PhysAgeNet Deliverable D4.5 Consensus report on final state of the art and further needs

CA20104 – Network on evidence-based physical activity in old age (PhysAgeNet) Deliverable D4.5. D4.5. Consensus report on final state of the art and further needs Contributors Working Group 4 Signe Tomsone (Associate Professor/WG4 leader), Jonathan Gómez-Raja (Chief Scientific Officer/WG4 vice-leader), David Paar (Associate Professor/WG4 member) 1. INTRODUCTION The demographic shift towards an increasingly aging population represents one of the greatest societal and public health challenges worldwide. While life expectancy has risen steadily over the past decades, healthy life expectancy has not increased at the same pace, leading to extended years lived with functional limitations, chronic diseases, and reduced quality of life. Physical activity is a proven, cost-effective strategy to promote healthy aging, preserve functional capacity, and mitigate the burden of non-communicable diseases in older adults. Nevertheless, despite a large body of research demonstrating the benefits of physical activity across physical, cognitive, and psychosocial domains, substantial gaps remain in the translation of scientific evidence into practical, tailored, and sustainable interventions for heterogeneous older populations. The COST Action CA20104, Network on Evidence-Based Physical Activity in Old Age (PhysAgeNet), was established to address these gaps by fostering a transdisciplinary European research and innovation network. Its overarching goal is to consolidate and advance the evidence base on physical activity in old age, and to enhance the integration of innovative information and communication technologies (ICT) and open data solutions into research and practice. PhysAgeNet brings together experts from sports and exercise sciences, medicine, gerontology, psychology, public health, and digital technologies, thereby creating a unique platform to bridge disciplinary boundaries and to align basic, clinical, and applied research with policy and practice. Within this framework, Working Group 4 (WG4) plays a central role in critically synthesising the evidence across domains and coordinating the development of consensus-based outputs. Specifically, the tasks of WG4 include conducting consensus processes on progress beyond the initial topical status, identifying emerging needs, and producing a final consensus report (Deliverable 4.5) on the state of the art and further requirements. This report reflects both the scientific progress achieved during the Action and the collective agreement of the network on priorities for future research, implementation, and policy development. By systematically analysing advancements in the field and aligning them with real-world demands, the consensus process ensures that the outcomes of PhysAgeNet extend beyond academic contributions. The ultimate aim is to deliver actionable knowledge, clear recommendations, and a robust roadmap that can guide researchers, practitioners, and decision-makers in promoting evidence-based physical activity interventions for older adults across diverse European contexts. 2. RESULTS BY WORKING GROUPS AND DELIVERABLES OF THE PROJECT 2.1. WG1 – Implementation and Development of Standards from EBM 2.1.1. D1.1 - D1.2 – SYSTEMATIC REVIEW USING THE DATABASE OF REFERENCES AND METADATA RELATED TO PA INTERVENTIONS AND BASED ON EBM Baseline and Progress During COST Action At the start of the Action, evidence on physical activity (PA) in older age was scattered and inconsistent. Brach et al. (2023) identified fragmented methods, limited inclusion of frail participants, and poor standardisation. Lamberti et al. (2023) advanced this by introducing a PRISMAand PROSPERO-based protocol to evaluate PA effects on health-related quality of life (HRQoL), establishing methodological rigour and replicability across diverse populations. Consensus Statements • Systematic reviews are the backbone of evidence-based physical activity (EB-PA) research. • HRQoL should be treated as a key outcome, alongside physical and physiological measures. • Transparent, pre-registered methodologies (PRISMA, PICOS, PROSPERO) are required for credibility. • Harmonized reporting (FITT parameters) enables data synthesis and cross-study comparison. Knowledge Gaps and Further Needs • Lack of uniform HRQoL measurement tools and outcome comparability. • Underrepresentation of frail and multimorbid populations. • Insufficient open-data structures for cumulative evidence analysis. Recommendations • Adopt unified reporting templates for exercise interventions. • Include HRQoL as a standard variable in future reviews. • Develop open-access European PA evidence databases to support continuous meta-analysis. 2.1.2. D1.3 – DESCRIPTION TOOL FOR PA INTERVENTIONS BASED ON EBM STANDARDS Baseline and Progress During COST Action The deliverable established the foundation for a shared intervention-description tool. Lamberti et al. (2023) demonstrated how detailed reporting of exercise characteristics (FITT), supervision, and adherence enhances study comparability and replication. Consensus Statements • Comprehensive documentation of exercise frequency, intensity, time, and type is essential. • Clear progression and supervision details determine both safety and replicability. • Standardized templates support transparency and future evidence synthesis. Knowledge Gaps and Further Needs • Heterogeneity in intervention documentation and adherence tracking. • Weak linkage between exercise dose and observed outcomes. Recommendations • Apply the COST template for intervention description across all future studies. • Combine standardized documentation with digital adherence monitoring systems. 2.1.3. D1.5 – CONSENSUS PAPER AND ROADMAP ON EBM FOR PA INTERVENTIONS SUBMITTED FOR PUBLICATIONS Baseline and Progress During COST Action Brach et al. (2023) emphasized the need for harmonized EBM practices and interdisciplinary collaboration to translate PA research into policy and practice. This roadmap underpins PhysAgeNet’s cross-domain evidence integration strategy. Consensus Statements • EBM should guide all stages of PA research, from design to dissemination. • Interdisciplinary networks are vital to reduce duplication and fragmentation. • Methodological transparency is the foundation for translation into clinical and policy contexts. Knowledge Gaps and Further Needs • Low adoption of EBM frameworks in non-clinical exercise research. • Fragmented communication between disciplines. Recommendations • Deliver structured EBM training for exercise scientists and practitioners. • Encourage open-access, reproducible protocols and cross-disciplinary collaboration. 2.2. WG2 – Data for utilising biomarkers and behavioural markers as well as environmental factors 2.2.1. D2.2 – ROADMAP FOR BIOMARKERS AND ENVIRONMENTAL FACTORS Baseline and Progress During COST Action PhysAgeNet expanded its biological and ecological evidence base. Vints et al. (2023) explored myokines (BDNF, irisin, IL-6, IGF-1) as mediators of exercise–cognition interaction. Oniszczuk et al. (2022) identified sclerostin as a bone-health biomarker. Oliveira et al. (2022) validated phase angle (PhA) as a non-invasive functional biomarker. Jansen et al. (2025) highlighted environmental and digital conditions affecting technology-assisted PA adherence. Consensus Statements • Biological markers (myokines, sclerostin, PhA) provide measurable insight into physiological adaptation. • Environmental and contextual factors shape accessibility, adherence, and real-world impact. • Integration of molecular and environmental data enables personalized, context-sensitive PA interventions. Knowledge Gaps and Further Needs • Lack of longitudinal biomarker data and standardized sampling. • Limited linkage between biomarker responses and environmental metrics. • Digital inequities hinder equitable access to technology-assisted programs. Recommendations • Develop harmonized biomarker protocols and reference ranges. • Combine biological, behavioral, and environmental datasets within open repositories. • Promote digital inclusion and user-centered environmental design. 2.2.2. D2.3 – OPEN DATA FRAMEWORK INCLUDING PA INTERVENTION AND MULTIPLE DATA SOURCES AND BIOMARKERS Baseline and Progress During COST Action This deliverable consolidates open-data practices linking physiological and biomarker datasets. Vints et al. (2023) proposed standardization of biological data integration, while Oliveira et al. (2022) validated bioelectrical impedance variables as scalable, non-invasive inputs for open databases. Consensus Statements • Open-data integration accelerates reproducibility and transparency. • Biomarkers and physiological variables enrich understanding of individual exercise response. • Ethical data governance is crucial for biospecimen sharing and reuse. Knowledge Gaps and Further Needs • Missing interoperability among biological and performance datasets. • Uneven data quality standards across institutions. Recommendations • Build interoperable, FAIR-compliant open repositories. • Standardize data annotation for biomarker and BIA variables. • Develop ethical guidelines for data access and reuse in PA research. 2.2.3. D2.4 – DEMONSTRATOR (PROTOTYPE) OF THE REPOSITORY INCLUDING REAL DATA FROM TECHNOLOGY-ASSISTED PA INTERVENTIONS Baseline and Progress During COST Action Jansen et al. (2025) identified key environmental and contextual variables (social support, usability, accessibility) necessary to accompany TA-PA datasets. This informs the design of a demonstrator repository that integrates contextual metadata. Consensus Statements • Environmental metadata (social, digital, infrastructural) are essential for understanding outcomes. • Contextual alignment improves sustainability and equity of interventions. Knowledge Gaps and Further Needs • Lack of harmonized contextual descriptors. • Insufficient linkage between environmental data and behavioral outcomes. Recommendations • Mandate environmental metadata in TA-PA data repositories. • Use open frameworks to connect environment–behavior–health datasets. 2.3. WG3 – Research methodology for technology-assisted PA and exercise interventions in old age 2.3.1. D3.1 – GUIDELINES ON REQUIREMENTS AND STRATEGICAL IMPROVEMENT OF RECRUITMENT AND SAMPLING FOR DIFFERENT TARGET GROUPS, USING A FORMAL CONSENSUS PROCEDURE Baseline and Progress During COST Action These studies addressed participant recruitment and representativeness. Gomes Ciolac et al. (2024) emphasized sex-balanced cardiovascular aging research, while Lee et al. (2025) established 34 international recommendations for inclusive, ethical recruitment. Consensus Statements • Recruitment strategies must ensure gender, health-status, and socioeconomic diversity. • Ethical inclusion and transparent consent processes are fundamental. • Balanced representation enhances external validity. Knowledge Gaps and Further Needs • Underrepresentation of very old, frail, and female participants. • Limited empirical validation of recruitment frameworks. Recommendations • Apply the COST recruitment consensus framework. • Report detailed recruitment metrics. • Engage community and healthcare networks for inclusive participant sourcing. 2.3.2. D3.2 – GUIDELINES AND FRAMEWORK FOR DESIGNING TECHNOLOGY-ASSISTED PA INTERVENTIONS INCLUDING APPROPRIATE ASSESSMENT STANDARDS Baseline and Progress During COST Action This deliverable unites methodological advances in digital, physiological, and mental health intervention design. The studies collectively established frameworks for cognitive, cardiovascular, affective, and neuromuscular outcomes, anchored by Wollesen et al.’s (2024) Delphi consensus on exercise intensity. Consensus Statements • Standardized intensity (Delphi taxonomy) is essential for reproducibility. • Multidimensional outcome frameworks must include physical, cognitive, and psychological measures. • Technology-assisted programs enhance accessibility and engagement. • Sex and health-status stratification improve intervention safety and relevance. Knowledge Gaps and Further Needs • Limited adoption of the Delphi framework. • Weak data integration between digital adherence metrics and physiological data. • Lack of harmonized outcome sets across research domains. Recommendations • Embed the Delphi intensity definitions in all studies. • Use standardized cognitive and mental-health assessments. • Calibrate wearable sensors to intensity levels. • Apply interdisciplinary co-design in digital intervention development. 3. CONCLUSIONS Over the four years of COST Action CA20104 – Network on Evidence-Based Physical Activity in Old Age (PhysAgeNet) – the participating experts tried to transform a fragmented and discipline-bound research field into a coherent, standardized, and transdisciplinary evidence base on physical activity (PA) and aging. Through the combined efforts of the four working groups, PhysAgeNet has built methodological and environmental bridges linking physiology, psychology, medicine, and technology with public health and social sciences. WG1 laid the conceptual and methodological foundations for evidence-based practice. By promoting systematic reviews and standardized intervention reporting (PRISMA, PROSPERO, FITT), it advanced the integration of quality-of-life indicators into PA evaluation and created the tools required for transparent, reproducible research. WG2 connected the biological and contextual dimensions of healthy aging. It identified key biomarkers – such as myokines, sclerostin, and bioelectrical impedance-derived variables – while also highlighting the decisive role of environmental, social, and digital contexts in supporting technology-assisted physical activity. Together, these findings pave the way for personalized, data-driven health promotion strategies. WG3 addressed the methodological challenges of technology-assisted interventions. Its deliverables produced standardized frameworks for exercise intensity (Delphi consensus), recruitment (inclusive and sex-balanced sampling), and design of multimodal interventions targeting cognitive, cardiovascular, and psychological outcomes. These methodological advances ensure that future studies will be both scientifically rigorous and ethically inclusive. WG4 synthesized all evidence strands into consensus statements and actionable recommendations. Its work demonstrates that exercise acts as a systemic intervention – simultaneously enhancing physical capacity, cognitive performance, cardiovascular integrity, molecular adaptation, and mental wellbeing – and that sustainable implementation depends on supportive environmental and technological infrastructures. Across all deliverables, several overarching conclusions emerge: • Physical activity is a cornerstone of healthy aging, providing multidimensional benefits across physiological, cognitive, and psychosocial domains. • Standardization and transparency are essential for evidence accumulation and international comparability. • Personalization and inclusivity must guide research design, ensuring that frail, multimorbid, and socially disadvantaged older adults are represented. • Technology and digitalization can dramatically extend access to individualized interventions when guided by ethical, user-centered principles. • Interdisciplinary and open science collaboration is vital for bridging mechanistic discovery with real-world policy and practice. Looking ahead, the PhysAgeNet network leaves a sustainable legacy: a community of researchers, clinicians, and practitioners united by shared standards and a commitment to advancing healthy longevity through evidence-based physical activity. Future European initiatives – whether under Horizon Europe, Erasmus+, or WHO Healthy Aging frameworks – should build upon these achievements by developing integrated, data-rich, and environmentally responsive systems that turn evidence into action. By maintaining and expanding this collaboration, Europe can ensure that every older citizen has the opportunity to remain active, autonomous, and connected across the lifespan. 4. REFERENCES Ballesteros, S., Audifren, M., Badache, A., Belkin, V., Giannaki, C. D., Kaltsatou, A., Marusic, U., Ziaaldini, M. M., Peskar, M., Reales, J. M., Rieker, J. A., Stavrinou, P. S., Tortosa-Martinez, J., Voelcker-Rehage, C., & Netz, Y. (2024). Effects of chronic physical exercise on executive functions and episodic memory in clinical and healthy older adult populations: A systematic review and meta-analysis protocol. Systematic Reviews, 13(1), 98. https://doi.org/10.1186/s13643-024-02517-0 Brach, M., de Bruin, E. 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