CA20104 – Ne wo k on e idence-based
physical ac i i y in old age (PhysAgeNe )
Deli e able D1.5
D1.5- Consensus pape and oadmap on EBM o PA in e en ions
submi ed o publica ion
Con ibu o s
Wo king G oup 1
Be ina Wollesen, Piesie A. G. Asuako, Mona He den, Ch is o o os D. Giannaki,
An oine Langea d , Nicola Lambe i , Melanie Mack, Michel Audi en, Yael Ne z
and Claudia Voelcke -Rehage oge he wi h he PhyAgeNe
SUMMARY
1. In oduc ion ....................................................................................................................................... 3
2. Aim o he CONSENSUS PAPER ..................................................................................................... 4
3. De elopmen o he CONSENSUS PAPER ................................................................................... 4
4. Roadmap on EBM o PA in e en ions ........................................................................................ 4
5. Suppo ing Re e ences .................................................................................................................... 6
1. INTRODUCTION
Comp ehensi e epo ing o exe cise in e en ions is essen ial o ep oducibili y, sys ema ic
e iews and me a-analyses, and he de elopmen o e idence-based exe cise p og ams o
olde adul s [Wollesen e al., 2024]. Comple e epo ing inc eases anspa ency, allowing
eade s o assess me hodological quali y and po en ial bias [Blanco e al., 2024], and helps
iden i y gaps in he e idence base.
The EQUATOR Ne wo k (Enhancing he Quali y and T anspa ency o Heal h Resea ch)
p omo es discipline-speci ic epo ing guidelines o imp o e accu acy and eliabili y in heal h
esea ch [Page, Hoogenboom & Voigh , 2017; Why e e al., 2021]. Howe e , inconsis en and
incomple e epo ing hinde s eplica ion, syn hesis, and ansla ion in o p ac ice.
Exe cise in e en ions p esen unique challenges due o hei complexi y, mul imodal na u e,
and need o pe sonaliza ion. Compa ed o d ug ials, exe cise ials o en show lowe
me hodological quali y, highe bias isk, and less equen epo ing o ad e se e en s
[Hans o d e al., 2022; Hans o d e al., 2024]. S udies compa ing epo ing ools such as TIDieR,
CERT, and i-CONTENT [Ka ackal e al., 2020; Hoogeboom e al., 2021; Da idson e al., 2021]
indica e ha supplemen al in e en ion de ails imp o e ep oducibili y, hough exis ing
guidelines lack speci ici y o exe cise-based in e en ions.
While cu en ools help s anda dize epo ing (c . [Slade e al., 2016; Ho mann e al., 2014]),
hey miss aspec s speci ic o olde adul s. High he e ogenei y, mul imo bidi y, and
psychosocial a iabili y [WHO, 2024; Cesa i, Cal ani & Ma ze i, 2017; Bea d e al., 2016] inc ease
he isk o incomple e epo ing. Fac o s such as mul imo bidi y p o iles [Ma ínez-Velilla e al.,
2022], baseline unc ional s a us [Layne e al., 2017], cogni i e impai men [Di Lo i o e al., 2020;
Dieckelmann e al., 2023], and men al heal h [Noe el e al., 2024; Shaw e al., 2022] in luence
in e en ion e ec s and adhe ence. Mo eo e , digi al li e acy and echnology access a ec
engagemen in echnology-suppo ed exe cise [Buyl e al., 2020; Jiang e al., 2024]. Thus,
ca e ul documen a ion o s udy design and pa icipan cha ac e is ics is needed [Ha dy, Allo e
& S udenski, 2009; Hawley-Hague e al., 2016; Lau e al., 2023].
De ailed epo ing o exe cise pa ame e s— equency, in ensi y, ime, and ype (FITT) [ACSM
2022]—as well as se ing, adhe ence, and d opou easons [Pico elli e al., 2014] is o en missing.
This hampe s eplica ion, bias assessmen , and me a-analy ic syn hesis [El Hadouchi e al.,
2024; Mila e al., 2020]. Addi ionally, links be ween hypo heses, ou comes, and heo e ical
models a e equen ly unde epo ed [Conn e al., 2003].
Exis ing epo ing guidelines [Slade e al., 2016; Signal e al., 2024] we e no designed o olde
adul s and o en lack speci ici y ega ding FITT p inciples o digi al deli e y. Consequen ly, key
in e en ion desc ip o s emain incomple e [El Hadouchi e al., 2024]. These limi a ions
highligh he need o PETIO, a popula ion- and con ex -speci ic epo ing ex ension o
exe cise in olde adul s.
Al hough non- andomized designs a e common in his ield, ou ocus on andomized
con olled ials is in en ional, as hey ep esen he me hodological gold s anda d.
S anda dized and comp ehensi e epo ing o exe cise in e en ions—including FITT
cha ac e is ics—will enhance gene alizabili y, eplica ion, and he de elopmen o ailo ed,
e idence-based exe cise p og ams o di e se aging popula ions.
2. AIM OF THE CONSENSUS PAPER
Building on he exis ing Consolida ed S anda ds o Repo ing T ials (CONSORT) guidelines o andomized
con olled ials and aking in o accoun he speci ic cha ac e is ics o exe cise in e en ions in old age, we
p esen an ex ended epo ing guideline designed o imp o e he anspa ency, quali y, and comple eness
o exe cise in e en ion desc ip ions, and o ensu e ha he demons a ed bene i s o olde adul s can be
accu a ely in e p e ed, eplica ed, and ansla ed in o p ac ice
3. DEVELOPMENT OF THE CONSENSUS PAPER
The consensus pape was de i ed ou o he guideline p ocess (c . Deli e able 1.3). The
guideline was de eloped h ough a six-s age p ocess using a igo ous, sys ema ic app oach
ha included a e iew o exis ing epo ing s anda ds, expe consul a ions, and i e a i e
e inemen based on s akeholde eedback, ollowing he p inciples o Mohe [39]. An
in e disciplina y g oup was o med (e.g., exe cise and mo emen scien is s, physiologis s,
heal h p o essionals, psychologis s). The p ocess comp ised an ini ial Delphi su ey (S age 1),
li e a u e e iews (S age 2), ace- o- ace mee ings and g oup discussions (S ages 3 and 5), and
consensus ques ionnai es (S ages 4 and 6). The ocus was on epo ing andomized con olled
ials (RCTs) e alua ing physical exe cise in e en ions in olde adul s. A e wa ds he esul s
we e summa ized in a manusc ip o publica ion o he Jou nal “Eu opean Re iew o Aging
and Physical Ac i i y” (IF: 3.5).
4. ROADMAP ON EBM FOR PA INTERVENTIONS
Al oge he , he p ocess led o he inal guideline, which included all i ems and hei explana ions (c .
Supplemen al Ma e ial - h ps://zenodo.o g/communi ies/eg apa/ eco ds). The Figu e p o ides an o e iew
o he key conside a ions o epo ing exe cise in e en ion s udies wi h olde adul s.
Figu e 1 Final o e iew o he guideline con ex ac o s o PETIO epo ing guidelines
Implemen a ion o he newly de eloped epo ing guideline o exe cise in e en ions in olde adul s will
enhance he cla i y, comple eness, and clinical applicabili y o s udy epo ing in his ield. Pilo ing he
guideline ac oss esea ch g oups would assess i s easibili y and pe cei ed alue among end use s. A
mixed-me hods e alua ion could combine quan i a i e su eys o assess cla i y and use ulness wi h
quali a i e in e iews explo ing bene i s such as imp o ed epo ing o adhe ence, ad e se e en s, and
pa icipan eedback.
Edi o s ha e indica ed ha he guideline could s eng hen epo ing, pa icula ly ega ding ailo ing o age-
ela ed limi a ions, sa e y adap a ions, and adhe ence acking. T aining ma e ials and esou ces (e.g.,
empla es, online p esen a ions) will be essen ial o up ake, wi h u u e s eps including de elopmen o
suppo ing ma e ials and a digi al implemen a ion ool (e.g., in e ac i e checklis o o m). B oade
s akeholde engagemen , including jou nal edi o s and olde adul ep esen a i es, as well as ansla ion
in o o he languages ia PhysAgeNe , is planned.
PETIO is designed as a epo ing ool, no a quali y a ing scale. Empi ical alida ion (po en ially in eg a ing
GRADE o ROB2 amewo ks) may help es ablish quali y h esholds. The GRADE app oach p o ides a
amewo k o e alua ing e idence based on s udy design, bias, inconsis ency, imp ecision, and e ec size
[GRADE wo king g oup, 2004]. Risk o bias in RCTs is o en assessed wi h he ROB2 ool [Higgins e al.,
2019], co e ing i e domains: (1) bias om andomiza ion; (2) de ia ions om in ended in e en ions; (3)
missing da a; (4) ou come measu emen ; and (5) selec i e epo ing.
In beha io al s udies (e.g., exe cise, cogni i e beha iou al he apy), blinding is o en in easible, inc easing
isk o bias, pa icula ly in Domain 2. This can be mi iga ed by acking ex e nal physical ac i i y, measu ing
pa icipan p e e ence be o e andomiza ion, and assessing sa is ac ion pos -in e en ion. Domain 4 bias
may a ise om sel - epo ed ou comes (e.g., mood, quali y o li e); using blinded ex e nal assesso s can
educe his. Imp o ed assessmen ools o epo ing quali y may u he minimize bias in beha io al ials.
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