Physical activity for small- and medium-sized enterprises: what features work in real life? A Delphi study

HEPA Europe Network Collaborators

doi:10.1093/eurpub/ckag100

Physical activity for small- and medium-sized enterprises: what features work in real life? A Delphi study

HEPA Europe Network Collaborators

University of Lleida (UdL)
National Institute of Physical Education of Catalonia (INEFC)
Artevelde University of Applied Sciences
University of Vic
Universitat Oberta de Catalunya
University of Nottingham
Amsterdam UMC
University of Lausanne
University of Glasgow
University of Southern Denmark
LAB University of Applied Sciences

Research output: Contribution to journal › Article › peer-review

Abstract

Regular physical activity is essential for preventing noncommunicable diseases and benefits both employees and organizations. Although small- and medium-sized enterprises (SMEs) employ most of the European workforce, they are often underrepresented in research on workplace health promotion. Most existing evidence from initiatives to promote health-enhancing physical activity (HEPA) focuses on large organizations and lacks insights into feasibility within SMEs. This study aimed to identify real-life HEPA initiatives perceived as most feasible for SMEs and to explore expert consensus on transferable features. We conducted a three-stage hybrid e-Delphi study including a grey literature review, an expert survey, and expert panel discussions, integrating both quantitative scoring and qualitative discussion. Experts independently rated the feasibility of workplace HEPA initiatives and participated in moderated sessions to interpret the findings and identify transferable elements. A total of 714 real-life HEPA initiatives were identified and categorized according to behaviour and intensity. Of these, 390 were evaluated by 17 international experts using predefined criteria, including feasibility by company size. No initiative-level consensus was reached across the WHO European Region. Panellists identified transferable features (most frequently in active-living and exercise/fitness domains) and emphasized adaptability, low-threshold approaches and enterprise size as an indicator. This study contributes a structured analysis of feasible workplace HEPA initiatives for SMEs, using a Delphi-based consensus process. The findings provide guidance for developing practical tools tailored to the needs and capacities of SMEs in the European context.

Original language	English
Article number	ckag100
Number of pages	9
Journal	European Journal of Public Health
Volume	36
Issue number	4
Early online date	19 Jun 2026
DOIs	https://doi.org/10.1093/eurpub/ckag100
Publication status	Published - 1 Aug 2026

Bibliographical note

Publisher Copyright:
© The Author(s) 2026. Published by Oxford University Press on behalf of the European Public Health Association. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected].

Data Availability Statement

The data underlying this article are available in Zenodo, at https://doi.
org/10.14787288 [40], and in EURPUB online at https://academic.oup.
com/eurpub/article/32/Supplement_1/i22/6676129#381324552 [36].

Acknowledgements

We thank Mr. Stephen Whiting from the World Health Organization for his valuable comments. HEPA Europe Network Working Group on Workplace HEPA Promotion Collaborators: Tina Dalager (Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark), Martine Duclos (Department of Sport Medicine and Functional Exploration, University Hospital CHU G. Montpied, INRAE, UNH, CRNH, Clermont Auvergne University, France), Liesbeth Groenesteijn (Inholland University of Applied Sciences, Department of Sport Science, The Netherlands), Ingrid Hendriksen (Living Active, The Netherlands), Kamilah Hylton (University of Technology, Jamaica), Matti Leijon (Region Osterg € €otland, Sweden), George Loucaides (Cyprus Sports Research Center, Cyprus Sports Organization, Nicosia, Cyprus), Paulo Rocha (Portuguese Institute of Sport and Youth, Portugal), Karen Søgaard (University of Southern Denmark, Denmark), Martyn Standage (University of Bath, England), R�eka Veress (Ministry of Human Capacities, Hungary). The authors used
OpenAI’s ChatGPT (version GPT-3-5, July 2025) to assist only with language editing and clarity improvement. All outputs were reviewed and verified by the authors to ensure accuracy and compliance with scientific standards.

Funding

This work was funded by Health-Enhancing Physical Activity Network (HEPA Network), World Health Organization Europe and supported by Institut Nacional d‘Educacio Fisica de Catalunya, Generalitat de Catalunya. The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

ASJC Scopus subject areas

Public Health, Environmental and Occupational Health

Access to Document

10.1093/eurpub/ckag100Licence: CC BY-NC

Cite this

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abstract = "Regular physical activity is essential for preventing noncommunicable diseases and benefits both employees and organizations. Although small- and medium-sized enterprises (SMEs) employ most of the European workforce, they are often underrepresented in research on workplace health promotion. Most existing evidence from initiatives to promote health-enhancing physical activity (HEPA) focuses on large organizations and lacks insights into feasibility within SMEs. This study aimed to identify real-life HEPA initiatives perceived as most feasible for SMEs and to explore expert consensus on transferable features. We conducted a three-stage hybrid e-Delphi study including a grey literature review, an expert survey, and expert panel discussions, integrating both quantitative scoring and qualitative discussion. Experts independently rated the feasibility of workplace HEPA initiatives and participated in moderated sessions to interpret the findings and identify transferable elements. A total of 714 real-life HEPA initiatives were identified and categorized according to behaviour and intensity. Of these, 390 were evaluated by 17 international experts using predefined criteria, including feasibility by company size. No initiative-level consensus was reached across the WHO European Region. Panellists identified transferable features (most frequently in active-living and exercise/fitness domains) and emphasized adaptability, low-threshold approaches and enterprise size as an indicator. This study contributes a structured analysis of feasible workplace HEPA initiatives for SMEs, using a Delphi-based consensus process. The findings provide guidance for developing practical tools tailored to the needs and capacities of SMEs in the European context.",

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note = "Publisher Copyright: {\textcopyright} The Author(s) 2026. Published by Oxford University Press on behalf of the European Public Health Association. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected].",

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AU - Farías, Estela

AU - Dorado, Víctor

AU - Matas, Sergi

AU - Puig-Ribera, Anna

AU - Aumatell, Eva

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AU - Loucaides, George

AU - Rocha, Paulo

AU - Søgaard, Karen

AU - Standage, Martyn

AU - Veress, Réka

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Physical activity for small- and medium-sized enterprises: what features work in real life? A Delphi study

Abstract

Bibliographical note

Data Availability Statement

Acknowledgements

Funding

UN SDGs

ASJC Scopus subject areas

Access to Document

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Cite this