Healthspan Connect Programme of Research

1\. \*\*SUMMARY\*\*

\*\*a) Rationale\*\*

Healthspan Connect is a new Programme of Research aimed at understanding the life course determinants of healthy lifespan and gain real--time epidemiological insights into health--policy relevant questions.

Healthspan Connect will study healthy volunteers and use digital and remote methods to support healthspan and ageing research, as well as study multiple long-term conditions. The study builds from the ZOE Health study, which Steves designed, with a view to creating capability for rapid scientific answers to policy driven research questions and will also be guided in part by CARICE (Centre for Ageing Resilience in a Changing Environment), a KCL-led research and policy centre on ageing resilience directed by Steves. Healthspan Connect, which will be a vehicle for agile research and the programme sub-studies preferentially focussed on answering clinically and policy relevant research questions.

Healthy ageing and an extended health span are essential as they directly impact quality of life, individual well-being, and societal sustainability. With populations ageing globally, the objective is not only to increase life expectancy but to ensure that these additional years are lived in good health, free from chronic diseases and disabilities. A longer health span enables individuals to maintain their independence, continue contributing to their communities, and enjoy a better quality of life in their later years. Moreover, promoting healthy ageing alleviates the strain on healthcare systems and social care, which can become overburdened by the rising incidence of age-related diseases. By prioritising healthy ageing, this research aims to enhance overall life satisfaction, reduce healthcare costs, and foster more resilient societies where older adults remain active, engaged, and healthy for as long as possible. Additionally, it is crucial to involve underrepresented populations in ageing research to ensure that the benefits of health span extension are equitably distributed. Understanding how ageing and health resilience manifest in diverse groups, including those historically under-represented in research, will enable the development of more inclusive public health strategies and interventions that address the needs of all individuals as they age.

Involving participants between the ages of 12 and 15 years will enable the study to capture early determinants of healthy ageing by following participants from adolescence to adulthood. This approach allows for the observation of physical, cognitive, and mental health trajectories from a critical developmental stage, when many lifelong health behaviours are established and when the risk of onset for certain health conditions begins to emerge. Adolescents remain underrepresented in longitudinal studies, yet their inclusion is essential for understanding how early life experiences, social environments, and behavioural patterns contribute to ageing outcomes. Following individuals from their teenage years will enhance the cohort's representativeness, support trans-generational analyses, and provide unique insights into how contemporary influences shape lifelong health and wellbeing.

Healthspan Connect is a new longitudinal cohort dedicated to researching ageing and health resilience. Healthspan Connect will enable advancements in study design, methodology and large--scale data collection through remote participant recruitment, mobile health data capture via connected devices and apps, and the ability to collect samples remotely. The research programme will focus on strategies to maximise the number of years individuals spend in good health by exploring the underlying mechanisms of health resilience. This will involve investigating the biological, environmental and social factors that contribute to ageing and how these can be influenced to promote health. Additionally, the programme will place a strong emphasis on including underrepresented groups to ensure that the findings are inclusive and applicable to diverse populations. The research will also address prevention and early detection, with the cohort serving as a dynamic resource for studying these factors over time. Furthermore, the programme will provide participants with insights into their health and the potential impact of various risk factors. Alongside this, the research will delve into the drivers and barriers of behaviour change, aiming to understand how individuals can be supported in making lifestyle changes that enhance their health span. This comprehensive approach will provide valuable insights that will inform strategies and public policies to support longevity, health resilience, and effective behaviour change across all segments of society.

\*\*b) Expanding Research Access\*\*

Digital platforms have become integral to modern health research and clinical trials, offering a range of functionalities that enhance the agility and ability of research teams to conduct studies more efficiently. For instance, the ZOE COVID Symptom Study recruited over four million users through a mobile app, enabling ZOE and researchers at KCL to monitor the spread of COVID-19, identify risk factors, and predict outbreaks based on self-reported symptoms. Similarly, the COVID-19 Citizen Science Study used the Eureka Research Platform to recruit over 50,000 participants, collecting real-time, self-reported health data via digital surveys, with a sustained engagement rate of around 59% every four weeks. The unprecedented scale and speed of data collection during a pandemic demonstrates how digital platforms can extend the reach of research beyond traditional settings. Tools such as remote recruitment, e-consent, app-based data collection, geofencing, and digital interventions allow researchers to respond rapidly to emerging challenges while increasing inclusivity.

One of the most significant advantages of digital platforms is their ability to engage under-researched and underserved populations. By removing geographical and logistical barriers, these platforms can involve individuals who might otherwise be excluded due to health limitations, social barriers, or lack of access to major research centres. For example, studies have shown that digital tools can improve representation by enabling participation from people across different socioeconomic backgrounds, age groups, and ethnic communities. Furthermore, the use of intelligent systems for participant matching and onboarding increases the ability to tailor recruitment efforts towards populations that have historically been underrepresented in clinical research. The collection of real-world data through wearables and mobile apps also supports a more patient-centred approach, capturing insights from everyday life that are often missed in clinic-based studies. Despite challenges such as digital literacy and internet access, digital platforms are helping to reshape clinical research into a more agile, inclusive, and representative endeavour.

To expand research access and ensure that younger people can contribute meaningfully, the study is designed to include participants from the age of 12, with two tailored consent pathways for 12 to15-year-olds. The adult-initiated pathway enables a parent or guardian who is already a volunteer to invite their child to take part, while the child-initiated pathway allows a young person to express interest themselves, with parental consent then sought. In both pathways, comprehension checks are built in to confirm the young person understands the study before consent is finalised. This approach is consistent with the UN Convention on the Rights of the Child (UNCRC), balancing autonomy and protection, and removing unnecessary barriers to participation for this underrepresented age group.

\*\*c) Participant Support\*\*

Of the current application, the participant advisory group for the COVID Symptom Study (CSS) Biobank (20/YH/0298) were consulted in July 2025 about the Healthspan Connect Programme of Research model and all members present were supportive of the new model and agreeable to be invited to sub-studies in this way. Additionally, a survey conducted in April 2024 among participants in the CSS Biobank asked whether they would be interested in taking part in similar studies beyond COVID-related research. Of the respondents, 3,242 (97%) indicated that they 'may' or 'definitely would'. This highlights the strength of the digital platform and study design in keeping participants engaged, making it a valuable foundation for future research efforts.

This current REC application describes Healthspan Connect as a Programme of Research, alongside an application for a Research Tissue Bank (Healthspan Connect Biobank) which will act as a biorepository for the Programme of Research, allowing it to also be a valuable resource for the wider scientific community.

\*\*d) Aims and objectives\*\*

Healthspan Connect aims to:

1. Investigate the biological, environmental, and social factors that contribute to healthy ageing and health resilience. This will involve a comprehensive analysis of how these factors interact and can be influenced to maximise the number of years individuals spend in good health. 2. Ensure the inclusivity and representativeness of the research by actively involving underrepresented populations. The aim is to generate findings that are applicable across diverse groups, enabling the development of public health strategies and interventions that are equitable and effective for all segments of society. 3. Provide participants with insights into their health and study the drivers and barriers to behaviour change. This will include offering insights into health risks and understanding how to effectively support individuals in adopting behaviours that enhance their health span, ultimately informing strategies and public policies that promote longevity and health resilience. 4. Be an agile platform to answer policy relevant questions as and when they arise to provide near real-time data for policymakers and the public. Envisaged uses include analysis of effects of local and national health policy interventions (e.g. changes in fortification of food, emissions zoning, neighbourhood health services) and environmental changes (climate change, seasonal variations, new infectious diseases).

\*\*e) Proposed cohort\*\*

Healthspan Connect will recruit participants that have taken part in previous studies health studies linked to The Department of Twin Research and collaborating organisations. They will subsequently be able to join sub-studies under this Programme of Research model. Any biological samples collected as part of Healthspan Connect will be stored in the Healthspan Connect Biobank, linked to this application.

2\. \*\*METHODS\*\*

\*\*a) Programme design\*\*

The Healthspan Connect Programme of Research will enable us to collect data and samples longitudinally from participants who take part in specific sub-studies, funded by grant programmes or by access requests from external collaborators. According to sub-study specific designs, researchers will collect biological specimens and/or data from Healthspan Connect participants mainly through home-based or postal studies. Researchers may ask participants to attend research visits for certain sub-studies. Researchers will recall participants at follow up time points to update their baseline data and to donate additional specimens as required by sub-study protocols.

\*\*b) Recruitment to the programme\*\*

Participants will be eligible to join Healthspan Connect if they are currently resident in the UK and are 12 years or older. Participants will be made aware of Healthspan Connect through media coverage, flyers and posters in public settings, social media campaigns, recruitment campaigns, partnerships with the NHS, community groups and health companies such as ZOE, and word of mouth from existing volunt