Lifestyle interventions and medication burden in older adults: insights from the Lifestyle Intervention and Independence for Elders (LIFE) and the Sarcopenia and Physical fRailty iN older people: multi-componenT Treatment strategies (SPRINTT) trials

Purpose: 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. Methods: 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). Results: 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). Conclusion: 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. Trial registration: ClinicalTrials.gov NCT01072500 (LIFE) and NCT02582138 (SPRINTT).