 LIFE participants (752 intervention vs 767 control group, mean age 78.9 years; 67.3% women) and 1,208 SPRINTT participants (602 intervention vs 606 control group, mean age 78.8 years; 72.8% women) were evaluated. For both studies, no significant difference was observed in the median number of DDDs at baseline and follow-up assessments for any of the medication classes considered. Longitudinal analysis performed using linear mixed models revealed no significant association between DDDs/day and lifestyle interventions, with the only exception of an increase in DDD/day of pain medications in the intervention group of SPRINTT (β = 0.16; CI 0.06-0.26 at 6 months; β = 0.12; CI 0.01-0.22 at 12 months; β = 0.12; CI 0.01-0.22 at 18 months).
Lifestyle interventions did not significantly impact on burden of medications used to treat chronic conditions in frail older adults. This finding does not undermine the beneficial effects of these interventions on health outcomes, but highlights the need for specifically designed trials to determine their effect on reducing polypharmacy.
ClinicalTrials.gov NCT01072500 (LIFE) and NCT02582138 (SPRINTT).
多重用药是一个日益严重的公共卫生问题，实施降低其流行率的策略被视为研究和临床的重点。健康的生活方式会影响慢性病的发生和发展。然而，对于这种影响如何作用于药物使用，人们的了解有限。本研究的目的是评估生活方式干预对治疗常见慢性病药物使用的影响。
我们对两项随机临床试验进行了二次分析：老年人生活方式干预与独立性研究（LIFE）和老年人肌肉减少症与身体虚弱：多成分治疗策略（SPRINTT）试验。LIFE研究招募了年龄在70至89岁、身体活动不足且身体功能下降的美国8个中心的社区居住男性和女性。SPRINTT招募了欧洲16个临床地点的年龄在70岁及以上、身体虚弱且患有肌肉减少症的社区居住男性和女性。积极干预组在LIFE中包括一项体育活动计划，在SPRINTT中包括一项基于体育活动并辅以技术支持和营养咨询/饮食干预的多成分干预。主要结局指标是心血管、糖尿病、情绪和焦虑以及慢性疼痛药物使用的变化，以每日剂量（DDD/天）衡量。
共评估了1519名LIFE参与者（干预组752人，对照组767人，平均年龄78.9岁；67.3%为女性）和1208名SPRINTT参与者（干预组602人，对照组606人，平均年龄78.8岁；72.8%为女性）。对于这两项研究，在所考虑的任何药物类别中，基线和随访评估时的DDD中位数均未观察到显著差异。使用线性混合模型进行的纵向分析显示，DDD/天与生活方式干预之间无显著关联，但SPRINTT干预组的疼痛药物DDD/天有所增加除外（6个月时β = 0.16；CI 0.06 - 0.26；12个月时β = 0.12；CI 0.01 - 0.22；18个月时β = 0.12；CI 0.01 - 0.22）。
生活方式干预对体弱老年人治疗慢性病所用药物的负担没有显著影响。这一发现并不否定这些干预对健康结局的有益影响，但突出了需要进行专门设计的试验来确定其对减少多重用药的效果。
ClinicalTrials.gov NCT01072500（LIFE）和NCT02582138（SPRINTT）。
