Effectiveness of community-based and on-line behavioral interventions on the health of older adults in Slovakia: prospective randomized controlled trial

Objective To evaluate three 14-week behavioral coaching interventions for later-life adults, with changes in health indicators. Methods In a three-arm randomized controlled trial (September 2023–December 2024), adults aged 55–80 classified as overweight and/or having hypertension were assigned to (a) community group coaching, (b) online one-to-one self-coaching, or (c) self-management using a Health Diary. Content addressed nutrition, activity, sleep, stress, cognition, and socialization. Of 465 recruits, 314 completed and were analyzed per protocol. Outcomes (blood pressure, body mass index, waist, 30 s sit-to-stand, 2 min step test) were measured at baseline and 14 weeks. Results The community arm ( n = 167) achieved the largest blood pressure reductions (Δsystolic blood pressure − 7.10 mmHg; Δdiastolic blood pressure − 3.00 mmHg) and fitness gains. The online arm ( n = 100) produced the greatest reductions in weight and waist circumference (Δbody mass index −0.67 kg/m 2 ; Δwaist −2.80 cm). The self-management arm ( n = 47) showed modest but significant improvements for most indicators except body mass index. Dropout rates were 12%, 36%, and 63% respectively. Conclusions Community-based coaching produced the largest blood pressure and fitness improvements, while online self-coaching led in weight and waist reduction, though self-reported home measurements warrant caution. Dropout decreased with intervention structure, suggesting that engagement is critical for success in older adults.