Removing barriers to physical activity for people with long-term conditions: co-creating patient-centred guidance through a multistakeholder consensus approach.

Medical clearance is still required for many people living with long-term conditions before participating in organised physical activity (PA) despite international guidance suggesting it is usually unnecessary. Existing physical activity readiness tools often direct people towards medical review, creating avoidable barriers. This study aimed to co-create digital, patient-facing guidance to support informed, autonomous decision-making about physical activity without routine medical clearance. This three-phase study used the Knowledge-to-Action framework to develop patient-facing information. Phase 1: Literature review, audit of industry adverse events and stakeholder surveys. Phase 2: Cross-sector workshops with healthcare professionals (HCPs), patient advocates and industry representatives. Phase 3: Creation of consensus statements through patient focus groups, multidisciplinary HCP panel, secondary patient consultation and implementation partner consultation with final consensus validation. Consensus development followed ACcurate COnsensus Reporting Document (ACCORD) principles and Appraisal of Guidelines for Research and Evaluation (AGREE II) criteria. There was cross-sector agreement that current processes are not fit for purpose. Clinicians reported low confidence in providing medical clearance, industry stakeholders identified governance and implementation challenges, and patients expressed concern about worsening symptoms and requested clear, supportive guidance. Through iterative consensus, four headline safety statements and seven symptom-specific statements were developed, addressing musculoskeletal pain, fatigue, shortness of breath, cardiac chest pain, palpitations, diabetes and falls, including practical self-management advice and indicators for seeking medical review. These patient-centred, evidence-based statements offer a credible alternative to routine medical clearance and may reduce barriers to engagement with organised physical activity opportunities for patients and industry providers. Future work will evaluate feasibility, acceptability and safety in real-world settings.