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We aimed to evaluate the effects of a personalized lifestyle intervention on health-related behaviors and adverse outcomes among adults aged\u2009\u2265\u200960 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\u2009\u2265\u200960 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\u2009=\u20090.66, 95% CI 0.28\u20131.53). Significant overall time effects were observed for fruit and vegetable consumption (\n                    <jats:italic>\u03b2<\/jats:italic>\n                    \u2009=\u20090.052, CI 0.026\u20130.074), smoking reduction among current smokers (\n                    <jats:italic>\u03b2<\/jats:italic>\n                    \u2009= \u2212\u20090.372, CI\u2009\u2212\u20090.528 to\u2009\u2212\u20090.222), and psychological variables. A significantly greater reduction in estimated alcohol consumption was observed in group B among baseline drinkers compared with group A (\n                    <jats:italic>\u03b2<\/jats:italic>\n                    \u2009= \u2212\u20091.357, CI\u2009\u2212\u20092.425 to\u2009\u2212\u20090.187), particularly in women. However, BMI among participants with obesity increased in group B (\n                    <jats:italic>\u03b2\u2009<\/jats:italic>\n                    =\u20090.068, CI 0.013\u20130.119). 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).\n                  <\/jats:p>","DOI":"10.1007\/s11357-026-02585-1","type":"journal-article","created":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T05:07:13Z","timestamp":1792386433000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of telemedicine-delivered lifestyle interventions in older adults during the COVID-19 pandemic: a nationwide two-arm randomized trial 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