CA20104 – Ne wo k on e idence-based
physical ac i i y in old age (PhysAgeNe )
Deli e able D3.1
D3.1 Guidelines on equi emen s and s a egical imp o emen o
ec ui men and sampling o di e en a ge g oups, using a
o mal consensus p ocedu e
RCO 7 De elop guidelines o ec ui men and sampling o
di e en a ge ageing g oups. Imp o ing planning and
moni o ing he ec ui men p ocesses will educe bias and enable
gene alisaz ion o s udy esul s (EBR), hus imp o ing he g ound
o in e en ion designs (ICT).
Achie emen : guidelines submi ed o publica ion (D3.1).
This publica ion is based upon wo k
om COST Ac ion PhysAgeNe ,
CA20104, suppo ed by COST
(Eu opean Coope a ion in Science
and Technology).
COST (Eu opean Coope a ion in Science and
Technology) is a unding agency o esea ch
and inno a ion ne wo ks. Ou Ac ions help
connec esea ch ini ia i es ac oss Eu ope and
enables scien is s o g ow hei ideas by
sha ing hem wi h hei pee s. This boos s
hei esea ch, ca ee and inno a ion.
Con ibu o s – WG3
Lead au ho s
Sunwoo Lee
Palacky Uni e si y Olomouc
Czechia
Magdalena Cyma-Wejchenig
Poznań Uni e si y o Physical Educa ion
Poland
Ana Mo ais
Uni e si y o É o a
Po ugal
Veysel Alcan
Ta sus Uni e si y
Tü kiye
Iuliia Pa lo a
L i S a e Uni e si y o Physical Cul u e
Uk aine
Ra ał S emplewski
Poznan Uni e si y o Physical Educa ion
Poland
Panel expe s
Michael B ach
Uni e si y o Müns e
Ge many
Elpidio A oh-Mensah
Uni e si é de Limoges
F ance
Eleni Epiphaniou
Eu opean Uni e si y Cyp us
Cyp us
Zau Gasimo
Scien i ic- esea ch ins i u e o Ca diology
Aze baijan
Sebaha Gözüm
Akdeniz Uni e si y
Tü kiye
Aysegul ILGAZ
Akdeniz Uni e si y
Tü kiye
An oine Langea d
Uni e si é de Caen
F ance
Melanie Mack
Uni e si y o Gene a
Swi ze land
Hugo Rosado
Uni e si y o É o a
Po ugal
Giacomo Pie o Vigezzi
Uni e si y o Pa ia
I aly
Ad iso y commi ee
Jana Pelclo á
Palacky Uni e si y Olomouc
Czechia
Rosema y Dubbeldam
Uni e si y o Müns e
Ge many
Ch is McC um
Uni e si ei Maas ich
Ne he lands
Pa ick Esse
Ox o d B ookes Uni e si y
Uni ed Kingdom
Yael Ne z
Le insky-Winga e Academic College
Is ael
Co esponding
Sunwoo Lee, Facul y o Physical Cul u e, Palacký Uni e si y Olomouc, Třída Mí u 117, 771 11 Olomouc,
Czech Republic; +420 585 636 113; [email p o ec ed]
* PhysAgeNe membe s who pa icipa ed in he wo- ound Delphi su ey ha e con ibu ed o
Deli e able 3.1. A ull lis o pa icipan s will be acknowledged in he publica ions.
Table o Con en
1. In oduc ion ......................................................................................................................................... 0
2. Me hodology ......................................................................................................................................... 3
3. Resul s ............................................................................................. Fehle ! Tex ma ke nich de inie .
1. INTRODUCTION – BACKGROUND AND PURPOSE
Despi e subs an ial e idence suppo ing he bene i s o physical ac i i y (PA) in olde adul s, engaging
his popula ion in PA emains challenging. Gaps pe sis , including: 1) unique ba ie s aced by olde
adul s a indi idual, communi y, and ins i u ional le els, 2) insu icien e idence add essing he di e se
needs o ageing popula ions, pa icula ly he mos ulne able g oups, and 3) a lack o clea guidelines o
esea che s and heal h p o essionals on e ec i e ec ui men and e en ion s a egies o ackle hese
challenges. D3.1 aimed o de elop e idence-in o med equi emen and s a egies o designing,
de eloping, and implemen ing he ec ui men o olde pa icipan s in PA in e en ions, equipping
esea che s and p o essionals wi h ad anced unde s anding and echniques ac oss di e se ields.
2. METHODOLOGY
To achie e he goal o D3.1, we employed a mixed consensus me hodology, in eg a ing a o mal
consensus p ocedu e and he Delphi echnique. The o mal consensus in ol ed ace o ace discussions
wi hin an expe panel h ough i e a i e on-line mee ings ha aimed o de elop ini ial
ecommenda ions and each a inal consensus on he guidelines. The Delphi me hod was used o collec
anonymous eedback on he ecommenda ions h ough a wo- ound su ey (one ound o he ini ial
p oposal and ano he o he e ised p oposal), which u he p o ided ex e nal alida ion on he
guidelines. While guideline de elopmen p ocesses ypically adop a single app oach, his mul is ep
consensus me hod ensu es a well- ounded pe spec i e and os e s expe ag eemen , wi h each
app oach complemen ing he o he .
2.1 Pa icipan s
A o al o 399 PhysAgeNe membe s we e in i ed ia email be ween July and Augus 2023; The ini ial
in i a ion ou lined he pu pose o he guidelines, as well as he oles and esponsibili ies associa ed wi h
each wo king g oup, (S ee ing G oup, Panel o Expe s G oup, and Ex e nal Re iew G oup). Ne wo k
membe s we e asked o egis e o he one o he g oups o hei in e es . Pa icipa ion was olun a y,
and he wo king g oup membe s decla ed no po en ial con lic s o in e es ega ding he esea ch,
au ho ship, o publica ion o hese guidelines.
The S ee ing G oup (N=6) was esponsible o coo dina ing he guideline de elopmen p ocess. Tasks
included de ining he scope o he guidelines, o mula ing key ques ions o he panel expe s, ga he ing
panel inpu h ough semi-s uc u ed online su eys and discussions, acili a ing consensus-building
sessions, and p epa ing dissemina ion documen s.
The Panel o Expe s G oup (N=12) was asked wi h de eloping he ini ial p oposal o he guidelines,
inco po a ing expe ise and eedback om he ex e nal e iew g oup, and eaching consensus on he
inal guidelines. The g oup consis ed o academics and heal h p o essionals wi h di ec in ol emen in
he a ge popula ion. Panel membe s we e quali ied based on hei expe ise in ields ele an o he
guidelines and hei clinical and esea ch expe ience, e lec ing di e si y in gende , geog aphy, and
p ac ice a eas.
The Ex e nal Re iew G oup (N=42) p o ided pee e iew o he p oposed guidelines, assessing hei
ele ance and impo ance using a 2- ound Delphi su ey.
2.2 Guideline De elopmen P ocedu e
In gene al, we ollowed h ee s eps: 1) a p e-consul a ion ound o de elop an ini ial lis o ec ui men
s a egies and ecommenda ions p oposed by he panel expe s, 2) a wo- ound su ey o e alua e he
ele ance and impo ance o each measu e, and 3) a panel mee ing o inalize he consensus. Figu e 1
p esen s he p ocedu e ollowed in he me hod.
2.2.1 P econsul a ion and cons uc ion o he guidelines
Once he panel g oup was es ablished/cons uc ed, a p econsul a ion mee ing was p oceeded o
in oduce panel membe s and ou line he consensus p ocedu e. Gi en geog aphic and ime cons ain s,
p e-consul a ion mee ings we e o ganized online o acili a e e ec i e collabo a ion among panel
membe s om di e en loca ions. Fo he simila easons, and o educe he bias ha migh occu in
ace- o- ace discussions, and o combine di e se pe spec i es, p oduce well- ounded conclusions, he
S ee ing G oup de eloped an open-ended, semi s uc u ed ques ions based on hemes and opics on
speci ic ec ui men s a egies and echniques ha can acili a e olde adul s' pa icipa ion in physical
in e en ions and esea ch ha eme ged du ing he p econsul a ion mee ings. This on-line
ques ionnai e was sen ou o each panel membe . This app oach helped ensu e ha all panel membe s
had he oppo uni y o e lec on hei knowledge and expe iences and p o ide in dep h and a ied
pe spec i es in p oposing guidelines. All sugges ions om panel membe s we e sha ed wi h he g oup
be o e eaching he ini ial consensus on he guidelines, allowing o u he e lec ion and e inemen .
The panel membe s hen me online o inalize consensus on he lis ed i ems. Some clea ly epea ing
i ems we e combined based upon ag eemen among he Panel o Expe G oup and S ee ing G oup.
2.2.2 Fi s ound Delphi su ey
Based on he consensus eached by he Panel o Expe s G oup on he ini ial ecommenda ions, he
S ee ing G oup ans o med hese p oposals in o a se o i ems o e alua ion by he Ex e nal Re iew
G oup. The ini ial p oposal lis ed 112 i ems ac oss se e al key domains: s akeholde in ol emen ,
e hical p inciples and in o med consen , inclusion/exclusion c i e ia, pa icipan e en ion, and socio-
cul u al di e si y and di e ences. Each ecommenda ion was e alua ed o ele ancy and impo ance
using a 3-poin scale ( ele an , somewha ele an , o no ele an ) and a 10-poin scale (1 = leas
impo an , 10 = mos impo an ), espec i ely. The i s ound o he su ey ook app oxima ely 40 - 50
minu es o comple e. Da a collec ion ook place be ween Ma ch and Ap il 2024, wi h po en ial
pa icipan s in i ed ia email. All pa icipan s p o ided in o med consen p io o comple ing he
ques ionnai e. A o al o 42 expe s pa icipa ed in he i s ound.
Based on he i s - ound Delphi su ey, he panel g oup eached a consensus on hose o be e ained o
a second ound o expe e iew. To es ablish consensus, he Panel o Expe s and S ee ing G oups
p io i ized he pe cen age o ag eemen as he p ima y c i e ion o inclusion, while also conside ing
mean sco es. A 70% ag eemen h eshold was se as he cu o , in line wi h documen ed s anda ds o
p ac ice guidelines (Ki k e al., 2024). Fo i ems ha did no mee he 70% ag eemen h eshold, he
panel expe s had wo op ions: ei he o emo e he ecommenda ion o , i hey unanimously ag eed, o
p opose e isions o a second- ound e iew. The panel also e ined he ini ial p oposal by me ging
duplica e measu es and inco po a ing quali a i e esponses om he i s su ey o add ess gaps in he
ecommenda ions.
2.2.3 Second ound Delphi su ey
A new se o i ems was used o nex ound o he ex e nal e iew su ey. The ques ionnai e included a
o al o 60 i ems, which we e e alua ed o ele ance and impo ance as in p e ious ound. Expe s
om he Ex e nal Re iew G oup who had comple ed he i s ound o he su ey we e in i ed o
pa icipa e. Responses we e ob ained om 31 o he 42 expe s (a 74% esponse a e) be ween May
and June 2024. The second- ound su ey used iden ical assessmen scales as he i s ound. Following
his ound, he S ee ing G oup conduc ed a desc ip i e analysis pe cen age o ag eemen , mean/SD) o
each i em. A summa y o he desc ip i e analysis was hen ci cula ed among he Panel o Expe s G oup
o inal consensus on he guidelines.
2.2.4 Final consensus
Based on he second- ound Delphi esul s, he panel expe s engaged in ei e a i e online discussions o
each a inal consensus on he a ed ecommenda ions. Se e al key conside a ions guided his p ocess:
1) he ou comes om each ound o expe e iew, in pa icula , whe e ex e nal e iewe s p o ided
su icien ag eemen , 2) he p o essional knowledge and p ac ical expe ience o he panel membe s,
and 3) he le el o a ailable e idence. The guidelines we e subsequen ly o med based on hese
consensus poin s. I is impo an o no e ha ollowing a side by side app oach, we balanced he
quan i a i e e idence om ex e nal e iews wi h he panel expe s’ opinions and pe spec i es as hey
p o ide mo e nuanced, con ex ual jus i ica ion o he guidelines.
Figu e 1 Guidelines de elopmen p ocess using a o mal consensus p ocedu e and Delphi echnique
Da a p ocessing (s ee ing g oup)
Panel mee ings: discussion o
Delphi esul s
Modi ying ini ial p oposal
Final consensus mee ings
Panel mee ings: Discussion o
Delphi esul s
P econsul a ion
D a ed guidelines p oposal
Panel o Expe s G oup
(N = 12)
1s ound o Delphi su ey
( esponse, N = 42)
Ex e nal Re iew G oup
(N = 42)
Da a p ocessing (s ee ing g oup)
2nd ound o Delphi Su ey
( esponse, N = 31)
Oc obe 2023
Janua y 2024
Ma ch 2024
Ma ch o Ap il
2024
Ap il o May
2024
June 2024
July o Augus
2024
Sep embe o
Oc obe 2024
3. RESULTS
Achie emen : De eloped guidelines ha e been published in BMC
Medical Resea ch Me hodology.
D3.1, which aimed a guideline de elopmen , has been comple ed, and i s esul s ha e been published
in BMC Medical Resea ch Me hodology: Lee, S., Cyma-Wejchenig, M., Alcan, V. e al. Key conside a ions
and ecommenda ions o ec ui ing olde adul s in physical ac i i y s udies. BMC Med Res Me hodol 25,
207 (2025). h ps://doi.o g/10.1186/s12874-025-02659-2
In addi ion, D3.1 dissemina ion ask was accomplished by p esen ing he esul s a 1) he PhysAgeNe &
EGRAPA Con e ence 2025 (T abzon, Tu key; May 7–9, 2025); and 2) he PhysAgeNe T aining School
(Gdansk, Poland; Sep embe 9–11, 2025).
A summa y o he esul s
The panel expe s, inco po a ing esul s om he Delphi su ey (ex e nal e iew), eached a consensus
on h ee key domains ela ed o planning and implemen ing he ec ui men o olde adul s. These
include adhe ence o e hical p inciples, in o med consen , and he in ol emen o s akeholde s. In
addi ion, o add ess key ba ie s—poo heal h and limi ed e-li e acy, which a e di ec ly linked o ech-
assis ed PA in e en ions, a se o ecommenda ions was p oposed o acili a e olde adul s’ consen
and pa icipa ion. A o al o 38 i ems we e e ained based on he inal consensus. Fo he pa simony o
he guidelines, he s ee ing g oup and panel expe s e ined he (highly) duplica ed measu es.
The guidelines ein o ce he e hical app oaches in esea ch and p ac ice, a aining he highes le el o
consensus among bo h panel expe s and he ex e nal e iew. This includes conside a ions o p i acy,
con iden iali y, and sa e y ha align wi h au onomy and espec o olde adul s. Also, he olun a y
na u e o pa icipa ion should be emphasized, and measu es should be in place o add ess any conce ns
o ques ions ha may a ise h oughou he ec ui men p ocess.
Selec ed ecommenda ions and expe s’ ag eemen (%) and a ing (Mean, SD) ollows:
S eng h o he
ecommenda ion: s ong
Recommenda ion 1:
Ensu e anonymi y and p i acy a e main ained when communica ing wi h olde
adul s.
93.5%, 9.23 (1.36)
Recommenda ion 2:
Ensu e p i acy when communica ing in o ma ion and assessing decision-making
capaci y.
83.9%, 8.58 (1.52)
Recommenda ion 3:
P o ide assu ance o con iden iali y o pa icipan s and explain da a handling
p o ocols.
93.5%, 9.06 (1.36)
Recommenda ion 4:
Respec olde adul s as au onomous indi iduals and a oid ea ing hem in a
pa onizing manne .
87.1%, 9.23 (1.38)
Recommenda ion 5:
Consen should be eely gi en and ongoing, wi hou any nega i e consequences
o wi hd awal.
87.1%, 9.23 (1.31)
Recommenda ion 6:
87.1%, 8.58 (1.31)
Reassu e pa icipan s abou he p i acy and secu i y measu es o build us and
educe hesi ancy ela ed o da a misuse, p o iding de ailed in o ma ion on da a
enc yp ion, secu e s o age p ac ices, and how hei da a will be used and
accessed only by au ho ized pe sonnel.
Recommenda ion 7:
Es ablish us and clea communica ion channels wi h olde adul s.
80.6%, 8.77 (1.56)
Rela edly, panel expe s eached a s ong consensus ha in o med consen should only be ob ained
a e he esea che is con iden ha he pa icipan s unde s and he in o ma ion. To ensu e ha bo h
pa icipan s and ca egi e s a e well-in o med du ing he ec ui men p ocess, imp o ing accessibili y o
in o ma ion and consen ma e ials is a p io i y. Consen ma e ials should be ailo ed o pa icipan s
wi h low li e acy, using s aigh o wa d language and a simpli ied s uc u e. Consen o ms should be
w i en in plain language, a oiding ja gon and echnical e ms ha may be di icul o non-medical
audiences o unde s and. A clea imeline o p ocedu es and ac i i ies, om ec ui men o s udy
comple ion, should be p o ided o pa icipan s in o ganized and clea o ma . This includes de ails on
he pu pose, how he da a will be collec ed and used, and he measu es in place o p o ec p i acy.
Visual aids such as pic u es, diag ams o pic og ams could be added o he in o ma ion and consen
o m o imp o e comp ehensibili y.
Selec ed ecommenda ions and expe s’ ag eemen (%) and a ing (Mean, SD) ollows:
S eng h o he
ecommenda ion: s ong
Recommenda ion 8:
Make consen o ms easie o unde s and by using clea , simple language
ins ead o echnical e ms.
96.8%, 9.55 (0.85)
Recommenda ion 9:
Gua an ee cla i y and easy access o consen ma e ials.
96.8%, 9.32 (1.14)
Recommenda ion 10:
P o ide a clea desc ip ion o he ac i i ies ha olde adul s will unde ake
du ing hei in ol emen in he esea ch, om inclusion o conclusion.
96.8%, 9.00 (1.21)
Recommenda ion 11:
Emphasize in a lay desc ip ion he po en ial immedia e, long- e m indi idual
and g oup bene i (s) o he in e en ion.
96.8%, 8.97 (1.28)
Recommenda ion 12:
Explain in lay language he challenges olde adul s migh ace while aking pa
in he in e en ion asks (physical limi a ions, ime cons ain s, e c.) and he
bene i s.
93.5%, 8.97 (1.22)
Recommenda ion 13:
Tailo consen o ms and in o med shee s o a low li e acy le el, using clea ,
simple language ins ead o echnical e ms o ensu e unde s anding.
90.3%, 9.00 (1.34)
Recommenda ion 14:
Imp o e accessibili y o pa icipan s wi h impai men s by using isual aids
such as diag ams, pic u es, ideos, o audio p esen a ions, and inco po a ing a
la ge on size.
83.9%, 8.68 (1.45)
Recommenda ion 15:
Ensu e explici consen is ob ained o obse a ion o eco ding in home
se ings.
80.6%, 8.71 (1.44)
Recommenda ion 16:
71.0%, 8.58 (1.41)
