Digital Engagement for Lifelong Health

• DELPHI Personalized Digital Prevention Platform (Other): the full version of the DELPHI digital platform, designed to support personalized primary prevention and health promotion. The intervention includes continuous monitoring through wearable sensors (Fitbit Inspire 3), mobile app-based data collection, and adaptive lifestyle recommendations generated by artificial intelligence algorithms within a Human Digital Twin framework. Participants will receive personalized feedback and notifications related to physical activity, sleep, nutrition, hydration, stress management, and psychological well-being. The platform also delivers multimedia educational content, including guided exercises, mindfulness and breathing practices, wellness educational videos, and behavioral micro-actions. Data collected through wearable devices, digital questionnaires, and behavioral monitoring are used to dynamically tailor recommendations and preventive strategies throughout the study period.
• Passive Digital Monitoring Control (Other): Participants assigned to the control group will use a limited version of the DELPHI application restricted to passive monitoring functions. The application will collect data from wearable devices and questionnaires related to physical activity, sleep, nutrition, and well-being, but participants will not receive personalized recommendations, adaptive educational content, interactive feedback, or behavioral notifications. The control condition is intended to provide observational digital monitoring only, without active preventive intervention or AI-based personalization.

Primary outcomes

• World Health Organization Quality of Life (WHOQoL) [Baseline and 6 months]: The World Health Organization Quality of Life (WHOQoL) is a questionnaire used to assess quality of life.The WHOQOL-BREF, its short form, includes 26 items and evaluates four domains: physical health, psychological health, social relationships, and environment. It does not generate a single total score; instead, it provides separate domain scores, with higher values indicating better quality of life
• Depression, Anxiety, and Stress Symptoms (DASS-21) [Baseline and 6 months]: The Depression, Anxiety and Stress Scales-21 (DASS-21) is a 21-item self-report instrument designed to assess the severity of depression, anxiety, and stress symptoms. It consists of three subscales, each containing 7 items, and uses a 4-point response format. The scale provides separate scores for depression, anxiety, and stress rather than a single diagnostic score. * Depression: normal 0-9, mild 10-13, moderate 14-20, severe 21-27, extremely severe 28+. * Anxiety: normal 0-7, mild 8-9, moderate 10-14, severe 15-19, extremely severe 20+. * Stress: normal 0-14, mild 15-18, moderate 19-25, severe 26-33, extremely severe 34+.
• Beck Depression Inventory-II (BDI-II) [Baseline and 6 months]: The Beck Depression Inventory-II (BDI-II) is a 21-item self-report instrument designed to measure the severity of depressive symptoms over the past two weeks. Each item is rated on a 0 to 3 scale, and the total score ranges from 0 to 63. The total BDI-II score is calculated by summing all 21 items, giving a range from 0 to 63. Common interpretive cut-offs are: minimal depression 0-13, mild 14-19, moderate 20-28, and severe 29-63
• International Physical Activity Levels (IPAQ) [Baseline and 6 months]: The International Physical Activity Questionnaire (IPAQ) is a self-report instrument designed to assess physical activity levels over the previous 7 days. It provides both a categorical score, classifying individuals as low, moderate, or high active, and a continuous score expressed as MET-minutes per week. * Categorical score: low, moderate, or high physical activity. * Continuous score: total physical activity expressed as MET-minutes/week. The continuous score is calculated using standard MET values: * Walking = 3.3 METs. * Moderate activity = 4.0 METs. * Vigorous activity = 8.0 METs.
• Prevention with Mediterranean Diet (PREDIMED) [Baseline and 6 months]: The Prevention with Mediterranean Diet (PREDIMED) questionnaire is a 14-item tool designed to assess adherence to the Mediterranean diet. Each item is scored as 0 or 1, and the total score ranges from 0 to 14, with higher scores indicating greater adherence to the Mediterranean dietary pattern.

Secondary outcomes

• Heart Rate [Continuously monitored from baseline to 6 months]: Average heart rate measured through wearable sensors in beats per minute (bpm). Normal resting heart rate in adults is commonly about 60 to 100 bpm
• Heart Rate Variability (HRV) [Continuously monitored from baseline to 6 months]: Nocturnal heart rate variability measured in milliseconds using wearable sensors.
• Body Weight [Baseline, every 2 weeks during the 6-month intervention period and 6 months]: Change in body weight measured in kilograms (kg).
• Body Mass Index (BMI) [Baseline and 6 months]: adults, BMI is usually interpreted as follows: Underweight: below 18.5 Healthy weight: 18.5 to 24.9 Overweight: 25.0 to 29.9 Obesity: 30.0 or above
• Nutritional Intake [Weekly monitoring from baseline to 6 months]: Daily caloric, macronutrient, and micronutrient intake measured through in-app food diary records.
• Mental Well-Being Weekly Check-in Scores [Weekly from baseline to 6 months]: Weekly emotional well-being indicators measured through a 6-item Likert-scale in-app questionnaire assessing mood, calmness, energy, tension, and distress.

Sex: All, ages: 18 Years to 65 Years, accepts healthy volunteers

Inclusion Criteria:

* Apparent good general health status, confirmed by medical history and initial self-assessment.
* Ability to understand the study information and provide informed consent.
* Availability and motivation to participate for the entire duration of the study (12 months).
* Access to a smartphone compatible with the DELPHI application.
* Willingness to wear the wearable devices for continuous monitoring of physiological parameters.
* Basic familiarity with mobile applications or willingness to receive training on their use.
* Signed informed consent.

Exclusion Criteria:

* Presence of severe chronic diseases in active phase (e.g., oncological, cardiovascular, or neurological diseases).
* Acute or unstable conditions that could compromise participation in the protocol.
* Current pregnancy.
* Diagnosed major cognitive or psychiatric disorders that hinder understanding of or adherence to the protocol.
* Current use of medications that significantly affect the parameters being monitored (e.g., psychotropic drugs, beta-blockers).
* Simultaneous participation in other clinical studies.
* Logistical difficulties that prevent frequent interaction with the platform (e.g., lack of connection, unwillingness to attend periodic follow-ups).

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• Gennaro Tartarisco, Principal investigator, Institute for Biomedical Research and Innovation (IRIB)-National Reasearch Council (CNR)