Changes in the physical behaviour of older adults during the 13 weeks GOTO intervention explain a boost in immuno-metabolic health.

Background: The aging population faces numerous health challenges, with sedentary behavior and decreased physical activity being paramount. We explore the physical behaviour of older adults in the GOTO combined lifestyle intervention study and its related immuno-metabolic health effects. Methods: The research utilized accelerometers and machine learning to assess physical activity behaviours during a 13-week program of increased physical activity and decreased calorie intake. Subsequently, the association of variation in physical behaviour with immuno-metabolic health parameters is investigated cross-sectionally at baseline and longitudinally using sex-stratified linear regression and linear mixed regression respectively. Results: Participants exhibited physical behaviors similar to their age-matched peers from the UK-Biobank. Interestingly, gender-based differences were evident, with men and women showing distinct daily physical behavioural patterns. At baseline, a positive correlation was found between higher physical behavior and a healthier immune-metabolic profile, particularly in men. The longitudinal changes depict an overall boost in activity levels, predominantly among women. While increasing general activity and engaging in intense exercises proved advantageous for physical health, the immune-metabolic health benefits were more pronounced in men. Conclusion: The short-term GOTO intervention underscores the significance of regular physical activity in promoting healthy aging even in middle to older age. Gender differences in behavior and health benefits deserve much more attention though. Our results advocate the broader implementation of such programs and emphasize the utility of technology, like accelerometers and machine learning, in both monitoring and promoting active lifestyles among older adults. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial NTR3499 at the Dutch Trial Register, https://www.onderzoekmetmensen.nl/en/trial/27183 ### Funding Statement This work was funded by the Netherlands Consortium for Healthy Ageing (NWO grant 050-060-810), the framework of the BBMRI Metabolomics Consortium funded by BBMRI-NL (NWO 184.021.007 and 184.033.111) and the VOILA Consortium (ZonMw 457001001). The funding agencies had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics committee/IRB of Leiden University Medical Center (P11.187) gave ethical approval for this work. In detail, the trial design for GOTO study received approval from the medical ethical committee at Leiden University Medical Center (P11.187) and all participants provided written informed consent. The completion of the study adhered to all applicable guidelines and regulations and was registered as NTR3499 at the Dutch Trial Register, https://www.onderzoekmetmensen.nl/en/trial/27183. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors