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Article History

Accepted: 22 June 2025

First Online: 9 July 2025

Declarations

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: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment (NIHR128334). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funder had no role in writing the manuscript or the decision to submit it for publication. CG and CC receive funding as NIHR senior Investigators. The study was supported by NIHR Applied Research Collaborations (ARCs) North Thames, East of England and Yorkshire and Humber.

: RMH has received funding from AstraZeneca: advice on commissioning cardiovascular disease management in primary care, is treasurer for the Health Economists’ Study Group (unpaid role), receives National Institutes for Health Research (NIHR) funding for DenPRU-QM and sits on trial steering committees for NIHR trials. KW has received funding from NIHR programmes and is a member of the NIHR School of Public Health Research and NIHR Three Schools Prevention Advisory Boards. RF is Chair of the Study Steering Committee for the NIHR-funded CASCADE project and is Treasurer for the British Society of Gerontology (unpaid voluntary role). DAS is Director and holds shares in Later Life Training, a not-for-profit training organisation that delivers exercise delivery training to health and fitness professionals, which supported the exercise training programme for HomeHealth support workers included in the intervention. DAS has received funding as a Co-Investigator on grants funded by NIHR Applied Research Collaboration National Priority for Ageing, Dementia, and Frailty, Chief Scientists Office, UK Research and Innovation Public Health Intervention Development, European Commission (H2020-MSCA-ITN), Orthopaedic Research UK, and Singapore Physiotherapy Association. DAS is Chair of the British Geriatrics Society Rehabilitation Group, a member of the British Geriatrics Society Special Interest Group on Falls and Fractures, a member of the Scientific Advisory Board for the Older People and Frailty NIHR Policy Research Unit, is Chair of Academic Advisory Group, PACES Project, and the Medical Research Council funded project, University of Glasgow, and a member of the NIHR Advanced Fellowship Selection Committee. AC led the development and UK implementation of the electronic frailty index, which is licensed to suppliers of electronic health-record systems at no cost, on the basis a premium charge is not applied to the end UK National Health Service user. AC has received funding from NIHR, Dunhill Medical Trust, UK Research and Innovation, Geras Centre for Aging Research (2023 Centre Review), and Australia and New Zealand Society of Geriatric Medicine, and is Chair of global Ageing Research Trialists collaborative, member of National Institute for Health and Care Excellence Falls Prevention Guideline Development Group, and sits on Trial Steering Committee and Data Monitoring and Ethics Committee for NIHR trials. All other authors declare no additional competing interests.

: Data collected for the study, including the statistical and health economics analysis plan, de-identified participant data, and a data dictionary defining each field in the set, will be made available to others on receipt by Priment CTU (priment@ucl.ac.uk) of a reasonable request, at any date after publication of this paper. All requests will be reviewed by Priment CTU in line with Priment CTU guidance on sharing data and anonymising data. This process is to ensure that the request is reasonable and the data set is suitably anonymised. The study protocol is available on open access [].

: The study was reviewed and approved by the Health Research Authority Social Care Research Ethics Committee (20/IEC08/0013). Modifications caused by the COVID-19 pandemic were reviewed and approved by the Research Ethics Committee and by our independent Trial Steering Committee.

: All participants provided written or verbal (audio-recorded) consent to take part in the trial. Consent for access to medical records was optional and data were only accessed and recorded for trial participants who provided consent.

: Not applicable as no identifiable participant information has been reported.

: Code for the analysis of the health economics analysis will be made available to others on receipt by Priment CTU (priment@ucl.ac.uk) of a reasonable request, at any date after publication of this paper. All requests will be reviewed by Priment CTU in line with Priment CTU guidance.

: RMH conducted the analysis and wrote the first draft of the paper. KW was Chief Investigator, and contributed to review and editing the of report together with RF, SK, LM, SP, CA, AC, CC, VMD, BG, CG, PL and DAS. RMH, RF, SK, LM, CA, AC, CC, VMD, BG, CG, PL and DS contributed to conceptualisation and funding acquisition. All authors contributed to methodology and oversight. RF was the trial manager, SK was the deputy trial manager. CA was the clinical safety lead and site PI, CG and AC were site PIs and supervised trial delivery at their site. SP did the main statistical analysis, and PS and LM provided statistical oversight and advice. RMH, SP and LM directly accessed and verified the underlying data reported in the manuscript. All authors had full access to all the data in the study, contributed to review and editing of the manuscript, and had final responsibility for the decision to submit for publication.