BackgroundWhile　western　studies　suggest　a　temporal　association　between　chronic　pain　and　frailty,　as　well　as　the　impacts　of　healthy　lifestyle　interventions,　these　relationships　remain　underexplored　in　the　Chinese　population.MethodsWe　conducted　a　longitudinal　study　with　13,601　participants　from　the　China　Health　and　Retirement　Longitudinal　Study,　covering　2011-2018.　Pain　was　assessed　via　self-report,　and　frailty　was　evaluated　using　a　29-item　deficit-accumulation　frailty　index.　Five　lifestyle　factors,　such　as　physical　activity,　alcohol　consumption,　smoking,　body　mass　index,　and　sleep　duration,　were　assessed,　and　the　participants　were　categorized　into　favorable,　intermediate,　and　unfavorable　lifestyle　groups.ResultsDuring　the　7-year　follow-up,　3,356　cases　of　frailty　were　discerned.　Participants　who　reported　pain　at　baseline　assessment　had　a　higher　risk　of　developing　frailty　compared　to　those　without　pain　(hazard　ratio　[HR]　=　1.10;　95%confidence　interval　[CI],　1.03-1.19).　This　association　was　particularly　evident　in　middle-aged　individuals　(HR　=　1.13;　95%　CI,　1.01-1.26).　Participants　with　severe　pain　at　baseline　assessment　had　a　1.16-fold　higher　risk　of　frailty　(95%CI,　1.05-1.28,　Ptrend=　0.0067).　Among　the　participants　with　mild　or　moderate　pain　at　baseline　assessment,　the　risk　of　developing　frailty　was　significantly　reduced　by　a　favorable　lifestyle　(HR　=　0.62;　95%　CI,　0.51-0.76)　or　intermediate　lifestyle　(HR　=　0.83;　95%　CI,　0.70-0.98).　Additionally,　a　favorable　lifestyle　was　significantly　associated　with　a　decreased　risk　of　developing　frailty　in　the　participants　with　severe　pain　at　baseline　assessment　(HR　=　0.75;　95%CI,　0.59-0.96).　Mediation　analysis　indicated　that　a　healthy　lifestyle　could　mitigate　2.97%　of　frailty　risk　associated　with　chronic　pain.ConclusionsChronic　pain　is　strongly　associated　with　an　increased　risk　of　developing　frailty　in　Chinese　older　population,　but　the　implementation　of　healthy　lifestyles　can　significantly　reduce　this　risk.